As someone who hadn’t seen patients on an outpatient basis for several years, I decided in late 2021 to explore the world of telehealth. Telehealth was new to me as it was to many clinicians. I think the combination of more time at home and the increased need for access to behavioral health I was seeing in my role as a crisis clinician sparked my desire to begin seeing patients again. As I began building my client load, many clients were couples. It was a box I checked without much thought as I had training in couple’s work and had seen a fair number of couples during my decade of private practice, but not something I was actively seeking out in this new venture.
What surprised me is how much I enjoyed working with couples. Yes, it is more challenging (at least for me) than seeing individuals, but I also find the successes more rewarding. While I have had some couples who are experiencing extreme distress, many couples I’ve seen are coming in because one or both are noticing a lack of connection they had previously. This is exciting as therapist, as it allows for connections to be rebuilt before a relationship crisis (separation, filing for divorce, affair) has occurred. On a less personal level, it is exciting because it feels like a cultural shift from the belief that counseling is a last-ditch effort---which had been my experience with many couples. Often during the assessment phase, it became apparent that one or both in the relationship have at least one foot out of the proverbial door.
A common theme that arises in couple’s therapy is the belief that regardless of what is going on in their lives, they have it worse than their partner and that their partner doesn’t acknowledge their level of distress. When the conversation begins to turn to this competition for who has it worse, a gentle reminder can be necessary that it isn’t a competition, both situations can be equally distressing and just distressing in different ways. This originally came up with my couples who had recently experienced a deployment. They struggled to find empathy for their partners given the stress they had experienced during the deployment cycle. Deployment brings with it unique stressors for both partners and it is critical for the partners to acknowledge the other’s experience of deployment.
“I had the kids by myself for an entire year with no breaks!” the non-military parent would lament.
“I didn’t see my kids in person for an entire year!” the deployed parent would rebut.
I would agree they both sucked. By acknowledging their partner’s experience, it didn’t take away from their experience. The impact of that shift in perspective never fails to impact a shift in the tone of the room and the relationship.
This also plays out in the couples I am seeing post-pandemic. The survival mode many have been in since the beginning of the pandemic is playing out in relationships. Partners are struggling with empathy for each other which leads to conflict about who is doing more or who has it worse. Without the time and energy to nurture themselves, they also struggle to offer those to their partner. Relationships struggle without this shared understanding of each partner’s experience. Battles between stay-at-home versus working parents, or even divorced couples who have uneven distribution of parenting times may experience this type of conflict.
Shifting the focus of individual stress to a shared stress, shifts the dynamics in the therapy room and in the relationship. Partners are able to acknowledge their partners stress without fear of it somehow lessening their own. In my experience, it only takes initial buy in from one partner. Once the other partner feels heard, it allows them to reciprocate. Once this occurs, they feel less isolated and alone in the relationship. Momentum is then built outside of the therapy room, and they begin looking for ways to decrease the practical and emotional load for their partner. Homework tasks includes time together and time spent doing something to make their partner’s week better. I continue to be surprised at the impact this shift has on relationships. Once both partners feel heard and supported, it allows the therapy to begin addressing other issues within the relationship, but this shift is a great place to start. Couples seeking treatment before the relationship is in extreme distress allows for the couple to be more receptive to making needed changes.
I think in all aspects of our lives we will continue to feel the affects of the pandemic for years to come. As I wrote in an earlier blog post, it is important to find the positives in the pandemic. One such good is accessing behavioral health care earlier in relationships. Normalizing mental health as health and seeking care before a crisis is a win in my book.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Christy Collette, LMHC, is a Program Associate for the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, she is coordinating the expansion of the Star Behavioral Health Providers into new states across the nation. SBHP trains civilian behavioral health providers to work with Service members, veterans and their families.