When one or both partners in a relationship have been diagnosed with a mental illness, that person is often engaged in individual therapy. Why then, should you also consider a couples counselor?
Couples counseling is focused on the relationship between the partners. It is not primarily a place to deal with individual issues, except in the way that they are impacting the relationship. As a result, you can expect to talk about things that happen between the two of you, like communication, intimacy, decision making, trust, changing patterns, parenting issues, the impact of one partner's decisions on the other, fears and love. In some cases, one partner may not feel that they can discuss these topics when it is just the two of them alone. A third party can help ease discomfort.
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Different marriage and family therapists may conduct the counseling sessions differently but generally the focus is on the relationship first and how its dynamics impact each partner. Some therapists will ask a lot of questions. Others will guide you through exercises and ask you to focus your conversations more on each other. Often, therapists will give you things to do, or assignments, between the sessions.
Counseling sessions are often conducted once a week, but may be more frequent in the beginning, if the situation needs more urgent care. They may be as infrequent as monthly or quarterly later in treatment — if you get to the stage where counseling is more "maintenance" within your relationship. Sessions are usually forty-five minutes to an hour and may even include group sessions with other couples. Some couples will be able to address a simple issue within just a few sessions, whereas others will remain in therapy for months or even years. This is determined by what is going on in your relationship, what you want to work on and what other underlying issues are present.
When someone in the relationship has a mental illness, couples therapy can be especially important. This occurs in several key ways:
- Often the symptoms of the mental illness will cause significant impact on the relationship. This can be the result of behaviors outside the relationship that impact the couple. For example, consider an alcoholic partner who loses their job after a DUI, and now is unable to contribute financially. It can also be the result of behaviors within the relationship, such as one partner feeling depressed and not wanting to engage in intimate behaviors; the other partner may take it personally.
- Another key issue couples often encounter when mental illness is present is that the partners have different understandings of the illness — and what is reasonable to expect. Imagine someone who is newly diagnosed with bipolar disorder and on new medication(s). The partners may have conflicting expectations about how quickly symptoms should be controlled and how soon things should return to "normal."
- During acute periods of the mental illness, the one with the diagnosis may not be as able to do certain things. This can throw off the existing balance within the relationship. As a result, the person who is still functioning as they normally do may feel that they are being "dumped on" and have to "parent" their partner. In turn, the one with the illness may feel that the other person is treating them like a child.
- Some people will experience the daily effects from a mental illness over long periods of time, even for the rest of their lives. When this is the case, it may be hard for the couple to find new comfortable patterns for their relationship, or to understand how the relationship and their love is still present amidst the chaos.
In all of these cases, it can be helpful for the couple to have a therapist help them explore issues and to guide them through the process. The therapist is trained to help both of the partners meet from where they are, and to move to a new understanding that includes peace and wholeness for everyone involved.
Usually, when a couple comes in for marriage or couples therapy, one partner is more motivated than the other. If you want to engage in couples therapy and find that your spouse is reluctant, you are not alone. Talk to your partner about why you want to start couples therapy and what it's really all about. Reassure them that it is not a precursor to separating; it is a way to save your relationship.
Let them know that couples counseling is just a new way to talk about and address difficult issues. If you are the one with the mental illness, reinforce that you want to help the relationship (not shift the blame or diagnosis to them). If you are the healthy one, talk about how you deserve help too, and this could be a healing experience.
A mental illness diagnosis is not a death sentence for your relationship. Consider couples therapy to help you both heal individually and as partners.
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