A spouse or partner can be a primary source of support to a cancer survivor. However, if communication begins to break down, it can be stressful and result in low levels of support for both. While the cancer journey can be emotionally challenging for survivors, it can also be hard on loved ones. In some cases, a caregiver may experience more emotional distress than the one with cancer.
Both partners may have strong emotions such as fear, anger and guilt. Stress is also common. A decline in the physical or emotional status of either may create a "cycle of distress" for the couple. If this happens, one person's distress also affects the other. High levels of emotional distress can strain the relationship. Good communication may be the most effective strategy for breaking this cycle. It may also improve the quality of life for both.
Benefits of Good Communication
The cancer experience can be a time that enriches and strengthens the relationship. A partner can play a large role in shaping the emotional experience of the survivor to the experiences of cancer and life after treatment. Research shows that those who feel they have support from their partners are more likely to focus on the positive aspects of their cancer journey. This can improve their quality of life.
Good communication skills include:
- Receiving and offer emotional support.
- Getting help making decisions.
- Sharing advice and encouragement.
- Learning new ways of handling stressful situations.
- Clarifying misunderstandings.
- Learning new coping strategies.
- Planning for the future, such as family, employment and financial decisions.
Issues to discuss with your partner:
- Ways to solve problems with changing roles and responsibilities in the relationship.
- Instructions and preferences for decisions about health care and financial matters.
- Concerns about changes to sexual relations and expressions of intimacy.
- Challenges adjusting to the cancer experience.
- How to maintain the quality of the relationship.
- How to talk to their children about cancer.
There may be a number of reasons why it can be difficult for those with cancer to communicate with their partners.
A partner's negative response may discourage open communication. Research shows that a person is negatively affected if his or her partner uses criticism, withdrawal or acts uncomfortable when talking about the cancer experience. Emotional problems can result and a cycle of distress may occur in the relationship. Negative responses from partners include:
It can be hard for those with cancer to ask for help. This is particularly true if the survivor has always been the one to help others. Some may continue to try to do tasks that have become too emotionally or physically challenging.
Worries about stress on their partners. Those with cancer may feel guilty about asking partners to take on new roles and responsibilities. They may be concerned that a partner is as distressed (or more) than the survivor. A survivor may try to protect his or her partner by not sharing information. Important discussions about certain topics, such as health care directives and financial matters, may be avoided in an effort not to upset the partner.
Signs that You Need Better Communication with Your Partner
- Frequent misunderstandings.
- Withdrawal from one another or avoidance of talking together.
- Frequent use of criticism, sarcasm or name-calling.
- Not sharing information with your partner.
- Frequent disagreements over the same issues.
- Concerns about sexual matters.
- Lessening of expressions of love and affection such as talking, touching and sharing.
- Confiding in others instead of the partner.
- Inability to ask the partner for help or support.
- Finding the support received from the partner is unhelpful.
- Feeling hurt emotionally by the partner.
The cancer journey may require that couples communicate about topics they normally would not talk about. For example, some survivors experience incontinence, sexual or fertility problems or changes in self-esteem and body image. These may be very hard for some people to talk about.
Long-lasting complications, such as fatigue and chronic pain, may be difficult for partners to understand. This is especially true when the survivor is in remission or looks healthy. The partner may want the survivor to move on and return to life the way it was before cancer.
Sensitive issues include:
- Living with uncertainty.
- Feelings of guilt.
- Financial difficulties.
- Dealing with fear of recurrence.
- Changes in outlook on life and death.
- Other health and physical problems.
- Losses of all kinds including job, friends, abilities.
- Changing roles and responsibilities.
- New compromises that need to be made.
- Feeling overwhelmed.
- Making healthy behavior changes such as quitting smoking, adopting a healthy diet or exercising.
Those with cancer and their partners sometimes have different priorities. Things that were important to them before treatment are no longer as important. There may be a change in the way they view life. Some decide to change jobs or other relationships in their lives.
Sometimes both partners can easily understand the change in priorities and be comfortable with them. Other times, one of them might not understand why these changes are happening or may not agree with them. This can feel threatening to a relationship.
How to Communicate Well with Your Partner
Couples sharing the cancer journey can learn new and effective communication strategies. Even though it can be difficult to change old habits, learning skills and developing new communication habits is possible. The key is to practice the new skills regularly. The benefit is that healthy communication can increase satisfaction in a couple’s overall relationship and positively affect the quality of life for both.
