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In Couples and Illness, Dr. Tamara Goldman Sher demonstrates her approach to working with couples in which one or both partner suffers from an illness. The goal of this therapy is to help the couple understand how the illness or recovery process affects the couple's relationship, and identify resources that will help the couple to cope.
In this session, Dr. Sher helps a couple deal with older relationship issues that have affected their ability to rebound as a couple from the stress of a recent serious illness, concomitant surgery, and the return to health.
The goal of both therapy and assessment with couples facing medical problems is to better understand the reciprocal relationship among the couple's functioning and illness processes. The therapist, the patient, and the partner explore how the illness and recovery process affects the couple and how the couple's functioning affects the illness and recovery process.
Areas to explore include
mobility changes as a direct result of the illness,
communication issues, and
beliefs about each person's responsibility to the relationship in light of the illness/recovery process.
In keeping with the principles of cognitive–behavioral couples therapy, the therapy takes on both a skills-oriented and a cognitive processes approach. Adaptation to a serious illness varies on basis of the illness and on the life stage of the couple. Couples for whom the illness process is least expected (i.e., younger couples) are expected to have a harder time adapting than couples who face illness at a more appropriate life stage.
This approach strives to help all couples identify the resources they have to deal with and the changes they have experienced, as well as to better understand both the patient and the partner roles in the relationship.
Couples facing illness encounter changes in both the individual's and the couple's lives. As a result, they are forced to reconceptualize the roles within and outside the marriage. These roles change with each stage of the illness process. Stages are different by diagnosis but generally include
adaptation to chronic illness,
end of life.
Each stage requires different sets of skills by the patient and the partner. Sometimes these skills are complementary among partners, but sometimes they can conflict, such as when the patient needs more assistance in activities of daily living but the partner needs to work outside of the home to maintain a household income.
The couple is first assessed on many levels including an analysis of both the resources and the immediate stressors confronting each partner. The resources and stressors include
This assessment can be accomplished with standardized measures such as the Beck Depression Inventory or the Dyadic Adjustment Scale, or more informally by interview. Dr. Goldman Sher tends to prefer the informal approach because she finds that gaining a good understanding of each area builds rapport with both members of the couple. The assessment is typically conducted with each partner alone as well as in conjoint sessions. Therapy proceeds with skill building and attention to behavioral changes that might be necessary.
Additionally, therapy includes a focus on cognitive processes such as each partner understanding the violation of expectations and standards for being ill. Both the patient and the partner are encouraged to understand the process from the other's point of view and analyze how their decision making might impact the other person's experience in the illness/recovery process.
In This Video
In this session, Dr. Goldman Sher helps Bill and Helen understand how old issues and hostilities are impacting their abilities to recover as a couple from the illness process, despite Bill's physical healing. Helen voices frustration with putting her own needs second to Bill's throughout their lives, separate from her attention to him during the illness process. She also expresses anger with his failure to understand that she feels entitled to making decisions that are right for her, separate from him and his needs, since the crisis of his illness passed. Bill expresses his own frustration about Helen's unwillingness to fully share in his own passions and hobbies now that he is able to resume them and that she is not taking better care of herself physically. The roles of Helen as caretaker and Bill as patient are beginning to change with Bill's recovery, but neither partner knows how to proceed with a new pattern of interaction.
Couples that have a history of working well together typically will do better than couples that tend to be combatant when faced with stressors. However, some couples can learn the skills of problem solving and emotional expression as well as the cognitive steps toward confronting the illness process as a team, even if they have not had the experience of many stressors before. It should also be noted that other issues facing couples do not disappear with the emergence of illness in one of the partners. These issues, such as financial issues or problems with extended family, can be exacerbated by the illness process, making adaptation that much more difficult.
Bill and Helen need help adjusting to a new phase of their lives. This new phase includes the major changes of retirement for Bill and health for both of them. Bill was forced to retire as a result of his illness, but he has not been able to adjust to life without work in his recovery. Both wellness and leisure are new for Bill and Helen and they do not currently possess the resources to adapt as a couple to these changes.
As a result, there is a struggle between the partners as to how to spend their time, their money, and their lives together. They have individual ideas and preferences but do not seem to be able to focus on how each of their ideas and preferences might complement or clash with those of the other.
Dr. Goldman Sher works to help them to take the perspective of the other one, to learn to compromise, and to understand how old patterns come into play in the decisions that may no longer be adaptive (i.e., Bill makes the decisions outside of the home and Helen makes the decisions inside the home).
About the Therapist
Tamara Goldman Sher, PhD, is an associate professor in the Department of Psychology at the Illinois Institute of Technology in Chicago. She received her PhD in clinical psychology from the University of North Carolina at Chapel Hill.
Dr. Sher's focuses include couples and illness, couples and communication, women's health, and behavioral medicine. Currently, she is working on a project funded by the National Heart, Lung, and Blood Institute entitled "A Couples Approach to Cardiac Risk Reduction," which explores the advantage of working with couples facing cardiac disease in favor of a more traditional patient-centered approach.
Kiecolt-Glaser, J. K., & Newton, T. L. (2001). Marriage and health: His and hers. Psychological Bulletin, 127, 472–503.
Schmaling, K. B., & Sher, T. G. (1997). Physical health and relationships. In W. K. Halford & H. J. Markman (Eds.), Clinical handbook of marriage and couples interventions (pp. 323–345). New York: Wiley.
Schmaling, K. B., & Sher, T. G. (Eds.). (2000). The psychology of couples and illness: Theory, research, and practice. Washington, DC: American Psychological Association.