Podcast: Maintaining a Mentally Healthy Relationship

Jenn talks to Dr. Lisa Coyne about how to maintain healthy relationships with family members, friends, and significant others. Lisa highlights the effects of mental wellness on relationships, explores the ways in which communication can positively impact the relationships’ dynamic, and answers audience questions about the importance of working through challenges together.

Lisa W. Coyne, PhD, is an assistant professor of psychology in the Department of Psychiatry, part-time, at Harvard Medical School, and is a senior clinical consultant at the Child and Adolescent OCD Institute (OCDI Jr.) at McLean Hospital. Dr. Coyne has published numerous peer-reviewed articles and chapters on anxiety, OCD, and parenting. She is the author of “The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years,” a book for parents of young children.

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Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Hi folks. Good afternoon, good morning, good evening. Thank you for joining us wherever and whenever you are joining us to talk about the value of maintaining mentally healthy relationships.

I’d like to introduce myself, I’m Jenn Kearney, and I am a digital communications manager for McLean Hospital. And one of the relationships that is most impacted by mental health or by mental illness, besides the relationship that we have with ourselves, is the relationship between you and your partner.

And just like no two people are alike, no two relationships are alike. So all relationships can really benefit from having open lines of communication, addressing stigma, bringing your most authentic self, and ways to build on skills to cope and navigate through challenges together.

So I’m really excited to have Lisa with me to talk about all of this and the effect of mental wellness or mental illness on our relationships with our partners.

We’re going to talk a little bit about the ways in which communication can positively impact the dynamic of a relationship as well as why some of your biggest hurdles are best conquered with a partner instead of as a solo act.

So, if you are unfamiliar with her, Dr. Lisa Coyne is a psychologist and senior clinical consultant for the Child and Adolescent OCD Institute at McLean Hospital. She is also author of several books, including “Stop Avoiding Stuff” as well as “Stuff That’s Loud.”

Oh, those are actually two different books, so the way that I just said it made it sound like that was one title. So she’s helped write, “Stop Avoiding Stuff,” and “Stuff That’s Loud.” So, Lisa, hi.

Lisa: Hi.

Jenn: You think after like 70 of these I’d be better at it but every year it’s a learning opportunity, every time. So, thank you for joining me again to talk about all of this stuff.

I would love to get started by just asking you why is mental health, or the very least, talking about mental health so important for our close relationships?

Lisa: So, it’s really important.

And I want to say I hope that folks are listening about their partners, and also if there are parents out there, or kids out there, and you want to think about how do you talk to your parent or child about a mental health issue, I want to expand it so that I have lots and lots of resources for you today.

So, we are herd animals, humans are, and while we do like our downtime, it’s really important because social connections give us pleasure, but they also influence our long-term health, both mental and physical.

And you can really think of having a good relationship, a healthy, nurturing, supportive relationship, as an important factor in your mental health the same way as you might think about sleep or good diet or exercise or not smoking because there is data showing that it is actually that important.

It has important health benefits. One of the things as we age, not that either Jenn or I are aging ever, of course not, when you have a lack of social ties, you’re more likely to experience depression and later life cognitive decline as well as increased mortality. So it really, really is important.

Jenn: So, how can we better cope with mental illnesses in our relationships?

Lisa: So, I think it’s really important. First of all, there’s so much stigma around mental illness, and this is one of the reasons I love doing these webinars with you, Jenn, because I feel like one of the things that’s really important about this is communicating that we need to start breaking down stigma.

They are ubiquitous. One in three people over the course of their lifetime is going to have a clinically significant issue or struggle with anxiety, for example. And so it’s really, you’d be hard pressed to find a family anywhere that didn’t have some sort of stress, mental health issue somewhere in the family.

So, I think it’s really, really important. When we sort of try to hide pieces of ourselves that we feel shame about or that we feel scared of or that we are worried that might impact our relationship, that’s going to take up your bandwidth for coping with stress.

It’s really, really important. And openness and honesty is of course at the heart of good relationship skills and healthy relationships.

So, it’s important to think about, to, first of all, to be open about it, second of all, to think we can talk about how to talk about it, how do you introduce it? What’s the right way to do it? Are there helpful ways to do it? Are there unhelpful ways to do it?

And then how do you actually, whether you have a mental health issue yourself or whether your partner does, or if you’re a parent or a child, how do you have healthy boundaries around that, where you have your own self-efficacy and you look after yourself and also you can reach out to your partner, parent, or child for support.

Jenn: So, I know one of the most challenging things is, you want to be the best person for your partner and for yourself, and sometimes, especially with the stigma that’s around, it feels like if you have a mental health condition, if you disclose that, it’s almost like you’re not bringing your best self. And that’s a lot of the self-stigma that’s talking.

So, should you be sharing these conditions with a partner, whether, like, you’re newly diagnosed or you’re new to the relationship?

Lisa: So I think that there’s a question that’s bigger about this, and it is, do you want to be in a relationship if you’re really worried that someone is going to not care or accept a piece of you?

