Spirituality and Relationship: A Holistic Analysis of How Couples Cope with Diabetes
Cattich, John, Knudson-Martin, Carmen, Journal of Marital and Family Therapy
This study explores how couples' spirituality and relationship processes holistically interact to inform diabetes management. Qualitative analysis of interviews with 20 heterosexual couples identified five spiritual coping styles based on the spiritual meaning they ascribed to the situation and the nature of their relationships with God and each other: (a) opportunists approach the illness as an opportunity for growth; (b) mutual problem solvers collaborate with their partners to respond to their disease; (c) individualistic problem solvers take personal responsibility for managing their disease; (d) accepters endure their disease; and (e) victims take a hopeless, discouraged approach. Results suggest that spirituality and couple communication and problem-solving patterns appear intertwined and integral to the practice of family therapy.
Researchers and clinicians increasingly recognize the important role of spirituality when working with people facing stressful situations (e.g., Hodge, 2005; Marsh Sc Dallos, 2001; Miller, Korinek, & Ivey, 2006; Moules, 2000). Several have explored its role in relation to coping with diabetes (Paterson, Thome, Crawford, & Tarko, 1999; Polzer & Miles, 2007; Rapaport, 1998). However, spirituality is usually discussed as an individual or additional dimension for assessment and consideration, and is not yet integrated into a holistic understanding of family processes. Holistic approaches suggest that spiritual, physical, and relational dimensions of health care are interrelated and should not be isolated from each other (Patterson, 1998). However, how spirituality and intimate relationships work together to organize responses to illness has not been well articulated. In this article we examine how these dimensions are integrated among couples managing the diabetes of at least one partner. We focus in particular on the couple relationship as the relational unit through which diabetic patients come to terms with the disease and adapt to it on a day-to-day basis.
Diabetes is a common chronic illness faced by 20.8 million persons in the United States (American Diabetes Association, 2006). Coping with this disease demands significant lifestyle changes in such areas as exercise, diet and nutrition, as well as routine monitoring of blood glucose levels. Adherence to the recommended regime is a common problem (Campbell, 2003). Patients diagnosed with diabetes also have increased risks for developing mental health problems such as depression and anxiety (Kruze, Schmitz, & Thefeld, 2003; Thomas, Jones, Scarinci, & Brantley, 2003). Perhaps most important from a psychological and behavioral perspective is that patients must adhere to the demanding requirements of diabetes management while knowing that eventual onset of complications is almost inevitable (Thomas et al., 2003). The strain of diabetes care and the associated effects on the patient's mental health have also been shown to significantly stress patients' families (Auslander, Bubb, Rogge, & Santiago, 1993). In fact, Fisher, Chesla, Skaff, Mullan, and Kanter (2002) found that the partners of diabetic individuals experienced levels of psychological distress as high, or higher, than patients - especially if the partner was female.
Couples' Relationships and Adaptation to Diabetes
Diabetes becomes intricately embedded in the emotional life of a couple (Rapaport, 1998). Fisher et al. (2004) report that stable, cohesive families with high marital quality and low conflict show greater ability to manage chronic disease. Intimate couple relationships have been shown to play an important role in a person's ability to cope with diabetes and related stressors (Fisher et al., 2002; Trief, Hirnes, Orendorff, & Weinstock, 2001; Trief, Wade, Britton, & Weinstock, 2002). Trief et al. (2002) found that among insulin-treated adults with diabetes, quality of marriage prospectively predicted diabetes-related quality of life. …