Relationship Contract

This relationship contract was developed by one of my clients. It might help you think about what you might need from your partner in order to feel healthier in your relationship. Please read and share any comments that you would like about it.

If you’ve found a person you can truly see yourself growing old with, you’re going to need to make some promises to them. It’s important that you keep these promises throughout your relationship in order to continue building a trustful and loving foundation throughout both of your lifetimes. Among others, the following vows are meant to show just how much you care for your significant other, and how dedicated you are to your relationship. Place each of your initials on each promise to demonstrate and solidify your commitment to one another.

1. I promise to listen.
Relationships are also built around communication, and communication is a two-way street. If I want my voice to be heard, I must also be sure to listen to what my partner has to say. I promise to be open-minded, and try to see things from your perspective. In doing so, it will open the door to true understanding.

2. I promise to learn.
Relationships are hard work, especially if we’ve never been in a healthy one before. There is a lot to learn about how to treat a person you love, how to live with them, and how to grow together. We will make mistakes along the way, but as long as we learn from them together, our relationship will continue to flourish.

3. I promise to let you grow and help you be the best version of yourself.
As each person in a relationship is still an individual, we should both be free to grow as people, too. I promise to not hold you back from following your and dreams. I promise to have faith that your hard work and long work days will eventually pay off for our family. I will continue to foster a positive healthy environment for you and help you to be the best version of yourself. I promise to help you achieve your potential by constantly building you up.

4. I promise to live for us.
Remember, we are now living for a family, not just ourselves. I promise never to make major decisions without consulting you. I promise to discuss my wants, needs, hopes, and dreams together, and build our relationship upon a common ground.

5. I promise to find time and never get stuck in a routine.
No matter how hectic life gets, I will always find time to spend with you. I promise to never get complacent in our relationship, even after a long day of work. We should always want to take time out of the day to spend with each other. Don’t let time slip away; it’s the one thing we can never get back. I promise to try to keep things fresh and to try to do something new every week. I promise to make memories every single day.

6. I promise to work as a team and strive for equality
I promise to make sure I follow the Golden Rule in our relationship: do unto your partner as you would have done unto you. I promise to strive for a fair division of household duties and other tasks, and I won’t expect or demand special considerations I’d be unwilling to offer in return. I promise to mix up the chores, participate in the food shopping, washing the animals. I promise to never think of a task as “my boyfriend’s job” or “my girlfriend’s job,” “men’s work” or “women’s work.” We are in this together; and I promise to act like it.

7. I promise to show appreciation.
I promise to never get tired of making it clear to the world that I love you. I promise to hold your hand in public, and introduce you to new friends and coworkers as “my girlfriend” or “my boyfriend” or “my fiancé.” I promise to let you know on a regular basis what it is that I like most about you – what I admire, what makes me proud, what your strengths are in my eyes. Building a romantic relationship isn’t just about the initial bonding – it’s about encouraging and supporting each other’s growth over the course of our lives.

8. I promise to keep trying to win you.
Just because we’ve found each other doesn’t mean we can’t lose each other. I promise to do something every day that surprises you, or makes them feel worthwhile. Clean the house, send a loving text, surprise you at work,- anything at all to keep things fresh. By doing so, we will be proving our worth as well.

9. I promise to always pick up the phone.
I promise to never let a call from you go to voice mail if I can help it, you never know if the next call you get will be an emergency. I promise to show you that you’re your number one priority at all times.

10. I promise to love your family as my own.
When you fall in love, you’re not just adding one person to your circle of loved ones. You also add their entire family, and you should want to be a part of their circle, as well. I promise to learn their traditions, and visit them during the holidays. Be an aunt, uncle, big brother or big sister. I promise to be true to them as I would my own flesh and blood.

11. I promise to show affection.
Small acts of physical intimacy – the hand on the small of my back as you brush by in the hallway, your arm around my shoulder on the sofa, your hand on my thigh when seated side-by-side, holding hands while walking down the street – I promise to give you a warm feeling and convey the love and affection I feel for you.

12. I promise to share myself.
I promise not to keep my likes and dislikes, dreams and fears, achievements and mistakes, or anything else to myself. If it’s important to me, I will share it with you. More than that, I will be sure to share more with you than I do with anyone else.

13. I promise to be there for you.
It’s obvious what you need to do when you face a major life challenge like the loss of a job or the death of a loved one. But it’s just as important to be supportive when you face life’s little challenges, too – an argument at work, a rough commute, a bounced check.

14. I promise to be the voice of calm and reason when chaos strikes, to listen to what’s bothering you and offer whatever help – even if it’s just sympathy – I can.

