Renewal Ministries Fellowship ~ Discipling, Uniting, Equipping & Mobilising the Body of Christ
. ........... Renewal ~ rebirth, regeneration, restoration, rekindling, revitalisation, replenishment & revival
......................"..we proclaim Jesus Christ as Lord and ourselves as your servants for Jesus' sake" (2 Cor. 4:5)
line decor

  Scripture Moment




FORGIVENESS (by Anita Femiano, October 2004 - extracted from an assignment written in June 1999)

It is generally understood that we need to forgive those who have mistreated us. This scriptural imperative, however, is often applied in ways which further wound and disempower the victim of the wrongdoing. Even worse, the injunction that "God won't forgive you unless you forgive them" can further separate people from the God who declares that He is close to the broken-hearted and saves those who are crushed in spirit (Psalm 34:18) at the very time when they most need to be drawn into His arms of unconditional love. Psalm 147:3 declares: He heals the broken-hearted and binds up their wounds. When God works forgiveness in our lives it brings healing, restoration and empowerment. When we encourage people to 'just forgive and forget it' without ever properly addressing the hurt and the evil that caused it we cheapen forgiveness, rob it of its restorative power and turn this grace of God into yet another legalistic requirement and burden to heap upon the wounded. This paper examines types of forgiveness, developmental issues in forgiveness and the nature of the forgiveness that Jesus taught in Matthew 18: 23-33.

The area of forgiveness requires special attention in any instance where severe trauma was inflicted by another human being. The implications of that trauma being inflicted during childhood are even greater as developmental issues in forgiveness are also involved. While some tout forgiveness as a choice of obedience that must be made if we are to be forgiven or healed (Bulkley, 1995) others assert that forgiving an abuser reflects a lack of self-respect and dignity on the victim's part and may exacerbate feelings of low self-worth and powerlessness (Snow, 1993; Romig, 1998). McCullough and Worthington (1994) note that while general forgiveness and intrinsic forgiveness (both characterised by overt benevolent behaviour toward the offender and inner change in attitudes and feelings towards the offender) lead to decreased anger and an increased sense of personal power over time, role-expected forgiveness (performed by lower power individuals in deference to high-power offenders without any attitudinal or emotional change towards the offender) and expedient forgiveness (performed as a means to another end without any attitudinal or emotional change toward the offender) leads to increased anger and decreased sense of personal power over time. The reservations come counsellors express regarding the therapeutic value of forgiveness may be understood in relation to the motives for forgiveness.

From a developmental perspective the motives for pursuing forgiveness differ dramatically according to the stage of moral development of the injured party (Roming, 1998). Persons who employ Kohlberg Stages 1 and 2 reason morally according to what is perceived to increase their pleasure or avoid pain, they have limited capacity for intimacy and resent authority or control by others, their forgiveness is thus motivated by self-interest and a desire for restitution or revenge. Children and those who have not resolved the trust versus mistrust issue in a satisfactory manner (Erikson's first stage) were found to reason through decisions to forgive based on Stage 2 moral reasoning and are likely to have serious difficulties responding to unjust injuries with forgiveness (Romig, 1998). The difficulty that many survivors of childhood sexual abuse have forgiving molesters are therefore not surprising. Sexual abuse also impacts on Erikson's second stage of psychological development (autonomy versus shame) resulting in a profound sense of shame and powerlessness that a person may attempt to mitigate against through holding unforgiveness toward the offender. For persons who use Kohlberg Stages 3 and 4, the middle stages of moral reasoning, forgiveness is motivated by wanting to please others and gain their approval. Adolescents were found to be emerging into Stage 3 moral reasoning and most adults had gaining the approval of their immediate peers or some higher authority as their primary motivation for forgiveness (Romig, 1998). Failure to satisfactorily resolve Erikson's sixth developmental stage (intimacy versus isolation) could lead one toward self-absorption, fear of emotional connecting and profound ambivalence toward being in a committed relationship with unjust injury reinforcing the tendency to remain fearful of and isolated from intimate relationships. Individuals who use Stage 5 moral reasoning forgive because it provides a means to maintain good relationships or social harmony. Failure to negotiate Erikson's seventh developmental stage (generatively versus stagnation) would have more concern for their gratification than the well-being of others and are therefore not motivated to react to an injury by forswearing justice for the sake of showing mercy to one who injured them. Only at Stage 6 moral reasoning is forgiveness offered unconditionally out of genuine concern for the well-being of the offender and desire to promote a true sense of love. Very few adults were shown to use reasoning reflective of Stage 6 in relationship to forgiveness of unjust injuries (Romig, 1998). Pingleton (1997, p403) described forgiveness as "both difficult and rare" and Beck (1995, p269) stated that "we humans stumble with the task, often refusing to forgive or forgiving partially at best".

When Jesus talked about the necessity of forgiveness was he concerned with our motivations for forgiveness? When asked by Peter how many times he should forgive his brother if he sins adjust him (unjust injury) Jesus answered with the parable of the unforgiving servant (Matthew 18:21-35) where He clearly states that the motivation required for forgiveness "from the heart" (Matthew 18:35, NKJV) is compassion -


"Then the master of that servant was moved with compassion, released him, and forgave him the debt... ...Should you not also have had compassion on your fellow servant, just as I had pity on you?" (Matthew 18:27&33, NKJV)

As was his custom, Jesus did not just command a decision to forgive (an act of the will) but also addressed the necessary motivation (heart attitude) for such a decision. It was this motivation of compassion that led the father of the prodigal son to forgive him (Luke 15:20). Those who admonish the unjustly injured to forgive so that they can be forgiven, so that they will not be judged, or so that they will be blessed (Bulkley, 1995, p173) - the self-interest of stage 2 moral reasoning - or because they will gain God's approval or show others that they are good Christians (Bulkley, 1995, p173) - the approval seeking of Stages 3 and 4 moral reasoning - or any reason other then compassion for the offender, fail to apply the essence of Jesus' teaching. God does not forgive us so that He can earn 'Brownie Points' but because of His compassion for us, because He loves us, because He takes pity on us, because He is merciful, because He is gracious. If we are to forgive others as God has forgiven us then the motive for such forgiveness must be compassion for the other (Stage 6 moral reasoning), not concern for our own spiritual, emotional or social well-being

How, then, does one whose psychosocial development has been stunted and distorted through the effects of abuse (particularly when that abuse occurred in childhood) possibly forgive the offender? Just deciding that one has to forgive because that is what has been preached does not provide the necessary heart motivation (although, just as in His grace God can miraculously heal in any other area, there are certainly times when He steps in at that point and miraculously heals, restores and enables the full release of compassionate forgiveness, but how do we proceed when there is not that miraculous intervention from the Almighty?) Further examination of Jesus' parable will yield some insight into this difficult question:


"Therefore the kingdom of heaven is like a certain king who wanted to settle accounts with his servants. And when he began to settle accounts, one was brought to him who owed him ten thousand talents." (Matthew 18:23&24, NKJV)

There came a time of reckoning when the king decided to settle his accounts. In the unjustly injured one there comes a time of reckoning when they decide to address the matter. The king did not settle his accounts by ignoring or minimising the servant's debt, its full extent was calculated. McCullouch and Worthington (1994, p11) state "forgiveness begins by perceiving the offence". Veenstra's (1992) first three phases in forgiving are: presenting the wrong, determining the wrong and admitting the wrong. Clearly forgiveness is NOT denial, repression, condoning, excusing, indifference or just forgetting (Wahking, 1992). For survivors of any form of abuse forgiveness begins with acknowledging the atrocities committed against them and what they have suffered as a consequence.


