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Clinical, Mental health

The impacts of growing up with a sibling with mental illness

Psychotherapist Hester Bancroft is hosting a British Psychological Society webinar on Wednesday 22 September on working with clients who have grown up with a sibling with severe mental illness. Ella Rhodes asked her about it.

26 August 2021

What will your webinar cover?

This webinar is designed to support clinicians when working with clients who have grown up with a brother or sister with severe mental health illness. This webinar looks at how 'well' siblings may have been impacted by their childhoods and what support they may need. In particular, it explores how their childhood experiences may impact their intimate relationships in adulthood.

Growing up in this situation can have a profound impact on siblings' relationship to self and others. Indeed, many siblings display signs of chronic anxiety and an insecure avoidant attachment style. In addition, they have a very real difficulty in holding compassion for themselves or managing conflictual situations. Perhaps unsurprisingly, they also have a very real difficulty in recognising their own needs. Furthermore, these clients tend to operate from the defence mechanisms of binary thinking, omnipotent control and the creation of a false-self. This webinar looks at how those defence mechanisms can play out in the therapeutic environment, what challenges they can bring to the therapeutic relationship, and how to work with, and support, these clients going forward.

How did you first become interested in this area?

I grew up with a sister with severe mental illness. Her issues began when she was 13-years-old and were with her, to varying degrees, up until she died aged just 52 from an accidental overdose. Unsurprisingly, both my sister's life and her death have had a profound impact on my life and the lives of my entire family. I recognise that my childhood experiences of growing up with a sister with mental illness has hugely impacted my, and my brothers' way of being in the world. In my private practice I have come across others who have had similar experiences to ours; I have seen how it has affected their way of relating to others, their ability (or inability) to recognise their needs, trust others and deal with conflict.

Both my own experiences and bearing witness to the experiences of others, led me to be curious about what research there was into the impact growing up with a sibling with mental illness has on individuals and, specifically, on their way of being in intimate relationships. This exploration, and the discovery of there being scant research in this area, motivated me to carry out my research.

What still needs to change in this area? 

'Well' siblings have long been overlooked in research, and by statutory bodies. What interest there has been, has mostly been borne out of the desire to establish how best to engage these siblings in providing care and support for their mentally ill brother or sister when their parents are no longer able to, rather than what support they, themselves, may need. In addition, there is currently very little provision in the UK to support adult siblings of those with severe mental illness. These adult siblings should have the opportunity, should they wish to, to attend either individual or group therapy so that clinicians can support them in all of the areas outlined.

In addition, parentification can be thought of as an almost inevitable consequence of growing up with a brother or sister with severe mental illness, parents, therefore, should be supported in understanding the importance of providing healthy boundaries around roles and responsibilities assigned to their 'well' children. Parents should be encouraged to ensure these roles and responsibilities need to be age-appropriate, reasonable and acknowledged by family members. In this way, the dysfunctional aspects of parentification can be defused. In addition, parents, educators and clinicians alike can provide validation of these children's feelings and help them recognise and voice their own needs so that they can be helped to feel visible and valued.

Could you tell us something that might surprise someone not familiar with this area of work?

'Well' siblings often present as independent, high-achieving, responsible individuals whose symptoms of dysfunction and pain are hidden. This is what Abrams (2009) poignantly called 'a paradoxical mix of apparent adjustment and secret distress'. Moreover, research suggests siblings of people diagnosed with a mental disorder reported higher post traumatic growth scores than those without a brother or sister diagnosed with a mental disorder. Indeed, some siblings feel their experiences foster maturity, strength and an orientation to achieve. Although, for most, it appears to be at the expense of their own emotional needs.

What do you hope people will take away from the webinar?

This type of childhood can significantly impact a person's functioning in adulthood and can pose specific challenges to the therapeutic work. This webinar provides clear and comprehensive ways to meet those challenges and help those in this client group develop a deeper understanding of themselves and their processes and, in doing so, help restore trust in the self and others. It is designed to help clinicians develop an understanding of how this type of childhood may impact their client's functioning out in the world by drawing on attachment theory, parentification and post traumatic growth. It also draws on Winnicott's theory of a true and false self. It highlights how clinicians can support these clients in developing a deeper understanding of themselves and their experiences; to develop self-compassion, to understand their defence mechanisms and to, ultimately, reconnect with their true selves.

Since publishing this Q&A online, we have received a comment about your use of 'mental illness' being 'medicalising/pathologising'. How would you respond?

It is a fair point that has been raised and I am not entirely surprised. The discourse around mental health is, indeed, difficult and rigid and we are all right to have sensitivity around how we use our language. In fact, as a (soon to be) counselling psychologist, I am, of course, very aware of the need to actively challenge and disrupt the current discourse around mental health. However, the use of the term 'severe mental illness' or 'SMI' is understood and used across disciplines, the NHS and, most relevant for this webinar, in most of the previous research in this area, so I have used the term to ensure people recognise that the population I am talking about (regardless of label) is the same. As Dr Lucy Foulkes has said, sometimes we need to prioritise clarity over other issues. She commented that 'mental illness' 'clearly signifies the sharp end of the spectrum. "MH issues/problems" is so broad it can be meaningless, e.g. it covers exam stress but also psychosis and suicide attempts.' 

I will now make reference to this debate at the beginning of the webinar.