And one important thing to notice is, you’re not your mental illness, it’s a part of you. That’s really, really important to understand.

And if you feel like you have to hide any piece of yourself in order to be acceptable in a relationship, that’s probably not a very healthy relationship. Now, does that mean you should leave? No, not necessarily.

It means that it’s probably helpful to have a conversation about this kind of thing because, again, openness and sharing and intimacy are going to be really important parts of healthy relationships.

Jenn: So, let’s say I decide to share with my partner that I’m feeling challenged by a mental illness or I have a new diagnosis, how do I even approach this conversation? Like, how do I even start with this?

Lisa: So, it’s really tough. And I think that one of the things that is really important is to think about, like, how old you are. Are you a kid or are you a partner?

So, a couple of things that are important is, think about, first of all, gather information about your own mental issue that you’re dealing with. Find some stuff that you think is useful, that kind of summarizes the things you think are important and make sure you have that as a resource, as information.

And then you want to think about when and how to introduce this because this is an important topic. So, in the middle of a fight? Not a great time. In the middle of trying to get the kids out the door? Not a great time.

Pick a time, make an appointment, say, “Can we chat?” And if that feels too big and momentous, you could even start with a text, say, “Hey, I’ve got something to talk to you about. I’m a little scared.”

And we’ve talked about these ways of having these sort of values and vulnerabilities conversations in previous podcasts. And here’s another place where they’re useful.

And the two ingredients of a conversation that can really help you be heard are, what’s important to you, and something that’s a vulnerability.

So, it might go something like, “I’m a little anxious about talking to you about this, and yet I think it’s really important because what’s most important to me is that we have a really strong, healthy relationship and that we can share things openly.”

So, thinking about having those components of it will be important. But think about the timing. It doesn’t need to be all at once. It’s probably going to be a series of conversations.

You can introduce the topic and say, “I’m not ready to tell you tons, but I just want to let you know this is going on with me. You can ask me questions about it if you need, if you want, I’m happy to try and answer them. And by the way, here’s some resources for you to read about them.”

Jenn: So, how would we approach the conversation if our partner comes to us with all of those? Like, how would we... What are some best ways to react and be supportive?

Lisa: So, I’m so glad you asked that because I think that, first of all, it’s really... It’s a sign that someone really trusts you if they come to disclose this thing.

And your mind might be swirling with, “Why didn’t they tell me earlier. Oh my gosh,” you could be scared, you could be mad, you could be like, “Oh, that’s why all this stuff’s been going on. I thought something was there.”

Listen, notice what you’re thinking and feeling, make a space for it to swirl around in your head. And when you listen, don’t think about the next thing you’re going to say. Take it in, right?

And it’s okay if it catches you off guard, because it might. We’re not always so skillful and thoughtful in how we share this stuff.

So, think about, just focus on, this is really great that this person is telling you this. This is a sign of their care for me, that they’re wanting me to know, and sit back, take it in.

And my rule of thumb in my relationship with my husband is, and I don’t always get this right, I mean, none of us always get it right, is if you’re feeling a super strong emotion, wait, pause, think about it.

Let it kind of spin around and then come back when you’re calm. That’s a really important thing because you’re not going to know the right things to say.

And also, one thing that will show up for you is, “Oh gosh, what do I say to make them feel okay,” right?

And so, the most important thing is to just empathize where you can, and it might be something like, “Wow, I am so glad. I don’t know what to say,” it’s okay to not know what to say.

“And I’m so glad you shared that with me. Thank you so much for trusting me with that. Give me some time to think about it.” And that’s it. And you can leave it right like that for the first conversation.

Jenn: So, I know a lot of times there’s a lot of stigma still, particularly when it comes to men seeking mental health help.

How, if our partner is male and comes to us and says, “I’m having a really hard time with ABC,” how do we suggest therapy in a way that might not continue to feed their stigma or anxiety about going to therapy?

Lisa: I think that’s such an important question. And I think this all the time because I have, in my household right now, my daughter is 21. She’s going to 22, almost. She’s going to graduate from college. But I have two guys. I have my husband and my son who is 16.

And I think about the strictures that people who identify as men have to deal with in terms of what’s okay to share, what’s not okay to share and all of the sort of socially derived stories about what it means to be a strong person, what it means to be vulnerable, and all of that stuff.

So, the very first thing I think I would say is, “Thank you for telling me. It’s a sign of strength that you’re willing to be vulnerable.” And I kind of want to get that tattooed in their heads.

It is a sign of strength guys if you share your vulnerability, okay? Really. And if I may be so bold, it is also sexy guys if you share your vulnerability. It really is. So just kind of, I don’t know what Jenn thinks about that.

Jenn: I’m just nodding. No one can see me, but I’m nodding over here, that I have told my partner that what you identify as your weakest moments are actually your strongest moments.

Lisa: 100% true. So, that’s the very first thing. And the second thing is, I wouldn’t ever tell someone, “You should go get therapy.”