15. I promise to be faithful to you.
I choose you to be my partner in life. I promise to love you and commit to only you. I take you to be my best friend, lover, and partner throughout this journey we are in together.

16. I promise to abstain from any drugs and alcohol.
I promise I will let my partner know when I am having a craving, and I will do whatever is necessary to curb the craving to stay drug, alcohol, and tobacco free. This includes, but is not limited to: marijuana, tobacco, alcohol, prescription drugs that I am not prescribed, street drugs, and/or anything else I know my partner will not approve of. If there are times when prescription drugs are deemed medically necessary, I will let my partner dispense them according to their dosage instructions.

17. I promise to continue in my part of rebuilding trust.
I promise to come clean and tell THE WHOLE TRUTH, NO WHITE LIES, HALF TRUTHS, AND/OR WITHOLDING OF ANY INFORMATION. I will admit all of my mistakes. Even if there are parts that I can keep hidden without getting caught, I promise to still reveal them to you. Only in admitting all my mistakes can I be forgiven for all of them. I promise to make as heartfelt apology if I have done anything that has hurt you and caused you to mistrust me. I will promise to recognize you are hurt, saying what I should have done instead, and doing that behavior in the future.

18. I promise to forgive myself.
When you violate someone’s trust, you may feel so regretful that you have a hard time forgiving yourself for the violation. While a repentant heart is an essential part of making up with the person you betrayed, you also need to accept and learn to forgive yourself after you put the effort into making amends. Remember that no one is perfect. Whether your error in judgment was minor or major, it goes to show that you are only human. Accept your failure, and try to push forward into the future. By clinging to thoughts of past failure, you risk devaluing yourself. Once you begin to have such thoughts, it could zap your motivation for self-improvement.

19. I promise to make my life transparent to you.
I promise to forfeit a portion of my privacy. I know that by making my life transparent, so that my partner will be able to confirm with their own eyes that I am not in the midst of another betrayal. I promise to give my significant other complete, uncensored access to my texts, phone logs, emails, and anything else requested for a few months after the betrayal. I promise to let you know where I am and who I am with whenever possible.

20. I promise to avoid making the same mistake at all costs.
Actions speak louder than words. Trust between two people means that I have to be dependable and consistent over a long period of time. I will make a promise to do better, but I understand a promise or apology alone will only restore trust short-term. If I can’t be honest in the future, or cannot do all that I promise to do, the person I betrayed will be unable to accept that I have changed or that I am worthy of being trusted again.

21. I promise to take nothing for granted.
I promise to cultivate a daily sense of gratitude for you and the thousands of little blessings you have brought into my life. Remember that, if I’m happy in our relationship, you are doing a thousand little things for me every day to make our relationship work (as, hopefully, I am for you). I promise to never take that for granted – a relationship is work of the highest order, and the second we stop it starts to slide away.

22. I promise to tell you I love you.
Although it’s true that actions speak louder than words, words often speak more clearly than actions. I promise to take a moment every now and then to verbalize my feelings for you. A simple “I love you” or “You mean the world to me” can go a long way towards making us feel wanted, cared for, and secure in our relationship

23. I promise to keep you.
I promise to keep you close, keep you with me at all times. Keep you on my mind, and in my heart. Keep you from danger, and keep you from falling. I promise to keep you in my life for as long as we both live.

I, ¬¬¬¬¬¬¬¬¬________________________________________, make these promises to ___________________________________, and
will do everything in my power to honor and keep them every single day of our lives together, dated ____________________.

I, ¬¬¬¬¬¬¬¬¬________________________________________, make these promises to ___________________________________, and
will do everything in my power to honor and keep them every single day of our lives together dated ____________________

PTSD & NURSING

Dr. Michele A. Finneran-Clinical Psychotherapist
7401 Wiles Road
Coral Springs, Florida 33067
561-350-1599
http://www.psychotherapist-services.org

In my practice, I help people sieve through their stressors and burnout. As we know that nurses, police officer and our military personnel see things that the normal human eye does not see like death and dying on a normal every day basis. This exposure can lead a professional to feel stressed and burned out. I help these professionals relieve some of the trauma by helping them recognize the type of stressors that they are engaged in, and to formulate a strategy in which that it does not affect their lives on a lower level. I help them process how demanding their jobs can be, their administration and their overall feelings of lack of control over their professional and work life. In many cases, because one is so burnt out professionally, that burnout tends to bleed into personal areas of their lives leaving with a feeling of becoming apathetic, and not participating in normal, pleasurable activities that they once enjoyed. It is important to determine whether post-traumatic stress disorder (PTSD) and burnout syndrome (BOS) are common in nurses, and whether the co-existence of PTSD and BOS is associated with altered perceptions of work and non-work related activities. Below is an article of some conclusions of how nurses BOS and PTSD are inter-related.
In this article, researchers identified that PTSD and BOS are common in nurses and those with PTSD will almost uniformly have symptoms of BOS. Co-existence of PTSD and BOS has a dramatic effect on work and non-work related activities and perceptions.