"But as he was not able to pay, his master commanded that he be sold, with his wife and children and all that he had, and that payment be made." (Matthew 18:25, NKJV)

Anger is presented as the next step in the process of forgiveness. The king demanded that payment be made. In Matthew 18:6 Jesus made clear his anger towards the exploitation of children declaring "whoever causes one of these little ones who believes in me to sin, it would be better for him if a millstone were hung around his neck, and he were drowned in the depths of the sea". To those who claim to be Christians while committing this atrocity he warns:


"Not everyone who says to me, 'Lord, Lord' shall enter the kingdom of heaven, but he who does the will of my father in heaven. Many will say to me in that day, 'Lord, Lord, have we not prophesied in your name, cast out demons in your name, and done many wonders in your name?' And I will declare to them, 'I never knew you; depart from me, you who practice lawlessness!" (Matthew 7:21-23, NKJV).

It is important for Christians who have been abused to realise that God is at least as angry about the abuse as they are.

McCullough and Worthington (1994, p11) describe the second task inherent in forgiveness as recognising negative emotions such as anger, sadness, fear and desire for retaliation. Pingleton (1997) notes the similarities between the forgiveness process and Kubler-Ross's sequences of dealing with death and dying. Grief and sorrow over the losses are an important part of the forgiveness process. Just as the servant in Matthew 18 was unable to pay, so there is nothing that the offender could do, even if they wanted to, that would make up for what the survivor has lost and suffered.


"The servant therefore fell down before him saying, 'Master, have patience with me, and I will pay you all.'" (Matthew 18:26, NKJV)

Here we see the powerlessness and vulnerability of the debtor. Often our debtors do not display to us their powerlessness and vulnerability, we see only their power to wound us and/or those we love. Survivors of abuse can have great difficulty feeling pity or compassion for one who appears to be strong, powerful, in control of life and taking pleasure in so wounding them. The perception that the offender has a happy and fulfilled life that has, through the abuse, been denied to the survivor can be a powerful deterrent to forgiving out of compassion for the abuser. McCullough and Worthington (1994) describe the third task inherent in forgiveness as the offendee making attributions about the offender's behaviour through reframing important aspects of the hurtful situation such as the offender's motivation for the hurtful behaviour. Recognising that the abuser is in fact a weak, powerless, needy, lonely, tormented, hurting, sin-stained individual whose actions reflect these characteristics, while not in any way excusing the abuse, helps provide basis for pitying and having compassion on the poor individual. This elevates the survivor from a position of powerlessness to the position of the king who had compassion on the one who owed him so much. This is the position that the King, who has compassion on us and has forgiven us of so much, desires each of us to rise too.


"Then the master of that servant was moved with compassion, released him, and forgave him the debt." (Matthew 18:27, NKJV)

Compassion is the motivation for both forgiving ourselves and others. It takes humility to acknowledge our need for compassion and love to have compassion on others. "We are all equally fallen human beings who need to forgive and to be forgiven. ...In order to forgive, one must relinquish one's egocentric position of seeing others exclusively in terms of one's own needs, wishes and longings" (Pinglenton, 1997, p410). The ability to relinquish that position comes with psychosocial development as the issues of trust/mistrust, autonomy/shame, intimacy/isolation and generatively/stagnation are resolved. Forgiveness is thus a continuing process as we heal, grow, develop and mature. Allender and Longman write: "To forgive another is always an ongoing, deepening, quickening process, rather than a once-fo-all event" (1992, p158). Forgiveness flows most effectively from the powerful position of having or identity in Christ Jesus.

Kane, Cheston and Greer (1993) suggest that an effective treatment strategy for Christian victims of abuse is to reread the New Testament, placing themselves in the roles of some of the characters. In dealing with the issue of forgiveness it may be helpful for the survivor to reread Matthew 18:23-27; first placing themselves in the position of the servant before King Jesus, powerless and needy yet receiving compassion and being fully pardoned, having the slate wiped clean; choosing to have compassion on themselves and receiving the total cleansing of that pardon - then, rising to their position in Christ Jesus, sit as the king settling accounts with the perpetrator; confronting the offence and demanding restitution; recognising the abuser's powerless and needy position before the judgment and, in character with their Lord, choosing to have compassion on that spiritually, emotionally and morally bankrupt individual (as we all are) and so extend forgiveness to them - looking to Jesus, not the perpetrator, to meet their needs.


Allender, D. 1991. The Wounded Heart. Colorado Springs: NavPress.

Allander, D.B. & Longman, T. 1992. Bold Love. Colorado Springs: NavPress.

Beck, J.R. 1995. When to Forgive. Journal of Psychology and Christianity, Vol.14, pp 269-273.

Bulkley, Ed. 1995. Only god Can Heal the Wounded Heart. Oregon: Harvest House Publishers.

Holy Bible, New King James Version

Kane, Donna; Chaston, Sharon E.; & Greer, Joanne. 1993. Perceptions of God by Survivors of Childhood Sexual Abuse: An Exploratory Study in an Unresearched Area. Journal of Psychology and Theology. Vol.21, pp228-237.

McCullough, Michael E. & Worthington, Everett L. 1994. Encouraging clients to Forgive People Who Have Hurt Them: Review, Critique, and Research Prospectus. Journal of Psychology and Theology. Vol.22, pp3-20.

Pingleton, Jared P. 1997. Why We don't forgive: A Biblical and Object Relations Theoretical Model for Understanding Failures in the Forgiveness Process. Journal of Psychology and Theology. Vol.25, pp403-413.

Romig, charles, A. 1998. Forgiveness and Psychosocial development: Implications for clinical Practice. Counselling and Values. Vol.42, April, pp185-197.

Wahking, H. 1992. Spiritual Growth Through Forgiveness. Journal of Psychology and Christianity. Vol.11, Fall, pp198-206.

© 2006 Renewal Ministries Fellowship


Implications for Counselling with Individuals or Couples where there is a Disability due to Accident or Illness. (by Anita Femiano, October 2005)

Disability due to accident or illness presents many challenges for the individual, their spouse and the couple relationship. Bienvenu (1997) writes: "Even the strongest partnerships can falter when chronic illness moves in and makes it a threesome". Lindsay (2005) argues: "The primary goal for couples facing this challenge, is to keep the illness in its place so it does not become a third party in the marriage relationship". Rolland (1994) contends that; "Serious illness and disability are among the greatest challenges couples face, yet often shame, anger, guilt, burnout, and isolation can undermine their partnership just when they need each other the most". The issues such couples face are interrelated and can include those existing prior to the illness/accident; interaction with the medical community; loss and grief; vocational and financial; identity; spiritual issues and beliefs; intimacy and sexuality; social isolation; caregiving issues; family systems changes and marriage contracts; all of which are overlaid with life-cycle implications and the effects of gender differences (Atwood & Ruiz, 1993; Bienvenu, 1997; McDaniel, Hepworth, & Doherty, 1992; Rolland, 1994). This provides some indication of the complexities which may be involved in counselling a couple adjusting to a disability due to accident or illness. Two models which have been developed to help guide the counselling process with this population are the Family Systems-Illness Model (Rolland, 1994) and The Non-Illness Intervention Model (Navon, 2005).