I would say, “Do you feel like you have enough support? Would it be useful if there were some help for this? Would it be useful to you to look into it? Would you like me to look into it for you? Did you know...”

And if you’re a partner, do a little research on your own and find out if there’s an evidence-based treatment for that. Find out if there’s something that might be helpful for your partner and bring that to the table.

Say, “Did you know this?” Now, make a space too because if you start to offer stuff like that, people can take it the wrong way and that’s okay. That’s okay. No one’s perfect.

And we all kind of step on each other’s toes and it’s just part of it. So, these conversations are messy, and making a space for that messiness I think is really, really important.

Jenn: So, I know that one of the most important questions is, if a person doesn’t feel like they should be going to therapy, you can ask them, “Do you feel supported enough?” And that can be a gateway to seeing if they need additional help.

What do we do if our partner feels really supported by us but we’re feeling overwhelmed? Because a lot of times you want to shoulder the burden with them. Do we seek our own therapy? Do we try couples therapy? Like, what’s the best approach to that?

Lisa: That’s such a good question because there’s just a whole bunch of different things you could think about. But one thing that’s really important is, first of all, yes, get support for yourself. Absolutely.

And two, is think about what it means to be in a healthy relationship. Our job in relationships, couples relationships, is not to fix or carry the other.

Now, that helping, over the course of relationships, absolutely, there are going to be periods where you’re vulnerable and your partner’s going to step up hopefully and help you and vice versa.

Certainly in my relationship we have had that same thing, and we’re going on, knock on wood, we’re celebrating our 25th wedding anniversary this summer. I know I might toss him off the boat, but no, I’m just kidding, but seriously...

But you’re not responsible ever in a relationship for someone else’s emotions, and that’s really, really important. That’s not to say that you shouldn’t be empathic, kind, and supportive, but it’s not your job to fix how they’re feeling.

And so thinking through what does it mean to have healthy boundaries with respect to this is important. And if you feel like that’s a tough conversation for you to have together with your partner then both of you should go and you should go for couples work.

That’s a really great use of that because those kinds of things when left unaddressed can lead to all sorts of resentments and difficulty. And it’s like a snowball gathering, snow rolling down a hill. You don’t want to do that.

So definitely, seeking support for yourself, making boundaries with your partner that are healthy, or, if you can’t handle it together, and it is totally okay if you can’t, get couples work. Have somebody help you talk it through.

Jenn: So, what do we do if both people in the partnership are coping with mental illnesses?

So, for example, if both people are dealing with anxiety, how do we prevent it from becoming a self-fulfilling cycle of feeding into one another’s anxiety?

Lisa: Well, I would say, if anxiety... If you’re worried that anxiety is an issue, there are great evidence-based treatments out there for anxiety.

And whether you do them individually, which I would recommend, if it’s your issue and two of you have it, absolutely go and get some support for that. I think that that’s really important.

And I think that keeping curious about how does my behavior work in this relationship? How does it impact this relationship is really, really important.

And sometimes if you’re worried about anxiety and managing it, that can take your eye off the ball, and you can become really focused on that instead of the relationship that you’re building with your partner.

Jenn: I do have a couple of questions about blended families. And as much as I hate the statistic that they say one in two marriages end in divorce, there’s a ton of blended families out there.

So, what do we do when our new partner is having a difficult time with things that are from our previous family? How do we work through this with them?

Lisa: I think, again, it has to do with openness and communication. Cultivating... So, there’s a couple of things that predict healthy relationships. And one is, communication. Really healthy communication and openness.

Which means bi-directional. It doesn’t mean just telling. It means listening, taking in, being influenced by what your partner is saying. And then the other thing is how you manage conflicts because I can imagine that that kind of stuff can lead to all sorts of conflicts, and that’s really tough.

And so, thinking through how to compromise, how to talk through conflict in a healthy way, and there are some things that we can do that really are not great in relationships.

Like, sort of, criticism, treating our partner with contempt, being really defensive about things, or stonewalling. “No, I’m just not going to talk to you about this.” Those are things that are predictive of not good outcomes in relationships.

So all of this is to say that, we all know it’s really tough sometimes to talk about those things that are hard. You can feel vulnerable, you can feel ashamed, you can feel angry.

And part of being in a healthy relationship means allowing yourself to feel the emotions that are coming up, and instead of reacting to them, noticing them, pausing, and then choosing, What do I want to do?

What is this next right step here? Is it listening? Is it pausing? Is it taking in criticism or feedback? And we all have that kind of stuff going on in our relationships. It’s really, really important.

And there’s nothing so good for intimacy when one of you is really cranky but takes a step forward and says, “You know what, this is really bothering me. And I wish, it would be so helpful if you could not do that?”

And the other one says, “Wow, okay, I hear that. I can do that.” It’s really good. And you’re going to have those over and over and over in your relationships. So it’s so important to deal with them.

Jenn: One of the challenges about blended families too is a lot of times there’s co-parenting.

Lisa: Oh yeah.

