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Sustaining marriage through mental health challenges

Marriage is not a simple relationship. There are so many levels of differences in individuals. And so many ways for a couple to feel connected, both physically and emotionally. And also so many ways to feel alone. And there are varying levels of need to draw a boundary and have that alone time sometimes.

Add in biological children, step children, careers and jobs, ex-spouses from prior marriages, and aging parents and it can be quite a hectic mix of opinion and stress. Many interactions every day, with the potential to devolve into a morass of tension as competing needs and activities pull at the busy family.

On a daily basis, emotional balance, emotional maturity, self-restraint, humor, tolerance, understanding, kindness and just enough honesty contribute to a realistic baseline of possible family harmony.

What happens in a relationship when one person has a predisposition to a mental health issue such as depression or anxiety? Long term, chronic stress is a known factor in bringing on an episode of depression and or anxiety. And these are just the "garden variety" mental health diagnoses. Emotional volatility is higher if there is a diagnosis of chronic bipolar disorder or post traumatic stress disorder.

Steve and Sarah came in to talk about their relationship stress. Steve began. He said he always had anxiety, but it was more manageable and didn't interfere with his daily functioning during the beginning stages of the relationship. But, after they married and blended their lives and families, the stressors of life converged. He was promoted to project manager at work with added responsibility and was putting in more hours. He found himself feeling emotionally overwhelmed. The constant stress morphed into anxiety and this morphed into a depression. He noticed he didn't have the same zest for life he had before. He woke up tired. People irritated him. He felt unable to cope with his team's and his family's emotional needs. He also minimized his contributions to the family and felt unappreciated. His feelings of self-efficacy and self-worth started to suffer. He began to withdraw from the relationship, and paradoxically, began to lean more heavily on Sarah for his his emotional needs, looking for approval from her.

Sarah began to feel smothered by Steve's emotional neediness. His lack of energy began to show up in the relationship. Steve didn't feel like going out on the weekends and also stopped doing things around the house. At first Sarah said she tried to talk to him about how he was feeling. But, as time went on, she felt like she just didn't have the emotional capacity to deal with her aging father, her young children and his emotional neediness. HIs depression felt heavy and exhausting and irritating to her.

Sarah and Steve had a good foundation, but the stressors of life, children and work unearthed Steve's predisposition to anxiety and depression. Which, in turn, was painful for him and stressed the relationship further.

Sarah started to feel like she was caregiving all the time. She became resentful as she wanted to feel like there was a partner in her life, but Steve was too overwhelmed and withdrew. She felt like he wasn’t holding up his part of the adult bargain. Steve sensed her disapproval, her resentment, and wounded, withdrew even more.

Both Steve and Sarah expressed they still loved each other. After they each had time to describe their perspective, we looked at emotional and practical solutions to move the relationship forward from where it had gotten stuck.

For Steve, we discussed treatment options for depression and anxiety, which is generally a combination of individual counseling and medication. Steve didn’t want to try medication yet, but saw the value in trying some individual counseling, to explore his emotional patterns and building a healthier sense of self.

Next, we looked at their internal family dynamics. What specifically was it that Steve felt overwhelmed about? Sarah admitted she had alot of energy and was very socially dynamic. She worked full-time and also coached her 6 year old son’s soccer team and looked after her elderly father. Steve was more of an introvert and needed more time to himself. We examined each person’s capacity for social interaction. They gave each other permission to set boundaries over how much social interaction per month felt good. Then, they designed a schedule that built in down time for the nuclear family. This helped Steve alot. This helped reduce his anxiety. Sarah became more understanding of his needs and more cognizant of how much she was driving the “bus”.

We also looked at the external stressors. We examined how their ex-spouses shed emotional turmoil into the mix. They agreed to step back from blaming each other for their ex-es’ behaviors. They aired their resentment about the ex-es’ influence. Then the recognized that this was a real situation, not imaginary. Then, they decided to pledge to inoculate each other from jealousy and resentment around this issue by pledging to face the emotional turmoil together. In this way, their nuclear family was acknowledged and protected by an emotional boundary.

Steve started to feel better. But he was still lethargic and tended to withdraw. After a few weeks of individual therapy, he and his therapist discussed medication. He referred Steve to a local psychiatric nurse-practitioner. Steve worked with her and came up with an individualized medication regimen. It took a few months, but the medication began to work and his mood lifted. He felt more bel to cope with the numerous stresses of everyday life.

Plus, Steve and Sarah’s marriage was strengthened as they learned more about each other’s emotional patterns. Sarah cut back a bit on her social schedule and consciously channeled more of her positive energy into the marriage. Together, they recognized they needed to give honor to the marriage as an entity. So they co-created a boundary system to protect their emotional space together.

So, things aren’t perfect, but each partner became more realistic and accepting about the other’s emotional process.


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