Prior Issues

Couples who face the challenges of disability had various strengths and weaknesses in their lives and relationship prior to the accident or onset of the illness. These issues may have been totally unrelated to the accident or illness but are usually magnified by the additional stresses of the disability (Bienvenu,1997). Without a "history of love and friendship to cushion the illness" people in troubled relationships face greater difficulties in coping with the effects of disability, as does their partnership (Wallerstein J.S. & Blakeslee, 1995). Couples may deny the impact that the disability has on prior issues or blame it for them, taking on a victim mentality that since they cannot change the disability they cannot change the difficulties in their relationship. Navon's (2005) Non-Illness Intervention Model may be useful to help differentiate illness/disability issues from prior relational issues over which the couple can gain mastery. Stress placed on a relationship by the disability may provide the impetus for the couple to re-examine their relationship and work through their prior issues, enabling them to grow and draw closer together (Bienvenu, 1997).

Interaction with the Medical Community

Being dependent, as a patient, on the medical system and having strong, ongoing ties to that system can present some relational problems. The medical environment is conductive to doctors and patients creating parent-child relationships or inverted hierarchies (Atwood & Weinstein, 2005). Medical personal can become a permanent, important sphere of influence on the family and can be triangulated into the family system. The triangulated relationship may be with the patient or the caregiver and can contribute to confusion and conflict in the family.

Loss and Grief

Loss and grief are major ongoing issues for couples dealing with disability due to accident or illness.ÊPerkins (2000) wrote: "Our illness is erratic and unpredictable and requires constant readjusting. We are likely to endure multiple losses... In addition to these, we may also have to face the possible relinquishing of our hopes and dreams and face the fear of more ongoing losses. This ongoing, evolving loss and recurrent grief throughout life is defined by Bruce & Schultz (2001) as non-finite loss and grief while Robertson (1992) attends to it through a transitions perspective of life changes".

When the loss is due to a progressive disorder the couple may even have difficulty defining when it began (Hall, 2000). The initial impact of the diagnosis is generally shock and anxiety with people feeling confused, numb, disorganised and helpless (Hornby, 1992; Livneh, 1986). This is typically followed by defence mobilisation, which may continue through the first couple of months post diagnosis, involving bargaining and denial as the suffer expects to recover (Hendler, 1993; Hornby, 1992; Livneh, 1986). Hendler (1993) suggests that somewhere between two to six months post diagnosis the person realises that they are not getting well and begins to worry that they will never recover. This leads to an array of, often very intense, negative emotions including sadness, depression, anger, aggression, guilt and detachment where accepting the reality of the disability leaves little meaning in life (Hornby, 1992; Livneh, 1986). Jennnifer Rees Larcombe wrote:


For eight years now I have been in constant pain and increasing disablement through repeated, life-threatening attacks of encephalitis... As a mother of six young children I found this sudden devastating loss of freedom and identity quite ghastly and the first two years of the eight were a nightmare of depression, guilt and resentment. I believed in God's ability to heal, so why didn't He? What sin had I committed to cause all this? My marriage felt as if it was falling apart with the strain, my children were becoming insecure and we were having to leave our home in the country because I simply could not cope with life there. I felt I was losing everything I valued, yet if God would stir Himself and heal me, everything and everyone would be all right again and we could go back to serving Him.

Some of the turmoil of this stage is captured in Kenny's (1994) description:


I had plenty to be angry about... I lost my health, my healthy appearance, much of my intelligence, my perfect memory, my job, my career, my earning capacity, my responsibilities as the head of my household, my beloved flying, and my friends and staff... who had become a family to me. It seemed as if I'd lost control of my entire life... I went through many months of bitter anger, sometimes shouting at the walls, sometimes crying all alone, sometimes just quietly inventorying all that had been taken away from me. Other times I'd focus on someone who was completely innocent, at my wife or family... at friends who didn't call or who didn't seem to care... There was...only hours of loneliness and pain and the terrible feeling of being left behind by a world that had better things to do. (Pp. 146,147, 164)

Hendler (1993) suggests that this phase may last up to eight years following the onset of symptoms. Somewhere between three and twelve years into the illness, proposes Hendler (1993), the person learns to reorganise and adapt to their pain and limitations, attaining the final stage of adjusting to their disability (Hornby, 1992; Livneh, 1986).

This adaptation or integration is not, contend many authors (Bruce & Schultz, 2001; Kenny, 1994; Hendler, 1993;ÊTully, 2003; Webb, 1992; Werner-Beland, 1980), synonymous with acceptance, an end to the grief, or closure. Rather it marks what Kenny (1994) describes as a "reluctant equilibrium" which involves "settling into a life filled with compromise" (pp202) and "exchanging the unrealistic dream... for a realistic but downsized new way of life" (pp204). Having integrated what had happened to him "into a new and useful life" (pp150) - doing speaking engagements and writing "what I can with a positive message" and "working daily to be an example of the good things that can happen to someone facing a serious chronic illness" (pp188) Kenny's (1994) poignant confession highlights many of the continuing struggles associated with a painful disability:


I hurt inside and out, and I struggle daily with the notion of ending the hurt with my own selfish shortcut. Now fear is my constant, unwelcome companion. There is a loneliness, too, that comes even when I am surrounded by others... I regret the days and nights alone. I regret not being the husband I should be... I regret the friends who have fallen by the way side and I regret pushing some of them out of my life in the early days of my illness. I regret lost income, promotions that didn't come, the good things that I never accomplished... I have remorse for what could have been... A very big part of me has died. I look at [my wife]... and I feel guilt... first because I can only imagine what sacrifices she has endured... the parts of her life that have been put on hold and may never be regained... guilt from...the question... Would I, if our roles were reversed, be able to be all to [my wife] that she is now to me?...Another source of constant emotional pain for me is the hurt that comes from being misunderstood, from being called a liar, from not being believed [when describing my symptoms]... shame has stolen much of my dignity... the dashed hopes... the cure that didn't come... Physical pain is with me at virtually every moment... Pain is my sixth sense; at times my only sense... the constant physical and emotional hurt that never goes away... With that hurt comes an exhaustion in every fibre of my being, an aching for relief, a yearning for a normal life I am much too young to feel this dam old. (Pp187-194)

Hendler contends that the personality of previously well adjusted individuals changes as a result of chronic pain (1982) and that "chronic pain almost always leads to depression" (1984). Tully (2003) is more optimistic, suggesting that integration encompasses a "healthy acknowledgement that all that occurs during life offers opportunity for growth". Jennifer Rees Larcombe wrote:


The day I reached the point of despair He met me and showed me that I had pushed Him out of the central place in my existence. I wanted only to manipulate Him into doing my will, and was not resting in the fact that His will was best for me and for my family. I asked Him back into the central place that day, and after a week of fasting, repentance and prayer... That was when God did a far greater miracle... He gave me and the family His peace-joy. He did not change the circumstances that were destroying us, He changed us so the circumstances no longer overwhelmed us. I did not recover physically; in fact I grew progressively worse, but I can honestly say the last six years have been deeply happy and fulfilling. Many people have been won for the Lord through the books I have had the time to write and chances I have been given to speak at gatherings all round the country.

