Written by Liz Fernandes, AMFT 151527, APCC #18938

Whether it’s cancer, MS, or chronic pain, when health-related challenges enter a relationship, things change. Sometimes it’s sudden, sometimes it builds over time. Daily life starts to look different, and many couples find themselves unsure of how to stay connected through it all.

The Gottman Method, a research-based approach to couples therapy, offers tools that help couples stay connected and resilient through life’s hardest seasons. At its heart is something called the Sound Relationship House: a model that outlines the essential components of a healthy, lasting relationship. When health-related challenges are present, certain parts of that “house” can feel wobbly. The good news is that those areas can be repaired and even strengthened.

Let’s explore how three core levels—Friendship, Conflict Management, and Shared Meaning—are uniquely affected when couples are facing health-related challenges.

Friendship: The Foundation That Often Gets Shaken

Friendship is the foundation of the Sound Relationship House. It’s made up of the everyday moments that keep couples emotionally connected: knowing each other’s world, showing appreciation, and responding to each other’s bids for connection.

When health-related challenges enter the picture, those small moments often fall away. Fatigue, stress, and fear can leave couples feeling like they’re coexisting, not truly relating. Here are some common shifts I see:

• Knowing each other’s inner world: After a diagnosis or major health event, partners sometimes realize they haven’t checked in emotionally in a long time. Questions like “What are you most worried about right now?” or “How has this experience changed you?” can help rebuild that inner map.
• Showing appreciation: It’s easy to focus on logistics—appointments, medications, insurance claims—and miss chances to say, “I see you,” or “Thank you for being here.” Small acknowledgments matter more than we think.
• Responding to bids for connection: In times of stress, couples often miss each other’s subtle bids for connection. A sigh, a touch, a quiet “Can we talk?” can go unnoticed. Re-learning how to notice and respond to these moments helps couples reconnect in meaningful ways.

Conflict Management: What We Avoid Can Grow Heavy

Many couples facing health-related challenges fall into a pattern of conflict avoidance. One partner might feel like they can’t bring up concerns (“I don’t want to add stress”). The other might feel emotionally overwhelmed (“I can’t handle one more thing right now”).

The Gottman Method teaches ways to approach tough conversations with care and respect. A few tools that are especially helpful:

• Repair Attempts: These are small gestures that help de-escalate tension. A joke, a pause, a sincere “Can we start over?” In high-stress situations, repair becomes even more important.
• Accepting Influence: This means being open to each other’s needs and perspectives. It’s especially valuable when roles are shifting—when one partner becomes a caregiver, for instance—and both people are trying to make sense of new responsibilities.
• Self-Soothing: Health-related challenges can raise the emotional temperature quickly. Learning to recognize when you’re emotionally overwhelmed (the Gottmans call it “flooding”) and knowing how to calm your nervous system—taking a break, breathing, walking—can keep conversations from spiraling.

Shared Meaning: What Matters Now?

At the top of the Sound Relationship House is shared meaning: the values, rituals, goals, and roles that give your relationship a sense of purpose. These often get rewritten during or after health-related challenges.

• Rituals of Connection: Maybe you used to hike together, cook elaborate meals, or travel on birthdays. Maybe that’s not possible anymore. That doesn’t mean rituals disappear—they just evolve. Even a five-minute check-in on the couch can become a grounding ritual.
• Roles and Identity: Health-related challenges can deeply impact how we see ourselves and how we relate to one another. You may feel like a partner, patient, caregiver, or some blurry combination of all three. These shifts are worth naming and exploring together.
• Dreams and Goals: Sometimes, health-related challenges halt or reshape what you imagined for the future. That can feel devastating. But it can also create space for new dreams. In therapy, I often support couples in honoring what was while asking, What still matters? What feels meaningful now?

If you or your partner are navigating a health-related challenge, know that support is available—not just for individuals, but for your relationship as a whole. You don’t need to wait for things to stabilize or get worse. Therapy can help you find new ways to stay connected, even when the ground underneath you is shifting.

You are not alone in this.