Joey Wahler (Host): It can be challenging, so we're discussing starting a mental health and well-being conversation with a partner. Our guest is Ashley Zarco. She's a mental health clinician with WakeMed Mental Health and Well-Being. This is WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks so much for joining us. I'm Joey Wahler. Hi there, Ashley. Welcome.

Ashley Zarco: Hello, how are you?

Host: I'm good. Yourself?

Ashley Zarco: Doing good

Host: Excellent. We appreciate the time. So first, in a nutshell, why would you say it's so important to talk to your partner when you notice signs that they may be struggling with their mental health, beyond just the fact that you're partners and it may seem an obvious thing to do? Why is it crucial?

Ashley Zarco: Yeah. I think mental health is just so common. And even though it is so common, it's often one of the things that's not even talked about a lot. Often it can be kind of pushed underneath the rug and the view to just keep kind of going. But often people who struggle with mental health concerns, they feel very alone, maybe feel embarrassed. And so, the more that we're able to talk about it and provide support to these people, they can feel seen, less alone, and maybe even get connected to help sooner.

Host: So when you mention the embarrassment factor, Ashley, other than that, what are some other reasons why some may hesitate to tell their partner they're struggling with mental health?

Ashley Zarco: Yeah, I think it can go on how mental health is viewed in their culture, in their generational kind of growing up of things. Was it something that was talked about? In some cultures or some beliefs, it's viewed as weak to experience some of these things when mental health is really just a common human experience that we're all susceptible to.

Host: So what are some common signs someone may be dealing with anxiety, depression, burnout, or another mental health challenge? What should we recognize there?

Ashley Zarco: I think anything that is going to be different from their normal are going to be any kind of red flags. Going down to are there changes in their sleeping? Are they sleeping more or less than normal? Changes in their eating, changes in their behavior or mood. Is your partner somebody who normally is outgoing and very connected to the community, and all of a sudden they're kind of staying at home and being a little bit more withdrawn? Or vice versa, if they're someone who's maybe more of a homebody and now is signing up for 10 different clubs all at the same time, those can be some red flags to kind of look out for. As well as changes in mood, for depression, anxiety, maybe even irritability because they just don't know how to express how they're feeling.

Host: Absolutely. So, that being said, what's the best way to approach a partner when you're concerned about their mental health? In other words, you may be well-intended, but you still want to do it the right way, and they don't necessarily go together all the time, right?

Ashley Zarco: Definitely. I think this even starts before we even have the conversation. And so as the partner who is concerned for your partner, thinking about when is the best time to have this conversation? Is there a location that they feel most comfortable in that we can make sure that they feel secure?

Obviously, you wouldn't want to do it in front of the family dinner table, but maybe finding a good neutral time in your house, in the living room or some kind of open space like that, as well as just kind of checking in on how you're approaching it. What is your language that you're using? What is your body language? What is your tone? Are you really showing that you care? Is your face kind of matching your words that you're saying? I think are really important things to keep in mind.

Host: All right. And when you mention language there among what you just said, what are some good conversation starters that clinicians like yourself recommend?

Ashley Zarco: I think anything that starts with these I-statements of what we call. And so, putting your concern first instead of accusing the other person of things. So, that could look like, "I feel concerned about you," or "I'm worried about you because I have noticed all of these changes that are happening," versus maybe coming in with a accusatory statement of, "You are different. You are angry. You are doing these things," which can lead for people to be defensive. So, anything that can help create conversation, take the I-statements, and open-ended questions.

Host: Well, what you just mentioned there, I-statements, open-ended questions, I would imagine that goes a long way toward this next question, namely, how can someone express that concern without making their partner feel defensive? Because that's so important here, right?

Ashley Zarco: It definitely is important. I think, we all have good intentions when we sit down to have these conversations, but the language and communication that we use have completely different impacts on the person. And so, I think if you're able to help make sure that they're comfortable in these things is the biggest thing.

Host: What's the best response would you say, Ashley, if a partner becomes emotional or upset during a conversation about all this?

Ashley Zarco: I think it can be very natural for people to become upset sometimes, maybe because it's not a conversation that they're used to having. Mental health is so common, but it's not really talked about. And so, they get defensive just because maybe they feel vulnerable in those scenarios.

And so, I think the most important thing that we can do to help our partners is by staying calm and not reacting in those scenarios, knowing that this is a natural response, and recognizing their emotion, saying, "I see that this is frustrating for you," or "I see that you're getting angry," and helping return back to the goal of the conversation. "I see that you're angry. I'm really worried and I'm concerned, and I want to help you," can be a great way to help circle back. I think, too, you can let them kind of control the conversation from that point. You can give them some options. Maybe one is option is, like, would you like to continue with these conversations? Or another one could be like, "This is really upsetting to you. Do you want to take a break and have us come back to it?" can be a good way to help give them some control. But I think the most important thing is always making sure that you come back to the conversation to really show them that you care, instead of just saying, "Oh, we tried," and kind of having it be at the end from there.

