MARITAL CRISES IN ONCOLOGY PATIENTS - AN APPROACH TO INITIAL INTERVENTION BY PRIMARY CLINICIAN

Life-threatening illnesses such as cancer may precipitate marital cris es in vulnerable relationships, and oncology clinicians often feel unc ertain about how to approach them. This paper presents a framework for initial intervention based on the nature of the principal threat to t he relationship. Immature relationships need distance and support for their identity as a couple; hostile dependent couples need to find con sensus in order to structure communication; physically abusive relatio nships require monitoring in order to promote safety; and estranged co uples need help in understanding their disappointment and identifying available support. Clinicians working in oncology can help couples in crisis by promoting a realistic balance of independence and dependence , clarifying the complexity of factors contributing to the crisis, con sidering referral for couples treatment, communicating with the ream w hile respecting patients' confidences, and by choosing clear and compa tible clinical roles. Primary clinicians can stabilize and treat marit al crises, but need access to medically knowledgeable couples' therapi sts.