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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Minding Your Mind Minding Your Mind

Help for Couples Facing a Serious Illness

May 27, 2013

By Michael Craig Miller M.D.

Harvard Medical School


Traditional wedding vows include a promise to stay together in sickness and in health. But cancer, heart disease, major depression, substance abuse and other types of serious medical illnesses can stress a marriage or any committed relationship.

Illness affects not only the person who receives the diagnosis, but his or her partner as well. For example, breast-cancer treatment may make a woman physically uncomfortable, constantly tired and worried about her sexuality and body image.

Likewise, a man being treated for prostate cancer may experience unpleasant side effects, such as impotence and incontinence.

Both may worry about the future, not just during treatment, but even when it's finished.

Many couples cope well with the challenges of illness. Others need help. For those who do, couples therapy can enable partners to better handle any kind of stress, including the stress of medical illness.

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Working Through Feelings

The stress of a serious illness may upset a couple's usual ways of relating. For example, an ill partner may want to keep a sense of control by working full time during treatment. The other partner may try to act as a "savior" by stepping in and taking over responsibility for everything. The therapist can help both partners understand how they are trying to deny their feelings of helplessness.

Or, an angry, critical, complaining partner confronts the defensive and withdrawn sick partner. The anger may come from the first partner's fear of abandonment. The therapist can help the withdrawn partner listen to the other person's concerns, rather than react to the anger.

The therapist also helps partners recognize and appreciate their connection and need for each other. This can provide comfort and feelings of safety.

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Focus on Behaviors

Sometimes it's helpful to look at a couple's behaviors first. Indeed, poor communication, habitual arguing or nastiness can contribute to a destructive cycle in a relationship.

Here are some techniques a therapist might use.

  • Behavioral exchange. The therapist helps a couple negotiate a trade. Each partner agrees to grant a wish to the other by changing an unwanted behavior. The therapist encourages follow-through and recognition when change actually occurs.
  • Communication training. Each partner learns how to listen actively and sensitively, and to express what they want without accusations.
  • Problem-solving skills training. The couple learns how to identify the issues that are causing conflict, find solutions, negotiate to determine which strategies to follow, and compromise.

These techniques, if successful, allow partners to feel more satisfied in their relationship. These tools also reinforce their ability to support one another.

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Psychotherapy Approaches

Therapists use many of the same approaches to treat couples as they do to treat individuals. Here are some examples.

Cognitive behavioral couples therapy

This approach targets distorted thinking, feelings and behaviors. The therapist helps couples build new skills and learn how the stress of an illness strains the relationship. The therapist can then help partners find more positive ways to communicate about their differences.

Psychodynamic couples therapy

This type of therapy assumes that relationship patterns get set during childhood. For example, a controlling person may have felt powerless in an early relationship. A therapist may try to help partners separate current feelings from feelings and responses that originated in their families of origin.

Psychodynamic therapists focus on more subtle interactions between couples. For example, one person may deny his or her own dependent feelings. In turn, he or she may criticize the partner's dependency, while at the same time acting in ways that make the partner more dependent.

Systemic couples therapy

This approach examines a couple's rules and roles, particularly dysfunctional ones. For example, one partner may behave as the take-charge person, while the other tends to be accommodating. This type of therapy may be particularly helpful when serious illness results in couples having to reverse roles.

A therapist helps a couple understand how habits shape each partner's actions. The goal is to help partners negotiate and plan more flexibly to avoid recurring problems and respond more effectively when circumstances change.

Gottman method couples therapy

Dr. John Gottman is a psychology professor at the University of Washington. He has observed that happy couples have two things in common: They treat each other like good friends (providing respect, affection and empathy), and they handle conflicts in gentle, positive ways instead of becoming defensive, critical or withdrawn.

A therapist who adopts Gottman's view will help partners express conflict in positive ways. Therapists target the "four horsemen" that can derail relationships: excessive criticism, defensiveness, sarcasm and stalling.

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Taking a Varied Approach

Try to find a therapist in your community who uses a combination of approaches. Some experts believe that these therapists are better able to help couples meet the challenges they face in their relationships.

Approaches include:

  • Interpreting emotional conflicts and the influence of the past
  • Understanding habitual ways of relating
  • Encouraging insight and empathy into how those patterns may derive from early life experiences of each partner
  • Giving "homework" exercises for behavior change
  • Challenging beliefs
  • Offering advice, reassurance and support
  • Teaching social skills and problem solving

All of these skills may be useful in helping couples to deal more productively with a serious illness.

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Michael Craig Miller, M.D Michael Craig Miller, M.D., is Senior Editor of Mental Health Publishing at Harvard Health Publications. He is an assistant professor of psychiatry at Harvard Medical School. Dr. Miller is in clinical practice at Beth Israel Deaconess Medical Center, where he has been on staff for more than 25 years.


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