Recognizing Unhealthy Relationships and Creating Healthy Ones

Dr. Kenneth Appel,our guest speaker, is a clinical psychologist who works with individuals, couples and families on relationship issues. Our discussion centered around unhealthy relationships, creating healthy relationships, being in a relationship with someone who has a mental illness, and online relationships.

David Roberts: HealthyPlace.com moderator.

The people in blue are audience members.

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I hope everyone's day has gone well.

Our conference tonight is on "Recognizing Unhealthy Relationships and Creating Healthy Ones". Our guest is Kenneth Appel, Ph.D. Dr. Appel is a clinical psychologist who has worked with individuals, couples, and families for over 37 years. He is on the faculty of the University of California, where he teaches psychiatry residents and also teaches in the Department of Psychiatry at California Pacific Medical Center. I also want to mention that Dr. Appel met his wife online and later tonight we'll talk to him about that and the subject of online relationships.

Good Evening Dr. Appel and welcome to HealthyPlace.com. We appreciate you being here tonight.

So we are all on the same page here, please give us your definition of a "healthy relationship" and an "unhealthy relationship".

Dr. Appel:: A healthy relationship is characterized by dynamic balance and intimacy. An unhealthy relationship is characterized by being severely out of balance, with intimacy diminishing on a rapid curve.

David: "Dynamic balance" means what?

Dr. Appel: Well, consider a picture of the Tai Chi symbol, a circle containing black and white in the form of an OGEE curve. Compare it to the same circle with one half painted black and one half painted white, and you'll see the difference between a relationship with dynamic balance versus one which is static though balanced.

David: Is it hard to find and maintain a healthy relationship?

Dr. Appel: I think not. I think that the opportunity to find healthy relationships is directly correlated with self-knowledge and maturity.

David: A significant number of people seem to hook up with the "wrong person." Why is that? Is it something within ourselves?

Dr. Appel: I think that's a good way to put it, that it might be something within ourselves that's perhaps unconscious, that motivates us to seek out a compliment to something unhealthy in ourselves. So we can learn from relationships like this and learn more about ourselves perhaps than about the other.

David: I'm also thinking that sometimes we meet a person, develop a relationship with them, then after several years, it all seems to fall apart. It used to be that when a person considered marriage, that it would be forever. That's no longer true. Do you think that it's extremely difficult to have a satisfying long-term love relationship?

Dr. Appel:: The nature of marriage seems to be changing parallel to the extension of life span. That is, as we have many many more years to live, the notion of "till death do us part" is being defied by current sociological evidence about divorce. However, there are many relationships which follow a developmental course, that last indeed forever and remain in dynamic balance, share intimacy, and continue to grow.

David: What is the criteria one should use to decide this is an "unhealthy relationship?"

Dr. Appel: There will be gut feelings that will inform you that "something is wrong." These feelings should be trusted. As they are trusted, they will begin to clarify what is going wrong in the relationship. For instance, diminishing intimacy, lack of sex, which usually begins with the distaste for kissing, fewer common goals. But above all, what you will feel is a closing of the heart, and everything in the relationship is then open to criticism.

David: The reason I asked that question is that, as you know, we are a mental health community here at HealthyPlace.com. I get letters all the time from visitors and one topic that comes up a lot is how difficult it is to maintain a relationship when either you or your partner, have a psychiatric disorder. As you can imagine, there can be some very trying times. I would like you to address that subject and give us some insight into when, or if, the non-ill partner should say "I'm getting out."

Dr. Appel: Good question. In the presence of a severe psychiatric disorder, that is one that is clinically manifested, relationships are severely stressed, and it is natural for the non-ill partner to wish to be out of the relationship and at the same time not to abandon the partner who is in trouble. The more severe the illness, the greater the stress on the relationship. And here, I'm talking about uncontrolled bipolar disorder, untreated psychotic depression, severe obsessive-compulsive disorder, agoraphobia, etc.

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On the other hand, there are conditions known as borderline conditions (for instance, Borderline Personality Disorder, BPD) in which the partner who is ill is always in a very strong or avoidant position, making them very difficult to live with.

