Summary/Review of The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps by Melissa Orlov (and Edward M. Hallowell)

By Nicole marino AMFT

Recently, I had the privilege of reading The ADHD Effect on Marriage. I thought the book was well-written and incredibly helpful for marriages consisting of an ADHD and non-ADHD spouse. As a therapist, I found this book enlightening to how ADHD shows up in many relationships, and how it impacts both the ADHD spouse and the non-ADHD spouse. The book was broken down into three main parts: Understanding ADHD in Your Marriage, Rebuilding Your Relationship in Six Steps, and Worksheets/Tools. I am going to go through each part and give a brief summary of what you can expect when reading.

The first part went through the common symptoms of an ADHD diagnosis and how the symptoms present for both the ADHD and non-ADHD spouse. It is important to note that not every relationship has a non-ADHD spouse and an ADHD spouse, but for the purpose of the summary, this is the language and dynamic that was chosen to highlight. This part of the book, from my own experience, allowed me to have a better idea and understanding of what ADHD looks like and how to cultivate empathy for both partners in the relationship who may be suffering. This part went through and explained many statistics and research around ADHD’s impact to a marriage., and the different types of dynamics within a relationship. This part also highlights the rewards of rebuilding a marriage that has been affected by ADHD in a very encouraging, positive, and motivating way. This section goes through symptoms that the non-ADHD spouse may be experiencing and normalizes the impact by including real life examples posted from Melissa Orlov’s interactive blog: adhdmarriage.com.

The next part, and the main part of the book is broken down into six steps to take towards bettering the marriage/relationship. I am not going to fully go through what each section explains but will give a brief overview for reference. To learn more, I highly recommend reading the book to gain more insight, information, understanding, and tools!

1. Cultivating Empathy for Your Spouse: The first step is incredibly important, especially when it comes to healing past resentment. It is key to understand your partner and their experience in the marriage, whether that is the experience of the ADHD spouse or non-ADHD spouse. Being able to empathize with what both partners are going through is a main step towards feeling more connected and on the same page. This also helps when it comes to reactions and responses towards certain triggers or symptoms. Gaining empathy can slow those reactions down to be able to choose a different response to the symptom knowing what the other person is experiencing as well.

2. Addressing Obstacle Emotions: This section better highlights different emotions and responses to symptoms of ADHD specifically from the non-ADHD spouse. For example, anger was a common response to the ADHD struggles in a marriage. The author did a good job including examples to show how anger presents and how it impacts the ADHD spouse most likely on the receiving end of the anger (even though impulsive anger is also another symptom of ADHD). This step discusses how to let go of certain negative emotions/responses as they do nothing productive for the relationship and partner interactions.

3. Getting Treatment for You Both: This step discusses the importance of seeking treatment for both the ADHD spouse and non-ADHD spouse throughout the process of bettering the relationship. For the ADHD spouse, it is helpful to seek professional help to understand symptoms better and gain tools for symptom management. For the non-ADHD spouse, it is important to seek professional treatment to gain support and better coping techniques to manage reactions and emotions towards partner. This step also talks about the choice around medication.

4. Improving Communication: This part walks you through different techniques around having various conversations in a marriage and how it is vital to improve communication in order to improve connection. It is important to listen to one another, validate each other’s experiences, negotiate/compromise respectfully, and increase emotional safety for both partners. This step also goes into how gender plays a role in communication differences, and what to look out for.

5. Setting Boundaries and Finding Your Own Voices: This section goes into personal boundaries, how to identify your own personal boundaries, and how to enforce personal boundaries. The author notes the importance of identifying which boundaries are most important for an individual and where your threshold is for each boundary. With this, you can better understand expectations for each other and what is realistic versus unrealistic to expect. The step then goes into processing how each spouse can respect their partner’s boundaries and create an action plan.

6. Reigniting Romance and Having Some Fun: This step discusses the importance of reintroducing romance and intimacy into your marriage, and how having fun together is a vital part of relationship success. It is important to try and get back to doing fun things together that you use to enjoy at the beginning of the relationship or trying new things together. Having new adventures brings you closer together and reignites that romantic spark and excitement.

