Medically Unexplained Illnesses: It’s not just all in your head!


Having a stigmatized chronic illness can make it more challenging to cope with illness. This is an introduction to CFS, FMS, and MCS, all medically unexplained illnesses. Having compassion and greater understanding for people with these conditions, may help sufferers reduce their stress.


A Brief Introduction to Medically Unexplained Illnesses

Some chronic illnesses have specific titles, treatments and are much more easily understood by medical professionals. They have a consistent set of diagnostic criteria and so they are easy to diagnose, treat, and maintain. More research is done to find drugs and treatments that help with their treatment, and so while they are not curable, they are treatable and people can have a fairly decent quality of life with those illnesses. Some examples are diabetes, thyroid disease, osteoarthritis, and some psychiatric disorders like depression and Bipolar illness.

However, there are some illnesses, like Fibromyalgia (FMS), Chronic Fatigue Syndrome (CFS), and Multiple Chemical Sensitivity (MCS), whose symptoms are not well-understood by medical professionals, and since those symptoms overlap with other disorders and don’t lend themselves well to specific diagnosis, they don’t get as much research funding and effort. Their causes are also not well understood either; hypnotheses include viruses, childhood trauma, injury, psychiatric disorders like depression and PTSD, chemical reactions gone awry, etc. The fact that the disorders are not well-understood does not mean that the disorders are any less distressing to sufferers. It also doesn’t mean that they are simply “psychosomatic” (i.e., psychiatric symptoms masquerading or perceived as physical disorders). There has been a great deal ofstruggle to gain legitimacy in the medical field for people who suffer Medically Unexplained Syndromes (MUPS), as people with these conditions have an added stress of not being believed by family, friends and medical professionals. If they could point to a well-defined diagnostic label like cancer or arthritis, they might have a chance to be believed by others. Some prominent medical researchers have suggested that these disorders are purely psychological, and that if they just got Cognitive Behavioral Therapy, they would be fine. However, as anyone who has coped with fatigue, joint pain, cognitive dysfunction (like poor memory and concentration), or extreme discomfort after chemical exposure can attest, it is not just “all in your head.” Other people demean MUPS symptoms as “just being lazy” or “the yuppy flu.”

Fibromyalgia is perhaps one of the relatively better-researched MUPS and is characterized by joint pain in 11 of 18 tender points on the body, fatigue, insomnia, and at times cognitive dysfunction, like mental “fogginess” that makes it hard to concentrate, focus, or remember things. Many people with Fibromyalgia are limited in what they can do, how they can move, and sometimes their employment opportunities and capacities are severely hampered by their symptoms. Similarly, Chronic Fatigue Syndrome can negatively impact fulfilling social and occupational roles, and sometimes they have to apply for disability as they struggle to even achieve minimal activities of daily living. CFS has many similar symptoms to FMS (fatigue, cognitive problems, joint discomfort) but also have tender lymph nodes, flu-like symptoms, and “post-exertion malaise” which means that if they do too much during the day, they feel even worse for the next day to week. You may be able to see how this could interfere with holding down a job, raising children, having a social life, or running a household. While these disorders usually affect women, men can also be affected. Children and adolescents can become ill with CFS and FMS too, although it’s much rarer.  Most of the studies on CFS and FMS that have been done involve adults from 40-60 years old. It affects all socioeconomic statuses as well as ethnicities.

Multiple Chemical Sensitivities (MCS) is perhaps the most controversial of the MUPS and while it shares a few symptoms with FMS and CFS, it is more focused on negative reactions to exposure to chemicals in every day products. Some of those products include cigarette smoke, gasoline, solvents, perfume, clothing dyes, dryer sheets, cleaning agents, pesticides, and hairspray. People have a range of symptoms when exposed to these types of chemicals, including respiratory problems, skin rashes, headaches, cognitive problems, etc. people with FMS and CFS sometimes have sensitivity to smells, but it is not a defining feature of either of those conditions. Because there’ve been some studies where people failed to show increased sensitivity to certain agents in a laboratory, some medical professionals regard MCS as merely a psychosomatic illness. However, the reactions are real, cause physical and mental distress, and sufferers are not merely imagining what they experience. Instead of invalidating people’s experience, it seems more beneficial when doctors, friends, and workplaces can work with people who are sensitive to smells to make them comfortable, happy and productive. Other people might not perceive the same smells as threatening, because they get no physical reaction. However, there are number of factors that might contribute to some people’s extra sensitive reaction. I will address these factors in the next blog post.