In less severe disorders, minor personality problems, transient depressions, relationships are less stressed, and consequently more easily maintained. But the real answer that people are seeking, is about when to leave. And I think that one has to get professional help to make this decision and to look for points where they can no longer contain the illness and are beginning to be symptomatic themselves. That's clearly time to think about leaving.

David: We have a lot of audience questions. Here's one that deals with what we are talking about now:

Kirsten700: I am currently separated (husband's choice) and am trying to figure out if my marriage is worth saving. Husband refuses to go to counseling, he thinks he can work out his 'issues' on his own. Should I bother or should I walk away? I get the feeling he still loves me but has some childhood things he needs to deal with. I just don't know if he will. And if he won't, is it worth it for me to stay??

Dr. Appel: You've hit the nail right on the head. He probably does have some childhood issues that he has to deal with, and it's natural to want to know whether you should wait while he goes through that or get on with your life. That he will not seek help to work these through is an indicator of a strong need for independence and autonomy, as well as an avoidance of what could be talked about and resolved in counseling, if he really wanted to. My guess is, that if he doesn't go to treatment, that he will not work them out on his own, and that you might profit by a couple of counseling sessions investigating the question, "What's keeping me in there?"

cindydee: I am borderline. Do you think two borderlines can have a healthy relationship?

Dr. Appel: I would have to know how you define "borderline", but when I think of the defenses of borderline, such as things are all good or all bad, not being able to integrate themselves or others as whole people, I would think that it would be very difficult for two borderlines, who actually fit the diagnostic criteria, to have a relationship which is in dynamic balance and intimate. Withdrawal of love, and lack of object constancy make relationships between borderlines extremely difficult, though exciting.

waterfall: What if I have Bipolar Disorder, Manic Depression and it was triggered by the failure to maintain a much-needed relationship and the partner was the one to blame. I asked him to come with me to get help and he refused. Now I've been through two manic episodes and more alone than when I was in the relationship with him. What do I do now? Thanks

Dr. Appel: Bipolar disorder is a neurophysiological problem which can be dealt with through the use of mood stabilizers, anti-depressants, and psychotherapy. Though the loss of the relationship might have been coincident with your first episode, it would be off the mark to say that a relationship, or the end of the relationship, was responsible for the bipolar disorder.

My suggestion is to get appropriate treatment, and when you are feeling more self-confident, to seek another relationship.

rwilky: Hi Dr. Appel. I have personally found that I had to get my life in order and become responsible for myself, and know myself to find a better relationship. That caused me to stop looking for "cheap thrills" and find someone that is already more stable and that has her life in order. That has helped me to have a more peaceful and stable life, and helped me take charge of my own life. What I am asking is, can't people benefit more from selectively "weeding out" poor candidates and finding people that are more stable themselves?

Dr. Appel: Good for you! Not only will it benefit individual relationships, but in the end, it will benefit the gene pool if people begin by selecting mates who have qualities of mental health and physical health that are at least equal to, or somewhat above, their own level. To put it in your terms, someone who is more stable can certainly help another to grow and to move to a position of stable mental health themselves. In terms of weeding out candidates, it seems to me that's the whole job one begins in adolescence, and continues on to some level where they can find a mate with whom they can be in a dynamically balanced relationship.

David: As I'm reading your responses, I'm thinking to myself, would you suggest to almost every person that they go into therapy yourself BEFORE you start looking for a mate or, at least, before you get married?

Dr. Appel: Absolutely not. I would stay as far away from therapy as I could if I felt self-confident, alert, and socially mobile. I would not recommend premarital therapy because there is a natural developmental course that we all follow, which will eventually lead us to a suitable mate.

David: Before we move on, I also want to touch on the subject of single parenthood and how difficult it must be to have children who suffer from a mental disorder and then trying to find a partner. In fact, here's an audience question on that subject, then I'll ask my questions.

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ksisil: As a single parent of a special needs child, how would you even go about having a relationship. I mean if it doesn't work, then my child is suffering, or his disorders scare most men off.