Grief is not something that just the person who acquires the disability goes through. As alluded to in the above quote from Kenny (1994), their spouse also suffers significant losses that "remain an integral part of daily life" (Webb, 1992, pp204) and take on new forms throughout the life cycle. These losses include reactions to what the disabled spouse is going through and the changes in them, as well as the losses associated with those changes (eg loss of family income, status, roles) and with responding to those changes (eg loss of income, career path and identity when taking on the role of carer) (Perkins, 2000). Other family members such as children also suffer losses and this, too, impacts on the couple relationship. Each member of the family goes through the grieving process in their own way and timing (Lindsay, 2005). This can be hindered if family members feel that they have no right to grieve for themselves (Webb, 1992). The whole process can be more difficult and disruptive to family functioning when, as is often the case, family members are at different stages of the grieving process. Here open communication in a safe environment is important to enable family members to understand and support each other through this difficult time. Hettie Kenny (1994) wrote: "If I hadn't gotten help and learned to talk with Tim frankly about my thoughts and feelings, I don't think our marriage would have survived those first terrible months of adjustment".(pp207)

One of the aspects of the grieving process that can have profound effects on the couple relationship is anger. Rolland (1994b) stated: "A serious illness or disability can normally generate levels of upset well beyond any such thing people have ever experienced in the relationship, and this can be terrifying"(Pp. 233). Those closest to the disabled person (usually their spouse) frequently become the target of angry outbursts (Kenny, 1994; Lindsay, 2005). The spouse is going through their own grieving process and may also explode in anger. This can produce a very volatile situation where the couple are reacting to and attacking each other, thus increasing their loneliness, fear and anger, at the very time when they most need the comfort of the other's love and support. Kenny (1994), Rolland (1993) and Lindsay (2005) all suggest redirecting the anger towards the disability and thus externalising it. This process of externalisation helps establish a boundary between the couple and the disability and encourages a greater sense of control over both the disability and the emotions. Kenny (1994) concurred: "That change has made life so much easier. I can enjoy times with my wife, even when I'm feeling bad, even when I'm disappointed about a career onÊhold or a body that doesn't look anything like it did a few years ago.(pp148) Couples counselling can provide an opportunity for the couple to experience this different way of relating to each other and the disability.

Vocational and Financial Issues

When the disability results in a reduction in or loss of employment significant vocational and financial issues are encountered. Vocation often forms a large part of a person's identity and sense of self-worth. To go from 'I'm a doctor/ lawyer/ plumber/mechanic/ etc.' to 'I'm a... nothing, a burden on my family and society' (as those who do not contribute financially are perceived in our materialistic society) can be a devastating blow to self-concept. When the husband was the main breadwinner in the family and then becomes unemployed issues of identity, status, prestige and authority in the family are raised with feelings of inadequacy and self-degradation (Holosko, 1992). Loss of earning capacity, career path and planned achievements can affect both the disabled spouse and the carer spouse. The cumulative effect of this loss on the family, along with increased medical expenses, can dramatically effect their financial situation which may impact on housing, transportation, leisure, schooling, and other choices, thus exacerbating the feelings of having lost control of their lives. "I've met many of them" wrote Kenny (1994, pp137) "real people who have lost their homes, their cars, everything they've worked their entire lives to accumulate... I'm talking about people who are a hair's breadth from being out on the street". Herein are many opportunities for us, as the body of Christ, to provide practical demonstration of His love.

Identity Issues

"Perhaps the most difficult of these transitions is the loss of the identity one held before becoming sick" wrote Perkins (2000). Illness and disability counter our society's (and often the church's) values of "prosperity, speed, independence, self-reliance and productivity"(Lyons, 1999). Loss of abilities, loss of career, loss of earning capacity, loss of functions within the family, loss of finances, loss of independence, loss ofÊhopes and dreams, loss of leisure activities, and changes in relationships all impact on the person's sense of identity. In a society that defines and values people according to what they do and accomplish dis-ability impacts heavily on the concept of self. "It is not surprising", wrote Lyons (1999), "that individuals and relationships struggle to adapt to this new life terrain that feels unfamiliar". Building a new identity and concept of self-worth based on things that the illness and disability cannot take away (who we are in Christ) is essential for both the individual and the couple relationship. This can present an opportunity for considerable personal and relationship growth.

Intimacy and Sexuality

"Ongoing health problems stir up decidedly unromantic feelings of anger, grief, fear, frustration, depression, guilt, low self-esteem or resentment" wrote Bienvenu (1997). Death wishes, escape fantasies and angry outbursts are frequent responses to the devastation of the situation (Lindsay, 2005). Many of the activities which previously built intimacy in the relationship can be difficult or impossible to continue after the accident or illness (Kenny, 1994).ÊLyons (1999) reports reductions in the range of companionate activity and social space along with discomfort in communication and support processes. This is especially so with conditions involving degenerative or unpredictable health problems, severe chronic pain or loss of cognitive functioning. "Inevitably", contends Lyons (1999), "relationship quality is affected as a result of the absence of valued relationship provisions and the difficulty of negotiating relationship constraints produced by illness and disability". Others (Bienvenu, 1997; Kenny, 1994; Rolland, 1993) testify that despite all the negative impacts disability has on the development of intimacy it can still offer couples the opportunity to deepen their relationship as they do the hard work of addressing the issues, forgiving themselves and their partner and develop a bond "forged by crisis and strengthened by the triumph of survival" (Kenny, H. 1994 pp207).

Research shows a marked consistency in the effects of disability on sexuality regardless of the cause or physical limitations of the disability (Boldrini, Basaglia & Calanca, 1991;Carod, Egido, Gonzalez & Varela de Seijas, 1999; Ferreiro-Velasco et al., 2004; Giaquinto, Buzzelli, DiFrancesco, & Nolfe, 2003; Korpelainen, Nieminen & Myllyla, 1999; Kreuter, Sullivan & Siosteen, 1994a; Kreuter, Sullivan & Siosteen, 1994b; Kreuter, Sullivan & Siosteen, 1996; Reitz, Tobe, Knapp & Schurch, 2004; Maruta, Osborne, Swanson & Halling, 1981; Phelps, Albo, Dunn & Joseph, 2001; Roy, 1985; Siosteen, Lundqvist, Blomstrand, Sullivan & Sullivan, 1990; Yim, Lee, Yoon, Song, Rah & Moon, 1998). There is generally a decrease in the frequency of intercourse and sexual satisfaction in spinal cord injury (Kreuter et al, 1994 and Yim et al, 1998), stroke (Carod et al, 1999), and chronic pain patients (Maruta, 1981 and Roy, 1985). Reduced libido was found in both the patient and, often more so, in their spouse (Giaquinto et al 2003; Korpelainen et al 1999). Many spouses experience fear, anguish, lack of excitation, or even horror, which inhibits them from encouraging sexual activities (Giaquinto et al, 2003). This correspondes with Loyns' (1999) disabled subjects who reported "diminished feelings of sexual attractiveness, exacerbated by the perceived lack of interest from partners". In hemiparetic stroke patients no significant correlations were found between physical abilities and changes in sexual life (Boldrini et al, 1991). In spinal cord injury patients the neurological level, completeness of injury and preserved sexual abilities were not significantly correlated to sexual satisfaction (Kreuter et al, 1996; Phelps et al, 2001; Reitz et al, 2004; Siosteen et al, 1990). The various study results concurred with Kreuter's conclusion that "psychosocial rather than physical factors were important for a satisfying sexual life and relationship"(Kreuter et al, 1996, pp541). The key roles of psychological and interpersonal factors in sexual adjustment and of the partner's reactions to the disability suggest the need for counselling in this area.

