Siblings in the Shadows

Fostering Resilience in Siblings of Teens with Mental Health Issues

Apr 07, 2025

When I took my 14-year-old daughter Leah to the mountains during her spring break, it wasn’t just a way to spend time together. It was also a choice to invest in a child who often lives in the shadows of her sister’s health challenges.

For a few days, it was all about Leah. We chose the vacation that she preferred (within my budget constraints). I found an Airbnb that made her brim with delight, because it represented her favorite landscape: a humble cottage nestled in the woods next to a little stream, with fresh eggs from the nearby chicken coop. At the grocery store, I surprised Leah (and myself) by saying yes to her requests for chocolate treats. Each day, we hiked a trail that pleased Leah and talked about her concerns: friends, school, our family, faith. At night, we watched movies with strong female protagonists who shone for their brains rather than their bodies.

Leah insisted on climbing to the mountain peak to touch the seal. I swallowed my anxiety about scaling boulders to honor her request.

When we came home, I found that Leah impulsively initiated hugs with me, representing a stronger bond between us.

We needed a trip like this to focus on our relationship and to create joyful, peaceful family rhythms, because much of the time, our family revolves around my oldest daughter Ellie’s health challenges.

Background

Four years ago, our family dynamics shifted dramatically, when Ellie (then 15) hit a crisis point with suicidal depression, anxiety and an eating disorder. Unintentionally, we created a family system that centered around Ellie’s needs. As Ellie’s primary caregiver, I invested my best time and energy in saving her life. Even though my husband Peter and I tried to nurture our younger children William and Leah, we were often less available, drained and short-tempered. We could not make life “normal” again.

Over the years, Ellie’s eating disorder stabilized, but she has developed other debilitating health conditions. So we continue to wrestle with these same family dynamics. We still have one child who requires significantly more parental support, whose health challenges influence our family plans. Yet as time has gone on, we’ve taken conscious steps to support all our children.

Kids like Leah and William often face many challenges as they watch a sibling wrestle with mental health issues. Over the next few weeks, I’ll explore ways we can support those siblings who are often sidelined.

The Challenge: Focused Parental Attention

Often, siblings of teens with health issues feel neglected. As their parents’ attention focuses on their struggling sibling, they may feel overlooked or even ignored for being the “easy” child.

I know how hard it is to find the time and energy to support both my teen with health challenges and the rest of the family. It can feel next to impossible to take care of ourselves, let alone anyone else. Some of us also juggle a full-time job, a marriage, aging parents, church and community commitments. In the darkest seasons of Ellie’s health challenges, I could not do much beyond the very minimum for anyone besides Ellie. My ability to invest in my other teens felt limited.

Robin Entress, LCSW Director of Community and Home-Based Services at Community Child Guidance Clinic, notes:

“Because caregivers are often so involved in facing the struggles of their high-need children, young siblings with less severe needs may be ‘out of the loop’ and may not receive enough support. And yet, these children are also profoundly affected by living in households with children with special needs.”1

Potential Solutions for Focused Attention

The more we can find creative ways to support these teens with focused attention and support outside the home, the more they can find stability during their sibling’s trials.

I’m thankful that while I served as primary caregiver for Ellie, my husband always held a vision for supporting William and Leah. We did our best to plan times for parental connection with them. When I crawled into bed early, weary from trying to get Ellie to eat dinner, Peter played board games like “Sorry” with William and Leah. When Ellie required my full-time supervision, Peter took the younger kids on an ice cream date.

Okay, this is not a photo of Peter & Leah, but it could be. Playing tennis together is their favorite activity.

Some of us may be single parents or have a spouse with less capacity. Grandparents are a godsend. When my mom visited, I was so thankful for another loving adult who took Leah shopping for a new dress and did crossword puzzles with William. I also leaned on our good friend Amy, who generously offered to host my kids at her house anytime. Rather than feeling my absence as I took Ellie to an appointment, my kids high-fived each other at the chance to hang out with their friends and enjoy a sense of normalcy at someone else’s home.

When Ellie stabilized, we took William and Leah on longer adventures. In the past year, I’ve taken William and Leah separately to the same national park. For four days, they get my undivided attention. I’ve been surprised by how much more they chatter and confide in me when we’re away from their usual routines and away from our daily family challenges. It's like I’m redirecting the current to nourish all streams, not just the loudest one.