Keywords: Burnout Syndrome, Post Traumatic Stress Disorder, and Nursing

Hospitals are stressful places of employment due to the increased complexity and demands of most job descriptions, the unpredictable changes in one’s daily work routine, unrealistic expectations from patients and their families, and common encounters with ethical and end of life issues. Of all of the various types of hospital employees, nurses are often exposed to many of these stressors and may be predisposed to develop work-related psychological disorders such as symptoms of post-traumatic stress disorder (PTSD) and burnout syndrome (BOS). PTSD is a psychiatric disorder caused by exposure to a traumatic event or extreme stressor that is responded to with fear, helplessness, or horror. In the United States, 8–10% of the general population has developed PTSD at some point in their lives, making it the fourth most common psychiatric disorder.

BOS occurs in response to interpersonal and emotional stressors that are experienced in the workplace and are characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. Emotional exhaustion is defined as being overwhelmed by work and is considered the first stage of burnout. Depersonalization refers to impersonal feelings towards those receiving care and reduced personal accomplishment refers to negative self-evaluation and a perception of reduced achievement in working with people. As mounting expectations and inherent stresses are increasingly common in the workplace environment, BOS is reaching epidemic proportions in the United States.

We have previously reported that symptoms of PTSD are common among inpatient nurses. There has been extensive research on burnout in nurses as BOS is hypothesized to occur most frequently in caring professions. Sometimes referred to a work stress in this literature, BOS is prevalent among nurses, especially those who work in the intensive care unit (ICU). However, there are presently no studies that have determined the actual incidence of a diagnosis of PTSD or whether symptoms of PTSD and BOS co-exist in individual nurses. In addition, the impact of PTSD and BOS on work and non-work related activities and perceptions in nurses is presently unknown. Furthermore, the specific work related triggers for symptoms of PTSD and BOS have not been adequately delineated.

To address these issues, the researchers distributed a survey to a variety of nurses at a university hospital with the goal of obtaining a more complete psychological assessment of nursing–related PTSD, BOS, and other psychological disorders. The primary aim of this study was to determine the incidence of a PTSD diagnosis and BOS in the nursing profession and to elucidate the relationship between PTSD and BOS with life functioning outside of the work environment. Researchers hypothesized that nurses with PTSD would represent a subset of those with BOS and that nurses with BOS alone would experience less discord outside of work.

Researchers identified that psychological symptoms including BOS, PTSD, anxiety, and depression are common in nurses. Our results are similar to previously reported levels of burnout in the nursing population. The researchers also identified important variability in the prevalence of symptoms and a diagnosis of PTSD based on the primary type of unit where the nurse is employed. Nurses who work in the outpatient setting are significantly less likely to have a diagnosis of PTSD when compared to inpatient nurses. Additionally, nurses who fulfill the diagnostic criteria for PTSD almost uniformly will have symptoms of BOS. However the opposite is not always true, as only 21% of all nurses with BOS will carry a concurrent diagnosis of PTSD. The researchers findings suggests that nurses who have developed PTSD represent a subset of those with BOS. Furthermore, a concurrent diagnosis of both PTSD and BOS appears to have a dramatic effect on nurses in regard to their perception of their work and home environment. In the work environment, nurses with PTSD and BOS have more negative opinions regarding both the doctors and nurses with whom they work. Outside of the hospital, the presence of a combination of PTSD and BOS in nurses also affects their perception of life including feelings concerning relationships with friends and family, their sex life, and their leisure activities when compared to nurses with BOS alone. Finally, nurses with both PTSD and BOS have worked on average 11.6 fewer years as a nurse when compared to those nurses who did not have either PTSD or BOS, which may be caused by nurses who develop these symptoms leaving the nursing work force at an earlier time. It is also possible that nurses learn to adapt and cope more effectively over time.