This is been an overview of medically unexplained illnesses, which are often chronic and whose prognosis is often uncertain. Many of these illnesses overlap in symptoms, but the sufferers have very real struggles in meeting their life roles and functioning well. Hopefully, with more understanding, research, and compassion, we can make their experience a little better and a little less stressful. I will be writing about them more in future blog posts, in specific the link between psychological factors and physical symptoms of these illnesses.

Coping with Loneliness


Being alone doesn’t have to equate being lonely. There’s a distinction, and your interpretation of the state of being alone makes a big difference in your experience.


Lonely panda
Loneliness is a normal feeling, but we don’t have to dwell in it forever. A lot depends on what you tell yourself about being alone.

With the upcoming holiday, Valentine’s Day, much of the focus is on people who are involved with a loved one romantically or sexually. There is not very much attention paid to people who don’t have dates or romantic partners. People can feel pressured to either get into a relationship in order to not be lonely and be perceived as undesirable, or to feel inadequate because they are not romantically involved. There is a difference between being alone and being lonely, as Adrea Cope notes[i]. Being alone can be seen as a choice or a condition imposed upon a person by cruel circumstances. Loneliness is an emotional reaction to the state of being alone. It sometimes involves an element of grief about lost relationships or lost opportunities for being with people.

By contrast, one can view being alone as a choice or as a decision to be independent. Being alone is not necessarily a sign that you could not find a partner if you wanted one. Rather, it can be a deliberate choice to be autonomous, liberated, and free to live your life the way you want. Some of us experience being alone as a pleasurable experience, one they seek out to regulate the balance between being with others and being by themselves. Have you ever wanted to just have some “me” time?

Being alone can also be cleansing after a relationship that didn’t work out. I’ve seen a lot of clients rush into relationships after they break out because they don’t want to be perceived as “losers.” The implication is that if you’re alone, you can’t get a date. Sometimes it takes time to learn what went wrong in the last relationship. It also takes time to heal from the damage that relationship might have caused.

People who take the time to evaluate what went wrong, how they contributed to the demise of the relationship, and what they need to do now to grow and heal are well positioned to have a healthier relationship next time. It’s crucial to observe how you interpret your aloneness. What are you telling yourself about it? How are you interpreting it? That process of recognition and acknowledgment can make your alone time much more pleasant and productive. You can use journaling or meditation to explore what messages you’re sending yourself, and perhaps also open up to new ways of seeing your alone state. What self-valuing messages can you use to start replacing the criticism and pessimism?

There’s no rule saying you have to be in a relationship in order to be sexy, desirable, lovable, or a “winner.” In fact, some very likable, sociable, and interesting people are single, by choice. I believe it’s time we respected the diversity in people’s need or desire to be with another person. Some people feel very little need to be in a relationship and prefer solitude, while others have a strong desire and need to be in a relationship. The level of involvement is really up to each person, and I don’t think there’s a need to shame people for wanting what they want.

One caveat about being alone: Sometimes depressed people isolate, as do people who have Panic Disorder, Agoraphobia, and at times, PTSD. It’s important to distinguish between preferring to be alone because you like your own company and feel comfortable enjoying life that way, and avoidance. It’s understandable to avoid being hurt, as you have been in the past. No one can fault you for that. However, it often is accompanied by emotional misery and time spent either in self-reproach or immobilized numbness. If that is the case, I encourage you to get psychiatric care. You don’t have to be in contact with people all the time, but the time you spend whether alone or with people should generally be at least neutral, if not pleasant. If it’s hard to be around people and/or yourself, there’s a good chance that some healing needs to happen, to restore you to normal interpersonal functioning.