The last brief part of the book is a reference chapter full of different tools, techniques, and tips for achieving the six steps. As you read each of the steps, there are different tips and tools specific to what the step’s goal is to help both partners improve on these skills and achieve overall betterment in the marriage/relationship. Not all the tools will be applicable for every person or marriage, depending on the specific struggles you are going through, but you can tailor your toolbox with whatever works best for you and your partner!

Overall, I found this book incredibly beneficial to read not only for my knowledge as a therapist and for my work with my couples/clients, but just to gain a better understanding of how ADHD presents in a person, and a relationship. As someone who has personal relationships with individuals diagnosed with ADHD, I have gained a different perspective on what they may go through every day and how their ADHD shows up for them in their personal relationships. For more information around the book, author, or ADHD in general, you can visit Melissa Orlov’s website at adhdmarriage.com (blog posts included there).

Love Languages: A Give and Take with Couples

By Nicole Marino, AMFT

In my experience working with couples (and individuals), the importance on love languages is very prevalent. I see it similarly to the idea of showing support. We all have our natural ways of wanting to show support given how we know we want to receive support. But when the other person doesn’t need or want to be shown support in that way, they may feel the other person doesn’t care to fulfill their needs for support accurately. The same thing goes for love languages and the way we want to receive love.

We will be talking about the five original love languages: words of affirmation, acts of service, gifts, quality time, and physical touch. It is important to keep in mind that there may be differences in your love languages based on how you want to receive love and the way you want to show love. I find this distinction very relevant for couples work because it can take extra effort to shift your focus of showing love if the way your partner wants to receive love is different than how you naturally show love. I always tell couples that if this is the case, it doesn’t mean you can never give your partner gifts if that is how you express love; it just means that you also must make a conscious decision to put effort forth to give your partner words of affirmation if that is the way they need to receive love. Another thing to note is that many people do not just fall into one category for love languages but may be a mix of a few or have a certain priority list for which they prefer/need the most.

Words of Affirmation: A partner desires being shown love or giving love through verbal connection and affirmations. This can be as simple as an “I love you” in the morning, a sweet post-it note on the mirror, showing appreciation and acknowledgement for their efforts around the house, or even a handwritten love letter. Someone whose love language is words of affirmation needs emotional intimacy through words and hearing that a partner cares and loves them.

Acts of Service: A partner desires to be shown love when their partner is physically helpful and partakes in certain tasks, so the other person does not have to. This can be concrete tasks such as the dishes, laundry, cleaning the snow off the car, picking them up from the airport after a trip, or making dinner. It can also be smaller things such as putting toothpaste on a partner’s toothbrush in the morning, filling up their water bottle, starting the shower for them, etc. When living with a partner, there are many options of tasks around the home that can be done to show acts of service especially knowing a partner’s everyday routine.

Gifts: People who love gifts or gift-giving don’t always view this is as some grand gesture. Often, it is the little things that can make a partner feel special such as picking up their favorite meal from the grocery store, bringing back something they were running low on, their favorite sweet treat, flowers, and anything that made you think of them. A person with gifts as their love language just wants a partner to show they love them by thinking of them in little (or big) ways in the form of a physical item. To know their partner went somewhere and thought of them makes all the difference.

Quality Time: A person who needs to be shown love through quality time just wants to physically and mentally be present with a partner. They thrive from doing activities with a partner even activities like running errands, driving around, playing a game, going on a walk, going on a date somewhere, etc. It is so important to keep in mind that quality time is different than just passive time together such as living together and going about your routines and watching a show or movie. A partner who desires quality time wants the quality in it. Maybe try putting phones away and just enjoying each other’s company one on one.

Physical Touch: A person or partner who needs physical touch to be shown love doesn’t always want the touch to be sexual, even though that is part of it. Physical touch can be as innocent as hugging, holding hands, cuddling, and massaging. They feel most loved through someone physically expressing it to them and feeling a partner wanting to be close to them.