I want to acknowledge that some siblings may resist time with their parents, especially if they feel resentful or jealous about how parents have handled their sibling’s mental health issues. My friend Ilana’s college-age daughter avoids coming home when her struggling sibling is also there; this means she also distances herself from her mother. In situations like these, especially with young adults, we may need to find creative solutions to spend time together. We may need to rely on other caring adults to invest in these siblings for a season.

Share Evidence of Grace

Challenge: Expressing Big Feelings

Leah and William have experienced a variety of emotions in witnessing their sister’s struggles. When we first explained that Ellie had a condition called depression that made her sad and tired, I watched thirteen-year-old William as his face fell in despair. I remember ten-year-old Leah’s tears when we broke the news that Ellie was going away to a “hospital” to “get better” because she had another condition that made it hard for her to eat. I can still hear Leah wailing in disappointment when Ellie’s health challenges made her unavailable to play. During a panic attack, Leah held Ellie’s hand and William tried to soothe her.

Siblings may feel scared and sad about their sibling’s well-being, confused about their condition, and angry about its impact. Sometimes they feel overwhelmed by these big feelings and wonder if they should stuff them away. They also might wonder if they should hide their feelings from their parents, who may seem too stressed to listen.

Diane Marsh, a professor and member of NAMI (National Alliance for the Mentally Ill) writes:

“Frequently, siblings experience intense feelings of anger. The anger may be directed at God or at fate. . . Sometimes it is directed at parents whose energy is consumed by their efforts to cope with the mental illness. Anger may also be directed at their brother or sister for disrupting family life or for not getting better. And sometimes the anger is turned inward because of their inability to protect and rescue someone they love.”2

Potential Solutions: Supporting Big Feelings

In imperfect ways, Peter and I have tried to welcome our children’s feelings. It takes patience and skill to listen to teens as they share feelings, even ones that feel irrational, uncomfortable or embarrassing. We’ve tried to create an environment in which no feeling or thought is off-limits. We ask William and Leah how they are feeling about their sister’s challenges and how it’s affecting them.

The one boundary we’ve set is that we ask that they share those feelings with us, rather than Ellie herself. We think it’s healthiest for everyone if we as parents help William and Leah to process their experience apart from their sister.

The Child Mind Institute suggests that “having a regular outlet for expressing feelings” is key for these siblings to process their emotions effectively.3 As our kids share feelings, we listen and validate. We don’t talk them out of their feelings or explain why they shouldn’t feel that way. We refrain from agreeing with negative judgments or conclusions about another sibling, but we offer a safe space to process, knowing they can share anything with us. When they bring up ways that we may have disappointed them as parents, we try to listen without getting defensive. Often, providing teens with an opportunity to name their feelings helps them heal.

One of our best decisions in the heat of Ellie’s mental health crisis was to offer William and Leah their own therapists. At ages thirteen and ten, neither asked for that kind of support, but I felt they would benefit from having someone outside the family to lean on, someone who understood mental health and could be their advocate. Even though both kids seemed hesitant at first, they both found it helpful to have their “person.”

I still remember Leah beaming after her first therapy appointment. Since Leah was only ten years old, I joined the appointment. Her therapist brought out an amazing array of fidgets, putty, and art supplies which we both sunk our hands into. Afterwards, Leah and I picked up Ellie from her eating disorders program, where she spent about eight hours a day. Leah proclaimed repeatedly to Ellie, “Do you have a person? I LOVE my person so much! When can I go back, Mom?”

Ellie, who had more ‘persons’ in her program than Leah could imagine, winked at me. “Yeah, I have a ‘person,’ Leah. So glad you like yours!”

Even though the next several months became harder, not easier, with Ellie’s mental health, I remember the relief I felt in finding wise, safe adults to support my younger teens through the dark valleys. I felt grateful knowing that we all had places to express our uncensored feelings with loving people who would guide us to hope and healing.

These are just a few principles among many about supporting siblings of teens with health challenges. Next time, we’ll hear one mom’s story of empowering a son with independence and outside interests in the face of his brother’s mental health challenges.

If you’ve supported a child whose sibling has faced a health challenge or another crisis, I’d love to hear what worked for your family. What ideas or tools felt helpful?