For a while now–maybe a few weeks, months, or even years–your partner has been doing well. They take their medications, attend therapy, are employed, and your relationship is going well. The harrowing days when the clouds their illness overshadowed everything in life have long parted and the sun is shining on you and your partner again. The future forecast is for sunny and mild temperatures.
Relapse can hit a relationship like a thunderstorm that appears out of nowhere on a summer day, or it can creep in like a cloud cover that precludes a change in weather. Depending on the illness your partner has, they can go from “fine” one day to needing immediate intervention the next (as in the case of alcoholism) or there may be little signs along the way that the illness is seeping back in, which is more typical of illnesses like depression and the bipolar disorders.
When someone has a history of mental illness, it is never safe to be complacent. While it is nice to think that during remission, the illness is gone forever and will never cloud your life and relationship again, the reality is that mental illnesses often need lifelong maintenance in order to remain in remission. For some people, that means medications and therapy for the rest of their lives. For others, medication and therapy may not be needed forever, but good self-care–including diet, exercise, and sleep–are essential to preventing relapse.
As the partner of someone with mental illness, you are often in the position to be the first person to notice the clouds of relapse on the horizon.
Or if the relapse storm comes suddenly, it’s up to you to have the appropriate plan in place to provide shelter and safety for yourself and your partner while the storm passes.
Planning for relapse
When someone is feeling good, the last thing they want to do is imagine being in the depths of their illness again. However, that’s also the best time to make a plan for relapse, just in case.
Something I do with my clients when we are terminating therapy is to ask, “What thoughts and behaviors are red flags that mean you need to check in with me [or another mental health professional]?” I’ve never had a client hesitate to list three to four signs that they know are definite indicators of relapse.
When your partner is feeling well, it would be helpful for you to discuss the possibility of relapse and decide not only what signs are the red flags, but also what the plan will be if those flags go up for either of you. For most people, there just needs to be a verbal agreement. For others with more serious illnesses–especially the types that can render a person incapable of making good decisions when they are in the midst of an acute episode, such as bipolar and schizophrenia–creating a psychiatric advance directive is an excellent idea.
Another reason why advance planning is so important is because admitting relapse can be even harder than admitting there is a mental illness in the first place. There is often much shame that comes with not “being successful” at beating the illness, and your partner may try to hide their symptoms or deny anything is wrong. By having an open and honest discussion with your partner about the possibility that the illness may return, and how you will handle it as a couple will relieve your partner of some of the fear and anxiety about what your reaction will be if the time comes that treatment is necessary again.
Important points to remember about relapse
- Relapse does not mean your partner will never achieve remission from their illness. What it does mean is that some part of the maintenance treatment plan was not working, and therefore, a new plan needs to be put in place. (If there was no “maintenance plan,” that is part of the problem!)
- Relapse can be a sign that your partner was overwhelmed by something in their life, and the old habits and behaviors felt “safer” than their new coping skills. It might be time to try a different type of therapy than before, or perhaps other issues that were not previously addressed now need to be.
- Your partner needs extra support and encouragement, perhaps more than when they dealt with the illness before. If you struggled with this the first time around (or if this is not the first relapse), it’s essential that you get support as well, through individual therapy, couples therapy, support groups, and online forums. Also remember your own self-care!
Wellness Recovery Action Plan (WRAP) information (Ideally, this should be done with professional guidance, but there are free resources on the website if a therapist is not available.)
Relapse Prevention (More for the patient than the partner, but still helpful for discussion.)
How to Come Back from a Relapse (Also more for the patient than the partner, but fodder for discussion!)