In closing, being lonely is a state of mind that crosses everyone’s path from time to time. It doesn’t need to be a constant visitor, and the way we view other people and ourselves can make a big difference in how long and how strong we experience loneliness. If you are without a romantic partner this Valentine’s Day, I strongly encourage you to embrace it and see it as a chance to spend time with a cherished loved one: yourself!

[i] http://thoughtcatalog.com/adrea-cope/2014/04/the-difference-between-being-alone-and-being-lonely/

2017’s Antidote to Poor Physical and Mental Health: Altruism and Volunteering


Contrary to the idea that we are all out for ourselves, there are definite benefits to working together not only to survive but thrive emotionally and physically. Volunteering, kindness, and altruism are all good tress individually and collectively.


the-hands-of-help-and-friendship In this age of rancor and hatred, it seems more important than ever to make this a year of kindness and civility. We’ve seen a rise in hate crimes, bullying in the schools, and xenophobia that is hard to stomach sometimes. However, we can each be individually responsible for how we conduct our lives and how we want to be in the world. There is not just a benefit to society in being kind to others; we also stand to gain individually by turning our focus outward and helping our fellow human beings. Some social theorists such as Richard Dawkins and Charles Darwin believed that we are hardwired for selfishness, competition, and ruthless egoism. However, other theorists state that altruism “flies in the face of” theories that we are programmed genetically to be selfish. Instead is survival of the fittest, we’re just as naturally inclined toward social resilience. Social resilience is defined as “’ the capacity to foster, engage in, and sustain positive social relationships and to endure and recover from stressors and social isolation’” (John Cacioppo, quoted in Seligman, 2011, p. 146). The same author just quoted argues that we survive as humans because we work together and combine our strengths and resources to help one another. Seligman gives further examples in the animal and insect kingdom of how working cooperatively both productivity and survival.

There is also evidence that volunteering can reduce symptoms of depression and anxiety. Being kind to others takes the focus off of one’s own inner strife, as well as develops skills and social networks that buffer stress. In addition, volunteering and kindness engage a person in meaningful activity, which can be described as a “flow” state. Flow is described as “the experience of working at full capacity,” in which a person uses challenge and skill to accomplish something that is rewarding at a deeper level than immediate gratification (Peterson, 2006, page 67). In a flow state, we can lose track of time because we are so absorbed in what we’re doing; athletes describe it as being “in the zone.” Of course, when you’re feeling depressed or anxious, we naturally want to avoid other people. There’s a strong tendency to get trapped in inaction and avoidance. Milton Erickson helped a wealthy lady who was depressed overcome her isolation by prescribing altruism to the members of her church. He told her to get some potting soil and to give African violets to all the members of her church for every major life event; this not only increased her social interaction, but engaged her in an activity that she loved (caring for and raising flowers). Instead of just keeping all of her flowers for herself, she reached out and blessed her community with kindness and generosity. They repaid her favor with their love and appreciation. This is one small example of how you can be involved with other people in an informal, yet meaningful way.

Some people may say, “I don’t have the time for this” or “I don’t have the energy.” If you consider the act of being depressed or anxious, and you consider how exhausting it is to feel fear, self-loathing, and concoct negative scenarios from the past or future, you might argue that you already have plenty of energy that is being directed at self-sabotaging pursuits. How would you use that energy if it weren’t engaged in these negative pursuits? You don’t necessarily have to volunteer 40 to 100 hours per year, although that can definitely boost the positive effects of volunteering. Consider small ways that you can help people you know already. Maybe someone just needs a phone call and to know that someone cares about them. Perhaps an elderly or disabled person in the neighborhood needs help with housework or yard work. There are many ways to reach out beyond yourself and to be kind, so much so that you might find yourself enjoying it more and more. I encourage you to think of ways to help other people, or even animals or the environment. Ultimately, they are all part of the web of existence and our actions come back to us and sometimes unexpected ways.

References

https://www.nationalservice.gov/sites/default/files/documents/07_0506_hbr_brief.pdf

Peterson, C. (2006). A Primer in positive psychology. New York, NY: Oxford University Press.

Seligman, M. (2011). Flourish. New York, NY: Atria Paperback.

