O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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How to Keep Your Marriage Healthy While Coping with Chronic Illness

Relationships and chronic pain.

Most marriages will be confronted with challenges. How we cope, make meaning from, and find benefit in challenges affects our overall satisfaction in our marriage. One of these biggest challenges marriages face is health

In Sickness and In Health Till Death do us part

We take our marriage vows in innocence and with deeply felt sincerity. That’s probably a very good thing, because the reality of coping with a chronic, debilitating illness such as a stroke, Parkinson’s disease (PD), or dementia, makes many question or regret their vows to stay together in sickness and in health.

When our love is new, we don’t vow to love honor and cherish until. And usually, we don’t intend to leave when our partner becomes ill—but we may feel like it at times.

When One Partner Becomes a Caregiver

In the United States, spouses are first in line to take on caregiving responsibilities (Pinquart and Sorensen, 2011.) We are living longer than ever before, so the likelihood that one partner will become a caregiver is high. Studies have shown that the caregiver burden when a spouse has a chronic illness negatively affects the non-ill partner both physically and mentally: more depression, more financial and physical strain, and lower levels of well-being.

Take PD, for example. PD is a chronic debilitating illness characterized by complex motor and non-motor symptoms. When PD is first diagnosed and during much of the illness, the non-PD partner provides most of the informal caregiving. Roles and division of labor often shift, with the caregiving spouse taking over such tasks as scheduling and driving to medical appointments, assuming the banking and paying bills, and so forth. Chores increasingly fall on one partner, making it difficult to find time for the non-PD partner to practice their own self-care or see friends.

Research on marital satisfaction and quality of life shows that social support is a key factor in coping with illness, yet sadly, couples often become more isolated, withdrawing due to an increase in interpersonal distress, shame, or apathy. The need to cut back on work-life or retire abruptly brings another set of challenges, such as loss of work identity, fading ties with coworkers, more dependence on family, and decreased income.

My Illness or Your Illness: Attending to the relationship

Chronic illness needs to be seen not only as an individual challenge but as a relationship challenge as well. Anger at the unfairness of life when newly diagnosed is entirely normal, for example, especially if the implications of the disease process are fully understood. Wanting to blame someone is understandable, but with an illness such as PD, it’s important to ascribe the difficulties to the disease, not the person.

Studies have looked at how dyadic coping—a process by which a couple works together to cope with the stressors that one or both face—might be one way of improving health and in turn, the quality of the marriage. Couples who see the illness as a relationship issue rather than an individual issue will be more satisfied with their relationship than couples that don’t.

Coping together: We-ness in marriage

One clue to how couples see the relationship is their pronouns. These seemingly innocuous parts of our everyday speech give us an important window into the inner workings of relationship. If one member of a couple comes into my office and is talking at his/her partner, using pronouns such as I, me, my, you, your, this shows a greater sense of independence and distance in relationship. Using words like we, us, our, implies a shared identification between spouses, more intimacy, and more emotional investment in their relationship.

Self and Partner Soothing

We-ness is also associated with more positive and fewer negative feelings, and with lower autonomic nervous system arousal—the fight or flight response. When one partner is anxious or distressed, we can calm them down by using we-ness words. This produces a soothing or emotion-regulating effect on the other spouse. I have seen this many times in my office when counseling couples. For example, when Joyce was becoming agitated about how she would cope with Al’s PD, Al reached over and gently stroked her arm, saying ”We’ll deal with this together.” This had an immediate impact on Joyce’s anxiety.

That simple act can make a big difference. We refer to these as emotion-regulating behaviors. Couples can help each other cope with anger, frustration, and fear and minimize the damage to the marriage. In couples therapy, we help partners understand the importance of self-soothing during difficult times and the value of providing that to their partner when needed.

 Benefit Finding: Glorifying the struggle

 When couples come to therapy, I assess their strengths and the areas that need work. Asking such questions as “Looking back over the years, what moments stand out as really hard times in your marriage? Why do you think you stayed together? How did you get through these difficult times?” Or, “How would you say your marriage is different from when you first got married?” With such questions, I am looking for growth as a couple and for a sense of how they cope. Are they a team? Or do they point fingers and accuse their partner of messing things up?

