Caring for a Partner with Cognitive Impairments Due to Multiple Sclerosis: A Psychodynamic Perspective

Abstract

Cognitive impairments in married people under the age of 60 are not common and have received little attention. Using a single case study and drawing on the author’s wide experience of counseling couples in this situation, this paper discusses some of the psychodynamic mechanisms that may come into play when multiple sclerosis (or any other neurological illness) threatens the cognitive capacities of one partner. Normal couple interactions, arising from attachment and affection and important for their maintenance, may be challenged. The author considers some of the problems associated with carers identifying with cognitively-deteriorating partners, including difficulties in thinking. Defenses against recognizing emotionally painful deficits contribute to frustration. Either partner’s lack of conscious awareness or acknowledgment of cognitive deficits and uncertainties as to the origin of troublesome behavior can also cause problems. Cognitive impairments impact on grieving and can give rise to a loss of an internal good object, as well as the loss of normal signals by which carers know they are loved. Also noted is the impact of cognitive problems on sexual relations and on relationships with children and with health professionals. The role of a counselor for a carer in this situation is discussed.

Keywords:

• cognitive impairment
• counseling
• identification
• multiple sclerosis
• personal relationships
• physical aggression
• psychodynamics