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Helping families heal

Sometimes it got so bad that she would go outside and cry in the rain, just sit there in the freezing rain, sometimes for an hour. He would go to her, and she would tell him to go away. But she didn’t mean it. “When you’re depressed, you don’t want to be around anybody,” she explains. Except that wasn’t really true.

They didn’t communicate, not really, not for years. “We tended to keep our opinions to ourselves, and it became a wall. We were fighting each other instead of helping each other,” Caitlin says. “We didn’t understand each other’s point of view.”

The problem intensified when Caitlin, a health care professional, started working an overnight shift. The schedule change affected her sleep patterns, which seemed to spark a recurrence of her depression. Her schedule was exactly opposite David’s; while he was at work during the day, she was at home with the kids. “We never made time for each other,” she says.

This is familiar terrain for most couples at some point in their relationship. But when one partner is coping with mental illness, a relationship can strangle on unspoken words.

For Caitlin and David, longevity wasn’t necessarily a positive. “It’s a lot easier to be complacent when you’ve been together for years and years, and you take so much for granted,” says Caitlin. “You can take things way too far and step on the other person.”

They met when she was eighteen and he was twenty-three and she was in a church youth group with his sister. He was an older guy with a cool car who wasn’t afraid of her abusive father. She was already struggling with depression. For the next 18 years, he would struggle too – angry and withdrawn by turns, periodically trying to “fix” Caitlin’s problems. She just wanted him to listen.

“I’d get all bummed out,” David says. “I’d want to give all the answers. But sometimes it’s best to communicate with the two ears, you know? God gave us one mouth and two ears for a reason. The Bible says don’t let the sun go down on your wrath, and we’d try not to go to sleep angry … but we’d never seem to get over the hump.”

“I’ve been angry for the way I’ve been treated … but I’m not really angry anymore,” he adds, his voice trailing softly away.

Ironically, it started to get better for them after Caitlin took the pills on Thanksgiving morning. He wanted to go to his mother’s house for dinner. She didn’t want to go. He started to leave the house with the kids, saying that they’d probably be better off without her. He meant on Thanksgiving. She thought he meant forever. He caught her in time.

The episode brought Caitlin to Butler Hospital. And Butler Hospital brought family therapy to Caitlin and David.

Learning to listen

During Caitlin’s inpatient stay at Butler, the couple began to work with Alison Heru, MD, who heads the hospital’s marriage and family therapy program. Almost immediately, their conflicts began to rise to the surface. He tended to look at the bright side. She didn’t. He liked to get an early start while away on vacation. For her, vacation meant a chance to sleep in. And, complicating the ordinary challenges of family life, there was Caitlin’s depression hanging over them like a cloudy sky.

“We always understood that we have some differences and don’t always see them,” says Caitlin. “A pair of outside eyes was very helpful.”

David began to see how fundamentally different his life view was from his wife’s – and that it wasn’t necessarily something she could embrace, particularly when she was in the depths of depression.

“I like to look at a half-full glass and I can usually find something good in any situation. I’d say to her, be grateful that you have a roof over her head. It would seem superficial, but I meant it as a really positive comment,” he says. “I would hear her stressors and not value them to the same level that she did.”

Caitlin found an opportunity to verbalize her own insecurities and articulate what she needed from David – both in and out of depression. “I said you have to love me both ways. I said you can’t take the emotion out of me.”

Some of it was hard to hear. And both Caitlin and David say that one of their most important lessons in family therapy was how to listen. In fact, they were contractually committed to learning that skill.

Signing on the dotted line

In collaboration with their psychiatrist, each couple entering family therapy at Butler Hospital develops a customized contract” with each other. The document features specific behavioral techniques, which are designed to address the couple’s unique challenges and problems, and is signed by both partners. At each session, the couple reports on progress.

One of Caitlin and David’s contractual responsibilities was to practice listening without interrupting – each allowing the other to talk about an issue for five minutes, without breaking in with an opinion or response. They find the technique extremely helpful. “When you’re getting ready to jump in and defend yourself, you tend to focus on your own defense mechanisms and you don’t hear the rest of what’s going on,” says Caitlin.

They easily recite a litany of other lessons learned in family therapy. Subtle hints don’t transfer. Don’t use always and never. Address minor disagreements and issues early, before they build up over time. Concentrate on listening. Read expressions; don’t just listen to words. Don’t personalize.

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