My husband of 38 years was in weekly in-person psychotherapy for 17 years without change to his behavior or character. I think it was for general anxiety, profound procrastination and indifference about earning a decent income. His therapist reinforced this by not asking for upfront payment but taking whatever our insurance reimbursed, which she rarely got because he didn’t apply for it. (That therapist, previously mine, had been helpful to me.)
Although I was upset, I tolerated this because I didn’t want to be without him. I semi-contained his messes, took care of all financial matters and appreciated him otherwise for being a smart, kind and loving husband. I think it’s a biochemical matter: He has attention deficit without the hyperactivity aspect. The therapy ended a few years ago when he suddenly stopped going.
Two years ago, he began weekly remote psychotherapy for the same difficulties. While I have gotten him to regularly apply for reimbursements, it is still costing us a good sum. He says, “We can afford it” — thanks to me! He earnestly wants to change but is now 87 and in good health. I feel I shouldn’t interfere with his private process; a previous engagement ended when my fiancé whined, “How long will you be in therapy?”
My husband refuses to discuss his therapy, but I think he does it for superfluous emotional support. I want to set a limit of one more year. How should I handle this?
From the Therapist: I hear how frustrated you are, but in order to help you figure out how to handle this, I want to help you get clear on what you hope to accomplish by telling your husband he must stop his therapy.
You’ve mentioned three concerns: cost of treatment, lack of tangible progress, and the toll of taking on financial and logistical responsibilities because of his diagnosis. Let’s look at all three.
Starting with money, it sounds as if his earlier therapist charged only what insurance reimbursed, and despite his neglecting to submit the claims, the therapist saw him anyway. Putting aside the question of whether that was a wise clinical decision, you spent little to no money on his treatment. You say that with the current therapy, he’s now submitting the claims and believes the remaining balance is affordable. Is the issue that you believe the cost is prohibitive, even if he doesn’t? If that’s the case, your “limit” might be that he needs to find a therapist who works within your budget.
If the cost isn’t prohibitive but you’re feeling resentful because you’d like to use the funds for something else — travel, a hobby or passion — then you might have a conversation about financial priorities in your marriage. Ask yourself: If the roles were reversed, and you felt you benefited from long-term weekly therapy, would you be OK with ending treatment if your husband said, “We can afford it, but I prefer to spend the money on something more important to me”? The answer might help you determine whether your priorities align or need to be negotiated.
Of course, your answer might be: “I’d happily spend the money on his therapy — if it were working.” And this brings us to the issue of progress. For you, progress would be a “change to his behavior,” yet you also say he has deficits in attention which lead to the very behaviors you understandably find so frustrating. (Attention-deficit disorder without hyperactivity is now diagnosed as A.D.H.D., inattentive type.)
Some people with A.D.H.D. respond well to medication, and if he hasn’t already consulted with a psychiatrist, exploring this possibility might be a limit you can set. But if it turns out that medication isn’t indicated — he’s tried it before with no benefit, or he can’t tolerate the side effects and medical risks at his age — then you might consider that the therapy is still helpful, not for mitigating his A.D.H.D. symptoms (which are lifelong), but for aiding in his ability to cope with them.
Recall that you left a relationship when your fiancé remarked, “How long will you be in therapy?” Your calling his therapy “superfluous emotional support” sounds like an echo of that. Your own therapeutic goals might have been growth, insight and tangible change, but what if he’s getting something else, such as emotional regulation, anxiety reduction, structure or a place to talk about important aspects of his life (aging, death, experiences he’d like to make peace with) in the safety and privacy of a therapeutic relationship? He might refuse to discuss his therapy with you precisely because he anticipates that you’ll tell him whatever he’s doing in there is “superfluous.”
Just as you found his previous therapist helpful for your goals, you might get curious about how his therapy has been helpful. Imagine, too, what his emotional state would be like had he not been in therapy. Notably, once he took a short break, he felt the need to resume, so he must find some benefit. And if you can appreciate even very small changes (such as his pivot to submitting the insurance claims), you might see his situation in a more expansive way that sits somewhere between “no change” and “significant change.”
None of this, of course, lessens your exhaustion with taking on a majority of the household management. For that, could you hire an inexpensive bookkeeper or assistant to free up some of your time and energy? Often I’ll see couples where one person is messy and the other neat, and when I suggest hiring a cleaning service they can afford, the neat person sometimes says, “But if my partner would just clean up, we wouldn’t need to!” True, I might say, but you didn’t marry someone neat. This is the partner you have. So you can get angry every day, or you can do something else.
In your case, you married a man you appreciate for being “a smart, kind and loving husband.” These are meaningful qualities, and you can take those into account as you choose how to handle this. One option is to say, “Honey, your therapy is a waste of money because you’re not changing, so I won’t pay for it after this year, and you can spend the rest of your life dealing with whatever you deal with in therapy on your own.”
Or you can decide that you’ll be the one to make a change: from insisting that his therapy is useless to accepting that he finds it useful; from feeling resentful that you’re paying for mental health support to considering whether he, with his loving disposition, would pay for yours if the situation were reversed; from focusing on what hasn’t changed to noticing the very small things that have (or might be worse without therapy); and from making him the problem to creating a solution, like getting some outside assistance with the tasks that feel exhausting or overwhelming.
What touched me most about your letter is that despite these very real problems, you said you didn’t want to be without him. At 87 and with good health, he’s still here. So are you. After 38 years of marriage, now might be the moment to embrace what can and can’t change and to make the most of the time you have left in this love story, with all of its strengths and imperfections.
Want to Ask the Therapist? If you have a question, email [email protected]. By submitting a query, you agree to our reader submission terms. This column is not a substitute for professional medical advice.
Lori Gottlieb is a psychotherapist and the author of the best-selling book “Maybe You Should Talk to Someone.” She offers readers advice on life’s tough questions in the “Ask the Therapist” column.
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