A Piece of Me Went With You


Losing a loved one is hard enough, but when you feel as though a part of you died too, it makes it even harder to cope with the loss. When you’ve lost someone you have known for many years and very intimately, your personality is influenced by that person, and vice versa. Sharing a life together, as family members and spouses do, makes it hard to distinguish where your personality is distinct from the other person’s. That’s not necessarily a bad thing if you have good boundaries. If you know your own mind, your own wants and needs, and are comfortable setting limits in order to protect yourself from unwanted intrusions, then having parts of another woven into the tapestry of your personality can be a welcome addition. Sometimes a mellow person can take the edge off their angry, sharp-tongued mate, or a bold, assertive family member can encourage their loved one to be more self-assured and outspoken. These bits of the other person shine through in the tapestry when necessity calls for it, and also when we make a conscious choice to emulate that loved one’s best qualities. Sometimes it’s automatic and unconscious, however; we are influenced without even knowing it. Of course, in the case of family members influencing each other, there is a genetic component that is also unconscious and at times mysterious.

I often hear from clients who have lost a spouse or long-term lover, “I can’t ever be the same again.” I can understand where it might feel as though that’s true when you first lose someone, but I think it’s a limiting belief that in time is not necessary. It creates worry, anxiety and adds to the pain of grief. In some cases, the loved one’s death does change a person’s personality, and not necessarily for the better. However, I think that personality, and being in general, is fluid.

We generally are not the same at 20 as we are at 10, or at 30, 40, 50, and so on. There are some fundamental qualities like introversion or extroversion that usually remain stable over time, but I think bringing conscious awareness to how we behave and treat ourselves and others makes a huge difference in whether our personalities and psychological health becomes stuck or not. Pain of loss or trauma can make people feel stuck and stunt their development, but if worked through it can be transformative in a positive, healthy way too.

When I hear someone say, “I will never be the same,” I think that may be true but not necessarily for the reason you think. Since personalities change over time anyway, you very well may never be the same. But the death is only part of the picture of your development as a person. The pain of the person’s death will shape your experience as a human being, no doubt. Yet it isn’t necessarily a permanent change and the pain itself will probably morph over time from intense, sharp and burning to a muted, softer ache. At first you might find yourself wanting to be alone all the time, or feeling angry and very prone to tearful outbursts after the loss. As that dissipates and becomes less painful, you might find it acceptable to be around people again. You might even crave others’ company, and that’s okay too. The more you can see what you’re going through as part of an ongoing process, the less alarmed and fearful you need to be about the changes you’re going through.

Ultimately, you get to decide the person you want to be. When you first lose someone, very little feels within your control. This might include your personality and what you feel was taken away from you when you lost your loved one. With time and consciousness, however, you can restore those parts of your loved one and who you were when you were with them, and maybe improve upon those aspects as well. If you would like help working through this type of loss, please give me a call: 661-233-6771.

Grateful for our Hardships


How to derive strength and positive change from trauma and loss, especially with help.


When something tragic happens to us at first, it’s overwhelming, scary and painful. It takes all we’ve got to get through it, survive it, and heal from it. The thought of recovering from it enough to see the positive aspects of the event is remote and difficult. However, the ability to eventually find gratitude for our hardships helps make us resilient and stronger than before. It is an important aspect of healing, and transcending, trauma and loss. But what would allow you to be grateful for such a tragic event?

Dr. Martin Seligman stated that he and colleagues asked visitors of his website about traumatic events that happened to them, as well as a subjective wellness survey; he found that people who had survived at least one traumatic event in their lives had more strengths than people who had none (Dr. Seligman’s website). What is it about hardship that makes people become stronger? Is it the ability to relate to others? Maybe it’s being tested against extreme stress and surviving, that gives people a boost of confidence they might not otherwise have. Perhaps it makes a person appreciate their loved ones or re-evaluate their priorities in light of what happened to them.

