Harvard Mental Health Letter

Helping couples deal with medical challenges

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 create stress in a marriage or in any type of committed relationship. Illness affects not only the person who receives the diagnosis, but his or her partner as well. For example, a woman receiving treatment for breast cancer may be physically uncomfortable, constantly tired, and worried about her sexuality and body image. Likewise, a man undergoing treatment for prostate cancer may experience unpleasant side effects such as impotence and incontinence. Both are likely to worry about the future and their mortality. Although these concerns may surface at various times during cancer treatment, they can become especially troublesome once treatment ends, as couples make the transition to a "new normal." When the diagnosis is diabetes or heart disease, one or both partners may need to make significant lifestyle changes such as quitting smoking, losing weight, and adopting new dietary habits. Although some couples function as a team in response to these challenges, others may find themselves at odds over food choices, leisure activities, and the like. Many couples are able to manage the challenges of illness reasonably well and can find ways to cope on their own, but some will need help. For those who do, couples therapy can enable partners to cope with the stress of medical illness or addiction. The methods are similar to those employed in individual therapy: interpreting emotional conflicts and the influence of the past; understanding fixed patterns of relating; encouraging insight and empathy into how those patterns may derive from early life experiences of each partner; assigning exercises for behavior change; challenging beliefs; offering advice, reassurance, and support; and 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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