Jenn: So, what do we do if our former partners are disagreeing with our approaches to our kids’ mental health challenges? Any suggestions for how to deal with this?

Lisa: Absolutely. And that’s a really tough one. So, rule number one, mom and pop, or mom and mom, or dad and dad, or whoever, don’t fight in front of the kids. Do not.

If you disagree, that is something for you to discuss later. But if you undermine each other in your parenting, that is hugely unhelpful. And when you think about, when you look at the data on divorced families, it’s not necessarily a divorce that is the predictor of poor outcome for kids.

It’s conflict. It’s ongoing conflict. It’s using kids as pawns. It’s fighting over these disciplinary approaches in front of them. Be really careful.

So, it can feel bad if you’re like, “Oh gosh I really want to say something, and that’s not the way I would do this,” but hold it, talk about it later. Talk about how it worked, notice how it worked, and then see if you can come to a compromise because the other thing that is really important in terms of parenting is consistency across parents.

And so seeing if you can find a way to meet in the middle is really important. And again, if you feel like that’s tough, absolutely, talk to somebody about it. Talk to somebody. Do some family work, get some parent training.

There’s plenty of classes and things like that where you can learn, but it’s really, really important. And the other thing I’ll say about that too is, it’s okay that... No one’s great at everything as a parent.

In our family it’s really funny because there are the things that I am good at. Apparently I am never the weak link according to the kids, but I am also not the person who... I get into arguments with my daughter, not anymore, but when she was a teenager, and my husband used to say, “You’re just like her. So, you can’t be the one to talk to her about stuff because the two of you are like this.”

I’ll do it. And I actually had to step back and be like, “You know what, you’re right. You’re the right person to do this.” And I share that because nobody has to do everything, right?

And you can tag team, and you can tap somebody in if you need a break, you need your 10 minutes to calm down. Those things are really, really important. And support each other because parenting can be hard, especially if you have kids with mental health issues.

Jenn: I feel like parenting is one of the most rewarding and, at the same time, one of the most of thankless jobs--

Lisa: And terrifying. Don’t forget terrifying.

Jenn: I don’t know how you all do it, but you are all heroes in my book.

Lisa: Man. Seriously, yeah, I think that too, of all the parents that I work with, and it’s just, it’s so hard, it really is. Especially during the pandemic. I mean, and we’re looking at all this data about how, especially moms, increased rates of stress, depression, substance use.

And there have been lots and lots of pieces that have come out in the media about how moms are really bearing the brunt of this pandemic. It’s so hard. It’s so hard to figure out how do you work at home and manage all of this stuff.

Jenn: So, one thing I’ve always been curious about, and I am childless, but always curious, how can my partner and I set a good example for our kids? Not mine particularly but in terms of having mental health be a really visible part of our relationship’s fabric.

Because kids are sponges. They’re going to pick up everything that you’re doing in front of them. So, how do we do this? How do we make mental health a thing for them?

Lisa: Model. So, modeling means... So, here’s how not to parent. Don’t do what you say. Don’t do what you tell them to do. Modeling means if I say it, I’m going to do it too.

And so, I grew up... For example, I grew up with ADHD. I didn’t know, like nobody knew what it was back then. And I have, like, a ton of compensatory strategies at this stage to handle it. And my staff know I’m like, if you don’t get an email from me in 48 hours, you need to make sure, I won’t be mad, but email me again because I forgot it.

But my daughter has ADHD too. And so, the best way for me to teach her acceptance, awareness, and reducing stigma is for me to disclose. It’s the number one best thing, is to make a space for emotions. It’s make a space for conversations. Joke about it, be flexible about it.

It’s not the end of the world. You know, just ADHD. I mean, like, anyway, but you get the idea. So, making a space to talk about these things is really, really important in modeling, and welcoming it when your kids talk to you about it.

Now, I want to say something about teens because I think that that’s a point when lots of parents start to worry. Kids start to pull back, they start to want more privacy. It can be really scary because at the same time they’re pulling back, they’re more in the world, they’re more online.

You don’t know who they’re talking to, they are, you don’t know what kinds of relationships they’re having necessarily. And so there’s a real balance to be sought between being present, being supportive, being connected, and giving them flexibility and freedom to learn and to take some risks, et cetera.

And that’s a stressful time for parents. And the other thing I’ll say about that is that…we talked a little bit about parenting burnout earlier in the pandemic but one of the things that leads to burning out in your relationships with your kids is trying to parent perfectly.

And one of the things that parents can do when they have kids, whether they have mental health issues or not, is they’ll try and parent to specification. They’ll think of themselves as, “I got to build the perfect kid,” “I got to get them to school,” “I got to get them to a good college,” “I got to get them to do really well on their SATs,” “I got to get an A on this paper.”

And you see a lot of this actually in Massachusetts, where we are. A better model is to think of yourself as a gardener rather than a carpenter. And this is based on Alison Gopnik’s wonderful book of the title I think Gardner...

