This is a study of how couples talk to each other about not feeling well. Kandi Walker and Fran Dickson reported on 53 couples who provided interview and questionnaire information having been contacted through convenience sampling procedures. The couples reported an average age of 43 years (range = 22 to 81), and the majority was Caucasian (83%), followed by Native American (7%), African American (5%), Hispanic (3%), and Asian (1%). The average length of time married was 17 years (range = 1 month to 61 years).
The researchers reported that the major finding from their analysis of the qualitative data on illness-related narrative was that couples do have unique and distinct ways of managing minor illnesses in their marriages (p. 531). These approaches can be thought of as a typology on illness-related talk for couples based on clarity, needs, and spousal response. According to the researchers, Each spouse had distinct needs and expectations of the other spouse when minor health problems were present (p. 532). These needs and expectations became scripts, which are ritualized recurring patterns that dictate the ways in which couples deal with illness and incorporate them into everyday life and relational dynamics (pp. 532-533). The couples types were: sympathetic, independent, mixed, nonreciprocal, and rejecting.
The sympathetic couples were mutually needy (p. 533). They both openly talked about needing to be taken care of when they were ill, and they validated this need in one another, showing high levels of empathy. The independent couple was characterized by autonomy and self-sufficiency, wanting time to themselves when they were sick (autonomy) and to take care of their own needs (selfresearch digest High Maintenance Relationships sufficiency). The mixed couple occurred when one partner was more of the sympathetic type, while the other was more of the independent type. These couples rely on teaching their partner what they need and expect when they are sick (p. 537). The nonreciprocal couple was characterized by unmet needs and expectations. Perhaps one would meet the others needs, but not have his or her needs met in return. There appeared to be a gender split here, with more women meeting the needs of their husbands, while feeling neglected when the roles were reversed. The rejecting couple did not meet one anothers illness-related needs. As the authors observe, the mindset was I dont do what you want because you wont do what I want (p. 539).
It is interesting to consider ways in which couples may create their own illness-related talk or narrative. It may be helpful for Christian counselors to think about this couple typology when they work with couples in which one partner is facing an illness. As the authors observe, how couples relate during an illness may reflect other patterns that are reflected in their marriage as a whole. Finding ways to articulate expectations and identify and share creative solutions may be to the benefit of both partners.
Attachment, Reassurance and Depression Shaver, P.R., Schachner, D.A., & Mikulincer, M. (2005). Attachment style, excessive reassurance seeking, relationship processes, and depression. Personality and Social Psychology Bulletin, 31 (3), 343-359.
Phillip Shaver and his colleagues studied reassurance seeking and depression in couples. They report on two studies. The first is of 72 couples who filled out questionnaires on excessive reassurance seeking behavior, attachment style, depression, and relationship quality. Sixty-one couples participated in the second study, completing the same questionnaires and completing a daily diary over the course of two weeks.
Interestingly, partners notice their own and each others excessive reassurance seeking behavior, but this does not tend to lead to dissatisfaction in the relationship. The consistent finding across both studies was the excessive reassurance seeking behavior was related to depression, but apparently as a function of attachment anxiety. The importance of attachment anxiety or insecurity held true for both men and women. Relationship quality was related to avoidant attachment, with avoidant behavior being negatively correlated with relationship quality.
The second study allowed for the examination of processes at the daily level. Shaver and his colleagues reported that, for women, the more anxious the woman was, the more dsyphoric she would be after she sough reassurance. Less anxious women were less dysphoric following reassurance seeking behavior. The authors conclude: Reassurance seeking seemed to make anxious women feel worse emotionally, but it had no such effect on secure women (p. 356). It would be interesting to determine, as the authors suggest, whether anxious and nonanxious women seek reassurance in different ways (or view themselves differently as they seek reassurance).
It is interesting to reflect on the ways attachment style may be related to reassurance seeking behavior, and it is important to consider, too, ways in which men and women may be socialized to either seek reassurance or not, and whether this can occur independent of attachment anxiety. In any case, Christian counselors may want to consider attachment style as they work with couples to identify patterns in their approach to conflict resolution and daily relationship processes.
When Perfectionism Interferes with Intimacy
Martin, J.L., & Ashby, J.S. (2004). Perfectionism and fear of intimacy: Implications for relationships. The Family Journal: Counseling and Therapy for Couples and Families, 12 (4), 368-374.
James Martin and Jeffrey Ashby of Georgia State University studied the relationship between perfectionism and the fear of intimacy. The researchers reported on 200 college students (mean age = 19.86 years). They distinguished through cluster analysis (by which they identified naturally-occurring groups within the data) between adaptive perfectionism, maladaptive perfectionism, and non-perfectionism (based on scores on the Almost Perfect Scale " Revised).