Dr. Appel: It is difficult enough to find a relationship for a single parent period. Having a child with special needs makes this difficult, and would take someone with a really open heart, and a soulmate love for you, to move into this situation. I wish I could more clearly answer this question for you. I imagine this particular dilemma could be approached through online dating, which we'll be talking about soon.

David: One question I had was, as a parent, when can I put my "needs" forward as a priority? Needs for friendship, companionship, love, sex?

Dr. Appel: As a parent in a married relationship, the needs between the couple and the children are constantly changing and in flux. But the idea of dynamic balance should be kept in mind. As a single parent, that juncture will also depend on the age and stage of development of the child. The timing has to accord to the growth of both the parent and the child. If it is driven on the part of the adult, the timing is probably inappropriate. If it feels natural and agreeable, follow your feelings.

Jack_39: I have found someone that I love very deeply and she loves me as well. Unfortunately she is still married because she is afraid of hurting her young children. It has been over a year and we do love each other so much. What can I do? Should I let her go or wait?

Dr. Appel: Tough situation. If you love this person as deeply as you can, then you will take into consideration her need not to hurt her children. As a mother she knows more about this than anyone else. Respect her decision, and in terms of waiting, you will have to find time to go on with your life, and see if your feelings for her endure. And if your feelings prohibit you from forming other relationships as well. Sometimes we just have to back away from what seems wonderful, and let it play out in order to understand its lesson.

richcos: Dr. Appel: My wife, 34 years old, suffers from rapid cycling bipolar disorder. She takes all her meds, has an excellent physician, but she hasn't been herself for years. What can you recommend to the spouse in terms of coping skills, etc.

Dr. Appel: First coping skill: seek someone to talk to about it. It doesn't have to be a therapist. It could be clergy, or someone trained in listening. If she hasn't been herself in years, then you haven't been yourself in years either. So it's necessary to be that self, and to discover ways to cope while staying and ways to deal with the rapid cycling. I can only imagine it's extremely difficult for both of you.

David: I'd be interested in getting some audience comments. Maybe we can help each other here. If you are in a relationship with someone who has a mental illness, how are you making it work? For those who have asked, here's the link to the HealthyPlace.com Relationships Community. You can click on this link to sign up for the mail list at the top of the page so you can keep up with events.

Beverly Russell: I just got out of a relationship with someone who was diagnosed with obsessive compulsive personality disorder. What do you know about this disorder and how does it effect relationships.

Dr. Appel: Obsessive compulsive disorder, depending on its severity, can impact relationship in devastating ways. For the person with the disorder, control is everything. The major characteristic is the attempt on the patient's part to hold the world still while obsessing about problems of safety, contamination, etc. Or they may have repetitive ritual activities. All take the attention not only of the ill person, but of anyone living with him or her. I remember my mother saying some hundred miles into a trip, "did I turn the gas off? or did I lock the door?" She had a mild form of the illness. My father didn't turn around under her control and go back. But in the severe form of the illness where a person has say a compulsive hand-washing ritual, a severe fear of contamination, not only holds the world still, but shrinks it for himself and those around him or her.

David: Here are some audience responses to "how you are making it work - being in a relationship with someone who has a mental illness:"

catino: I have been married for over 25 years to the same person and just recently found out that she has MPD (Multiple Personality Disorder). We have been trying to work on our relationship but it is and has been a very difficult time for the past few years. I love her with all my heart and really want to work through all the problems and get our relationship back in harmony.

PEBBLES2872: Mental illness is 95% perception based on what one expects from someone else, and as time goes on, one finds out that they are not living up to your expectations.

David: Here's the flip side of the coin, Dr. Appel. How would you respond to this person:

Joni: I suffer from bipolar disorder, and I feel a burden to my mate. I'm separated and have met and love someone else - and he's "the one". I feel like a burden to him too.

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Dr. Appel: This should be handled in your therapy. And that is a real therapeutic issue. Feeling a burden to someone seems to be a part of the depressive side of the illness or disorder. I think you should talk to your therapist about this.

brooke1: Joni, maybe you should believe him if he says you are not a burden.