I’d like to tell you about a training program that the US Military uses to foster gratitude after traumatic experiences, as relayed by Dr. Martin Seligman in Flourish. The name of the program is Post Traumatic Growth and is headed by Brigadier General Rhonda Cornum, Dr. Richard Tedeschi and Dr. Richard McNally. It’s based on the idea that “we should make the most of the fact that trauma often sets the stage for growth” and it teaches soldiers how to create ways to grow because of their traumatic experiences. Soldiers are given a psychological test that measures how much benefit they derived from traumatic experiences and are then taught to understand their response to the trauma, reduce their anxiety, tell other people about their experiences in a helpful way, and to create a “trauma narrative” that helps them see that they both lost and benefited from the experience. In addition, the life principles that foster strength in the face of challenge are spoken, and this helps people remember that they can get through other challenges in the future as well. To learn and grow from the traumatic incidences is the ultimate power over the events, and this program helps them do that.

I greatly admire this program and encourage you to think about sad or trying times in your life. Yes, there were pain, fear, sorrow, and anguish. But you’ve survived those times, and you have the opportunity to learn and grow from them.

Created for Connection, Part I


I consider it courageous to show others our vulnerable, less polished and impervious sides, in situations where it is most tempting and easy to be jaded, phony or manipulative. I see this question of whether to connect when interacting with couples, families, friends, politics, and even day-to-day encounters with strangers. While we have exercise caution and care with our hearts and guard against being taken advantage of, we also can act as though we have more to fear than we actually do. How do we decide where there is a real threat of being hurt, physically or emotionally, and where we can let down our guards?

The Disconnected

I have met people who were extremely guarded and afraid of being hurt, although they would never admit to this. They hold up their shield of not-caring, or of cynicism or even aggression to keep themselves from being hurt themselves. The world can indeed be very frightening and dangerous, and we have a duty and responsibility to ourselves to accurately assess when to defend ourselves from others.

But when we can’t shift from that state of protectiveness once the threat is over, or can’t tell a truly dangerous situation from one that merely seems threatening, or one that is neutral but reminds us of past hurts, then we become rigid and incapable of opening up when we want to. And that is a sad and lonely state of existence. Even when such people connect, they often do so from a superficial, win-lose stance. By this I mean that the person feels that they must win and someone else must lose to be safe. Are they concerned for the loser? At this point, it’s every man or woman for themselves, and all such people care about is that they weren’t the loser. Empathy is lost at this point, and when empathy lost any kind of dehumanizing, cruel behavior is possible.

Hearts-Wide-Open

I have also met people who are so open and willing to experience anything and everything that they often get hurt in relationships. They tend to attract people like the ones described above, because they are easy prey for cynical, selfish people. They expose their soft, vulnerable sides in hopes that people will take care of them the way a parent takes care of a child. Unfortunately, the world is not made that way. When we reach 18, our society assumes that we are adults, capable of taking care of our own emotional and physical needs. When we depend on others to look after us and protect us from situations where we should exercise good common sense, we run the risk of being treated pretty savagely. We need to balance of looking after ourselves, but not exclude considering others’ needs and wants.

A Balance of Connection

Somewhere in the middle of these two extremes, we can meet each other and have a reasonable expectation of civility. Some of what we expect of each other depends on our cultural backgrounds. In some cultures, to leave oneself open for possible exploitation is a foolish act that leads to automatic exploitation. For other cultures, there is a level of trust that favors the tender-hearted and assumes the best in people. I think the United States is somewhere in the middle of the spectrum, but is edging towards the cynical end increasingly as time goes on.

We have to make choices about how to use our sensitive, tender parts of ourselves with others, and how much to give of our vulnerabilities to others. Unfortunately, the world is becoming increasingly inhospitable to this practice, as violence escalates and we become increasingly jaded and greedy. How do we carve out a space to meet soul-to-soul with others’ vulnerabilities and hold each other, and ourselves, in a tender, careful way? How can we show love, appreciation and kindness to each other even when we’ve been hurt in the past and have doubts about humanity’s worth? These are some of the issues that are especially salient to people who have been in traumatic situations, and can be explored in psychotherapy.

My Part, Your Part


Fights don’t usually start with only one person. This will help you recognize your part and drop the defensiveness that erodes and stagnates relationships.


Lately I’ve been noticing that many people notice what other people do wrong and get quite upset about it, without taking time to consider their participation in the perceived problem. This often takes place in arguments with loved ones, whether the loved ones are friends, family members or lovers. I’d like to take the time to help you rectify this problem if you notice it in yourself.