Two studies (Chan, Lee & Lieh-Mak 2000; Crewe, & Krause 1988) found differences between the marriages that took place after the onset of disability and pre-injury marriages. A third (Kreuter et al, 1994), however, found no significant difference between the two groups in satisfaction with current sex life. All the differences that were found between the two groups in these three studies favoured the post-injury marriage group. This may be due to the lesser effects of grief and loss on the post-injury spouse, having gone into the marriage with different expectations than the pre-injury spouse.

Social Isolation

The onset of a disability with its demands and limitations brings changes in the individual's and couple's social network structure. These changes include diminished network size (network shrinkage), decreased frequency of interaction and loss of friendships (Lyons, 1999). Individuals devoting considerable effort to their health problem have little energy left for managing their network of friends, family and workmates as well as the health care system. The individual's intense reactions through the grieving process can also sever friendships. Kenny (1994) wrote:


I've lost a lot to this illness but there are times when I think that I miss my friends the most. When people go through long periods of isolation... [as often happens with disability] something happens to their interpersonal skills... I had forgotten how to be a friend myself... I said and did things that I should not have... I was bitter and angry... I wasn't much fun any more... and so people who once occupied major roles in my life are now little more than memorie... friends made uncomfortable by tragedy... For those who remain close from the past, coping with the strains caused by my illness does not make fertile ground for planting seeds for future experiences together. (pp96-101)

Lindsay (2005) noted that caregiving tends to isolate people and increase the caregiver's own risk of illness. Daneker, Kimmel, Ranich and Peterson (2001) reported that spouses with high levels of social support had the least marital strain. Yet the demands of their new role and the feelings of not being understood by non-caregiving friends often rob spouses of the very social support that they, and the relationship, need. Rebuilding relationship skills, learning how to talk effectively with others about the disability and support groups can help reduce the couple's loneliness and isolation. The church can also help reduce this isolation by reaching out in Christ-like giving love and acceptance, affirming the worth of the person and not being deferred by angry outbursts or poor interpersonal skills. A powerful account of the love of Christ in action through many who faithfully prayed and fasted, encouraged and counselled, took care of practical needs and never gave up is found in Julie Sheldon's (1991) account of her struggle with Dystonia.


The role of caregiver places stresses on the spouse and the relationship. Caregivers may experience anxiety (Kitze, vonCramon & Walz, 2002) enormous frustrations, their own losses and grieving process, confusion as the disabled spouse's needs and abilities can change unpredictably and exhaustion from the extra tasks and responsibilities they take on. Depression is not uncommon among caregivers. Factors shown to negatively affect the caregiving spouse's well being are:

  • greater partner physical disability and lower functional capacity (Geisser, Cano & Leonard, 2005; Leinonen, Korpisammal, Pulkkinen & Pukuri, 2001; Manne, Alfieri, Taylor & Dougherty, 1999);
  • partner emotional lability (Croog, Sudilovsky, Burleson & Baume, 2001);
  • depressive and aggressive changes in partner behaviour (Jungbauer, vonCramon & Wilz, 2003);
  • disorganisation of household routines, difficulties with going away on holidays, restrictions on social life and disturbances of sleep (Thommessen, Aarsland, Braekhus, Oksengaard, Engedal & Laale, 2002);
  • family conflict (Clark, Dunbar, Shields, Viswanathan, Aycock & Wolf, 2004);
  • lack of tangible social support (Grant, Bartolucci, Elliot & Giger, 2000).

Factors shown to positively affect the caregiving spouse's well being are:

  • close relationships (Forsberg-Warleby, Moller & Blomstrand, 2002), as the body of Christ we need to be proactive in building and maintaining close, supportive relationships with those caring for others;
  • perceived partner support (Subramanian, 1991).

The disabled spouse may be unaware of the significant contribution they can make to their partner and the couple relationship through such emotional supports as appreciation and encouragement.

Spiritual Issues and Beliefs

The couples belief structure will determine how they view the challenges of the disability, the meanings they attach to it and the ways in which they manage it (Lindsay, 2005). Rolland (1993) contends that beliefs which sustain hope and empower the couple are beneficial while those that foster guilt, shame and blame are detrimental. Issues of faith and meaning may loom large during this time of emotional upheaval when so many of the previous 'certainties of life' are no longer. Hettie Kenny (1994 pp214) wrote: "In times of crisis people often turn either toward or away from religion". Her experience was one of "my faith sustained me when my intellect and my own imagination could not"(Kenny, H. 1994 pp214). Julie Sheldon (1991) describes her relationship with God as preparing her for, sustaining her throughout the devistation and trauma of struggling with a Dystonia that so wracked her with pain and contorted her muscles that it threatened to take her life, and healing her completely when all other hope was gone. Others interpret their suffering as punishment for some wrongdoing (Job 10:2) or as evidence that God either does not exist or is not good. The meanings that the couple attaches to these beliefs can build hope and empowerment or blame and despair.

Questions about divine healing are often wrestled with. James advises:


Is any one of you sick? He should call the elders of the church to pray over him and anoint him with oil in the name of the Lord. And the prayer offered in faith will make the sick person well; the Lord will raise him up, If he has sinned, he will be forgiven. Therefore confess your sins to each other and pray for each other so that you may be healed. The prayer of a righteous man is powerful and effective. (James 5:14-16).

What a powerful demonstration of the goodness, love and power of God when He miraculously heals someone who has been disabled through accident or illness! Isaiah prophesied of Jesus:


Surely He took up our infirmities and carried our sorrows, yet we considered Him stricken by God, smitten by Him, and aflicted. But He was peirced for our transgressions, He was crushed for our iniquities; the punishment that brought us peace was upon Him, and by His wounds we are healed (Isaiah 53:4-5).

