Healthy Living: Relationships

Q I’ve been injured for 10 months. My two young daughters don’t mind that I’m now in a wheelchair. But I think my wife is having a problem adjusting to my injury. What can I do?

A Since you don't say what kind of problems your wife is having, it is difficult for me to address your question directly. However, I will discuss what you can do to help ease her adjustment to your personal changes as well as the changes required within the relationship.

You mentioned that your daughters have had little difficulty adjusting to your spinal cord injury (SCI). Children are naturally curious and have the ability to ask questions. They ask a lot of questions because they make few assumptions about your condition. This changes as children grow up. Adults become more inhibited by their own beliefs and often jump to conclusions. The problem is that these beliefs are often incorrect. It is important to note that the process of adjustment to your injury is similar for both the spouse and the person with spinal cord injury (see page 1). After all, you are both affected by your injury. You can help your wife identify the assumptions that she is having about your injury. The two of you can openly discuss how these thoughts are affecting your relationship. In time, hopefully, the two of you can reach a mutual understanding of how, together, you can overcome the situation and strengthen the relationship (For a specific example, see the next question).

Remember, the key to every successful relationship is communication. Open communication requires patience and trust on behalf of both partners. Did you and your wife communicate openly prior to your spinal cord injury? If you did, then there is a strong likelihood that you will return to your former manner of communication, and you will probably find that her adjustment to your injury will come along given time. However, if your communication style was based more on fear, mistrust, and deception, then both of you may benefit from professional counseling to help you improve your communication.

Q Last year my husband had a car accident and now has C5 tetraplegia. Is it possible for me to be the primary caregiver without losing the romantic intimacy that we share as husband and wife?

A Your concern is very real and one that many couples struggle with after an injury. Unfortunately, the answer is not so easy and will depend on two things.

First, it depends on your ability to “compartmentalize.” This means you put something, like a task or a thought, aside (in a box or compartment) for a specified period of time. Couples who keep the dual roles of spouse and caregiver separate are most successful. One way to do this is to have a routine that keeps the caregiving activities apart from those of a spouse/partner. Another way is to have a specific area or room devoted to intimacy and where no caregiving tasks are performed. Keeping the two roles as distinct and separate as possible will help you to avoid confusing and blurring the roles in your mind. When you and your husband are feeling romantic, you will be better able to see yourself as his wife and partner, and not as his caregiver.

The second thing to look at is what type of resources you have available. Many couples choose to avoid the overlapping roles entirely by hiring a personal care attendant (PCA*). This way, the spousal relationship is not affected by the caregiver role. You can find a PCA by placing an ad in the paper or putting up flyers at your local churches, hospitals, or assisted living facilities. If you live close to a college or university with a nursing school, you may find a student interested in being an attendant. However, many people cannot afford a PCA without financial assistance. You may qualify for programs that can help. Some agencies that you might contact are your state Vocational Rehabilitation office, your local Independent Living Center, the Department of Veteran's Affairs, and your private insurance carrier. Usually insurance will only pay for "skilled nursing care" and not attendant care. If you are going to receive any financial settlement for your injury, be sure to include your expected lifetime costs for a PCA.

Dr. Rivera is a Rehabilitation Psychology Postdoctoral Fellow with the UAB Department of Physical Medicine and Rehabilitation.

* To receive your free InfoSheet #6 on Personal Care Attendants, send a self-addressed stamped envelope to the address on page 8 or download free from the internet at http://www.spinalcord.uab.edu/show.asp?durki=21479