By developing a shared narrative, and finding meaning in how we strengthen our bond (or we-ness), we can improve our marriage and how we cope with problems. Couples who view their struggles as hard, but worth it, demonstrate hopefulness and togetherness. Yet when one partner feels out of control of the events that they face, they may slip into passive endurance, believing there is nothing they can do about a problem. They struggle to survive instead of growing closer through the challenges. These marriages are less likely to be happy and more likely to end in divorce.

But for couples that find meaning and growth in difficult times, they “glorify the struggle” and will have a better chance of staying together through hard times. Hope and commitment toward growth as a couple are elevated over disillusionment and negative perspective. I don’t want to be dismissive of the real, hard problems such couples face or expect them to have a Pollyanna, rose-colored-glasses approach. We can acknowledge the pain and suffering we face, but at the same time, try to find something in our experience that helps us learn something new, to grow from it.

By viewing the inevitable problems that arise in marriage as “our problems” rather than blaming our partner, we strengthen our bond. Moreover, when we work as a team rather than in parallel, we are less likely to complain criticize, or be defensive. This has a valuable outcome: we naturally reduce each other’s tension or physiological arousal. When we are relaxed when confronted with problems or conflicts, we are more likely to find ways to manage them—in sickness and in health.

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Suffering, Compassion, and a Skate Ramp

 

Last summer my neighbor’s son built a huge skate ramp right next to our property line. (We’re on different streets, so I’d never met him or his family.) First sawing, then drills, and eventually it was finished. I was glad for the wild Toyon bushes that grew high along a chain-link fence, blocking the view—but they didn’t block the noise. In use, a wooden skate ramp has a distinctive mechanical rhythmic sound. It’s similar to the poinging back-and-forth of a tennis match, but is contiguous and unvarying, except for sudden yelps from the kid or his friends.

My work as a psychotherapist is focused and can be intense. Quiet time in my garden is where I replenish by slipping into reverie and stillness. I love the silence, punctuated only by bird song and breeze-tossed tree branches. But now all I could hear, from morning to dusk, was the skate ramp. I tried to counter my disgruntlement by reminding myself ”At least it’s not a meth lab, and I could be glad he’s getting healthy outdoor exercise instead of playing violent video games and watching TV all day.” But in truth, my first thought when occasionally I heard a thud followed by silence was ”Yes! A broken ankle.” I did also think ”Oh no, he could be seriously hurt.” But then the skating would start up again, shattering my peace and sending me back inside, grumbling to myself.

It’s true that in many ways, mine was a problem of privilege. I was just irritated by a noisy nuisance, while some people are living in refugee camps or dodging bullets in their own neighborhoods. Many people have no quiet, private, beautiful place whose silence can be invaded. But most everyone can relate to feeling dominated by difficult or negative emotions like helplessness and anger.

Finding Another View: Opening a window

This summer, though, something happened to help me accept the noisy interruption of my peace. When a Monterey pine succumbed to bark beetles, the tree guys removed some of the Toyon bushes, opening the way to roll giant slices of the dead tree to the driveway. For the first time, I had a window to view of the skate ramp. The opening allowed me to see a shadow dance, the blur of back-and-forth movement, that accompanied the rhythmic skating sound. Actually seeing the annoying kid had the interesting effect of making me less annoyed. Suddenly he was a person, a kid in a baseball hat having fun, not just a maddening, repetitive sound.

I felt compassion; I wasn’t trying to feel compassion, talking myself into it, as I had before. Catching glimpses of the kid trullunking on his skate ramp allowed me to view it differently. I can now sit in my backyard and know that the neighbor kid is doing what he enjoys. I can occupy that space literally alongside him. It becomes background sound, along with the birdsong and an occasional leaf blower. And it also nice to notice when it stops.

How does my experience relate to suffering and compassion? Because it’s only when we can see the humanity of others and acknowledge our own uncomfortable thoughts that we can transform them. When I couldn’t see what annoyed me, all I could do was feel passive and irritated. Once the view was clear, I saw the source of my feelings and could accept it. A kid having fun. On a skate ramp in his backyard, which happens to abut my backyard. We all have hedges that obscure our view and block compassionate response.