Martin and Ashby reported that maladaptive perfectionists endorsed extremely high standards for their personal performance, but consistently and self-critically appraise their performance as failing to meet those standards (p. 371). Students who identified as maladaptive perfectionists showed greater fear of intimacy than students in the other two groups. Interestingly, adaptive perfectionists tended to score low on fear of intimacy, but the lower scores were not statistically significant. According to the researchers, Fear of intimacy for those struggling with perfectionism may be related to perception of criticism (p. 372).
Both self-criticism and perceived criticism by another can lead to strain in intimate relationships. This is important information for Christian counselors as they work with people to promote honest self-disclosure (transparency), mutual acceptance, and the extension of grace in intimate relationships.
Severe Marital Stress
Cano, A., OLeary, K.D., & Heinz, W. (2004). Short-term consequences of severe marital stressors. Journal of Social and Personal Relationships, 21 (4), 419-430.
In a longitudinal study of the short-term consequences of severe marital stressors, Annmarie Cano and her colleagues examined emotional distress and marital dissolution among two groups of women (mean age = 40.87; SD = 8.64; 96% of the sample identified as Caucasian). The two groups were women who had reported a recent severe marital stressor, such as infidelity, the threat of separation or divorce, or physical violence (N = 25), and those who, although reporting comparable levels of marital discord, reported no such recent stressor in the previous six months (N = 25). Women in both groups provided information at baseline and one and two months following the initial interviews.
Those who identified a recent marital stressor reported greater reductions in negative emotions, such as anxiety and depression, over the three assessments than those women who did not report an identifiable stressor. Interestingly, they were more likely to separate or divorce within two months following the stressor. In other words, women who had similar marital discord, but no such identifiable stressor reported symptoms of anxiety and depression that remained stable over time, and these women were less likely to separate or divorce.
As the researchers acknowledge, the study does not measure and report on ways in which marital quality may be more complex and idiosyncratic and there is certainly much more to be gained from studying the relationships between marital discord and symptoms of negative emotions. At the same time, the researchers observed, Marital stressors may be qualitatively different from marital discord in that the former severely affected levels of commitment to the spouse and evaluation of the worth of the relationship (p. 428).
Also, Christian counselors may find it helpful when working with couples reporting marital stressors to consider, as the authors suggest, models of forgiveness as indicated and in keeping with the other goals for counseling.
Depression and Personality Disorders
Grilo, C., Sanislow, C.A., Shea, M.T., Skodol, A.E., Stout, R.L., Gunderson, J.G., Yen, S., Bender, D.S., Pagano, M.E., Zanarini, M.C, Morey, L.C., & McGlashan, T.H. (2005). Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity. Journal of Consulting and Clinical Psychology, 73 (1), 78-85.
In this study Carlos Grilo and his colleagues examined the course of remission from depression (Major Depressive Disorder) as it related to comorbid personality disorder. The researchers studied 302 participants (196 women, 65%; 106 men, 35%; mean age = 33.4, SD = 8.1 years) drawn from the Collaborative Longitudinal Personality Disorders Study. Seventy-two percent of the participants were Caucasian, 16% were African American, and 10% were Hispanic American. Participants provided information at baseline and again at 6-, 12- and 24-month follow-up.
The overall remission rate for Major Depressive Disorder was 74% over 24-months. Those diagnosed with a comorbid personality disorder (borderline, schizotypal, or avoidant) took longer to report remission of symptoms of depression than those who were not comorbid for a personality disorder. The findings were remarkably consistent across gender, with 79 of the 106 (74.5%) males and 142 of the 196 (72.4%) females experiencing remission from Major Depressive Disorder. Participants who were comorbid for Major Depressive Disorder and a personality disorder were more likely to seek treatment than those who only suffered from Major Depressive Disorder. However, treatment was not found to have a statistically significant effect on time to remission (neither did gender nor ethnicity).
As the researchers conclude, the next step is to identify the various factors that may contribute to the course of depression. These would likely included life events and specific treatment programs so that we can have a better sense of how to provide intervention and support to those suffering from Major Depressive Disorder, as well as those who are comorbid for depression and a personality disorder. Online counseling is always available to help you out.
_Mark A. Yarhouse, Psy.D., is associate professor of psychology at Regent University, Virginia Beach, Virginia. He is co-author (with Lori A. Burkett) of the book, Sexual Identity: A Guide to Living in the Time Between the Times (University Press of America)._