This is fulfilled in Matthew 8:16-17. In Mark 16: 17-18 Jesus declares: "And these signs will accompany those who believe: In my name they will... place their hands on sick people, and they will get well." 1 Corinthians 12:28 declares that God has appointed in the church those having gifts of healing. There are certainly firm scriptual grounds for praying in faith that God will heal. Yet we do not always see that healing manifest immediatly, and sometimes not in this life.The apostle Paul's description of the thorn in his flesh was deliberatly vague, enabling application to a wide range of ailments and struggles that we might encounter:


Three times I pleaded with the Lord to take it away from me. But He said to me, "My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly about my weakness, so that Christ's power may rest on me. (1 Cor. 12:8-9)

To young Timothy, Paul (who had raised the dead) advised "Stop drinking only water, and use a little wine because of your stomach and your frequent illnesses."(1 Tim. 5:23) So we also see scriptural grounds for coming to terms with healing not being manifest in this life and finding a working with and acceptance of the limitations, and natural means of dealing with them, that still demonstrates faith, makes the most of life and glorifies God. Jennifer Rees Larcombe (1991) recounts:


I sought healing with total determination, my mind became obsessed with this one thing as I consulted everyone with a healing ministry and avidly read their books. This generation worships health and often treats God as a lucky charm - I certainly did, but He is bigger than that. The day I reached the point of despair He met me and showed me that I had pushed Him out of the central place in my existence. I wanted only to manipulate Him into doing my will, and was not resting in the fact that His will was best for me and for my family. I asked Him back into the central place that day, and after a week of fasting, repentance and prayer, we called the elders of our church (James 5) and asked for prayer. That night I wrote in the cover of my Bible: "31 March 1984. The elders came to pray for my healing: I promise You, Lord, I will never ask again. I present my body a living sacrifice to You (Romans 12:2) as You gave Yours broken for me. Mine is broken now. Mend it if You wish or use it as it is. Thine be the glory."... That was when God did a far greater miracle than [healing my body]. He gave me and the family His peace-joy. He did not change the circumstances that were destroying us, He changed us so the circumstances no longer overwhelmed us. I did not recover physically; in fact I grew progressively worse, but I can honestly say the last six years have been deeply happy and fulfilling. Many people have been won for the Lord through the books I have had the time to write and chances I have been given to speak at gatherings all round the country.

Six years after coming to terms with being permanently disabled and discovering God's joy and peace in the midst of the pain and disability He unexpectedly, through a young Christian who felt indequate and not even really knowing how to pray, miraculously healed Jennifer. She later wrote:


Two days after I was miraculously healed, someone said to me, "What a shame you wasted all those years. If only you had developed more faith earlier on." Believe me, it takes far more faith to go on loving, trusting and serving God in a wheelchair than ever it does to walk out of one. Yet disabled and ill Christians are so often treated like sinful outcasts by their healthy, wealthy and successful brethren.

It is thus helpful in counselling to explore the couple's underlying belief system and challenge unhealthy beliefs.

Family Systems Change

The introduction of disability into the family system challenges its boundaries, roles, sanctions, values, attitudes and life scripts. Atwood and Weinstein (2005) contend that the illness/disability eventually becomes an independent functioning member of the system with its own separate identity. They wrote:


It is demanding in that it requires readjustment of schedules, roles, finances, etc. It elicits anger in that it is often uncontrollable and causes pain and fear. It is selfish in that it must be attended to whenever it demands, despite other activities or interests. It is isolating in that it often changes intimacy and friendship patterns. (Atwood & Weinstein, 2005)

These impacts on the family system are very similar across a broad range of disabling health problems including cancer, multiple sclerosis and spinal injury (Lyons, 1999). Changes in the rules that govern the family system are made as it becomes organised around the disability.

Disengagement may occur among family members who cannot cope or caregive acceptably to themselves or the system (Lyons, 1999). This relates to Schwartz, Slater and Birchler's (1996) research which demonstrated marital conflict leading to a subsequent increase in pain behaviours in the disabled spouse which led to greater negative affect responses and more punitive behaviour from the carer spouse. Cano, Weisberg and Gallagher (2000) also showed that more frequent negative spouse responses to pain led to increased pain severity and decreased marital satisfaction which was linked to increased depressive symptoms which elicit more negative spouse responses.

Enmeshment can occur so strongly among family members and the symptoms that it becomes difficult to distinguish between the sick member and those who are well. The enmeshed family may usurp the disabled spouse's ability to maintain past roles and elicit a lack of competence (Lyons, 1999). This is shown in the research which links spouse solicitous responses with increased patient pain and disability behaviours (Flor, H, Kerns, R.D. & Turk, D.C. 1987; Schwartz, L. & Kraft, G.H., 1999).

The balance of power in the relationship can be skewed by the entrance of a disability. Often the disabled spouse becomes dis-empowered in the relationship as they lose the ability to perform many former roles and functions in the family (Lyons, 1999). In other relationships the disabled partner may use their disability to increase their power, feeling entitled while the other partner may feel compelled to 'meet every need' (Lindsay, 2005). Rolland (1993) suggests that having the family view health problems as couple problems rather than individual problems avoids hostile imbalances in power. The quality of the relationship is enhanced as couples develop family roles that assign value and purpose to the disabled partner and the contributions that they can make to the system.

Marriage Contract

Disability as a result of accident or illness violates the implicit marriage contract. The disabled partner is no longer able to fulfil their perceived obligations and so may suffer from guilt and fear relationship loss (Lyons, 1999). They may feel distress at having their disability change the rules of the relationship and demand more from it at a time when they cannot give back into it what they used to. If their spouse has not come to terms with the disability and resists the changes required to accommodate it in the relationship conflict increases within the relationship and the fear of relationship loss is exacerbated (Lyons, 1999). Marriage contract work with the couple can help them work through these issues, develop a greater understanding of their own and each other's expectations, abilities and limitations and re-negotiate a workable marriage contract within the constraints of the disability.

Life-Cycle Implications

As expectations and skill mastery differ from one stage of life to another so does the impact of disability (Rolland & Williams, 1994). In early adulthood it may interfere with the couple's ability to have children or become successful in their careers. During the early child rearing phase a disorder disrupts the family developmental tasks involved in adjusting the couple relationship to new financial, household and child rearing demands along with realigning relationships with extended family (Carter & McGoldrick, 1999). In later life grand-parenting roles and retirement plans can be thrown into disarray. Life cycle transitions present new tasks, losses, and grief, thus providing some of the couple's greatest challenges in managing the disability. Recognising the timing of onset of the disability in relation to the developmental phases enables appreciation of the major life cycle tasks that are challenged along with the effects on future developmental tasks (Rolland & Williams, 1994).

Gender Differences

Gender differences have been shown to affect both patient and spouse responses to the disability. In male patient couples greater patient depression was associated with greater spousal depression and lower spousal marital satisfaction with wives reporting lower marital satisfaction than the husbands (Romano, J.M., turner, J.A. & Clancy, S.L. 1998). In female patient couples the husband reported significantly less depression than the wife (Romano et al, 1998). Husband caregivers had significantly higher anxiety scores than wife caregivers (Crogg et al, 2001). Wife caregivers are more likely to adopt a nurturing role which includes taking on the husband's tasks even when this is more than she can cope with (Lindsay, 2005). Husband caregivers are more likely to hire someone to do the wife's tasks. Recognising gender differences can assist clients in diffusing blame, giving the spouse room to react differently and gaining a greater understanding of one another.

Family Systems-Illness Model

Developed by Rolland (1984, 1987, 1994, 2003), this is a strength based model that views the disability as "our challenge", family relationships as a potential resource and focuses on possibilities for growth. The FSI model examines three dimensions: 1) "psychosocial types" of illness and disability; 2) life cycle issues; and 3) key family system variables. It assesses how the particular disorder (with its pattern of practical, emotional and relational challenges over time), interacts with the style, strengths and vulnerabilities of the family and its members (Rolland & Williams, 1994). It aims to "help couples maintain intimacy in the face of caregiving demands, overcome gender-role expectations, grieve together the loss of life dreams and goals when necessary, and counteract relationship imbalances that can emerge during the course of an illness" (Rolland, 1994).

