Selected social support and family research is reviewed to highlight potential problems in social support exchange as patients and families collectively cope with illness and disability. Results indicate that family support is a primary source of patient support and that the impact of illness on families is substantial, underscoring their need for support. Results also indicate that there are numerous opportunities for problematic supportive exchange within families. The case is made that future studies of social support are needed to answer a series of questions about social support process within families coping with serious illness.