We love to be right. We don’t like having people point out our flaws, because we fear their rejection and negative opinion. This is perfectly human and understandable. But it we persist in seeing only what other people are doing wrong and ignore our contribution to the interaction, we miss the opportunity to take responsibility for our actions and improve the situation by acting differently. So we keep feeling like victims, put upon by the whim of other people who are totally unpredictable and unfair.

Do you want to stay in a victim role? Or would you rather feel like you can behave differently in an argument? Hopefully you want the latter, because that is the only way I see out of this mess.

Next time someone gets angry at you or has a problem with what you’re doing, try these four steps:

  1. Notice the feeling that arises in you and accept that feeling. That doesn’t mean you indulge it by acting on it. But it also means that you acknowledge, “I feel angry and like defending myself” without judging yourself for feeling that.
  2. Reflect on what happened before this person got upset with you. As if you were observing the interaction on TV or in a movie, look at the actions that preceded and came after the anger. What were you doing, what were they doing, how did you react to their actions, how did they react to yours…. you get the picture.
  3. If you can see something that you might have done to contribute to it, accept responsibility for that. Don’t conveniently block it out of your mind. Don’t pretend that you had nothing to do with it. If you’re not clear on why they’re angry, ASK, don’t assume.
  4. If they’re not ready to take responsibility for their negative behavior, give them time to cool off before writing them off. If this is new for you, asking for responsibility from yourself and others in such interactions, then try to have patience for the other person and for yourself. It’s a new skill. You’ll get better the more you do it. So will they, hopefully.

Sometimes people don’t take responsibility because to admit fault is to sink into a quicksand pit of shame. If admitting wrongdoing does that to you, it’s probably indicative of low self-esteem and probably a good idea to get professional help. If you feel really angry every time someone points out something you did wrong, it may be an indication that you are covering up your shame or over-compensating for low self-esteem.

Hopefully you can take responsibility for your part in an argument, and the other person can too. It’s really a pain when only one person routinely takes responsibility, and that can lead to resentment, which makes your relationships suffer as a result.

 

 

Inclusion


What a beautiful account of raising a child with neurological differences that allow the individual to see world in a fantastic new way!

Squeeze the Space Man's Taco

INCLUSION

What’s the world like through the eyes of innocence? Somewhere over the spectrum I see the wonder. I see the wonder of a world not tainted by ignorance and hatred; where superheroes exist and fairy tales really can come true. Children give us a unique opportunity to regain this magic.

“Daddy,” queried my nineteen year old son. “What’s Santa Claus going to bring you for Christmas?”

“Let’s see,” speaking of himself in the third person, Cade answered his question. “Santa will bring you Batman, Superman and Justice League toys.”

“Wow Cade!” I exclaimed. “You must have been a good boy this year.”

“Yeah,” he so proudly agreed. “Daddy, what does Santa bring you if you’re nice?”

“What Cade?”

“A bag of toys.” Joy beamed from his eyes as he replied. “Daddy, what does Santa bring you if you’re naughty?”

“What Cade?”

“A bag of poo.”

Although physically an adult, Cade remains a child. Autism may have…

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You’re Not to Blame!


Children often blame themselves for the bad things that happen to them. As adults, we don’t have to keep blaming yourselves.


In working with trauma survivors for over 12 years, a common theme I have encountered has been that people who are abused as children often take responsibility for what happened to them. They think that if they were lovable, stronger, or better able to figure out what their adult caretakers wanted, the abuse would never have happened. The sad thing is that many perpetrators of abuse say things to encourage their victims to feel responsible for the abuse. Very often these are people whose personal developments are immature and do not allow them to take appropriate responsibility for their actions. Therefore, they project responsibility onto the people they harm. This is true for physical as well as sexual abuse.