Researchers identified specific work related triggers for symptoms of PTSD including nightmares and anxiety. Nightmares were most commonly related to the involvement of nurses with end of life issues, and anxiety was related to perceptions of being overextended at work in over 50% of nurses. ICU nurses were significantly more likely to have nightmares related to involvement with end of life issues when compared to those non-ICU nurses who complained of nightmares. These findings reveal that there are differences in the specific triggers of symptoms of PTSD depending upon the symptom (nightmares vs. anxiety) and the specific nursing work environment (ICU vs. non-ICU).
As hospitals strive to provide high quality care in the changing U.S. healthcare environment, the nursing supply remains insufficient and is becoming a national emergency, as the nursing profession is at times lacking in personal and people who are unwilling to go into the nursing field. Although issues surrounding the nursing shortage are multifaceted, it is important for nursing management and administrators to understand reasons for nursing turnover to help prevent departure of experienced nurses. Modification of the working environment or instruction in coping skills for the hospital environment could be helpful to treat and prevent the development of PTSD and BOS. This study identifies areas where environmental modification could be implemented.

“TREATMENT TECHNIQUES & STRATEGIES”

1-One of the strategies to treat or prevent nursing-related BOS is to effect individual change through teaching coping strategies. However, given the high prevalence of a concurrent PTSD diagnosis among nurses who have BOS, this focus alone may not be adequate. Symptoms of PTSD including severe panic or anxiety and nightmares were associated with triggers such as providing futile care and care of dying patients.

2- Improved communication between nurses and doctors when the provision of care appears futile, or support groups to address grieving over dying patients are potential methods to improve nursing job satisfaction.

3-Previous treatment strategies for PTSD have primarily been focused on individuals who were exposed to a single catastrophic stressor. In the hospital environment, repeated exposure to sub-catastrophic stressors may potentially result in the same diagnosis. As a result, modifying individual coping mechanisms without modification of the working environment may not be adequate to treat PTSD in nurses or prevent its development.

4-Creating awareness that PTSD and BOS is common in nurses and taking a proactive approach to this disorder has the potential to help with the growing nursing shortage.

5-Finally, the identification and institution of effective treatment strategies for PTSD and BOS in nurses is of particular importance as nurses are at increased risk for both substance abuse and suicide.
The results of this study are not without limitations. This survey was administered to a homogeneous sample of nurses within a single hospital setting in an urban area, and thus may not be generalizable to other facilities. Nevertheless, the prevalence of PTSD symptoms and our results related to both the PTSS-10 survey and the BOS assessment are similar to findings previously reported in other studies evaluating ICU nurses that further enhances the validity of our results.

Individuals were diagnosed with PTSD using a self-report diagnostic tool (PDS) instead of the examination of a trained clinician. However, the PDS has an advantage over other self-report measures for PTSD because it corresponds with all six criteria of the DSM-IV diagnosis and it is a well-validated tool with excellent reliability and accuracy. The researchers did not ask this cohort of nurses if they had ever been exposed to a traumatic event outside of the work environment. This is a limitation to our study as determining the lifetime history of trauma exposure has important implications for predisposition to subsequent development of PTSD.

In addition, all of outpatient nurses had previously worked in an inpatient setting, occasionally as an ICU nurse. We were unable to determine whether these outpatient nurses represent a more resilient group. However, the decrease in odds of PTSD with increasing age and years practicing could indicate that the most resilient nurses who stay in the profession have lesser probability of developing PTSD. Because we do not know the outcome for nurses who left the profession and were not included in the current study, it is not possible to establish causal risk factors with this data. Longitudinal studies where the temporal relationship between development of PTSD and differences in risk factors will be required to address such issues. The researchers response rate was 41%, and accordingly, our results should be interpreted with caution. Therefore, our findings may have overestimated the problem of PTSD and BOS as subjects with more severe symptoms may have been inclined to participate in answering the survey questions than those without any or only minimal symptoms. However, it is also possible that our results underestimated the problem of PTSD and BOS if those with more severe symptoms avoided participating in the survey. Our response rate was reasonable, particularly given that participation was voluntary and uncompensated.
In conclusion, psychological symptoms are common among nurses. A concurrent diagnosis of PTSD and BOS alters the perception of these nurses in regard to both their work environment and life outside of the hospital and may result in the exodus of individuals from the nursing profession. Novel therapies and interventions are needed that will improve the working environment for nurses, improve their job satisfaction, and reduce the growing exodus of nursing from their profession.

