"Family" can be used to describe many different relationships including those between parents, spouses/partners, children, siblings, extended family members, coworkers, friends, neighbors, and other community associates.

As family relationships develop, members take on different roles and responsibilities. These roles help to maintain balance and functioning within the family. Whether you discuss it openly or not, family members usually know who plays what roles. Roles and responsibilities can change, however, when there is major stress on a family. Sometime one person, for example an ill person, must give up their usual role and take on other roles. This forces changes on every member of the family.

Imagine that your family is like a mobile that hangs over a child's crib. Every person must play certain roles in order to keep things functioning and in balance. If one person or one piece of that mobile changes position everything gets out of order. The only way to get the mobile or family in balance again is for everyone to adapt to the change. This type of change and adjustment takes time. Things will never be the same in your family. But eventually you will find a "new normal" and adapt to the changes that you are facing. It is very common for life to feel out of control and chaotic as you are adjusting to changes. This happens when someone in your family has a serious illness.

It can be very helpful to:

• Talk about the changes that are happening in your family. (Talk both to your family members and people outside of the family.) It can be helpful to just acknowledge what is happening and how it feels.
• Be aware of the feelings that may be related to changes in the family. For example you or other family members may feel afraid, threatened, relieved, angry, overwhelmed, etc. about role changes.
• Understand that not every member of the family will feel or think the same way about the changes. Some family members may feel resentful while others are energized for example.

When a family faces a major crisis like serious illness and BMT, members often work together to care for and support each other through difficulties. When this happens it can provide opportunities for wonderful intimacy, honest communication and shared memories.

Unfortunately most families and relationships have areas of stress or tension. These can make coping with a crisis very difficult. Under normal conditions families can cope with these tensions. However, under stress they can develop into major strains on family functioning. It can feel like your family is totally falling apart. You may wonder how your relationships will possibly survive this crisis. The stress of serious illness can be especially challenging in a family where there is a history of abuse, addiction or little available support. It is important to know that you can make changes so that you are more satisfied with how your family is functioning. This may be a time to seek out resources from a counselor, social worker, or spiritual leader.

The changes and stress related to serious illness affect every member of a family. This can happen because of changes in his or her roles and responsibilities. Or it can happen because the roles and responsibilities of other family members have changed.

Examples of changes:

• An adult child needs to care for parent or sibling who was previously independent.
• A child or teen must take on additional household responsibilities.
• There are changes in the amount of attention/nurturing available to other family members.
• One family member is no longer able to manage the physical tasks he or she once did.
• There are changes in who manages family finances or social scheduling.
• The person who was the "foundation" or source of support and stability in the family is ill.
• The family may be separated by geographic distance over long periods of time.
• The family may be forced to make decisions in ways that are very new to them.

Keep in mind that every family is unique. Avoid comparing yourselves to other families. Even though it can be difficult, please, ask for help when you need it. There are supports available to help you and your family through this difficult time.