The crucial role of romantic relationships is often overlooked or avoided when working with people who are on the road to recovery. Understanding that factors such as hope, connection and social support significantly minimize isolation and prevent relapse, the Institute for Community Living (ICL) has recently expanded its lens of recovery support to include the role of intimate partnerships and has developed curriculum to address it.
Addressing a Service Gap
The focus on the role of intimate partnerships in the psychiatric rehabilitation process arose from a perceived lack of available services within one of ICL’s congregate treatment and support programs to specifically assist residents with cultivating healthy intimate relationships. As a not-for-profit agency that assists annually over 10,000 individuals and families affected by or at risk for mental illness and developmental disabilities with services and support designed to improve their quality of life and participation in community living, ICL actively identifies and addresses barriers that can challenge the ability of consumers to transition into permanent housing within the communities of their choice.
Before developing programming to address the role of intimate partnerships, our team first researched the topic of intimacy and relationships among people with mental illness and found that it has been largely neglected by the scientific and provider communities. While there has been significant examination of the role of social and/or peer support in the recovery process, these studies fail to address intimate relationships as a key factor. The literature also indicates positive correlations between social support and empowerment or self-esteem, but the influence of intimate relationships is by and large left unaddressed.
In order to better investigate the role of intimate relationships within the recovery process, program staff paired together with a specialist from ICL’s Program Design, Evaluation and Systems Implementation department and ran five focus groups over the course of two months with program residents. The main goal of the focus groups was to generate dialogue to better understand consumers’ experiences and challenges in building and sustaining intimate partnerships, as well as their impressions on the relationship between recovery and intimate partnerships. An average of 18 people attended each group, with each group lasting approximately 60 minutes. A series of 14 questions guided the discussion.
The participating residents largely expressed interest and excitement to have an open forum to communicate their concerns and discuss their feelings and experiences with each other. Many consumers viewed the focus groups as a rare opportunity to discuss a topic traditionally associated with a high degree of stigma and misunderstanding.
Based on a qualitative analysis of notes taken during the groups, the following conclusions were made – each of which underscore the need for more rigorous research:
- Intimate partnerships can significantly impact the recovery process in both negative and positive ways. For example, one male consumer stated, “[Intimate partnerships] can make you or break you,” while another declared, “you may have thought you were garbage or nothing and [an intimate relationship] might help you out of that.” Consumers stated that positive relationships could result in decreased isolation, increased confidence and increased intrinsic motivation: “No man is an island … it’s good to know that someone cares,” said one female consumer, while a male consumer shared, “relationships can help develop confidence in yourself.” On average, consumers endorsed that developing and sustaining an intimate partnership would almost always increase happiness.
- Communication, safety, trust, and understanding are key elements to developing and sustaining intimate partnerships. Participants rated trust as the most important factor in successful intimate relationships with emotional support and open communication as the second and third priorities. Incidentally, consumers endorsed “my recovery goals” as the fourth most important domain.
- Intimate partnerships may be easier to develop with others that have mental illness. Many group participants shared that it is less burdensome to develop and sustain intimate partnerships with others facing mental illnesses. Focus group members cited reduced stigma and the potential for more understanding as key reasons to why relationships with those with mental illness may be easier. As one consumer clarified, “You have to be with someone who is mentally ill, otherwise they don’t understand.”
- More sufficient support to address the topic of developing and sustaining intimate partnerships in treatment settings is needed. Many of the participants reported that they had never or rarely experienced direct opportunities to discuss their feelings surrounding intimacy, relationships and sex. Participants expressed interest in continuing to discuss this topic in other discussion forums.
Most consumers reported that they experienced a lack of support in the murky waters between social skills training and sex education, and there was rarely any guidance, information or assistance in developing or sustaining intimate relationships. Based on the responses made during the focus groups, most consumers are eager to discuss their feelings and experiences surrounding relationships and intimate partners but rarely have the distinct chance to do so.
Developing New Curriculum: Sexuality, Sensuality and Sensibility
The results from these discussions have been used internally to develop curriculum for a small skills development and support group entitled Sexuality, Sensuality and Sensibility, which has been held in two separate three-month sessions this past year. Preliminary results indicate increased awareness and appreciation of the relationship between intimacy and recovery, as well as increased willingness to be more open with participant’s partners about mental illness. Through Sexuality, Sensuality and Sensibility, participants began to receive the support that they need for fostering the kinds of social connections that can greatly aid the recovery process.
Other observations shed light on this historically wide gap in service. Throughout this project, some of the staff’s reluctance to broach the issue of intimate relationships among clients became evident. It seems useful to examine this hesitance among clinicians and providers as well as any larger systems issues that may be relevant. As clinicians work to address and understand all aspects of a client’s recovery, the clinician can begin to consider and explore experiences, hesitations, frustrations and successes in building and sustaining intimate relationships as they impact the client, thus providing a more comprehensive service. Training for clinicians may also need to be developed in order to assist them in appropriately addressing these topics with their clients. The role of case managers in filling this gap in service is also important to consider given that they often work more closely with clients than any other provider.
An integral part of the field of modern mental health services is to continue to determine additional and enhanced ways to positively impact recovery and aid consumer efforts to attain permanent housing. For persons with severe mental illness, the lack of intimacy and social isolation may often to lead to low self-confidence and despair. Yet far too often, discussions between clients and mental health workers around sex and intimacy only include highlighting the importance of safe sex practices, leaving little room for the myriad related issues in between. There is a clear need for service surrounding the development and sustainment of intimate relationships among people with serious mental illness.
David Kamnitzer, LCSW is Senior Vice President of ICL’s Adult Mental Health Services in Brooklyn. Brian Mundy, LMSW is a Specialist in ICL’s Program Design, Evaluation & Systems Implementation Department.