Something like that. Jenn can put it up, but it’s something about, are you a gardener or are you a carpenter? And think about the role of a gardener. It’s to provide the context in which a child can thrive.

Did I model? Did I teach them the skills through modeling about how to handle a mental illness? Did I teach them how to have good relationships by being open and nurturing?

Did I teach them how to hold themselves accountable by holding myself accountable? By holding them accountable? By giving them chores and roles in the family and things like that.

So thinking about how can you nurture like a gardener instead of building to a specification is a really important thing.

Jenn: I absolutely love that you used the gardener analogy. I was having a conversation last night with a friend about this and how, at a certain point, even when you are caring for other people, you have to remember to water your own grass.

You can’t be minding everybody else’s flower beds if you aren’t tending to your own.

Lisa: Exactly. Exactly right.

Jenn: So I do have to ask because there are so many of us who are feeling burnt out after the last, I don’t, 14 months or so, of mayhem.

So, how do we help our partners with burnout if we’re feeling a little bit crisp around the edges ourselves? And I want to say asking for a friend, but like, this is my own, this is my own question.

Lisa: I wasn’t going to pull... I have like my little pile of books to show you guys, but honestly, put your own mask on first. You can’t help someone else without taking care of yourself.

And there’s a lot to be said for slowing down and really listening to your body, listening to your emotions, their information. If you’re feeling burned out, your body’s trying to tell you something.

It’s trying to tell you either you’re working too hard. You’re doing too much. You’re ignoring some emotions that are wanting your attention. Maybe you’re very self-critical and trying to flog yourself on so that you can kind of do more. Don’t do that.

So, there’s a great sort of compassion focused therapy and compassion focused approaches that can cultivate self-compassion, self-kindness are really useful. And this is one of my favorite books. It’s really simple.

It’s by Laura Silberstein-Tirch, “How to be Nice to Yourself,” very simple. She’s a really dear colleague of mine. She’s a young mom as well. And it’s just a really great book. And it’s a really great approach to looking after yourself.

And remember that idea of modeling. If you were looking after yourself, you’re going to make a space for the people around you to do the same. It’s really, really important. If you value taking care of yourself, your partner, your child will start to value that too by your example. So, that’s really important.

Jenn: So, when it comes to like caring about yourself, I know one of the things with several mental illnesses including clinical depression, is, you just develop apathy. You don’t want to get out of bed, you don’t want to do anything. The couch is.... You’ve become one with the couch.

You’re, I think it was like a Family Guy episode where he ended up being adhered to the cushions at one point, and like, that’s what I think of when I think of like my seasonal depression.

I’m like, “I am one with the sofa,” but taking care of yourself can sometimes be really, really, it can seem forceful.

Lisa: It can.

Jenn: So, how do you recommend including your significant other or other people that you care about in activities that are healthy and that you love doing that are part of putting on your own oxygen mask without coming off as being pushy, forceful, offensive?

Lisa: Yeah, it’s hard. So are you saying how do you, when you’re depressed, how do you include your partner? Or when your partner is depressed?

Jenn: If your partner is not doing healthy, enjoyable activities, how do you get them involved without basically like pushing them out of a moving car?

Lisa: Yeah, gotcha. That’s a really tough one too because you can’t really get anyone to do anything. You can ask, and, again, I think I would go back to thinking about that values and vulnerabilities conversation, about, “I care about you, I’m worried.

I know you don’t feel like it. And I know this doesn’t feel good to you. And I think it’s really important that we spend some time together. And I’m wondering if there’s one small thing you might do with me today, even if it’s just kind of a small thing.”

And then asking, “Is there anything I can do to make that easier for you?” And you can say, “I don’t want to be pushy. That’s not my intention. It’s just that I care about you. I see you suffering, and I want to see what we can do. Why don’t we try this?”

And I think it’s really, it’s so hard because we’re not always so good at not reacting to strong emotion. And we’ve talked about this concept before Jenn, of psychological flexibility, which means stepping back from your emotions and your thoughts and choosing to behave really flexibly in ways that are consistent with the things that you most care about.

And so an example of that with depression might be, really not feeling reinforced or joyful about stuff and doing it anyway because what’s important is staying in your life and building a life.

And in fact, that is part of the evidence-based treatment for depression, which is called behavioral activation, which means scheduling pleasant or meaningful things to do every day, like a diet.

Got to eat your vegetables, got to take your walk, got to talk to your partner, got to do a little bit of exercise. And making a practice, even if it’s a tiny, tiny thing that you’re doing every day. Starting small but just getting in a routine of that. That’s one way that will help lead you out of that depression.

Jenn: And also making it fun.

Lisa: Yeah, to the extent that that’s possible. Yes.

Jenn: As a personal example, I, for the month of January, wanted to incorporate small habits into every day. So I made a habit tracker so that everything I wanted to add in had a different color assigned to it.

And by the end of the month I basically had like a colored mandala, or however you pronounce it. But I was like, but I was like, “Look at this, it’s all my artworks.”

