After a family member is diagnosed with MS, family roles can shift over time. These changing roles in family, work, and social situations can create additional adjustment problems for everyone. Children may be called upon to help out more; husbands may have to add on additional household duties, or perhaps the main breadwinner has opted to scale down to part-time work. When roles change, you have to learn to redefine yourself and rethink your established duties or routines within the family system. How much the roles of family members change is largely dependent on how well the member with MS is doing, both physically and mentally.

Along with roles come certain social and family expectations for how those roles should be fulfilled, so it's important to add flexibility into your own needs and expectations. Here are some tips to guide you in adapting to new roles within the family:

• Establish clear roles. Identify the roles played within your family system. Individual family members should clearly understand what is expected of them. It may be helpful to make a list for each family member to follow.

• Allow for flexibility. Being able to change roles is integral to a healthy family. Roles in all families can change over time, not just in families living with MS. Healthy families have the ability to adapt: The stay-at-home mother, for example, may head back to work, which might be a big adjustment for the rest of the family. Changing your expectations and adopting flexibility is an important strategy when coping with changes in the family structure.

• Allocate roles fairly. Roles should be spread among the various members so that no one is asked to take on too much responsibility. Problems can arise if one person is asked to take on too many roles. A full-time working mother cannot be expected to put in forty hours a week and then take on the lion's share of household duties. Everyone in the family should be expected to take on appropriate roles of responsibility.

• Teach responsibility. All family members should take their roles seriously and do their best to fulfill their duties. A healthy family system is dependent on each person taking responsibility for himself. In families where clear, flexible roles exist, individual members will be much more likely to take their responsibilities seriously.

• Family assessment. It's a good idea to take stock of your family's strengths and weaknesses and take steps to improve the family system. Having good communication skills comes into play here. Schedule family meetings and take stock of how well things are going.

It is important for a family to maintain a good quality of life. Being able to give and receive love, enjoy pleasurable activities together, and sustain hope as a family unit are important characteristics of a healthy family.

Communication Is the Key

Each family has its own unique coping style so it's no wonder there's not a “one size fits all” when it comes to communicating. Talking about changes or problems that arise in the family can be difficult. One person in the family may feel comfortable bringing up something “unpleasant,” while another has been raised to live comfortably with the big elephant in the room that everyone has been tiptoeing around. Communication is so essential to a healthy family that it's really important to get help learning how to talk to one another about what's going on if it seems as if everyone is avoiding important issues. If one of your children feels anxious about your diagnosis and is not expressing it, it is bound to surface in other ways — some of which may be unhealthy, such as sleeping disturbances. If you feel overloaded with spring cleaning in the yard during a relapse, it's important to communicate your feelings in a way that will promote a solution rather than resentment. The guidelines to effective communication promote respect for all individuals and include being a good listener:

• Don't be afraid to ask for help! Rather than assuming other family members are certain of their tasks, point out what needs to be done.

• Use “I” messages. Rather than saying “You are not helping enough,” use “I” statements, such as “I feel frustrated when I'm left to do all of the chores.” These messages help others to feel less defensive when you're speaking to them. Your goal is to express your point of view.

• Compromise. Rather than trying to win an argument, you're looking for solutions. Healthy communication involves finding a resolution that both sides can be happy with.

• Be clear. MS can be deceiving. You may be standing there in your shirt and tie, looking as if you just had a great day at work, and all you really want to do is put your feet up and watch the news. Since so many MS symptoms are invisible, it's important to express your needs without assuming that others know how you're feeling.

• Take a timeout. Sometimes you might need to take a break from a topic and wait for clearer heads to prevail. But don't give up. If something needs to be discussed, revisit the issue again when you've had a few moments to collect yourself.

• Find support. If communication within your family has broken down or is difficult, seeing a family therapist can help. A therapist can help break the silence or resolve conflict and also teach coping skills. Avoiding conflict, being defensive, blaming others, and not actively listening are a few of the common communication barriers that need to be resolved.

Effective communication is an important characteristic of strong families and is one of the factors that helps them get through hard times. Even though communication patterns are learned over a long period of time, it's possible to build new communication skills.

Keeping It Together

No matter what your role in the family has been thus far, it's likely that you're going to have to restructure your life in small or big ways to ensure that you're taking good care of yourself. This means that family roles may have to change, good communication skills must be learned, and flexibility will have to be exercised. Some people with MS find that they have to change very little in their households, while others may have more changes to contend with. Just as you created a plan to manage your MS, it's also a good idea to come up with a household management plan that outlines duties and responsibilities and clarifies how you're going to look at them from now on.

A good way to start is by learning how to simplify tasks. Reorganize your home so that you feel a certain ease in living. Come up with a chart that organizes chores and requires everyone to share the workload. Take a look at your budget and see if you can afford to get some help cleaning bathrooms or mowing the lawn. Prioritizing tasks can help you figure out where you need to direct your time and energy.

One of the most important tasks in keeping it together is prioritizing time with your family members. Many people with MS have reported difficulty in keeping perspective; MS can easily take over a family, so you'll want to establish quality time with your loved ones in an MS-free zone. Even if some of the activities you once enjoyed are off limits, the quality of your time together doesn't have to change. If hiking or skiing are no longer possible, a beautiful ride in the country can be a nice way to enjoy nature. You want to balance the needs of everyone in the family while leaving a little room for the realities of MS to coincide. Mom or Dad can read a good book in the ski lodge and have lunch ready for everyone at noon rather than having the whole family give up skiing. There is no shortage of ideas to help you adapt — it just takes creativity and flexibility on everyone's part.