Host: And when you talk about that look ahead to having a plan going forward there, that leads me perfectly into this next question, which is how often should a partner check in without making the other person feel pressured? I'm sure it varies, but is there a rule of thumb, would you say?

Ashley Zarco: It can vary from couple to couple. Generally, maybe even once a week is a good time to check in with people. Set aside some time in your busy life schedule to really sit down and see how they're doing. And as this becomes more of a normal conversation for people, maybe even working on identifying what are those signs that you're becoming more pressured and what would be helpful for me to do in those moments to have those kind of proactive conversations and open conversations about those things.

Host: And along those lines as well, Ashley, how can couples best create a space where mental health conversations like we're discussing feel normal rather than uncomfortable, forced? How can you really make them part of your relationship on a regular basis?

Ashley Zarco: I think with any kind of partnership or relationship, it often involves two people. And so, it is maybe starting with yourself. And so checking in with yourself and saying, "How was my day? How am I feeling today?" And communicating that with your partner. so if you're having a really difficult day, saying, "I had a really bad day," or "I'm feeling really depressed lately," to create that open space within your relationship can allow them to know that it's okay to share some of these difficult emotions, as well as having those more intentional check-ins versus saying, "How was your day?" Maybe it's asking, "Was there anything that you struggled with today?" or "What is something that went well today?" Asking those more pinpointing questions can be a good way to open up more of these conversations within a relationship.

Host: Yeah. And once again, you led me perfectly into my next question, which was going to be, are there specific phrases or techniques that help people feel heard and supported? And you kind of covered that there, but I guess your point really seems to be it's not just what you say, it's how you say it, right?

Ashley Zarco: And I think it's also kind of how we respond. Whenever our partner is discussing really difficult emotions with us, it can be human nature, right? We don't like seeing our partner upset. We want to fix it. We want to come in with solutions from A to Z. We want to try to find the silver linings, which there's a time for that.

But a lot of times when our partner is just first expressing some of these really difficult emotions, they're wanting someone to really listen to them and be there for them, which oftentimes can involve us being silent or just providing that emotional support. And so instead of saying, "We could do X, Y, Z," maybe it's saying, "I can't even imagine what you're going through," or "Thank you so much for sharing all the difficult things you've been experiencing."

Host: Absolutely. Couple of other questions for you, Ashley. First, when you mention there, people wanting to be heard, there are also people that are reluctant to talk about subjects like this, right? They're uncomfortable, they're embarrassed, whatever the reason may be. If you have someone that's just simply withdrawn or refusing outright even to talk about things involving their mental health, that's a tough nut to crack. How do you open that door if it really seems to be shut tight?

Ashley Zarco: That's a really difficult one, because you are just wanting to care and love for that person, and you're kind of getting hit with that door, that resistance sometimes. I think it is just sharing your own experiences, and sometimes it can be, you know, "I know that there's something going on and you're maybe not ready to talk about it, but I want you to know that I'm here for you." And constantly letting them know that message, that, "I'm here for you. I care for you." And so, maybe over time they feel more comfortable with some of these conversations.

Host: Yeah. That sounds like great advice because maybe if this technique or that approach don't necessarily work right away, perhaps if nothing else, the consistency of showing your concern will help break down that barrier, right?

Ashley Zarco: Yeah. And a lot of times maybe we want to fix things and we want to sit down, talk about it, come up with a solution, but sometimes it takes a little bit longer than that. And so, sometimes it could be just planting that seed that this is the safe person to talk to is a win. And looking at as a partner, it can be really frustrating, because you want to fix it and there's maybe some resistance, but knowing that there was a win because they know that they can come to you whenever they're ready.

Host: And in summary here, Ashley, you've done such a great job of going over some of these details very comprehensively, but what's the most important overall message you'd like couples, those joining us perhaps, to remember when talking about mental health? What's the one biggest overall takeaway here?

Ashley Zarco: I think the biggest takeaway is that you are not alone. Mental health is a very common struggle, and it can affect the individual as well as families and partnerships as well. That it takes time to have these conversations and maybe help break down some of those barriers or stigma. But the more that you talk about it, the easier it comes, and the less alone people can feel.

Host: Yeah, the old adage, if at first you don't succeed definitely seems to apply here. Well, folks, we trust you are now more familiar with those mental health conversations between partners. Ashley, great advice indeed for everyone. Thanks so much again.

Ashley Zarco: Yeah. Thank you.

Host: And for more information, please visit wakemed.org/conversations. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.