Lisa: That’s so awesome. I love that idea.

Jenn: I mean, it helped me out for the time being. Lisa, I wanted to ask you, you had mentioned psychological flexibility.

And I think that this is something that’s really important about how do we get better at taking feedback from our partners, and how do we know if they’re being helpful or unhelpful?

Lisa: Yeah, that’s a good question. Who likes feedback? And I think that, I like feedback.

Jenn: I actually really like feedback.

Lisa: I find it useful. Put it that way.

Jenn: I do. When it’s constructive, there are concrete examples. That’s what I’m like, I like feedback, yeah.

Lisa: And that’s kind of where my mind went because you know what? Depending on how the feedback is given, maybe you’re not the issue. And I think that that’s really important to know.

So, let’s talk about how do you get better at taking constructive feedback. And then we’ll talk about, like, when is it not okay, or how is it not okay or not helpful to give feedback?

So, when I give feedback to, like, my team, I usually try and give it from a really loving place. And I really kind of stand on this idea that, like, I one hundred percent trust this person that they can take this on and they can fix this thing.

I’ve always treated my staff like that. And I think that modeling how to... Like, that’s important, that’s a great way to give constructive feedback. Now, even when it’s given, it hurts. You know yourself that, like, you can have evaluations and like 99% of them could be like fabulous and you’re going to focus on the one that’s like, “Ah, that wasn’t so good.”

So, when we get feedback, it hurts, it feels bad. And so psychological flexibility means making a space for those feelings to show up and thinking about what is important about this feedback for me.

Feedback helps us learn. It’s essential. Really, really important. I mean, so, we have to make a space for that if we want to develop our skills in any area. And so it’s allowing ourselves to feel those negative things, or those unwanted things, taking some time and then taking it on and then maybe trying things differently in a way that’s consistent with the feedback.

Now, if the feedback is delivered as harsh criticism or meanness, you should not work hard on taking that feedback. That’s a sign of a toxic relationship if that’s happening over and over. If you feel routinely demeaned by someone, that’s not okay.

So, thinking through like, that is not... That’s something that you might want to talk to someone about to get some help making a better boundary and then deciding, if that pattern continues, that is this a relationship that you want to keep.

Jenn: So, I know that you touched really lightly on one of the factors of making a relationship toxic, but what other warning signs are there of toxicity, and what exactly makes a close relationship toxic?

Lisa: And there’s... And when we say toxic, there’s tons of stuff out there. Like, do we mean abusive? Do we mean emotionally abusive? And so, patterns of relationships that are unhealthy, let’s just talk about unhealthy relationships.

One where the tone is negative, and it’s just... There’s a cycle of criticism going on, where it’s just people, you’re saying things to your partner, your partner is saying things to you to hurt you on purpose. A contemptuous relationship. That’s not okay.

One where you’re being punished for feeling emotions or you’re punishing your partner for feeling emotions, not okay. And then withdrawing your caring to manipulate someone else or someone’s doing that to you.

If there’s any kind of control in that way, that’s really not okay. All of those are really, really toxic, and they are things to watch out for.

Jenn: So someone wrote in asking, they had recently asked their partner of many years to put a pause on their relationship because their mental health was unhealthy. They weren’t tending to their gardens, so to speak, even though--

Lisa: The partner or the person who wrote?

Jenn: The person who wrote in, that they weren’t really taking care of their own mental health as much, though their relationship was a really good support system.

How do they set boundaries in terms of giving themselves the time and the space that they need even though they still have that need to be communicating with their partner?

Lisa: I think just in having a conversation about just that, just the way they wrote it. Like, “I’m working on balancing these boundaries and I also need you and I don’t quite have a clear way to do that. We might need to feel our way through that.”

Lots of times people look for what’s the rule for this? What should I do? And sometimes there really aren’t any. But if you have really good communication, those are the kinds of conversations you can make space for and practice having.

It’s okay to not know all the answers. In fact, most of us don’t have all the answers... All of us don’t have the answers. And so making a space for that uncertainty I think is important, and having those sort of gentle conversations where you can think together about what would this look like?

And making a space for how your partner’s feeling too. They won’t get it right necessarily either.

Jenn: I guess that tees me up for the question of, how do we know when to call it quits with a partner, what’s the... I mean, obviously every relationship and every person is different, but how do we know?

Lisa: That’s a great question, and I think one of the things that is part of integrative couples therapy, which is another sort of evidence-based couples therapy, and there’s some lovely books.

I have another reference for you guys I’ll share in a minute, but it’s really thinking about, remembering that you can’t change other people. They can only change themselves.

In the relationship, are you trying to... Are you in it kind of contingently thinking about like, “If only he would,” or, “If only she would,” and, “I’m going to stay if I can get him to, or her to X.”

Sometimes people can choose to change and sometimes they don’t. So if they don’t change, if they don’t meet you in the middle, then there’s a decision to be made about are you willing to have this relationship as it is and let go of that as a conflict or are you not?

