In Sickness and in Health

How Illness Transforms Relationships

Thirteen years ago this month, my husband and I got married in our backyard garden with our five children and a small circle of family and friends. Part of the vows we made to each other was a version of, “in sickness and in health”. Little did we know then, that the “sickness” part would be up front and center during our 12th year of marriage when I was diagnosed with breast cancer.

In looking back on the last 4 months of physical and emotional ups and downs, the experience of deep fear, and anxiety-provoking uncertainty, I can honestly say that illness can be an opportunity for couples to create a deeper bond of intimacy, genuine connection to self and other, and interdependence. It is an opportunity for transformation.

Like in any crisis, even though there is an opportunity for transformation in the circumstance, none of us would choose to learn this way. But when we are brought to our knees in fear, if we allow ourselves to sit with the experience and not run from it, we learn just how strong we are. We discover new things about ourselves and about our partner. We enter the realm of transformative growth.

I am learning that there are many aspects to how illness impacts couples. One specific challenge is wrestling with the fact that the same life circumstance will be felt very differently for each partner. So for today I want to focus on understanding the non-ill partner’s experience.

What kind of context is needed in order for the non-ill partner to wrestle honestly with their fears, questions, and concerns? What are some ways to offer support, validation and acknowledgement for the non-ill partner, who must sit and watch their loved one deal with all that comes with illness?

1. Traveling into the Abyss

Creating a context that enables an honest wrestling with fears, questions, and concerns starts with the couple recognizing how essential it is for the non-ill partner to go into their own abyss. And by this I mean entering into the dark, internal and emotionally, scary places from which we usually try to escape. We live in a society that supports avoidance, numbing, and distraction from our difficult physical and emotional experiences. We prioritize quick fixes to help us feel better. But in remaining present and curious about what is truly coming up for us emotionally as we watch our partner become ill, we learn to trust ourselves and discover a wealth of strength previously untapped. We learn that our deepest fears will not destroy us.

If we try to hide our fears so as not to make our partner feel worse when they are already ill, we short-circuit the chance to explore the gifts of the abyss; the gifts that can only come from this journey, which are a deepening of our understanding of ourselves and a deepening of the emotional connection in our relationship.

This is not easy; it is hard and uncomfortable, but if we stay with this, the rewards are great. During this internal exploration, it is helpful to utilize the tools of self acceptance and compassion. In using these tools, we are more likely to embrace our experience rather than resist it. We will not fall into the traps of shame or guilt. We can be free from the need to change or fix the circumstances. We can be free to learn that we are more than our worries and concerns and emotions. We learn that we can survive the abyss.

2. Accepting Vulnerability

Watching someone you love become ill triggers one’s most vulnerable self. We are no longer under the illusion that each of us, as well as our life together and our relationship, are invincible. This requires us to courageously admit that at times, we need help, comfort, reassurance.

Often the internal dialogue for the non-ill partner can go something like this: “How can I possibly ask for anything at this time, when my partner is going through so much? How can I admit that these circumstances scare me and I also want comfort and support without burdening my partner?”

The fear of seeming self-absorbed or selfish has the potential to keep our true selves hidden. But that can only lead to misunderstanding, confusion, less connection, disappointment, and ultimately resentment. It is not selfish to share how our vulnerability is being manifested. It is human. It is real. It is an essential ingredient in transformation and in creating interdependence.

3. Admitting and Accepting Our Limitations

We must accept that the non-ill partner has limitations. It is helpful if they can share those limitations openly. We must acknowledge that there will be times we do not respond as needed or expected, that we will let our partner down. There will be times when we get tired, scared, and anxious. There may be times we become angry, impatient, and distant. We may need to ask for others to step in and help so that we can spend some time in regenerating self care activities.

It is important to clarify that our commitment is to being loving, supportive, patient, and relentlessly hopeful, but in an imperfect way. In this new territory, we may stumble and bumble our way along, and it will not always look graceful.

Expressing our limitations to our partner requires courage, authenticity, and an acceptance of differences. Within a context of empathy and trust, we are free to be our imperfect selves. We understand each other’s limitations and we can commit to working as a team, supporting each other to face the challenges in front of us.

4. Hello Differences!

My sister, who also had breast cancer, said this to me at the beginning of my illness: “I never stopped being a wife and partner to my husband. I realized he needed me, too, and in giving to him I felt as if I could maintain important parts of our relationship.”

Remember that the partner who is ill and the partner who is not ill will have very different emotional experiences. The non-ill partner usually is the care-giver and cheerleader, the one keeping up with daily responsibilities and life demands. That partner is the one taking notes in the doctors’ offices. The one who protects their partner from additional, unnecessary stress. He or she is the one who is tending to the children, making calls to family and friends post-surgery, balancing work with the demands at home. All of this being done mostly with a cheerful face. All of this very different from what their partner is experiencing.

Recognition that the care-giver has their own unique experience, perception and emotions allows space for validation and support. It frees them to seek out their own resources, support, and help. Most importantly, it is an opportunity for the one who is sick to experience “normal” role functioning: listening and supporting our partner, expressing gratitude for all they are doing, letting them know you are still present, aware, able to give.