David: Here's another audience comment from someone who had Borderline Personality Disorder:

sweetpea1988: Hello, I was married for 8 years and I have borderline personality disorder. He tried to keep me from getting better, he loved the control he had over me. Two years ago, I finally left him. I took our three daughters with me, but lost them due to my illness, but now I have learned a lot and I am on my own. I feel much better about myself and life itself. I have hurt myself for 16 years and now since I left him I have stopped.

David: As I mentioned earlier, Dr. Appel married a woman that he met online. People are doing this more-and-more these days--finding relationships online. Can you share a bit of your story with us Dr. Appel?

Dr. Appel: I'd be glad to. I was in San Francisco on Valentine's Day in 1997, and a promotional ad came in my email from One-and-only.com to place a free ad on their dating service. I immediately deleted it and went on with what I was doing. But then I had second thoughts and placed an ad describing myself and the kind of relationship I wanted. On April 18, I got an answer from Beverly. And that was the beginning of an email correspondence which numbered well over 1000 pages in two months. Beverly was in Tennessee, and our phone bills became enormous. And because our love had developed during this, we decided to meet in June in San Francisco. Everything we had learned about each other online/phone turned out to be wonderful and true. We have been together since that time, and truly feel we are soulmates. Out of this experience and correspondence and interviews with hundreds of people, we wrote "It Takes Two.Com," A Psychological and Spiritual Guide to Finding Love on the Internet Personals, in the hope that we could illustrate to others that good healthy relationship was possible on the Net, and that meeting from the inside-out could bring one closer than meeting in person.

David: We have some more audience suggestions on how to deal effectively in a relationship with someone who has a mental illness. I want to post those, and then we'll continue:

richcos: Serious mental illness in a marriage is tough, no doubt about it. Make sure you've found the best possible psychiatrist for your loved one. And then a therapist for yourself to make sure that you remain mentally ok. It's often unremitting stress and I would suggest looking at the spiritual angle for guidance. It's not easy, but if you can meet the challenge, you can feel a real sense of accomplishment that you didn't run away from the person you love.

Dr. Appel: richcos, I think this is a wonderful comment, and I am so glad to hear you say that the spiritual side will often help you through this dilemma, and enable you to stay with your loved one, and essentially see the relationship as a devotion without becoming martyred.

David: That is a wonderful story Dr. Appel. Commonality, of course, brings people together. And especially now, with the internet, many people with mental illness are meeting up and discovering they are not out there alone. Is this a good way to meet people?

Dr. Appel: It's going to depend on individuals, just like meeting each other face-to-face. The main thing is to be yourself, be honest, be mindful, and follow your feelings and intuition. The more you know from email, the more possible it is to make the right decision.

David: Do you think communicating via email is better, initially, than chatting?

Dr. Appel: Often it can be. It seems to give one a greater sense of distance and time to think about what they're feeling and saying. Chats often have the feeling of demand that you might find in a singles bar.

David: Here are some more audience responses to what's been said tonight:

bcooper: My boyfriend is having a hard time living with me. I have obsessive compulsive disorder (ocd) and panic.

Beverly Russell: My self-esteem has suffered a great deal as well as my self-confidence. I left because he no longer was interested in me and would not even speak or look at me when I informed him I was leaving. I have been thinking about therapy.

Jocasta: What are the chances/statistics of two people in a commitment (6+ yrs.) who both have mental disorders staying together in your experience with working with couples? Would you advise of a specific way for one party to convince the other that they need medication when that party is adamant about not taking any? And, can one party develop systems of the other's disorder from being attached for so long (codependence?) with very few friends?

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Dr. Appel: This is a really complicated question. The only thing I can say here is something often said in AA and other 12 step programs: It is imperative to take your own inventory. It is imperative not to take the inventory of others.

SkzDaLimit: I am currently engaged to a wonderful woman who is diagnosed Bipolar I (rapid cycler). The problem I have is she does have occasional fits of anger, and she seems to draw me into lashing out in anger towards her. Are there any suggestions as to how I might deal with this?