In psychotherapy, and in mindfulness-based therapies, we learn to see that our emotional suffering and problems in life are not only caused by external circumstances but by the way we react to them. When our minds are dominated by difficult or negative emotions, we feel out of control. We employ defense mechanisms like withdrawal, projection, and demonizing the other. In contrast, meditation and practicing mindfulness is helpful because we cultivate the capacity to watch what is arising in our mind.

We sit with feelings and thoughts, noting but not getting caught up in them as we refocus on breathing and sitting. Witnessing our thoughts and feelings and allowing them to move on, rather than reacting unreflectively, gives us more emotional control, more choices about how to respond with our better, less overwhelmed selves. Meditation provides a window to compassion, something like the window through the hedges. We may begin to see that things are not so bad.

W.H. Auden’s poem “As I Walked Out One Evening” contrasts the idealistic hopes of lovers with the quelling voice of Time, which recommends looking in the mirror—accepting things as they are—and the healing that comes from putting aside illusion:

‘O stand, stand at the window

As the tears scald and start;

You shall love your crooked neighbour

With your crooked heart.’

With my crooked heart, I do.

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Waking up on the Grumpy Side of the Bed: Coping with difficult moods

Coping with depression and difficult emotions.“Yesterday all day a small gardenia was a great consolation.”

Thomas Merton

A Year with Thomas Merton: Daily Meditations from His Journals

Some days are harder than others. It’s tempting to find something or someone to blame, even if it’s just the wrong side of the bed. Yesterday, I woke up grumpy, but instead of fault-finding, I announced to my family that I was grumpy and not to take anything that happens between us too personally.

My bad mood persisted through breakfast. In fact, I kind of enjoyed feeling grumpy. Especially because there was no apparent reason and I didn’t care to find one. I felt defiant.

I took my hike as I usually do, on this sunny morning. I begrudgingly admitted it was a stunning day. Yet my mood persisted—and became worse as a large group of hikers, some meet-up group or club, began to pass me on the narrow trail. As I walked in the opposite direction up the hill while they clomped down, one by one, they each said good morning, smiling as if the day was something really special. In my sour mood I thought, ”How many more are there? Don’t they realize that, as one person going against the tide of walkers, I would already have been greeted numerous times? And how many more good mornings and fake smiles do I have to return?”

Many, many more, it turned out, because the group numbered more than 80. And every single person smiled at me and said “Good morning,” or a variant of it. By about the 40th person, something happened without any volition on my part: I began to smile back with genuine happiness. At first, it was in amusement at my grumpy predicament of sharing a trail with 80 very happy hikers, but as the group moved past me, I felt a stirring of good will toward these cheerful strangers, who had unknowingly softened my mood.

Sometimes moods are like that: inexplicable and unpredictable. As a psychotherapist, I help people articulate their feelings. More expansive and more integrated awareness of emotions, achieved through therapy and mindfulness practice, helps people respond more healthily and flexibly in the moment and day by day. By doing so, we can change the quality of our lives.

It can feel as though we’re overpowered by emotions. We can become so absorbed in them that we become identified with what we feel and lose the ability to witness them. A simple misunderstanding with a friend can become an all-consuming and unbearable wound. In such cases, we risk getting stuck in a contracted state that can lead to depression or avoidance behaviors such as overeating, drinking, shopping, or sleeping, which provide a temporary illusion of feeling good. But as we know, those actions backfire, leading to more guilt and less overall effectiveness.

Noting and naming emotions, in contrast, gives us a path past denial or avoidance into acceptance, letting go, and even gratitude.

Sometimes our moods are not just difficult, but serious mood disorders, such as major depression. If feelings of sadness last longer than two weeks, and interfere with daily activities, it is important to get help from a psychotherapist to determine if psychotherapy and medication would benefit. Mindfulness-based cognitive therapy is often a good treatment for depression.

