My “first love” with therapy was the clients with issues of childhood sexual abuse. It was years ago when I was a graduate student at Syracuse University, taking the classes to become a counselor. I did the papers about therapy and sexual trauma for three consecutive terms. Ever since, working with trauma survivors have always been my primary practice.

After working with so many trauma survivors with post-traumatic stress disorder (PTSD), depression and/or anxiety as well as other mental health issues such as obsessive compulsive disorder (OCD), I started to see the impact of their struggle on their interpersonal relationship. Majority of the time, the survivors’ mental health issues have significant impact on their intimate relationship.
That is why I became a Licensed Marriage and Family Therapist.

Dilemma

On the surface, it is hard to comprehend there is a connection between couple or family therapy and one’s individual’s mental health problem. Let’s start with the story of Max and Wendy.

Mac and Wendy have been married for about 12 years. They have two children, age 10 (boy) and 8(girl). Everything seemed to be OK until their daughter turned 6 years old. Wendy started to feel depressed. She started to miss work, miss the household work, and miss their children’s school activities. Then, she started to feel very guilty and it paralyzed her even more. She quitted her work, hoping to put all of her energy into family. Unfortunately, she continued to decline until she was hospitalized for suicide ideation. After hospitalized for a week, she felt better but started to fall into depressive mood about a month later. She has gone through different treatment program and hospitalization in the last two years. 

Throughout the individual treatment, Wendy realized that her depression started when her daughter turned 6 because that was the age when she was sexually abused by her step-grandfather. Unfortunately, knowing the reasons why she was so depressed didn’t stop her from feeling depressed. This is just the beginning of her battle.

Her battle with her depression has caused the issues for her family and her relationship with Mac. During this time, Mac has become the sole provider for their family financially and the primary caregiver for their children. Mac tries to be understanding but has expressed to her about his exhaustion. She feels guilty but doesn’t know what to do. Her sense of guilt makes her feel Wendy more depressed.

When I was an individual therapist, I spent a lot of the time to try to understand Wendy’s perspective. It was very clear to me that I need to help Wendy to get better by focusing on the treatment of her depression. The standard question a therapist asks her client is “what do you want?” and the standard direction is to help the client to “take care of you first.”

What about Mac and their children’s wants and needs?

Holding Everyone in the System Hostage

After meeting with Mac and Wendy for the initial assessment (link to the assessment section), it became clear to me that Wendy’s depression and previous suicide ideation has kept this entire family hostage. Mac is scared to ask Wendy for support due to concerns about her depression and suicide ideation. Wendy is scared to ask Max for support because feeling like a burden already. She is also scared to provide Mac support because she is uncertain whether she can trust her own ability. Both children go to Mac for help and it made Mac exhausted and Wendy guilty for not helping out. Two years later, they found themselves in the place where both feel defeated.
After talking to both of them about this pattern, they also started to see this pattern: the more Mac tries to accommodate Wendy, the more depressed Wendy feels. She feels like a useless mother who can’t support her children and husband, just like how she perceived her mother. The more depressed Wendy is, the more Mac tries to accommodate. In the end, they both feel really lonely and helpless in their relationship.

More importantly, Wendy’s depression has not improved much because of her consistent feeling of “useless” and “guilt” about her current life situation.

Support but not Enabling

Once we were able to talk about the impact of Wendy’s depression on their relationship openly, it opened the door for them to discuss some difficult topics, such as parenting, finance, and household responsibilities. Wendy and Mac were able to brainstorm how to work together to finish the tasks in the household while working around Wendy’s depression. The often made this joke: “depression is our third child and we have to work around her.” 

During these sessions, we didn’t shy away from discussing Wendy’s childhood sexual abuse or deny the fact that she was depressed. Being able to have an open dialogue between them brings the “here and now” factor into Wendy’s depression treatment. That is, she didn’t stop living her current life and to allow the impact of her depression on her current life to become another risk factor to worsen her depression. 

More importantly, we are able to save their marriage and maintain the intact family for their children. I cannot imagine how long Mac would stay in this relationship based on the exhaustion, physically and emotionally, he experienced. Max was able to express his frustration and to ask for support from Wendy.

“For Better and For worse, in Health and in Sickness, Till Death do us apart. ”
So, here is my question, why do we separate the person with mental health issues from their partner when we provide the therapy to help them heal?

P.S 1, I deeply appreciated all the individuals and couples who have provided me a chance to walk into their lives and to share their journey of change with them. The story of Wendy and Max are fictional but the materials come from different couples who struggled with the similar issues.
P.S. 2, Just in case you wonders why I call them Wendy and Max, Wendy= Wendy’s. Mac= MacDonald. I often wonder what would be like if Wendy’s and MacDonald merge into one.