Like, my husband and I... It’s a silly example, but like, we have completely different ways we like to keep the house. I hate clutter. It drives me bananas and he can’t see it. It’s invisible. So, like, it’s like a little hurricane when he comes home.

Like, the bags here, and the shoes are there, and the dogs are eating the socks, and there’s stuff all over the counter. And I’m like, “Oh my God, clutter, I can’t stand it.” And I spent a lot of energy early on in the relationship trying to fix that. I was completely unsuccessful.

And so I had to think about like, is this something that I’m willing to have? And willing doesn’t mean that you want it. I still hate clutter. I can’t stand it. I can’t stand it. And I choose to have it in the service of having this really lovely friendship and relationship and marriage that we have had where we can finish each other’s sentences for 25 years.

We get the same joke, we get it. And we have this shared history. Yeah, I’m willing to make a space for mess. Yeah, I’ll clean it up, and I won’t like it, and I’ll be cranky, but that’s acceptance. And so, here, let me show you something. So, this is a great resource for those of you guys out there. It’s a fun, fun, little book by John Gottman. And it’s called “Eight Dates.”

And what, it is for couples, it’s by John Gottman, who, you know, he is the author of “Seven Principles for Making Marriage Work.” And he’s got a couple of coauthors, but it’s basically like eight conversations that you can have, and you can work your way through this book.

And it’s just a fun thing about how can you develop and deepen your relationship? And there’s topics like how to agree and disagree because, as we discussed, how you fight is a predictor of whether or not you’re going to stay in a relationship.

One of the dates is on trust and commitment. There’s all these different topics. And they’re just lovely. So, check this out. And it’s short too. It’s fun.

I mean, we’re in a pandemic. You could go on eight dates, they could be stay dates at home, maybe you can’t get out, but things are opening up. Maybe you can. So think about that.

Jenn: So, we had a couple of questions about friends, partners dealing with loss. So, first and foremost, someone asked, how do you support a friend that recently got out of a long-term and emotionally abusive relationship?

I feel as though their lives have already drastically changed for the good but I’m still really concerned about their mental health?

Lisa: Be present. Don’t pry, let them know you’re there. Just be in their orbit. That’s the best thing because when people make big changes like that, you have to remember they’re going through a grieving process.

Even if it wasn’t a good relationship for them, it’s still a grieving process. It’s a major life stressor. And it’s going to be a process for them as they go through it.

So, walking with them, just letting them know…Don’t assume what they need, ask them. They may not know. They may not be able to tell you, but at the same time, they’re probably going to appreciate just knowing that you’re there.

Like, “Hey, just letting you know I’m thinking of you.” Those little texts, even stuff like that can make a huge difference.

Jenn: So, I know, we’re in a pandemic, there’ve been close to 600,000 people lost in the U.S., and that’s not a number to not acknowledge.

How do we support our partners through their journeys of grieving and loss, whether it’s the loss of a loved one, the loss of a career, how do we do it?

Lisa: It’s so hard. And, again, put on your own oxygen mask first. And I think making a space for this heaviness as you walk through things, it’s something that’s just so hard and it’s part of life. And who knew we would be asked to deal with this? This is a hundred year event, once in a century.

Just our of luck it happened to us, our families, our friends. So I think being really gentle with yourself and also being really gentle with them, being supportive and empathic, helping them remember what is still here, that is still good, that we can be grateful for.

That’s one of the hardest things. And the other hard thing about grieving is, it’s important to feel it, it’s important to feel the grief, because if you... Imagine we couldn’t grieve the people that we lost? Imagine we couldn’t feel sad, how would you honor their memory?

So, in order to remember, we have to make space for sadness and heaviness and grief. And I think just kind of being clued into that, being mindful of your partner, maybe they’re not having a great day, maybe they’re irritable, and maybe it’s this stuff around the edges that they’re kind of carrying.

So, just kind of keeping your antenna out for that and being available when it’s useful.

Jenn: Yeah, I think it’s important to remember too that grief and loss, those journeys are not upward trajectories, especially if you’re dealing with the loss of a parent, somebody you’ve known your whole life, you will have moments where the days are okay and then a year later, you’re not okay all over again.

Lisa: Yeah, yeah. I’m just thinking, one of my coauthors, Ben, sadly, who wrote “Stuff That’s Loud” with me, lost his mom in the pandemic. And he’s in New Zealand. And so I think about him all the time and just, is he okay? How’s he doing?

And it’s up and down as it is with all of us. So, just really kind of allowing and being aware. There is a great podcast that Louise Hayes just did with Ricky Kierkegaard. Louise Hayes is a colleague, both Ricky and Louise are friends of mine and colleagues, from the ACT community, Acceptance and Commitment Therapy.

And Ricky’s a wonderful interviewer. And she talks about, with Louise, about the loss of her mom and about acceptance. And I’d love to recommend everybody to listen to that. It’s a really beautiful, really beautiful kind of podcast that might be beneficial.