The solution is not to ignore our difficult moods, but to acknowledge them as they arise. In some situations we will be able to trace what we feel to a particular event that we can bring insight to. For other moods, like my waking up grumpy for no apparent reason, we accept them and watch what happens next, much as we do with the weather. Eighty happy hikers eventually made me smile and my bad mood passed as they passed by. That was essentially effortless, but it is often quite effortful to cope with hard emotions.

When we cultivate a disposition that witnesses and accepts passing experiences, we become more stable. In mindfulness meditation or contemplative prayer, we accept thoughts and feelings without judgment and with open and spacious awareness. Emotions arise and pass without interference. I acknowledged my grumpiness and warned my family not to mind me. In doing so, I took responsibility rather than looking for someone or something to blame. This allowed me not only to be open to my bad mood, but also to become open to the good mood that emerged later on.

Sometimes, of course, bad moods can arise for good reasons, not just something that inexplicably overtakes us. In his journal, Thomas Merton describes waking up with heart palpitations and shortness of breath, surely cause for concern. But instead of dwelling on his fear, he starts his page by recognizing the small gardenia as a consolation. He describes walking out into the woods and gazing at the tall straight oaks, closing his journal entry for that day with the lines:

“Sweet afternoon! Cool breezes and a clear sky! This day will not come again. The bulls lie under the tree in the corner of their field. Quiet afternoon! The blue hills, the daylilies in the wind. This day will not come again.”

That is more than acceptance; it’s real gratitude. It starts with accepting all our moods, the grumpy and the grateful. Without that, we can only approximate gratitude in a kind of pretending. With my softened mood, I continued on my way, grateful to the hikers, and happy to be spending my morning in the hills.

 

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Remaking Love: When did you stop dancing?

Amor-Psyche-Canova-JBU04
Amor and Psyche

Taking Down the Walls to Intimacy

Love doesn’t just sit there, like a stone; it has to be made, like bread, remade all the time, made new. Ursula K. Le Guin, The Lathe of Heaven

Sometime during the first episode of BBC’s Pride and Prejudice, I fell in love with Mr. Darcy. So much so that my husband began to suffer in comparison. And why not? Darcy is handsome, rich, and unobtainable, not to mention the British accent and dark brooding eyes. But it was his radical transformation from an arrogant snob to a thoughtful, considerate gentleman who fiercely protects his beloved his sister that sealed the deal. I was smitten.

It’s easy to idealize the other when we fall in love, and it can feel like now, everything will be perfect. In The Symposium, Socrates explains that “Zeus resolved to cut [people] in half to humble them. He declared that they shall walk upright on two legs, but each forever desiring his other half. . . . Each of us when separated is always looking for his other half.” This metaphor describes the compelling nature of romance, where we see—and fall in love with—unacknowledged or unconscious parts of ourselves in another. By reflecting back to us our ideal selves (generous, sensual, strong) lovers seem to complete us. We all contain seeds of our potential selves within, but it’s hard to develop them fully on our own, without that loving reflection.

People spend lifetimes searching for this lost self, even if the longing is barely conscious.

When relationships are new, we’re intoxicated by the experience of being admired and desired. It’s enlivening, surprising, and immensely gratifying when another person helps you discover unexpected or forgotten qualities: confidence, spontaneity, sexiness, fun.

But should you expect the same thrill if you’ve been married for 10, 20, or 30 years? As George Bernard Shaw wrote in the play Getting Married, “When two people are under the influence of the most violent, most insane, most delusive, and most transient of passions, they are required to swear that they will remain in that excited, abnormal, and exhausting condition continuously until death do them part.”

Romances convey a warped view of love because they show only the highlights, from the infatuation to the happy ending. We’re not seeing the in-between—the reality of loss, hurt, and work. As Le Guin writes, love has to be made and remade all the time. The happy ending is only the beginning. No matter how romantic or meant-to-be a relationship seems, couples must endure lots of challenges to stay together in a maturing relationship.