Non-Illness Intervention Model

Developed by Navon (2005), this is a useful tool for limiting the power of the illness/disability so that while it is acknowledged it does not define the individual, the relationship, the family or life (Lindsay, 2005). Its first step is rapport building, through empathising with the verbal account of the illness/disability. Navon (2005) contends that having a good knowledge of the medical issues involved (tests, medications, rehabilitation programs) is important in building an atmosphere of trust. The second step involves the cognitive distinction work of differentiating the illness from non-illness aspects of the client's account to enable them to see how much of their lives are not determined by the illness/disability. The third step involved the cognitive distinction work with extreme, "black and white" beliefs about their misery and suffering. Fourth are the adjuvant techniques of challenge, reframing, metaphors and future questions with the fifth step being focusing on the non-illness issues and facilitating change in these areas to enhance the client's life.


When disability strikes a marriage partner both spouses and the relationship are dramatically effected. Changes in response to loss are wrought in each spouse individually and in relation to the other. The impact these changes have varies through the life cycle as each developmental stage presents its own expectations and demands. Throughout this journey non-finite loss and grief remains their constant companion, at times lurking in the background, at times overshadowing every aspect of life. The family system is altered, roles changed, marriage contract re-negotiated and identities reformed. As the couple learns to stand together and support each other in the battle to live life to the full their relationship can strengthen and deepen as they develop 'a bond forged by crisis and strengthened by the triumph of survival' (Kenny, N. 1994 pp207).


Atwood, J. & Ruiz, J. (1993 ). Social constructionist therapy with the elderly. Journal of Family Psychotherapy, 4(1), 1-31.

Atwood, J. D. and Weinstein, E.ÊFamily Practice, Family Therapy: A Collaboration of Dialogue. Retrieved 5th October 2005 from

Bienvenu, M. (1997).ÊHappily Ever After. Arthritis Today. Sept-Oct 1997. Retrieved 8th October from Boldrini, P.,

Basaglia, N. and Calcanca, M. C. (1991).ÊSexual Changes in Hemiparetic Patients. Archives of Physical and Medical Rehabilitation, 72(3), 202-207.

Bruce, E.J. and Schultz, C.L. (2001) Nonfinite Loss and Grief. A Psychoeducational Approach.Paul H. Brookes Publishing Co.

Cano, A., Weisberg, J.N. and Gallagher, R.M. (2000). Marital Satisfaction and Pain Severity Mediate the Association Between Negative Spouse Responses to Pain and Depressive Symptoms in a Chronic Pain Patient Sample. Pain Medicine, 1(1), 35-43.

Carod, J., Egido, J., Gonzalez, J.L., Varela de Seijas, E. (1999). Poststroke Sexual Dysfunction and Quality of Life. Stroke. 30, 2238-2248

Chan, R.C., Lee, P.W. and Lieh-Mak, F. (2000). Coping with Spinal Cord Injury: Personal and Marital Adjustment in the Hong Kong Chinese Setting. Spinal Cord, 38(11), 687-696.

Clark, P.C., Dunbar, S.B., Shields, C.G., Viswanathan, B., Aycock, D.M. and Wolf, S.L. (2004). Influence of Stroke Survivor characteristics and Family Conflict Surrounding Recovery on Caregivers' Mental and Physical Health. Nurse Res, 53(6), 406-413.

Crewe, N.M. and Krause, J.S. (1988). Marital Relationships and Spinal Cord Injury. Archives of Physical and Medical Rehabilitation, 69(6), 435-438.

Croog, S.H., Sudilovsky, A., Burlerson, J.A. and Baume, R.M. (2001). Vulnerability of Husband and Wife Caregivers of Alzheimer Disease Patients to Caregiving Stressors.ÊAlzheimer Dis Association Discord, 15(4), 201-210.

Daneker, B., Kimmel, P.L., Ranich, T. and Peterson, R.A. (2001). Depression and Marital Dissatisfaction with End-Stage Renal Disease and in their Spouses.American Journal of Kidney Disease, 38(4), 839-846.

Ferreiro-Velasco, M. E., Barca-Buyo, A., Salvador de la Barrera, S., Montoto-Marques, A., Miguens Vazquez, X. and Rodriguez-Sotillo, A. (2004). Sexual Issues in a Sample of Women with Spinal Cord Injury. Spinal Cord, 43, 51-55.

Flor, H., Kerns, R.D. and Turk, D.C. (1987). The Role of Spouse Reinforcement, Perceived Pain, and Activity levels of Chronic Pain Patients. Journal Psychosom Res, 31(2), 251-259.

Forsberg-Warleby, G., Moller, A. and Blomstrand, C. (2002). Spouses of First-Ever Stroke Victims: Sense of Coherence in the First PhaseÊafter Stroke. Journal of Rehabilitation Medicine, 34(3), 128-133.

Forsberg-Warleby, G., Moller, A. and Blomstrand, C. (2004) Psychological Well-Being of Spouses of Stroke Patients During the First Year after Stroke. Clinical Rehabilitation, 18(4), 430-437.

Geisser, M.E., Cano, A. and Leonard, M.T. (2005). Factors Associated with Marital ÊSatisfaction and Mood among Spouses of Persons with Chronic Back Pain Journal of Pain, 6(8), 518-525

Giaquinto, S. Buzzelli, S., Di Francesco, L. and Nolfe, G. (2003). Evaluation of Sexual Changes After Stroke. Journal of Clinical Psychiatry. 64(3): 302-307

Grant, J.S., Bartolucci, A.A., Elliot, T.R. and Giger, J.N. (2000). Sociodemographic, Physical and Psychosocial Characteristics of depressed and Non-Depressed Family Caregivers of Stroke Survivors. Brain Injury, 14(12), 1089-1100.

Hall, E. T. (2000). Caring for a Loved One with Alzheimer's Disease - A Christian Perspective. NY: The Haworth Pastoral Press.

Hendler, N. (1982) The Four Stages of Pain. In Diagnosis and Treatment of Chronic Pain. Hendler, N. et al (Eds). Bristol: The Stone bridge Press.

Hendler, N. (1984) Depression Caused by Chronic Pain. Journal of Clinical Psychiatry 45 (3, Sec. 2), 30-36.

Hendler, N. (1993). How to Cope With Chronic Pain. Boca Raton: Cool Hand Communications, Inc.

Holosko, M.J. (1992). Counselling People who are Unemployed. In Robertson, S.E. and Brown, R. I. (Eds.) Rehabilitation Counselling - Approaches in the Field of Disability. London: Chapman & Hall.

Hornby, G (1992). Counselling Family Members of People with Disabilities. In Robertson, S.E. and Brown, R. I. (Eds.) Rehabilitation Counselling Approaches in the Field of Disability. London: Chapman & Hall.

Kenny, H. (1994). Epilogne. In Kenny, T. (1994). Living with Chronic Fatigue Syndrome Ð A Personal Story of the Struggle for Recovery. New York: Thunder's Mouth Press.