5. Grieving and Creating a New Normal

During this process of transformation, as a couple creates a safe context to enter the abyss, be vulnerable, accept limitations and differences, grief will surface. The non-ill partner’s grief will share similarities but also be different than their partner’s. Acknowledging grief moves couples even further into the transformation process.

The non-ill partner may be grieving loss of their partner’s ability to spend time with them and to do previously enjoyable activities, a loss in sexual intimacy and emotional availability, loss in the ability to trust in the safety and certainty of their life, grieving their partner’s loss of energy and vibrancy, losing their cherished rituals and routines, grieving the changes in their partner’s body.

It will be essential for the couple to honor and acknowledge this grief. It requires listening without reactivity or defensiveness for each partner to hold onto themselves and allow space for difficult conversations. In doing so, they let each other know it is safe to talk about the toughest things. It is ok to voice what we miss. And as a result, they heighten their awareness in just how much the illness has changed them. This heightened awareness acts as a catalyst to create a new “normal” in the face of what has been lost.

Transformation Within Reach

In the midst of illness, it is possible to celebrate the ways in which we have become more awake, more intentional, and more capable in accepting uncertainty, difficulty and imperfection. As we let go of unrealistic demands, harsh expectations and unhelpful assumptions on ourselves and on our partner, we evolve into a sweeter, more gracious compassion for each other. We live from a place of contentment and acceptance. We can celebrate that as a couple we have gone into the abyss and we have emerged, transformed.

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I was very appreciative of this summary by Jane Ryan and I resonated with her messages of grieving deeply which leads to a transformation process. I cared for my wife for 10 years as we traveled into the difficult abyss of her Alzheimer’s initially with great anxiety, denial and anger for her, numbness and confusion (for me). As we educated ourselves and learned to accept the New Normal with the help of Gail Sheehy’s “Passages in Caregiving”, we were able to travel the labyrinth of her deteriorating dementia and maintain our connection with each other, grieving and nurturing each other. We created a “circle of care” for her so I could have daily breaks
from the stress of caregiving; “It is not a sprint, it is a marathon” (Sheehy). We had hospice care in our home for 10 months before her death which enabled us to emerge from the agonizing journey being transformed and remaining connected .

Reply to  Jerry

Hi Jerry,
Thank you for your feedback and I am so happy that this article resonated with you. Sounds like you and your wife were able to create a amazing connection in the midst of the uncertainty and pain. I am inspired by your story and your resilience!

Alexa Elkington
Alexa Elkington

Hi Jane,

You have really captured the feelings of the caregiver. It is a challenging situation to be the strong one and hold it all together. I think your article will open the doors for many conversations to take place in families dealing with an ill member. Thank you for sharing your thoughts on this very important aspect of what it means to come together in times of sickness. I look forward to your next article regarding this issue from the perspective of the ill partner. You have a wonderful way of presenting these deep, introspective thoughts in an understandable and relatable format. Thank you.


As always, your support means so much to me. Thank you for taking the time to read and respond to this post. I am looking forward to writing more on this subject and sharing it with others!

Nancy St. John
Nancy St. John

This is a beautiful, wise and courageous article, and I loved reading it. In my time working in a cancer care centre, the most distressed families were those who were unable to communicate openly and honestly with each other.

Your sister’s words about not stopping being a wife and partner were inspirational and comforting; that in her time of uncertainty and helplessness she chose to maintain control of an important part of her life.

Thank you for sharing this with us!


Dear Nancy,
Thank you for your feedback! I have often felt very inspired by your compassion and wisdom as you have shared with our training groups and when I had the pleasure to spend a couple of days with you at our April Mentoring gathering. So, your feedback means a lot to me!

Meg Luce
Meg Luce

Hi Jane,

Thank you for this article. I especially liked the “traveling into the abyss” section. It can be so confusing for the non-ill partner–whether to hide one’s own pain and difficulties so as not to add to the burdens of the ill partner. But, as you remind us, that would mean hiding one’s authentic self as well as missing the gifts of the “abyss”. Thank you for sharing these insights.


Thank you Meg. I am so glad that you liked it. I think the Developmental Model definitely teaches us how to help clients be honest about their experiences, thoughts and feelings and have those hard conversations in order to form a stronger bond and a more clear sense of self.

Aaron Deri, LMFT
Aaron Deri, LMFT

What a thoughtful and amazingly concise survey of a deep and difficult human experience. Thank you. Helpful both personally and professionally.


Thank you so much for reading my article and offering this encouraging feedback, Aaron!

Jane Ryan

Jane Ryan is a couples therapist with a private practice in Gig Harbor, Washington. She has been training with Dr. Ellyn Bader at The Couples Institute since January of 2014. Jane helps her clients and readers address couples’ issues in coping with women’s cancers. She will also be training therapists in the Developmental Model of Couples Therapy in Seattle/Tacoma, Washington starting January of 2016.

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