Being someone’s other half—being responsible for them to feel complete—is a lot for a relationship to hold. We find a person who makes a good screen for our projections and feel profound connectedness, hope, enlivened energy, and a feeling of coming home. But these projections are based on ideals, not reality. Real people who are living together on a daily basis are bound to disappoint the fantasy’s huge expectations.  The loss can feel catastrophic if you’re not emotionally pretty healthy. But at the same time, a good marriage is a path to wholeness if we respond well. When we withdraw our projections, and stop seeking unrealistic fantasy partners, we begin to see ourselves.

Recapturing the initial breathless excitement of romance is a fantasy too. It’s a little bit sad—but a long-term relationship does not have to be stale. Like bread, relationships will rise and fall, but by working at it, we will continue to nurture ourselves as individuals and as a couple. Committed relationships may not offer intoxication, but they do provide deeper satisfactions. But we have to take those opportunities when they arise.

I recall the poignancy with which a 50-year-old client—recently separated from her husband—told me that she regretted not continuing dance lessons when her husband asked. At the time she quit dancing, she felt old, unattractive, and preoccupied with things that seemed in hindsight, unimportant. She longed to go back in time and rekindle the fun and creativity she had ignored for too long.

The Importance of Vulnerability

In any long-term marriage, successful interactions over time build a sense of trust and allow for safety and dependency. Just as infants mold their bodies to their mothers, couples surrender to each other’s embrace, allowing them to be vulnerable, supported, and cared for. With many repeated experiences, these habits of trust and intimacy become ingrained.

But in committed relationships, we must acknowledge the reality of imperfection. Some interactions fail—the longed-for empathy and understanding is absent, and we get hurt. Failed interactions that get repeated become habitual. These failures of attachment can take all sorts of shapes: repeated criticisms, loss of sexual intimacy, years of feeling blamed or judged, or difficulty working with conflict. And over time, defenses are erected to protect our soft parts. We become distant, angry, and disengaged. When couples eventually seek therapy, the wall separating them is usually very high and very strong.

There is often a moment in therapy when couples realize, if only barely, that they want to save their relationship. They can acknowledge what they bring to the table and how each has a role to play in constructing their particular wall. In that moment of vulnerability, they ask, ”How do we take down a wall that has been standing for so many years?”

A wrecking ball is not the answer. And it can’t be solved by some simplistic listicle of “10 things to build back intimacy.” It has to be done brick by brick. Almost all of us are naturally oriented toward growth, with healthy needs and desires, but it’s hard to see our own defenses. After years of reinforcing rigidity, it takes an empathic and skilled therapist to help foster a new sense of agency and reprocess experiences to make new meanings. Success lies in compartmentalizing those aspects of the relationship that involve empathic failures while savoring and tending those habits of intimacy that allow for deep experiences of trust and safety.

Knowing the Ruts that Comfort and Confine

Thinking of a relationship in terms of intimacy rather than passionate romance can be helpful. Knowing a partner thoroughly and being known ourselves can be deeply joyful.

When we lower walls that were raised over years of earning a living and raising a family, we gain receptivity to surprise. We become more engaged in living in a way that allows for discovery and growth and brings excitement back into our relationship. We don’t blame our partner for our boredom. We open up to their creativity as well as our own. Relying on our partner to be the source of our excitement when we are unable to generate our own is unfair.

While some of the realities of long-term relationships are painful to face, giving up the fantasy of having something better with a new person is fiction. In contrast, knowing that you can capture and remake some of what drew you together, and hold onto your shared history (good or difficult) will bring depth and intimacy. Facing problems and challenges honestly, realistically, and together, even if there is no immediate or easy fix, is more sustaining than fantasy, just as bread is more sustaining—and to grownups, tastes better—than cotton candy.

 

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Look Into My Eyes: The crucial role of eye contact in relationships

Eye contact is crucial in couple and family relationship. People are innately attracted to faces, especially eyes. The human face is associated with our identity; we are recognized more through our eyes than through any other facial feature. ”Because the eyes offer such rich social information, adults and infants alike show a natural attraction to the whole face,” write contributors to the APA handbook of nonverbal communication (Washington, DC: American Psychological Association, 2016, pp. 335-362). Those who have trouble processing or dealing with social information, such as people with autism, schizophrenia, or social anxiety, tend to avoid eye contact; job seekers are told that good eye contact will make a positive impression.

