BC Schizophrenia Society, Victoria's spousal support group
Reprinted from "Couples" issue of Visions Journal, 2015, 10 (4), p.23
Any couple relationship, whether dating or a committed partnership, has its proverbial ups and downs. But what about when there is the extra challenge of dating or being the spouse/partner of someone who has a mental illness?
As with physical health issues, a mental illness can present extra challenges that can destabilize a relationship. Things can be very challenging for the partner without a mental illness, who may assume more of a caregiving role. He or she can find themselves isolated and unsure about how to manage their relationship, especially when their loved one is struggling.
We encourage people who are in this type of relationship to reach out and try a spousal support group like the one we host at our recovery-oriented BC Schizophrenia Society, Victoria (BCSS Victoria) branch.
Our spousal support group—a safe place to discuss unique issues
The Strategies and Support Group has been running for about six years and was started by Dana Lewis, a former family counsellor with BCSS Victoria who had received many requests for such a group. The group welcomes people whose partners or spouses have a mental illness, including schizophrenia, bipolar disorder and major depression, with or without addictions. The group meets once per month every last Thursday of the month from 7–8:30pm at no cost to attendees.
We provide a safe space where group attendees come together to find hope and revitalization. It can be hard to share thoughts and feelings with friends and family, especially for the unique issues that arise when it comes to intimate relationships, but in the spousal support group there are, as one participant says, others “who get it without me having to explain everything, and there’s the safety and comfort of not being judged.”
Common themes invariably arise in this group, such as anger, communication, sexual intimacy, enabling, finances, children, and whether or not to stay in the relationship.
If the partner with the mental illness isn’t working on his or her own self-care and recovery, their spouse can feel overwhelmed, and the dynamic in an equal partnership shifts out of balance. The spouse becomes the caregiver, and roles and boundaries become cloudy.
Some group participants have shared that they feel like they are in a parent-type role. This can be unpleasant and lead to feelings of frustration in both spouses, especially as communication becomes more challenging. For example the caregiving spouse may feel like they are nagging instead of being supportive—they may be using the word should instead of asking a question.
It can be especially hard when a loved one is not exploring ways to take responsibility for their personal mental wellness. Some examples of taking responsibility for personal mental wellness include: attending a Wellness Recovery Action Plan (WRAP®) course, accessing a local peer support program such as our Recovery and Hope Support Group, or attending an addiction recovery group in the community, such as Life Ring or Umbrella Society.
In the Strategies and Support Group and in family counselling, we offer information on communication tools—notably, Nonviolent Communication (NVC). Also called Compassionate Communication, NVC was developed by Dr. Marshall Rosenberg.1
NVC encourages people to engage in empathic listening, which entails stating one’s observation, expressing a feeling and need through “I” statements, and then making a request to the partner. Compassionate Communication deepens the understanding of each other’s experiences in a respectful and peaceful way. Courses are offered at local recreation centres and colleges, or can be learned directly through couples counselling with a counsellor trained in NVC.
When one partner is in a caregiver role, and sometimes in a parental rather than a partnership role, it can interfere with a couple’s intimate relationship. This can be an awkward topic to talk about but support group members can safely express their feelings of frustration, resentment and anger about this situation.
Side effects from medications can also affect sexual desire and performance. When this is the case, we encourage couples to have a conversation with their doctor, as well as to seek counselling with a practitioner who understands psychotropic medications.
Talking about boundaries can lead to talking about enabling or co-dependency. Enabling can be helpful when supporting a loved one to live and grow, but it can be unhelpful when approaches inhibit growth and may even prolong or worsen the situation. For example, doing things for a spouse that the spouse is capable of doing for him or herself can inhibit growth and undermine self-confidence. This co-dependent state occurs when an ill spouse becomes overly dependent on the caregiving spouse, including for approval and even identity and the caregiver enables.
Whether we are supporting or enabling our spouse is a tough question. Pat Deegan, a thought leader in the field of mental health recovery, puts forward the idea of a ‘continuum of care.’2 This looks at caregiving on a continuum from being involved a little or not at all on one end, to being overly involved in relation to how ill or well the other spouse is on the other end. For example, if your partner just had a psychotic break, you may be very involved in getting your partner’s care needs met (e.g., attending meetings, driving to appointments, etc.). Conversely, when your partner is feeling stabilized and able to do more things for him or herself again, you will become less involved. It’s important for the caregiving spouse to track these changes and adjust the amount of care being provided at any given time.
Financial struggles can present a huge challenge in these relationships. If most of the focus in the partnership has been on the illness, finances may not have been top of mind, and may have become neglected. Or there may have been some financial mismanagement taking place, which can also be common on the part of the person struggling with a mental illness. Also, at times, the spouse/partner may be the only wage earner, which can create extra stresses in a relationship and cause further imbalance.
