Growing up with a developmentally challenged brother or sister: a model for engaging siblings based on mentalizing

Growing up with a developmentally challenged child presents distinct psychological challenges, as well as potential opportunities, for the siblings. Questions about siblings' adjustment and successful psychosocial adaptation may become matters of clinical concern. In a previous research review on the vulnerabilities and strengths of siblings of affected children, the author found accumulating evidence that the siblings may benefit when their psychosocial adaptations are included in the purview of clinicians working with affected children and their families. The underlying concern is that family dynamics, including most importantly the focus on addressing the needs of the affected child, can and do interfere with addressing the needs of other siblings; clinical planning for the primary patient must guard against marginalizing the siblings' experience. This article presents a model for engaging siblings in time-limited, focused conversations about living with developmentally challenged brothers or sisters. It is designed to contribute proactively and preventively to siblings' overall relatedness to the affected children, and to enable siblings to overcome difficulties of being entrenched in negative interactions in mutually helpful ways by enhancing siblings' capacities to mentalize their experience. The model utilizes mentalizing questions adapted from Bateman and Fonagy's guidelines for adults. It covers several domains of the sibling experience, both within and outside the family context, including peer relationships. Difficulties of mentalization and the potential for enhancing resilience are discussed. Common concerns include parental differential treatment, impact on friendships, personal health, and future obligations. This model may be used in individual and group interviews, as shown in case illustrations. Current limitations of the model are reviewed.