When a relationship is new, lovers can spend hours gazing into each other’s eyes over dinner or while lying in bed, enjoying all the nuances of thought, feeling, and passion that can be communicated through facial expression. Young parents watch their children intently, searching their faces to read emotional reactions to sad or exciting events.

The Importance of Eye Contact

But at some point, we stop making eye contact. The romantic relationship matures, distractions (kids, work, medical problems, financial troubles) come in; kids attend to their devices, ignoring parents; parents chauffer their kids while talking on their phones; we eat dinner in front of the TV or our tablets, looking down every time a notification pops up. Whole days can go by without really seeing our partner’s or our children’s faces. In fact, in a previous post on non-sexual touch, I admit to a time when our twins were young, we were both working a lot, and I failed to notice that my husband had shaved his mustache three days before! That was a wake-up call for me.

In couples’ therapy, I gather a lot of information about how my clients communicate by watching their non-verbal interactions. Let’s take Amy and Paul as an example. If Amy and Paul never look at each other, or if Amy looks at Paul but Paul doesn’t return the gaze—his eyes darting around the room instead—I learn something of their connection. Paul has trouble making eye contact with me as well, which also tells me something.

They are coming to therapy because Amy feels that Paul is distant and disengaged. The two seldom interact, whether after work or on weekends. On a typical evening, Paul will come home and turn on the sports channel. Amy will call out from the other room with a question. Distracted, Paul doesn’t acknowledge her. Amy feels neglected, Paul feels he can never please her, and divorce looms. It is important to make eye contact to know that your partner is really listening. Trying to communicate from different rooms will lead to miscommunication and misunderstanding.

This scenario is very common in relationships. The partner calling for attention feels innocent of blame, saying “He never listens, he never responds.” When I gently point out that she’s trying to get his attention when he’s otherwise preoccupied, she explains that he must have heard her and is just ignoring her.

Maybe, after going on for years, this is has become the case. But often the simpler reason is that Paul is watching the game and he literally doesn’t hear. Or he half hears, but the question never gets into his long-term memory.

As is often the case with couples by the time they get to counseling, their dynamic has become entrenched after many years of hurt feelings on both sides. Each blames the other, Amy criticizing Paul for his lack of engagement, and Paul keeping all his feelings to himself. This apparent sulking serves to infuriate Amy more, and she in turn harps on him with progressive intensity. Walls go up and prevent the vulnerability that is needed for true intimacy. Neither Amy nor Paul realize what they are doing to prevent connection.

Look at me when I’m talking to you!

When someone makes eye contact with you, they’re signaling that you’re the object of their attention. There are cultural differences regarding gaze and respect, but in general, we look at those who are socially relevant to us. An averted gaze, in contrast, signals disinterest, shyness, or evasion (although research is mixed about whether lying causes less eye contact). That’s why parents demand “Look at me when I’m talking to you!” or someone suspicious of another might say “Look me in the eye and say that.” It is astonishing how often couples, and kids and parents, try to communicate without ever looking at each other.

But getting back to Amy and Paul, it was important for Paul to understand how dismissed Amy felt when he didn’t answer her or make eye contact with her. Of course, it was also important for Amy to have Paul’s attention before speaking to him. By taking the time to really look at each other, Amy and Paul began to feel closer. Each felt they were being heard.

Getting the focus where it belongs

If your family or romantic connection feels cold and distant, consider the role that gaze may play in preventing closeness. Here are some tips for getting the focus where it belongs.

  • Ban screens of any type (TV, computer, phone, or game) and reading at the dinner table so you can all converse face to face.
  • Make a point of turning to look at someone when they speak.
  • If someone isn’t meeting your gaze, don’t assume they don’t care. They may be preoccupied with work stress. Ask if there is a good time to talk and make a point of coming together a bit later.
  • Kids can be big distractions. If your kids continually interrupt your conversations, let them know that they need to respect adult time.
  • Make sure you have your partner’s attention when talking to them. Don’t try to talk from different rooms.
  • Turning toward your partner builds intimacy.