Now that we have gone over the five original love languages, it is important to figure out which love languages you gravitate the most towards whether that be one main way of showing and receiving love, or a mix of a few. It is also essential to understand the way your partner gives and wants to receive love. Like stated before, you can still show a partner love in the way that is natural and feels good for you to do so, but it is necessary to also learn their love languages to understand how you can show them love and when they are also showing you love in their natural way. It is a way to better understand each other and recognize when your partner is expressing their care and appreciation. There are many love languages quizzes and books to learn more such as: 5lovelanguages.com and The 5 Love Languages by Gary Chapman.

Tips and Tools for Dividing Up Household Tasks

By Nicole Marino, AMFT

Many couples often come to therapy to work on communication and conflict resolution skills. What we then discuss many times is conflict over household tasks and division of those tasks. I tend to find that the small things become the big things when left undiscussed and unresolved. This can lead to resentment and frustration if one partner feels that they are doing all of the work around the house. That is what we want to avoid. Here are some helpful tips and tools to lessen the constant conflict over keeping the home clean and tidy.

1. Express your expectations - Partners should be on the same page and understand the needs and expectations that their partner has for them and for the state of the home.

2. Compromise - There may be certain tasks or chores that are not you or your partner’s favorite to do (cleaning the bathrooms for example) so depending on how often you do these specific tasks, try to switch out with one another. If you clean the bathroom this week, then it is your partner’s turn next week. This way, you are still working as a team to get the task done. Also, keeping in mind that compromise may need to happen when it comes to expectations. Some things are not going to be perfect all of the time. You do want to be able to live in your home as well! Trying to figure out the middle point that feels good for both partners is important sometimes too.

3. Create a list of household tasks - Work together to come up with all of the tasks and chores that get done both daily and weekly. Then, discuss how you want to divide up those tasks to you, your partner, and to both of you together.

4. Discuss your daily schedules/routines - Depending on work schedules and daily routines, there may be certain tasks or chores that just naturally make more sense for one partner to do over the other, but make sure the amount/types of tasks still feels doable and fair for both.

5. Identify strengths and weaknesses - Similar to the tip above, there may be certain tasks that one partner can do a lot easier than the other so it is important to discuss your strengths and weaknesses together and divide up the tasks accordingly. What is going to feel comfortable and easy for one partner, may feel challenging and uncomfortable for the other.

6. Be compassionate and patient with each other - Some habits are hard to break so give it some time for you and your partner to improve on your cleaning routines and habits. If your partner has never put their towel away after showering, they are not going to magically wake up and remember to do this. It takes some time to break the habit to then create the new one. Give them gentle reminders to help, but avoid using blaming language or shaming them for forgetting.

7. Act as a team - Remember that you are working together; not against each other! This is a huge one. You are working together to keep the home clean and tidy. The problem in not you or your partner. The problem is the dirty home and how the two of you can fix the problem together.

Notice and Describe – A prescription for High Conflict Couples

By Anne DeCore, AMFT

Let’s look at the following scenario.

A husband and wife argue about cleaning the kitchen. They have an understanding that when one cooks, the other cleans. Tonight, it was the husband’s job to clean because the wife cooked dinner.

Wife tells husband: You do the bare minimum of just loading 75% of the dishes. I then have to do a whole second job of finishing the dishes, cleaning the table tops and the high chair. Why do I have to supervise you? We agreed, you would clean if I do the cooking.

Husband says: You have a ridiculous standard for cleanliness. And you fail to appreciate that I also have to walk the dog and go back to work in the evening.

Wife: You “work” with the basketball game on in the background. What happens is you’ve come to expect that I’ll pick up the slack when you sit back and relax. You’re being lazy. I don’t get to be lazy.

Husband: I’m lazy?! If it’s so easy to make a living, you go ahead and do it. Last I checked your salary barely pays for the kid’s summer camp. The reality is I could do the kitchen perfectly and you’d still nag! You love to micro-manage me! Nothing is ever good enough for you.

In this vignette, what husband and wife consciously experience is a back and forth of what they believe to be their genuine thoughts and feelings. These attacks escalate, polarizing the couple and moving them further away from understanding and solutions. They each storm off and feel overcome with a piercing disappointment that verges on a sense of betrayal. Each one thinks “You hid your true self from me. You’re not what I believed you to be. You don’t even know me.”

