The majority of clients who come into my office do not want to take psychiatric medication. I always leave the decision up to them, but as part of my assessment, I always explore with my clients where the resistance is.

Typically, the clients have picked up erroneous information, or had irresponsible doctors prescribing their meds before, resulting in a negative experience. I try to dispel some of the myths that come along with psychiatric medication, as many of them are either outright wrong or not true in all cases.

It is absolutely true that medication is not always necessary or appropriate to treat mental illness, and obtaining prescriptions from a doctor who is not adequately educated and/or does not actively listen and respond to your partner’s needs is dangerous. But if your partner won’t even consider medication at all, is it because of one of the following thoughts?

Nancy’s problems with spending began when her job stress increased. As she felt more anxious and depressed, she found herself turning to shopping as a way to make herself feel better.

At first, the “high” of a new purchase would help her forget her stress, but Nancy found herself spending more and shopping more often. As the bills piled up, she found herself hiding her purchases from her partner, and feeling guilty, too.

We all spend too much money from time to time, but there are some clear signs of compulsive spending:

• Being preoccupied with shopping or spending money
• Shopping when angry, sad, or anxious
• Buying things that are not needed or too expensive for the budget
• Experiencing a “high” after a purchase, but then having a mood crash afterwards
• Having relationship and/or legal problems because of the spending behaviors

Compulsive spending has the double-edged sword of both positive and negative reinforcement. Your partner experiences positive feelings from the purchase, and also relieves the negative feelings that led to the urge to spend in the first place. This can make breaking a spending habit really difficult…but not impossible.

Among the many reasons couples decide to seek therapy—including to learn better communication skills, to improve intimacy, and to heal old wounds—deciding whether or not the relationship is going to survive is the motive for about half.

A recent study from the University of Louisville that studied 249 couples in counseling found that when couples had the goal to improve the relationship, the ultimate outcome was better than those who came to therapy to determine whether or not the relationship could be saved.

Specifically, couples who sought therapy in order to improve their relationship were almost 80% more likely to be together six months later. More than half of those who wanted help deciding about whether or not to split up had indeed broken up six months later.

It is important to know what you want when going into couples therapy.

My client Cathy has a love/hate relationship with her partner, Julia. When Cathy is in a good mood, the world is perfect, their relationship is wonderful, and everything is “kittens and rainbows.” When Cathy gets upset about something—whether it’s related to Julia, work, or something else—everything becomes “doom and gloom and the worst ever!”

Cathy adores her partner, and values their relationship. However, she is very much controlled by her emotions, and allows them to dictate her behavior. She also gets caught up in “all or nothing” thoughts, and needs help with learning how to separate what is real from what her emotions are telling her is the truth. As you will see, those are not always one and the same.

If you have a partner with borderline personality disorder (BPD), the phrase “walking on eggshells” likely defines your life. People with BPD struggle to regulate their emotions, even though the emotions they experience are the same as the rest of us.

The difference is in the intensity of how they feel those emotions. Marsha Linehan, PhD, the founder of dialectical behavioral therapy (DBT), compares those with BPD to third-degree burn victims: “Lacking emotional skin, they feel agony at the slightest touch or movement.” What might just be a small slight for you might mean off-the-charts upset for your partner.

In the DSM-IV-TR, four of the nine criteria required for a diagnosis of BPD have to do with how the person handles emotions. These include:

• frantic efforts to avoid real or perceived abandonment
• intense and quickly changing moods, including irritability and anxiety
• inappropriate anger or the inability to control anger
• chronic feelings of emptiness

What does this mean if your partner has BPD?

I recently read the book Quiet: The Power of Introverts in a World That Can’t Stop Talking by Susan Cain.  She highlights how those who are naturally quieter than the extraverts are often overlooked and not valued, despite the tremendous contributions these people have made in the past (think Dale Carnegie, Al Gore, and Gandhi), and can make in the future.

In her work, Cain draws from the research of Elaine Aron, PhD, author of The Highly Sensitive Person. It makes sense that someone who is introverted might also be highly sensitive. High sensitivity can also be a part of many mental illnesses, including depression, bipolar disorder, the anxiety disorders, and borderline personality disorder, just to name a few.

Do you have a highly sensitive partner? The following information may be insightful for you in better understanding their experience of everyday life.

Whoa, a professional therapist is giving tips on how to stay out of her office?!? Yes, yes, I am.

Having said that, I always recommend that if you and/or your partner are having serious struggles with mental health, you consult a professional.

The tips that follow may not be enough to resolve your and your partner’s concerns, but they are a good place to start. They can also be used to supplement what you and your partner are working on in couples counseling as well.

Having a spouse with a mental illness can be exhausting and frustrating. And this fatigue and exasperation can spill over into your relationship, slowing chipping away at the love, romance and fun times.

Fortunately, though, couples can reclaim their love and romance each day. In Five Good Minutes with the One You Love: 100 Mindful Practices to Deepen & Renew Your Love Every Day, Jeffrey Brantley, MD, and Wendy Millstine, NC, help you learn to pay attention to your
relationship in a kind and nonjudging way. They offer super simple exercises you can do by yourself or with your partner to strengthen your relationship.

These are three of my favorite activities from their book.

Walk a mile in your partner’s shoes.

Empathy is the foundation of healthy relationships. But all partners can forget to empathize or may have a tough time doing so when frustration and fatigue set in.