Dr. Appel: This is a common situation in rapid cycling rage--that the partner is often drawn in. It is almost as if the partner takes on the rage of the bipolar. The only way to deal with it is to step away from it, even though this arouses more rage in the bipolar partner. The other solution is to "teflonize" yourself, that is, to contain the rage without absorbing it.

samantha 1: Do you think that codependence is a major problem in relationships?

Dr. Appel: I'm never sure what co-dependency really is. What I do know is that interdependence is a feature of healthy relationships. Co-dependence seems to be so enmeshed that often the sense of who is who is lost.

Sarah4: Is it possible to be in a relationship, break it off, and find that you have become better friends, more in tune to each other after, and if so, would you suggest trying it again?

Dr. Appel: It's absolutely possible, and I would suggest that you remain good friends. Natural development will take care of the rest. The less you think about it and the more you experience it, the more you will learn.

Dr. Appel: Also, Beverly has just written a new book, A Guide to Online Dating, which can be found at http://dlsijpress.com. It's an e-book, and also available for the sight impaired.ACMercker: Dr. Appel, how does one deal with infidelity on the part of their ill partner? My patience seems to be both a strength and a flaw.

Dr. Appel: If the infidelity is part of the illness, as it often is in hypomania, then one should understand it as such. If it's part of the pull out of the relationship, the only way to deal with it is through therapy or through a very strong spiritual approach. There is no understanding of repetitive infidelity. What I mean is that understanding will get you nowhere. Repetitive infidelity means the other person isn't in the relationship anymore, and you shouldn't be either. Even if it's manic acting out.

catino: I agree with ACMercker about patience.

David: Somehow, after awhile, even if you're a "saint," and maybe this is just my perspective, but "understanding" repetitive infidelity would be tough. Here's an important question on adolescent relationships:

ksisil: This may be a little off the topic but in terms of adolescent relationships, how can I encourage these with my son when any child who has seen his rage never wants to come around again and of course when he calms down he is broken hearted because no one will play with him.

Dr. Appel: There are groups in larger cities and at university centers dealing with the problems of adolescents such as you describe. In these groups, they learn relationship skills under techniques of cognitive behavioral therapy. They are quite successful, and you might be able to find groups like this online.

David: What about creating healthy relationships? When people say that, it sounds easy. "We just all get along." What are the keys to having a healthy relationship?

Dr. Appel: The key to a healthy relationship is that it is developmental in nature, many have beginnings and ends, and some last a lifetime. To create a healthy relationship, the main key is to give up judgment. This is extremely difficult. But if one can talk in "I" statements and not be judgmental and critical, relationships will endure. And, of course, as they develop, the development is deeper and stronger. It is not an answer to the wish, "I wish it was like it was at the beginning."

David: And intimacy takes effort, isn't that right Dr. Appel?

Dr. Appel: Absolutely. And once the effort is expended, it is so easy!

Jessica Neal: A year-and-a-half ago, I was diagnosed with bipolar disorder after having about 3-4 months of rapid-cycling episodes. During those episodes I said a lot of hurtful sexual remarks to my husband. Some I remember saying, some not. I'm wondering what can I do to help alleviate his pain? It was hard enough for me to deal with bipolar, but now we have this hanging over our heads.

Dr. Appel: He should get some help to understand that those remarks were made in the heat of mania. And even though you might feel them deeply to be true, he will still have to deal with the hurt in treatment. Now that you have your illness under control, you'll be able to begin to be complimentary in a way that will rebuild his sexual self-esteem.

catino: Why is it that people find it so hard to decide that they may need therapy? How do they know that they do, in fact, need it?

Dr. Appel: If one is thinking about it, then perhaps there are some problems alive that need attention. If the person feels that a lot of their energy is tied up in conflict, such as difficulties with authority, relationships, aggression, and other symptoms, then the time has come to seek therapy. If you sense these symptoms coming on, therapy might help to preempt them.

David: It is getting late. I want to thank Dr. Appel for being our guest tonight and for sharing his insights and knowledge with us.

I also want to thank everyone in the audience for coming tonight and participating. That's what makes these conferences so wonderful and informative.

Dr. Appel: Thank you for inviting me! I think you have a wonderful community here. It's been stimulating to talk with you.

David: Good night, Dr. Appel. And good night everyone.