How chronic illness affects couples

18 February 2021
How chronic illness affects couples

Katie Willard Virant :
Chronic illness affects not only the person diagnosed with disease, but also her social network.  The romantic couple - a person's most intimate social network - is perhaps affected most profoundly.  Managing chronic illness as a couple provides benefits to both physical and emotional health.  
Researchers call couple teamwork in the face of an illness "communal coping" (Rohrbaugh, 2020).  Communal coping has two components - appraisal and behavior.  First, the couple views the health issue in question as "ours" rather than "yours" or "mine" (appraisal).  Second, the couple collaborates in their management of the illness (behavior).  
Shared illness appraisal occurs when both partners view the illness as the couple's challenge and responsibility.  "He needs to take better care of himself" is NOT communal coping.  Contrast that statement with the following, which incorporates the idea that one partner's illness is a shared worry and responsibility: "He overextends himself at times, which isn't good for his health.  I've told him I worry about this and we've agreed to new parameters.  I remind him that I'm affected by his illness, too, and I want to problem-solve with him in terms of simplifying his life."
Shared illness appraisal is deepened through communication, and paves the way toward a couple sharing expectations and actions for illness management.  A couple who is working as a team will share knowledge and information about the illness, make treatment decisions together, implement healthy life-style changes, and provide emotional support (Helgeson et al., 2018).  
Viewing the chronic illness of one partner as a shared responsibility helps prevent resentment and isolation.  Support from the healthy partner is less likely to be given grudgingly if there's a perception that this support is helpful to the couple as a unit.  It's not charity; it benefits the healthy partner, too.  Similarly, the individual with the chronic illness is less likely to view partner support as intrusive if there is a shared sense that the illness affects both parties.  
Communal coping improves both illness management and relationship quality (Helgeson et al., 2018).  When a couple joins forces and pools both physical and emotional resources, there are more resources from which to draw.  
When one partner is exhausted, the other can fill in.  When one partner is discouraged, the other can offer emotional support.  Providing and accepting help are positions taken up by each partner at different times, so that each member of the couple has experience in being a giver and receiver. Depletion is less likely when the couple can rely upon their combined resources (Helgeson et al., 2018).
Rohrbaugh (2020) developed a narrative intervention designed to get couples thinking about how to face chronic illness as a team.  Each partner is invited to discuss their experiences with the illness.  The other partner is tasked with listening and understanding.  The couple reflects on how they've met some illness challenges successfully and where they've come up short on other challenges.  Losses and frustrations are processed, as well as overall strengths of the couple.  The process of talking together can facilitate new understanding and ensuing closeness.  
For some couples, talking together about the illness may feel emotionally fraught.  One or both partners may harbor resentments that feel dangerous to air.  The ill partner may believe that her partner has not really been present for her; conversely, the healthy partner may believe he can never do anything right with respect to supporting his spouse.  In these cases, a couples' therapist can guide the discussion and help the couple develop communication practices that feel safe and productive.  
Find a time when you can focus solely on being together.  Talk about what the experience of illness has meant to each of you as individuals and as a couple.  What's been most difficult?  What's gone well?  (Rohrbaugh, 2020).  
What are your strengths as a couple?  What holds you together?  How do you use those strengths to manage the illness?  How do you protect these strengths?
What are some past challenges you've encountered as a couple, and how did you face them?  What worked well and what did not?
What does teamwork look like in your partnership?  What are some successes you've have as a team?  What are some obstacles to teamwork?  
How can you use teamwork in facing the illness together?  Can you agree to make one change that you both believe will enhance teamwork as you manage the illness?
This is not a one-time conversation.  Come back to it again and again.  Making time to relate in this way prioritizes and strengthens the role of teamwork - of "we" - in managing the challenges of chronic illness.  

(Katie Willard Virant, MSW, JD, LCSW, is a psychotherapist practicing in St. Louis).

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