Kenny, T. (1994). Living with Chronic Fatigue Syndrome Ð A Personal Story of the Struggle for Recovery. New York: Thunder's Mouth Press

Kitze, K., vonCramon, D.Y. & Walz, G. (2002). The Emotional Burden in Caregiving Relatives of Stroke Patients. Rehabilitation, 41(6),401-406

Korpelainen, J.T., Nieminen, P and Myllyla, V.V. (1999). Sexual Functioning among Stroke Patients and their Spouses. Stroke, 30(4), 715-719.

Kreuter, M., Sullivan, M., and Siosteen, A. (1994a). Sexual Adjustment after Spinal Cord Injury Focusing on Partner Experiences.ÊParaplegia, 32(4),225-235.

Kreuter, M., Sullivan, M., and Siosteen, A. (1994b). Sexual Adjustment after Spinal Cord Injury -Comparison of Partner Experiences in Pre- and Postinjury Relationships. Paraplegia, 32(4),225-235.

Kreuter, M., Sullivan, M., and Siosteen, A. (1996). Sexual Adjustment and Quality of Relationship in Spinal Paraplegia: a Controlled study. Archives of Physical and Medical Rehabilitation , 77(6),541-548.

Leinonen, E., Korpisammal, L., Pulkkinen, L.M. and Pukuri, T. (2001). The Comparison of Burden Between Caregiving Spouses of Depressive and Demented Patients International Journal of Geriatric Psychiatry, 16(4), 387-393.

Lindsay, E. In Sickness and In Health. Retrieved 8th October 2005 from

Livneh, H. (1986) A Unified Approach to Existing Models of Adaptation to Disability: Part I Ð A Model of Adaptation. Journal of Applied Rehabilitation Counselling. 17, 5-16.

Lyons, R.F. (1999). Personal Relationships, Illness, and Disability. Journal of Leisurability. 26 (23)

Manne, S.L., Alfieri, T., Taylor, K.L. and Dougherty, J. (1999). Spousal Negative Responses to Cancer Patients: the Role of Social Restriction, Spouse Mood and Relationship Satisfaction. Journal Consult Clinical Psychology, 67(3), 352-361.

Maruta, T., Osborne, D., Swanson, D.W. and Halling, J.M. (1981). Chronic Pain Patients and Spouses: Marital and Sexual Adjustment. Mayo Clinic Proc., 56(5), 307-310

McDaniel, S. H., Hepworth, J & Doherty, W.J. (l992). Medical family therapy: A biopsychosocial approach to families with health problems. NY: Basic Books, Inc. Navon, S. (2005). The 'Non-Illness' Intervention Model: Psychotherapy for Physically Ill Patients and their Families. Retrieved 14th October 2005 from

Perkins, C. (2000) Coping with Loss Caused by Chronic Illness. Retrieved 5th October, 2005 from

Phelps, J., Albo, M., Dunn, K. and Joseph, A. (2001). Spinal Cord Injury and Sexuality in Married and Partnered Men: Activities, function, Needs and Predictors of Sexual Adjustment.

Rees-Larcombe, J. Beyond Healing. Hodder & Stoughton

Rees-Larcombe, J. (1991) Unexpected Healing. Hodder & Stoughton

Rees-Larcombe, J.(1994) Turning Point: Is There Hope for Broken Lives? Hodder & Stoughton Ltd.

Rees-Larcombe, J. (2005) Miracles of Healing. Eagle Publishing.

Reitz, A., Tobe, V., Knapp, P.A., and Schurch, B. (2004). Impact of Spinal Cord Injury on Sexual Health and Quality of Life. International Journal Impot. Res.16(2), 167-174.

Robertson, S.E. (1992). Counselling Adults with Physical Disabilities: A Transitions Perspective. In Robertson, S.E. and Brown, R. I.(Eds.) Rehabilitation Counselling - Approaches in the Field of Disability. London: Chapman & Hall.

Rolland, J. S. (l993). Helping Couples Live with Illness. Family Therapy News. Dec. l993 p. 15-26. Rolland, J.S. (1994). Families, illness, & disability: An integrative treatment model. New York: Basic Books.

Rolland, J.S. (1994b). Families, Illness and Disability: A Biophysical Treatment Model.New York. Basic Books.

Rolland, J.S. and Williams, J.K. (1994) Toward a Biopsychosocial Model for 21st Century Genetics Retrieved 15th October 2005 from

Romano, J.M., Turner, J.A. and Clancy, S.L. (1989). Sex Differences in the Relationship of Pain Patient Dysfunction to Spouse Adjustment. Pain. 39(3), 289-295.

Roy, R. (1985). Chronic Pain and Marital Difficulties. Health Social Work, 10(3), 199-207.

Schwartz, L. and Kraft, G.H. (1999). The Role of Spouse Responses to Disability and Family Environment in Multiple Sclerosis. American Journal of Physical and Medical Rehabilitation, 78(6).

Schwartz, L., Slater M.A. and Birchler, G.R. (1996). The Role of Pain Behaviours in the Modulation of Marital Conflict in Chronic Pain Couples. Pain, 65(2-3), 227-233.

Sheldon, J.(1991). Dancer off her Feet. London:Hodder and Stoughton.

Siosteen, A., Lundqvist, C., Blomstrand, C., Sullivan, L. and Sullivan, M. (1990).ÊSexual Ability, Activity, Attitudes and Satisfaction as Part of Adjustment in Spinal Cord Injured Subjects. Paraplegia. 28(5), 285-295.

Subramanian, K. (1991). The Multidimensional Impact of Chronic Pain on the Spouse: a pilot study. Society World Health Care, 15(3), 47-62.

Thommessen, B., Aarsland, D., Braekhus, A., Oksengaard, A.R., Engedal, K. and Laake, K. (2002).The Psychological Burden on Spouses of the elderly with Stroke, Dementia and Parkinson's Disease. International Journal of Geriatric Psychiatry, 17(1), 78-84.

Tully, J. (2003) Grief and loss: 'I'm not myself anymore. Australian Family Physician Vol. 32, No. 9, September 2003

Wallerstein J.S. and Blakeslee, S. (1995) The Good Marriage: How and Why Love Lasts. Boston: Houghton Mifflin Co.

Webb, S.B. (1992).Disability Counselling: Grieving the Loss. In Robertson, S.E. and Brown, R. I.(Eds.) Rehabilitation Counselling Approaches in the Field of Disability. London: Chapman & Hall.

Werner-Beland, J. (1980) Grief Responses to Long-Term Illness and Disability. Virginia, Reston Publishing Co., Inc.

Yim, S.Y., Lee, I.Y., Yoon, S.H., Song, M.s., Rah, E.W. and Moon, H.W. (1998).Quality of Married Life in Korean Spinal Cord Injured Patients. Spinal Cord, 36(12),826-831.


Renewal -Rebirth, Regeneration, Restoration, Rekindling, Revitalisation, Replenishment & Revival. Exalting Jesus - Restoring, Equipping, Releasing & Supporting People...


Uniting, Discipling, Equipping & Mobilizing the Body of Christ
United in ChristUniting together different churches and nations ...
Read more >

Discipling all to follow Christ Read more >

Equipping the Saints
Equipping - for ministry
Read more >

3 nations ministering
Mobilizing - from all nations into all the world with the good news
Read more >


line decor
© 2016 Renewal Ministries Fellowship
"...May they be brought to complete unity to let the world know that You sent Me
and have

-loved them..." (John 17:23)