Q & A with Connie O'Reilly: FM and Relationships



Dr. Connie O’Reilly has a private psychology practice in Beaverton, Oregon, and is associated with Oregon Health and Science University where she has worked with Dr. Robert Bennett and other researchers on the fibromyalgia treatment program. She took some time to answer questions about how fibromyalgia can impact relationships—and what you can do to minimize the negative impact.


Q: You have spoken about the concept of "relationship contracts." What do you mean by that term?

A: We all enter into a relationship with an implicit idea of how it’s going to go, who’s going to do what, based on how we were raised in our family of origin and society’s expectations and values. We assume it’s going to go a certain way—so much so that it’s never really verbalized, let alone negotiated. When a chronic illness comes into the family, that’s even more crucial, because everything is shifting. Everyone’s participation shifts.


Q: So how can a couple negotiate, or renegotiate, their relationship contract?

A: It varies greatly from couple to couple. I have handouts that list every conceivable task that has to go on in a household or family. In the office we can sit down and talk it point by point, or they can go home and talk about it. The deeper psychological work is getting the two of them to recognize [their assumptions]: "We got married and I assumed you were going to be the wage-earner," "We got married and I assumed you were going to raise the children and take care of the house." My job is to help people see there really aren’t rules. It doesn’t have to be any certain way; let’s talk about what might work.


Q: Do you recommend that couples make "renegotiation dates?"

A: In a really healthy couple, it doesn’t have to be that formalized because the communication is ongoing. There’s much more openness, and things get brought up just as a matter of living together. However, when couples are not quite that verbal with one another, or maybe weren’t raised to talk to one another that way, I do try to get them to make some kind of date with each other. It depends where we are [in the therapy] and where they are in the relationship. Sometimes it’s getting a couple to sit down once a week and say, "How did it go this week?" Some may do it once a month; some may do it on their anniversary.


Q: Pain and exhaustion make it difficult for people with FM to meet their commitments. How can couples affected by FM renegotiate their relationship contracts fairly? 

A: It’s so important [for spouses with FM] to participate at whatever level they can. Any small contribution will be so important in preventing the kind of resentment that can build up. The other important piece is communication—talking openly with one another about what’s going on, what they need, what they can do and what they can’t do.

[People with FM also need to] be supportive of their healthy spouse’s taking care of themselves in whatever way they have in the past: maintaining their friendships, their hobbies, their activities. The healthy spouse feels guilty for going off golfing or skiing because it’s something the ill spouse can’t do—so they quit because they feel guilty. But if they don’t take exceptionally good care of themselves, there’s no way they can support their partner or the family. They’re going to get depressed if they don’t take care of themselves.


Q: It’s easy for the focus of a relationship to land on FM and symptom management—leaving the health partner out of the spotlight. How can couples dealing with FM maintain the partnership aspect of their relationship?

A: It is [so important] for the fibromyalgia patient to understand what their spouse is going through. So often they forget that they have a lot of people on their team—rheumatologist, occupational therapist, physical therapist, primary care doctor—all of whom are trying to help them function at a higher level. So often the spouses are out there all alone, dealing with all the fear that the patient has dealt with earlier in the process, and the uncertainty. The well spouse, too, is dealing with the loss of their dreams—apprehension, anxiety, what is the future going to hold. They’re dealing with the sadness that they don’t have the relationship they had with the person they married. It’s very important that the spouse has some forum to be able to express those feelings; ideally the patient would be able to hear that and validate it and support it. [Well spouses] need validation that they too have to go through a grieving process, a reevaluation process. They so often feel that it’s not a valid thing to acknowledge, let alone talk about—after all, they’re not the one who’s in pain all the time. But their life has changed too.


Q: Are there other resources out there for couples who want to improve communication?

A: Dr. Phil and Oprah are always having programs on marital communication, and there are lots and lots of really good books. But if couples are bogged down, it’s not just something that’s going to fix itself. It takes them acknowledging there’s a problem and expending the effort to make things better. If it were as easy as it sounded, I’d be out of business—which would be fine too!