Financial struggles need to be discussed with the partner who is unwell, but a partner may find it challenging to bring up such issues. Support group members can assist in creating strategies to help.
Questions to ask yourself
If these questions sound familiar to you, and you want more resources, join our Strategies and Support Group or read a resource we like called the Spouses Handbook at www.bcssvictoria.ca
If children are involved in the relationship, questions such as these arise: “Can I leave my child or children in the care of my spouse while I go to work?” and “What will happen to the children if he can’t cope, or gets really ill while I’m not at home?” In the support group, spouses can share their experience and any fears of having child protection authorities called.
To address these kinds of questions and alleviate fears, we discuss preventative measures such as a Ulysses Agreement3 or the crisis plan component of WRAP®. These tools both provide advance care planning for children’s care when a spouse becomes unwell or a relapse may occur.
Couples can get help with creating such an advanced care plan through specialized family counselling, as is offered at BCSS Victoria branch. They also can receive information on educational activity and support programs for their children, such as “Kids in Control” (BCSS) or “Free to Be Me” (BCSS Victoria).
The involvement of children in a relationship may also be a motivator for an ill spouse to seek support, especially if she or he still has limited insight into their mental illness. In the group, we talk about identifying “leverage.” Leverage motivates a person, who doesn’t yet have insight into the fact that they are ill, to seek help. For example, one spouse told her husband, who at first was unaware of his psychosis: “If you want to come back into the home to be with me and our children, you need to go see your doctor for help.”
This may seem like a severe request from a spouse, but it was the only tool she saw available to her and it worked. Her husband of over 20 years still lives with his wife and children, happily. Despite some continued challenges and setbacks, he is moving forward on his recovery journey.
Do I stay or do I go?
What our support group participants have to say…
“This group gives me support, strength, encouragement and direction when dealing with the challenges of having a husband with the mental illness of bipolar.”
“The spousal support group is giving me the tools and encouragement to get back on my feet after supporting my ex-wife for over 20 years, and to find out who I really am.”
“I know I’m not alone and there’s no need to explain as I know others here understand. That is very comforting!”
Whether to stay or leave a relationship troubled with these challenges is often broached in the group. Anger, resentment and hopelessness can not only cause a big rift in a relationship, but can also cause the caregiving spouse to become burned out and depressed.
Healthy self-care strategies that can help avoid or reverse such relationship breakdowns are shared in the group. These may include joining a yoga class or meditation group, starting a new hobby, or getting together with a friend on a regular basis.
Exploring self-care can lead to exploring reasons for staying in a relationship or for leaving it. Group members often struggle with feelings of guilt and fear, stating things like, “If he had cancer, I wouldn’t leave him.” Their biggest worry is, “How will he [or she] manage without me?”
There’s no one right answer—only you know what is right for you as a spouse or partner. In the group we talk about what might be deal breakers for someone considering change and what can one accept and live with, provided we engage in good self-care.
Both people need to be working on the relationship together, and couples need to explore what is right for each partner. Solutions will depend on the mental health challenge, length of relationship, financial challenges, whether children are involved, and other such factors. To help with this, another resource that many people have found helpful is the Spouses Handbook,4 developed in Ontario and available on our website at www.bcssvictoria.ca.
Ultimately, people may choose to continue living together or to live separately. But overall, the goals for the loved one are to be taking as much responsibility for his or her health and wellness as possible. Goals for the caregiving spouse are to engage in, and model, their own self-care and closely monitor and adjust the level of caregiving.
About the authors
Susanne is the family counsellor at BC Schizophrenia Society, Victoria Branch (BCSS Victoria). She provides holistic and recovery-oriented information and support to family members, including spouses who have a loved one with a mental health challenge. Susanne facilitates three support groups at BCSS, including the spousal Strategies and Support Group
Hazel is Executive Director of BCSS Victoria, has over 20 years of clinical and administrative experience in non-profit and public-sector mental health, and is a board member with Psychosocial Rehabilitation Canada. Hazel works from a recovery-oriented perspective
Centre for Nonviolent Communication. Retrieved from www.cnvc.org.
Pat Deegan, PhD & Associates, LLC (2014). Retrieved from www.patdeegan.com.
For more on Ulysses Agreements including templates, see www.bcss.org/programs/2009/12/ulysses-agreement-planning-for-support.
Schizophrenia Society of Ontario, Hamilton Chapter. Schizophrenia and Family Support Centre (2005). Spouses handbook. Hamilton, ON. Retrieved from www.bcss.org/resources/topics-by-audience/family-friends/2004/05/spouses-handbook.