Of course, we humans are very good at justifying what we do, and our memory is self-serving in most cases. We’ll remember many events in a way that favors us and makes us look good. However, a healthy, normal adult can also take a step back and look at their behavior, realizing that there are more than one versions of any story. Thus, we can see ourselves as culpable and capable of mistakes in most situations, and hopefully take corrective action accordingly. People who hurt others often find it too uncomfortable and painful to take responsibility, so they have a binary system of responsibility. What this means is that they generally see everyone else as wrong and at fault, and themselves as perfect and poor victims who are acted upon by all those wrong-doers. Other adults can swat away people like this like so many flies, realizing that this way of thinking is unhealthy and dangerous to be around. But children are often stuck in a one-down position in relation to people like this. Imagine being the child of someone who can never admit fault, can never say “I’m sorry” after inflicting physical or emotional pain on you. Or worse yet, who can make you feel as though you deserved to get mistreated. This is one of the horrible side effects of abuse that takes a long time to heal.

If you have come to see your own childhood abuse as your fault, I hope that you can reach a point where you realize that you did not deserve it. It may take a while to realize this, but it is a very important part of healing from trauma. If you feel stuck and believes that don’t work for you, professional help may be essential to your healing. Please consider calling me if you are in the Antelope Valley area; my phone number is 661-233-6771.

When Your Partner Can’t Cope


Considerations when one member of a couple fairs better psychologically than the other does.


When I work with couples, there is sometimes a difference in the level of functioning between the partners. Sometimes, people who like to take care of other people wind up with partners who are very damaged psychologically. This can be challenging, because the partner who isn’t as damaged expects more out of their partners them what they can deliver. It is a fine line between accepting abusive behavior and understanding that the person has had a difficult childhood or difficult past experiences in general. I do think that compassion is always a good idea, but sometimes compassion can turn into enabling behavior. We can be supportive and understanding of each other’s painful past, and accommodate it to a degree, but when it starts becoming a one-way relationship wherein one party is always favored or given his or her way, it stops being healthy for both partners.

This difference in functioning is not necessarily restricted to heterosexual couples. It can also happen in gay, lesbian, or polyamorous couples as well. I use a heterosexual couple as an example here but it could be any two people whose psychological function differs significantly, enough to cause relationship problems.

Meet Mary and Mac

Let me give you an example. Mary and Mac have been together for six years. Mary has been through a lot of trauma and often has angry outbursts where she cannot be talk to in a reasonable way and she cannot control her anger enough to have a productive conversation. Mac, wanting to be understanding, allows himself to be talk to in a demeaning, hurtful way that makes him feel insecure and depressed. This is been going on for at least two years, and Mary expects back to tolerate this without question or objection. Mac has asked Mary on repeated occasions to get help, but Mary says that she’s not ready yet. The truth is that Mary is frightened of the idea of facing all the horrible things that happened to her, and would rather skip processing that and just go on with life as if nothing happened. I can understand why this would be more tempting, but when she drinks or is just stressed, the anger and frustration that she was never able to express to her perpetrators come out. What should Mary do, and what should Mac do?

Often by the time they reach couples therapy, a lot of damage has been done because they say things to each other during fights that cannot be undone. Max starts to shut down more and more, or stonewall his partner. As Mary senses Mac pulling away, she becomes more desperate and her emotions more out of control. Usually these situations don’t work until individual therapy for the person who is in the most distress, has taken place. This is especially true if there is domestic violence going on. Couples therapy can bring up a lot of painful issues, and it’s important that both partners have a safe, responsible way to cope with their feelings. Sometimes therapists mistakenly think that they can see a couple where battery is going on, but it is best to refer them to anger management and other resources before attempting couples therapy.

 

Recommendations

It’s also important for the person who is coping better to get some help. Work on boundaries and self esteem is crucial when you have a partner who is emotionally needy or abusive. If you feel as though you’re always giving in the relationship and never getting very much back, it’s important to look at that and ask yourself why. A few books that can be helpful are Stop Walking on Eggshells, by Paul Mason and Randy Kreger, and¶ Coming Home to Passion, by Ruth Cohn. I also find a lot of couples like Seven Principles of Making Marriage Work by John Gottman and Nan Silver, although that book is more general in its audience.

The hope is that both of you can cope with stress and an effective, healthy way and thus truly enjoy your relationship. A relationship should be mutually beneficial, warm, and loving. If yours is not, consider getting some help.