Siblings, fairness and
invisible responsibilities.
Nobody ever asked me if I wanted to be the backup plan.
Siblings of disabled people, the responsibilities nobody names, fairness without a competition for hardship, and planning the future together.
What this is: a systemic look at sibling relationships where one sibling is disabled.
Why it matters: siblings are often cast as harmed or as saints.
The sharpest reframe: the disabled sibling is a sibling too.
One thing to take away: separate being involved from being the carer.
The short version
Siblings of disabled people are often described in one of two ways: as quietly harmed, or as saints. Neither helps. Research on siblings of children with chronic health conditions finds, on average, small differences from other children, with more risk in some circumstances, such as highly intrusive conditions. Systemic work looks at the arrangements: what responsibilities siblings carry that nobody has named, how fairness is handled, what happens as parents age. It also looks at siblings as a relationship in its own right, with humour, rivalry and companionship, and at the disabled sibling as a sibling too, not only as the one being helped.
You might recognise this
Illustrative statementsDrawn together from common experiences. They are not quotes from individual people.
What research suggests
Research findingA 2012 meta-analysis of siblings of children with chronic health conditions (Vermaes and colleagues) found a small overall negative effect on siblings’ psychological functioning, with slightly more internalising and externalising problems and slightly fewer positive self-attributes than comparison groups. Older siblings, and siblings of children with life-threatening or highly intrusive conditions, were at greater risk.
What it can’t tell us: “chronic health condition” isn’t the same as disability; averages hide great variation; and the study doesn’t say what caused differences, which may lie in the family’s circumstances and support rather than the condition itself.
Orlaith is 31. Her brother Fiachra, 28, has an intellectual disability and epilepsy and lives with their parents, who are in their seventies. Orlaith lives an hour away and has always been “the sensible one”. Lately her mother has started saying, “When we’re gone, you’ll look after him.” Orlaith comes to therapy feeling guilty for wanting her own life. Fiachra, separately, tells his support worker he is worried that Orlaith is sad.
Orlaith and Fiachra are fictional teaching examples, not real people.
Fiachra’s account
IllustrativeFiachra meets the therapist on his own first, with an easy-read agenda and his support worker nearby if he wants her. With pictures and short questions, he says:
- What he values about Orlaith: “She’s funny. She takes me to concerts. She tells Mam to stop fussing.”
- The help he wants: with money and with his tablets. Not with choosing clothes or friends.
- Responsibilities he already has: he feeds the dog, and he rings their granny every Sunday.
- What he worries about: “Mam and Dad getting old. Where I’ll live. Orlaith being sad.”
- Whether he wants his sister checking his support: “Sometimes. Not every day. Not telling me what to do.”
His view shapes the rest of the work. He isn’t only the subject of other people’s planning; he is also a brother with his own worries about his sister.
Invisible responsibilities
Our frameworkSiblings often carry responsibilities that were never agreed: being the easy child, filling in at home, translating for a parent, being named as the future carer. The systemic questions are the same as for any care arrangement: how did this come about, who decided, and what would each person keep or hand over? See Who Carries the Work of Care?
Fairness without a competition for hardship
Families often handle fairness as if attention were a fixed amount, so that one child’s needs crowd out the other’s. A sibling may learn that their difficulties don’t count. The aim isn’t to rank whose life is harder. Each person’s experience gets its own room.
Planning for the future, together
Our framework- Fiachra takes part. His own wishes about where and how he lives come first, with whatever communication support he uses.
- Separate “being involved” from “being the carer”. Orlaith can stay close, visit, advocate and be his sister without providing daily care.
- Name what services must provide. A sibling shouldn’t be the default plan for a gap in housing or support.
- Let the plan change. Revisit it as lives change.
What it might sound like
Orlaith, when your mum says ‘you’ll look after him’, what do you hear?
That my life is already decided.
And what do you want your relationship with Fiachra to be, in twenty years?
His sister. The person who takes him to concerts. Not the person who does his tablets.
Would it help to have that conversation with your parents, and with Fiachra, with someone there to support it?
What changes: in a family meeting with an easy-read summary, Fiachra says he wants to live “with friends, like Orlaith does”. His parents start applying for supported housing. Orlaith and Fiachra agree together on the scope of her role: she will check in with his support provider every three months and whenever Fiachra asks, she won’t make decisions for him, and either of them can ask to change the arrangement. Orlaith says this is a role she can choose rather than one she inherited; Fiachra says it is “not too much checking”. The guilt hasn’t gone but has “shrunk to a size I can carry”. They still argue about who chose the last concert.
What needs attention here?
A sibling has been named as future carer
Possible focus: whether anyone agreed, and what they want
Watch for: assuming willingness
A sibling feels their needs don’t count
Possible focus: room for each person’s experience
Watch for: comparing hardships
Future planning happens without the disabled person
Possible focus: their wishes, with communication support
Watch for: planning around them
The family relies on a sibling to fill a service gap
Possible focus: what services should provide
Watch for: treating the sibling as the plan
Possible starting points, agreed with the person, not rules.
How you’d know it helped
- Siblings’ roles are chosen, not assumed.
- The disabled sibling takes part in decisions about their own future.
- The sibling relationship has room for ordinary things: fun, rivalry, companionship.
Words you can use
For clientsQuestions worth carrying, as a therapist
Therapist Reflection- Have I asked the disabled sibling for their view of the sibling relationship?
- Am I treating a sibling as harmed, or as a saint, instead of as a person?
- Who in this family has been named as the future plan, and did they agree?
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Siblings of children with chronic health conditions: a small overall negative effect on psychological functioning, with more risk for older siblings and for highly intrusive or life-threatening conditions. Vermaes, I. P. R., van Susante, A. M. J. & van Bakel, H. J. A. (2012), “Psychological functioning of siblings in families of children with chronic health conditions: A meta-analysis”, Journal of Pediatric Psychology.
Invisible responsibilities, fairness without competition, and future planning are this site’s synthesis. For an object-relations view of siblings, see Siblings and Family Roles.
Orlaith, Fiachra and the dialogue are constructed for learning. They are not real people.
We have not located research on adult siblings of disabled people in systemic therapy, or on disabled people’s own views of their siblings’ roles.
Last reviewed: October 2026.
How to cite this page: Donaghey, C. (2026). Siblings, Fairness and Invisible Responsibilities. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/what-is-psychotherapy/systemic-therapy/siblings-fairness-and-invisible-responsibilities/ (Accessed: [date]).
Shared under CC BY-NC 4.0, with an extra permission to teach from it on fee-paying courses. Credit the site. See Reusing This Material.