References and an additional Resource List
1. Baxter A. Posttraumatic stress disorder and the intensive care unit patient: implications for staff and advanced practice critical care nurses. Dimens Crit Care Nurs. 2004;23(4):145–150. [PubMed]
2. Breslau N, Davis GC, Peterson EL, Schultz L. Psychiatric sequelae of posttraumatic stress disorder in women. Arch Gen Psychiatry. 1997;54(1):81–87. [PubMed]
3. Yehuda R. Post-traumatic stress disorder. N Engl J Med. 2002;346(2):108–114. [PubMed]
4. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422. [PubMed]
5. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3. Palo Alto, CA: Consulting Psychologist Press; 1996.
6. Leiter MP, Maslach C. Six areas of worklife: a model of the organizational context of burnout 3. J Health Hum Serv Adm. 1999;21(4):472–489. [PubMed]
7. Mealer ML, Shelton A, Berg B, Rothbaum B, Moss M. Increased prevalence of post- traumatic stress disorder symptoms in critical care nurses. Am J Respir Crit Care Med. 2007;175(7):693–697. [PubMed]
8. Patrick K, Lavery JF. Burnout in nursing. Australian Journal of Advanced Nursing. 2007;24 (3):43–48. [PubMed]
9. Gillespie M, Melby V. Burnout among nursing staff in accident and emergency and acute medicine: a comparative study. Journal of Clinical Nursing. 2003;12:842–851. [PubMed]
10. Regan A, Howard RA, Oyebode JR. Emotional exhaustion and defense mechanisms in intensive therapy unit nurses. The Journal of Nervous and Mental Disease. 2009;197 (5):330–336. [PubMed]
11. Ilhan MN, Durukan E, Taner E, Maral I, Bumin M. Burnout and its correlates among nursing staff: questionnaire survey. Journal of Advanced Nursing. 2007;61 (1):100–106. [PubMed]
12. Bakker AB, Le Blanc PM, Schaufeli WB. Burnout contagion among intensive care nurses. Journal of Advanced Nursing. 2005;51 (3):276–287. [PubMed]
13. Embriaco N, Papazian L, Kentish-Barnes N, Pochard F, Azoulay E. Burnout syndrome among critical care healthcare workers. Curr Opin Crit Care. 2007;13(5):482–488. [PubMed]
14. Poncet MC, Toullic P, Papazian L, et al. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med. 2007;175(7):698–704. [PubMed]
15. Embriaco N, Azoulay E, Barrau K, et al. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med. 2007;175(7):686–692. [PubMed]
16. Aylard P, Gooding J, McKenna P, Snaith R. A validation study of three anxiety and depression self-assessment scales. Journal of Psychosomatic Research. 1987;31 (2):261–268. [PubMed]
17. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52(2):69–77. [PubMed]
18. Schelling G, Stoll C, Haller M, et al. Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med. 1998;26(4):651–659. [PubMed]
19. Weisaeth L. Torture of a Norwegian ship’s crew: the torture, stress reactions and psychiatric after-effects. Acta Psychiatr Scand Suppl. 1989;355:63–72. [PubMed]
20. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychological Assessment. 1997;9 (4):445–451.
21. Kalliath TJ, O’Driscoll MP, Gillespie DF, Bluedorn AC. A test of the Maslach Burnout Inventory in three samples of healthcare professionals. Work & Stress. 2000;14 (1):35–50.
22. Gil-Monte PR. Factorial validity of the Maslach Burnout Inventory (MBI-HSS) among spanish professionals. Rev Saude Publica. 2005;39 (1):1–8. [PubMed]
23. Vanheule S, Rosseel Y, Vlerick P. The factorial validity and measurement invariance of the Maslach Burnout Inventory for human services. Stress and Health. 2007;23:87–91.
24. Steinbrook R. Nursing in the crossfire. N Engl J Med. 2002;346(22):1757–1766. [PubMed]
25. Stechmiller JK. The nursing shortage in acute and critical care settings. AACN Clin Issues. 2002;13(4):577–584. [PubMed]
26. McAlonan GM, Lee AM, Cheung V, et al. Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. Can J Psychiatry. 2007;52(4):241–247. [PubMed]
27. Ben-Ezra M, Palgi Y, Essar N. Impact of war stress on posttraumatic stress symptoms in hospital personnel. Gen Hosp Psychiatry. 2007;29(3):264–266. [PubMed]
28. Battles ED. An exploration of post-traumatic stress disorder in emergency nurses following Hurricane Katrina. J Emerg Nurs. 2007;33(4):314–318. [PubMed]
29. Driessen M, Schulte S, Luedecke C, et al. Trauma and PTSD in patients with alcohol, drug, or dual dependence: a multi-center study. Alcohol Clin Exp Res. 2008;32(3):481–488. [PubMed]
30. Reynolds M, Mezey G, Chapman M, Wheeler M, Drummond C, Baldacchino A. Co-morbid post-traumatic stress disorder in a substance misusing clinical population. Drug Alcohol Depend. 2005;77(3):251–258. [PubMed]
31. Sareen J, Cox BJ, Stein MB, Afifi TO, Fleet C, Asmundson GJ. Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosom Med. 2007;69(3):242–248. [PubMed]