Practice Effective Communication Skills
- Schedule time daily to sit and talk with your partner. Make sure it is a time you both agree on and in a place where there will be no interruptions. It will most likely occur if it is a part of your daily schedules.
- Practice active listening when your partner is talking. It can be helpful to restate in your own words what your partner said. This shows that you were listening and allows your partner to correct any misunderstandings. Make sure you give your partner a chance to add or explain anything that was not understood correctly.
- Begin practicing your skills by discussing positive or neutral topics at first, such as those topics you frequently agree on.
- Avoid negative communication styles such as name-calling, sarcasm, yelling and criticism.
- Stay positive. Even when you are unhappy with your partner, start by mentioning something positive. Avoid blaming and name-calling. Your message will not be heard if everything you say is negative.
- Use "I" language when describing your feelings and thoughts. This can prevent judgment or blaming comments that may make your partner respond defensively. Make sure that "I"; statements are followed by a word that describes how you are feeling.
- Use statements such as: "I like that you included me in your decision about your new job. I felt confused and disappointed when not included in your decision to travel more frequently for work."
- Avoid broad statements such as, "You always seem to think only of yourself when it comes to our money."
- Take a break if a discussion becomes heated or too filled with tension. Agree in advance about how long the break should last. Each partner may need to go to a separate area to calm down. After calming down, you can try again to return to the conversation.
- Focus on the present, and do not bring up old arguments from the past.
- Focus on the topic of discussion, and avoid bringing up other topics of disagreement.
- Recognize that you may not yet know your partner's feelings or thoughts. Let your partner know what you are feeling. Give your partner a chance to agree or disagree with what you assume is true. Listen with an open mind.
- Share talking time. Make sure both of you get time to talk before ending the conversation.
- Include your health care team when you discussing medical topics. Your partner may better understand your physical and emotional symptoms when they are explained by a health care provider.
Ways to improve communication skills:
- Be aware of your own communication patterns and behaviors.
- Understand the communication patterns and behaviors of your partner.
- Learn and practic effective communication skills together.
- Take time to discuss difficult topics with your partner.
- Consult a licensed counselor about your relationship.
If communication between you and your partner is not what you would like, you may need the help of a licensed counselor. Talk with your health care team about getting a referral to a counselor who is experienced working with cancer survivors.
Ask your doctor for a referral to a counselor if you:
- Feel depressed, anxious, angry, disappointed, frustrated, lost.
- Use physical aggression with the other or use threatening statements towards another.
- Have thoughts of hurting yourself or someone else.
- Have problems with alcohol or other drugs.
- Think you cannot work out a solution without assistance.
Seek help immediately in the case of physical aggression between partners. Call 9-1-1 if you are in immediate physical danger. You can also get help from a crisis intervention specialists, mental health professional or legal professional.
Communication Patterns and Behaviors in Your Relationship
Before you can work on improving communication with your partner, you need to understand the patterns. You will need to identify areas that need to be changed because of the cancer experience.
Men and women generally communicate very differently. Men may want to try to solve the problems. Women often want to talk about problems and share emotions in an effort to give and receive support.
Questions to Discuss with Your Partner
- What topics do we frequently agree on?
- What topics do we frequently argue about?
- When we disagree, how do we each respond?
- Are we able to be honest with one another?
- Can we calmly discuss issues and try to resolve the disagreement?
- Do we criticize, blame, yell, walk away or give in?
- When have we handled a disagreement well?
- Can we trust one another?
It can be reassuring to men to know that sometimes simply sharing and discussing problems that cannot be solved is helpful to women. It may be helpful for women to be aware that discussing problems that cannot be solved can be frustrating for men.
It is important for survivors and partners to be aware of their own communication needs and behaviors. Both need to take responsibility for their own patterns and recognize their own role in communication challenges.
Christensen, Andrew, and Neil Jacobson. Reconcilable Differences. New York: The London Press, 2000.Fincham, Frank D., Leyan O.L. Fernandes, and Keith Humphreys. Communicating in Relationships: A Guide for Couples and Professionals. Champaign: Research Press, 1993.Manne, Sharon, Stephen J. Pape, Kathryn L. Taylor, and James Dougherty. “Spouse support, coping, and mood among individuals with cancer.” Annals of Behavioral Medicine 21 ( 2 ) ( 1999 ): 111 - 121.