The damage happens fast; the repair will take much longer. They are left wondering “how did this all happen?” The answer lies in a hidden process which occurs below the level of consciousness, based in the brain.

In a regulated state our brains employ perspective taking, long term views, and balanced thinking and reasoning. These are necessary for interpersonal success. When we begin to enter a state of high emotional arousal we lose these faculties which are critical in relationship management.

High emotional arousal is followed directly by biased thinking: our thoughts become overwhelmingly negative and imbalanced.

Next, we produce negative judgements and assumptions about our partner. The negative judgements and assumptions are what lead directly to misunderstanding and high conflict.

This process is automatic. The dangerous thing is not that this happens; there are many strategies for self-regulation which aim to bring our reasoning faculties back online. The dangerous thing is that we are mostly unaware when we are under the influence of biased thinking. We tend to think we are governed by reason when reason has long left the building. And the deeper (higher emotional arousal) a couple gets into the fight, the more indignantly each believes that their judgements and assumptions about each other are objective, verifiable fact. One partner’s brain supplies the missing parts (assumption) to the other person’s story and then the brain reacts to that story (judgement).

In the example above, we see it happen right away. Both make assumptions about the other: she assumes he’s only pretending to work. He assumes she doesn’t appreciate all he does for the family and that she has it easy. Both make judgements: she calls him lazy and he calls her critical. The frustration she felt over the incomplete kitchen put her in a state of high emotional arousal and from there they were both off to the races in creating narrow and inaccurate narratives.

Developed chiefly by Marsha Linehan in the field of Dialectical Behavioral Therapy, an antidote to this automatic process is to employ a deliberate method of thinking we can call “Notice and Describe.” You might like to think of it as relationship mindfulness.

In this mode a person notices and describes what is going on around them, much like a sports event announcer does on the radio. This means sticking purely to what is noticeable in the environment, noticeable about our partner, and noticeable inside our body. We pay attention. We notice. We describe. We do not engage in making any interpretations in this mode. This helps keep arousal at a manageable level and keeps us from straying into judgements and assumptions.

In the book “The High Conflict Couple” Alan Fruzzetti writes: “When you assume what his feelings are, interpret or evaluate her response, question his motivation, or focus on how illogical she is being, you have stopped paying attention to your partner, lack awareness, and are not being mindful of him or her. Mindfulness of your partner is the gateway to listening and understanding, and eventually to collaboration, support, conflict resolution, and closeness.” (p. 26).

The notice and describe mode leads us to curiosity and wanting to understand more. It highlights the parts of the context that we are missing and invites the other person’s experience to fill those blanks. It creates open thinking instead of closed thinking.

So what does it look like in practice? Let’s revisit the couple from above.

The wife says to herself: “I notice the dishes haven’t been completely finished. I notice he put all the food away. I notice he changed the lightbulb that I asked him to change. I notice myself feeling upset that he hasn’t wiped down the high-chair or the counters. I notice he looks tired. I notice he hasn’t changed out of his work clothes. I notice my own fatigue too. I notice how the fatigue feels in my body next to the frustration.”

This is an example of more balanced thinking. The wife can then share with her husband what she’s noticing without attacking.

Wife: “You look tired. Did you have a long day at work?”

Husband: “I did. The performance evaluations are really stressful this year. I have 3 more to write tonight.”

Wife: “I’m sorry. I know this has been a big project.”

Husband: “How was your day?”

Wife: “All good, I’m just really overtired. Baby has been waking really early. And I know when I get overtired it can lead to me being impatient with everyone. We are both working really hard for the family right now.”

Husband: “I know. Everyday is a marathon.”

Wife: “You had a long day and I don’t want to pile on but I have a quick request. When you clean the kitchen would you mind doing one final sweep to pick up any dishes you may have missed? And can you wipe down the high chair. I clean it using the Mrs. Meyers spray that’s under the sink.”

Husband: “Did I miss some dishes?”

Wife: “Yes.”

Husband: “Ok. Sure. I think I don’t even realize because I’m still thinking about work.”

Wife: “I get that.”

