The Four Phases Of Chronic Illness

By Patricia A. Fennell, MSW, LCSW-R
Albany Health Management Associates, Inc.

The following is an excerpt from the updated, 2012 edition of The Chronic Illness Workbook: Strategies and Solutions for Taking Back Your Life by Patricia A. Fennell, MSW, LCSW-R. Fennell has extensive experience with CFS. This is part one of a two-part series for Research1st. The second installment will be posted next week.

No matter what particular illness you have, you can improve the quality of your life if you learn about the phases that people with chronic illness experience. Unlike the traditional medical approach, the four-phase model does not assume that you will eventually be cured. Instead it seeks to integrate your illness into a different but meaningful life. If you do not achieve illness integration, the chances are that you will suffer repeated failures at each relapse and change in your illness. The four-phase model pursues specific treatments to eliminate or reduce your disease symptoms, but unlike the traditional medical approach, it also uses palliation as an active treatment option.

Palliation is the reduction of suffering. Often health-care workers believe they are providing palliation when they reduce physical symptoms. But true palliation actually includes the relief of suffering in the psychological and social aspects of the patient’s life as well as in the physical aspects. In the four-phase model, palliation includes interventions to improve your psychological and social well-being, and when possible to improve the situation for those around you. The phase model also encourages you, your family, and your health-care provider to work together. Medical specialists in this model don’t treat from outside but become part of a holistic system. They become partners, if you will, with you and your family.

The Four Phases

I use the term “phase” rather than “stage” because stages imply a progression that only goes forward. The phase model recognizes that you are liable to be thrown back into earlier phases when new and unforeseen crises occur in your life. You may also experience aspects of two different phases at the same time. If, however, you work through the phases once, you have the skills and the knowledge to take you through the processing sequence more quickly so that you arrive more speedily at integration of the new experience.

It’s also important to remember that you experience each phase in three different areas. Changes occur in your physical life, in your psychological life, and in your social and work life. As you read this book, you will see what happens specifically in each phase in each area and what you can do to help yourself.

Phase One: Crisis

Phase one is characterized by crisis and chaos. In this phase you move from the actual onset of your illness to an emergency stage that usually forces you to seek some sort of relief. Most people desperately seek a medical diagnosis and treatment of the problem. But others may look for spiritual help. Still others may simply try to ease the pain they feel with alcohol or drugs. Your task—and that of your family and doctor—during phase one is to deal with the immediate hurts or traumas of your new illness.

Phase Two: Stabilization

In phase two, you have reached a plateau of symptoms, and because they stay more or less the same, they become familiar. You begin to think that maybe you’re getting a little better. You still continue to experience a lot of chaos, however. You usually keep trying to behave as you did before you got sick, and this attempt frequently leads to relapses. These are very upsetting and feel like personal failures. But because a certain amount of the time you feel like you can manage, you keep trying to find a way to return to your old life. The task of phase two is to begin to stabilize and restructure your life patterns and perceptions.

Phase Three: Resolution

Phase three may bring a plateau of symptoms or you may have relapses. But at this point you’ve learned how your illness behaves and how the world responds to it. You’ve also finally learned that you can’t be the person that you used to be before you got ill. This can be a devastating perception, one that can makes you experience a “dark night of the soul.” Your task during phase three is to develop a new, authentic self and to begin to locate a personally meaningful philosophy to live by.

Phase Four: IntegrationPatriciaFennell_2011-300x199

In phase four, you may experience a plateau of symptoms or periodic relapses, but you’re now able to integrate parts of your old self from before the illness with the person you are now. Your task in phase four is to continue to find ways to express your new “personal best,” to reintegrate or form new supportive networks of family and friends, to find appropriate employment if you are able to work, or other vocations or activities, and to locate your illness experience within a larger philosophical or spiritual framework. In total integration, you arrive at a new, whole, complete life, of which illness is only one part, even if it is an important part.

Patricia A. Fennell, MSW, LCSW-R, is an expert on chronic illness, focusing on how the experience of chronic syndromes and trauma influence the psychological, social and physical experience of the patient and the family. She developed, researched and validated the Fennell Four-Phase Model (FFPM) for understanding and treating chronic medical and mental health conditions, trauma, disability and the effects of crime. Learn more about Patricia and her practice, Albany Health Management Associates, Inc., at

The 2012 edition of The Chronic Illness Workbook is now available. For more information about it and a new companion book, The Chronic Illness Workbook: The Exercises, please visit and click on “Books.”


Fennell, P.A. The Chronic Illness Workbook: Strategies and Solutions for Taking Back Your Life. Albany, NY: Albany Health Management Publishing, 2012.

Fennell, P. and Rieder Bennett, S.L. Chronic Illness. In The Encyclopedia of Social Work (21st ed.). Oxford University Press and The National Association of Social Workers, 2012.

Fennell, P., and Rieder Bennett, S. Chronic Illness. In Oxford Bibliographies in Social Work. In Edward J. Mullen (Ed.). New York: Oxford University Press, in press, 2012.

Fennell, P. Chronic Illness and the Fennell Four Phase Treatment™ Approach: Working with People Who Don’t Get Better. Paper presented at 10th global conference, Making Sense Of: Health, Illness, and Disease. Oxford, U.K. September 6-8, 2011.

Rice, J.S. and Fennell, P.A. Integrating Fennell’s Four Phase Treatment Model Within Restorative Justice Practices To Address Trauma’s Aftermath. Women, Girls and Criminal Justice. Vol.9 No.2, February/March 2008, pp 19-22.

Fennell, P.A. A four-phase approach to understanding chronic fatigue syndrome. In L.A. Jason, P.A. Fennell, & R.R. Taylor (Eds.). The Chronic Fatigue Syndrome Handbook. Hoboken, NJ: Wiley, 2003.

Fennell P.A. Managing Chronic Illness: Using the Four-Phase Treatment Approach. Hoboken, NJ: Wiley, 2003.

Fennell, P.A., Jason, L.A., and Klein, S.M. Measuring Phases of Recovery in Patients with CFS; Journal of Chronic Fatigue Syndrome Vol. 5, 1999 No. 3/4, 88-89.

Jason, L.A., Fennell, P.A., Taylor, R.R., Fricano, G., and Halpert, J. An Empirical Verification of the Fennell Phases of the CFS Illness. Journal of Chronic Fatigue Syndrome. 2000;6(1):47-56.

Jason, L.A., Fricano, G., Taylor, R.R., Halpert, J., and Fennell, P.A. Chronic Fatigue Syndrome: An Examination of the Phases. Journal of Clinical Psychology. 2000;56: 1497-1508.

Jason, L.A., Fennell, P.A., Klein, S., Fricano, G., and Halpert, J. An Investigation of the Different Phases of the CFS Illness. Journal of Chronic Fatigue Syndrome. 1999;5(3/4): 35-53.

August 9, 2012