Jenn: So, knowing that everybody handles difficult situations differently, what do we do if our partner, when faced with conflict, withdraws affection or caring?

Lisa: That’s a good question. And I think the answer has to be, it depends. I think get support yourself, because that’s a really hard thing.

Sometimes people do that intentionally, when they withdraw, that’s very manipulative, and that would be something to really watch out for as a sign of a potentially toxic relationship. But sometimes people just can’t.

It could be a trauma response, were there other things a foot that you might not be aware of that are impacting their behavior? They may or may not be aware that they’re doing it.

So, again, the answer is, it depends, but if it’s that latter piece, making a space, and then when they do come back, maybe having a conversation about, like, how it landed with you, what that was like.

And did they notice that they were doing this even, because sometimes people are just not aware. They’re not great observers of their own behavior, and they don’t really know how it’s landing.

Jenn: So, a couple more questions before we wrap this up. So, one thing I know is, maintaining a mentally healthy relationship isn’t just the relationship between you and a partner. It’s like you and your child or your siblings.

So, what do we do if we’re a parent and our child is refusing treatment for a mental health disorder? Do you have any advice, as a parent, for them to better access treatment without necessarily damaging the relationship?

Lisa: Wow. And that’s a really hard one, and that is a huge part of our clinical practice, actually, because this happens all the time. So, there’s some, depending on what the issue is, I can give Jenn a bunch of books that she can put on the website.

The first thing is, keep the conversation going. That’s the first thing, but there are some parent only treatments that are out there for things like anxiety, OCD, failure to launch.

One of them, this is a new book that just came out for anxiety and OCD, it’s a parent only approach, by Eli Lebowitz. And it’s really wonderful, it’s called the SPACE Program.

There are a number of clinics around in Massachusetts who are teaching it, ours is one. That’s one thing. Other things for, if you have an adult child that won’t get help, this is a good book that was recommended to me by Michelle Yakoobian-Friedman, who is the director of the CEDAR Clinic here in Boston.

And this is for individuals who have a partner or a child with a serious mental illness and they will not get help. And so, there’s a little acronym that he uses in the book called LEAP, and it’s listen, empathize, acknowledge, and partner.

So, to really think about like what are those things, or agree and partner. Listen, empathize, agree, and partner. So, just useful to build a collaborative relationship that can help get kids help.

And then another, just one other book to mention. Sorry, it’s heavy on the anxiety and OCD, but what can you do? This book just came out hot off the presses by Jon Abramowitz, really wonderful book for children and adult children who are struggling with OCD. It’s a really great guide for families.

And there are many more, but I think getting support for yourself as a parent is really important. Checking out what is there... Talking with a counselor about like, is this something that you can help with or not? And then just keeping that conversation going.

Jenn: Are there any other books off the top of your head that you would recommend for maintaining healthy relationships and/or psychological flexibility?

Lisa: There are but I want to give two more that are kind of more specific just because they might be useful. I want to give a broad variety there.

So, we work a lot with individuals who are on the autism spectrum, whether kids, parents, or adult kids. And one of the books that I found that was really useful is this book by... It’s an edited series of essays written by folks who are on the spectrum about their experience.

And I think that that’s really important. And then the other thing is, we know that mental health risks are higher for kids who are sexual minorities, who might be transgender. There’s a lot of stigma, there’s a lot of risk out there for them.

And so books like this can be very, very useful for making your family and your home a very accepting and open place for kids who are trans, who are non-binary or gender fluid, et cetera. So, I think those things are important. Yeah, how’s that? And then I should go.

Jenn: I got one more question for you, and I promise it’s a quick one. So, I’ve shared this with you before, but my partner and I, every time we had traveled and we met couples who had been married for X amount of years, we said, what’s the secret to X years of marriage?

My favorite anecdote was, my grandma, after 61 years of marriage said, “I sit in one room and he sits in another,” but, what is, now that you’re coming up on 25 years of marriage, what’s the secret? What’s your secret sauce, Dr. Coyne?

Lisa: Be humble, take feedback, and be flexible I would say. Be flexible and ask for what you want. That’s not one thing... I have to think about this, Jenn because I, there are, like, some things I think are really important but I think really being humble and trusting your partner is really important.

And remembering that trust is a choice. And I feel very lucky. I partnered with a really awesome person who, neither of us are perfect, but I think allowing the other person’s imperfection is great too because they will allow you yours then, or so we hope. Anyway, I got to run.

Jenn: I love that, thank you. Lisa, thank you so much. This has been wonderful.

Lisa: It’s great to see you too, Jenn.

Jenn: I appreciate you navigating all of the murky waters of dealing with partnerships and mental health. So, thank you very much.

Lisa: Such good questions people had. Thanks for all the great questions.

Jenn: It was a good one.

So, folks, thank you so much for joining and this concludes the session. But, until next time, one of my favorite pieces of advice I got from a couple 34 years of marriage is, you can either be right or be happy, be happy.

So, be happy everybody and have a great day. Thank you.

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Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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