Husband: “Yeah I have to be honest, I don’t think to clean the high-chair because you always feed the baby. Like, I don’t even look at it. Generally, I do the kitchen kind of rushed because I still have to get the dog out and, on a night like tonight, there’s more evaluations I have to get done tonight.”

Wife: “That makes sense. I will leave the high-chair next to the sink so it’s right in your sight line. Also, on the nights when you’re doing the kitchen, I’m happy to take the dog out. I can’t believe I haven’t thought of this before. I would actually love some fresh air. For me, on the nights where I’ve cooked and done the kids dinner, the thing I just can’t stand is spending more time in the kitchen. If I take the dog could you do all the clean-up and close up the kitchen.”

Husband: “Definitely.”

In this version of their interaction, we learn about his context, her context, and each one’s needs and worries. They have come to a solution that works by redistributing tasks and making expectations explicit. They have communicated successfully by keeping emotional arousal low through the notice and describe approach. Neither asserts themselves to be an expert on the other person’s experience (as they did in the high arousal version). They do not load meaning into each other’s actions. They seek to understand what meaning, if any, should be made.

In this version, they walk away feeling a boost in relational competence. They worked together in solving a problem, and in doing so came to understand each other’s inner worlds more intimately.

References: Fruzzetti, A. (2006). The High-Conflict Couple. New Harbinger, CA.

The Meaning We Make

By Karen Focht, MA, LMFT

I recently read an article written by a New York City based Marriage and Family Therapist, Esther Perel, who touched on so much of what I see both personally and professionally when it comes to relationship conflict.   The article, titled, “How to Stop Having the Same Fight With Your Boyfriend All the Time”, addressed different dynamics that play into frequent arguments for couples. I couldn’t help but ask myself “what is the meaning we make in conflict with our partners”?

While providing relationship therapy to couples of all different walks of life, I find that I am often addressing the common issue of repetitive arguments. Are we really talking about who is taking out the trash?   It is so easy to get caught up in content.  Content refers to language, circumstances and events within a relational argument. 

It is hard work to take that step back and look at the meaning underneath it all.  I often refer to this meaning as as Process.  Going back to our original question of “are we really talking about who is taking out the trash?”, the initial response might be “yes, yes it is important!”.  The reality is that the messages underneath it all are so much more powerful when it comes to implementing lasting change.   When I hear “the things we argue around are small and don’t hold much meaning” I will quickly point out this idea of Process VS Content to explore the meaning we make through our conflict. 

Here are some things to pay attention to as you switch gears from “content” to “process”. 

1.     “I STATEMENTS”

“I statements” work towards removing blame while creating an opportunity to identify and express thoughts and feelings. When you do “X”, it makes me think “Y” and feel “Z”.  X represents the content while Y and Z represent the process and meaning that is taken away.

Let’s go back to that same couple that often argues about the trash and switch gears to express the meaning made from this issue.  “When I see you haven’t taken out the trash “X” it makes me think “Y” our family home is not a priority to you, and makes me feel “Z” unloved and unappreciated.  Not only does this statement express meaning to the listener, it also helps the speaker identify what meaning they are taking in during conflict. 

2.      VALIDATION

Validation is not necessarily saying that you AGREE or UNDERSTAND your partner, but it is showing a level of respect, care and curiosity of what they might be expressing to you.  For example, responding to the above I statement with “I see where you are coming from” or “I appreciate you sharing your feelings with me” is much different than jumping directly into explanation or defense.  A healthy process includes validation and the willingness to accept one another’s experiences regardless of intent. 

3.     PRACTICE

I will often implement weekly check-ins with couples in order to intentionally practice looking deeper into the process within their relationship.  Making changes in our lives doesn’t come easy or naturally most of the time and we need to be patient with one another and ourselves in order to implement lasting change!  Try scheduling a weekly 15-minute “check in” where you are expressing process, using “I Statements” and paying attention to validation. 

So the next time you find yourself arguing about something in your relationship, I encourage you to take a moment, a breath and ask yourself…. “what is the meaning I make in conflict with my partner”? 

To check out the article mentioned above go to http://www.cosmopolitan.com/sex-love/a60435/fix-the-fights-youre-sick-of-having/