“Assumptions are the mother of f@#$-ups!”

My patient, a 60-something woman, made this declaration towards the end of a counselling session when we were trying to discover why she and her partner of more than 30 years were struggling to communicate. I laughed out loud at her statement and responded that I couldn’t agree more.

Most of us make assumptions about all sorts of things. In my work with couples experiencing sexual difficulties, I address this issue multiple times a week. Men with erectile difficulties often assume that their inability to have or maintain an erection is the reason for their relationship difficulties. Women with bodies altered by cancer treatment assume that their partner cannot possibly desire them in the way they did before. These assumptions, if not addressed, lead to a whole lot of suffering and distress.

When working with couples affected by cancer, a lot of my time is spent exploring these assumptions and encouraging both the patient and their partner to talk honestly about what they are thinking and feeling. This is not always easy, because people are often tied to their assumptions which in turn are linked to experiences in their past. What leads a man who has been in a committed relationship for more than 30 years to think that if he cannot have erections, his partner is going to leave him, ostensibly for someone else who can have erections? One hundred percent of the time when a man tells me that this is what he thinks is going to happen if he cannot fix his problem, his partner looks at him as if he is speaking a language they don’t understand. This assumption is so far from the reality that they both end up in tears when they finally start talking to each other. The partner had no idea that he was thinking this and had no intention of leaving him, for any reason. The partner had of course noticed that he was not his usual self and seemed distant and; at times, angry. The partner is shocked and even angry about this assumption, and mostly just sad that the man had come to this point without ever sharing his thoughts and feelings.

Women usually come to see me on their own the first time. They have either not told their partner that they have an appointment with me, or they are coming to check me out. After listening to their stories about self-doubt and distress about scars, weight gain or loss, a missing breast or other body part, I gently tell them that they are not going to resolve anything without their partner being present. I tell them that they need to hear from their partner in their own words, not the words that they hear in their own head. Most of these women come back, partner in tow. I gently ask questions about the changes in their relationship after treatment and then I sit back and listen to them talk to each other. The value of silence is vital in counseling and I know that if I just keep quiet, the couple will find the words they need to say to each other.

Some people need encouragement to articulate the assumptions they hold on to. I do this by asking probing questions to help them speak the words that they have long held in their hearts. And it’s only when these thoughts and feelings are spoken that assumptions are corrected.

There is utility in the connection that long-term couples develop. A single glance across the room can tell a partner that it’s time to leave a party. A raised eyebrow can communicate a paragraph about a relative who’s making a fool of themself. But non-verbal communication is not useful when there are challenges. This is when assumptions creep in and cause or add to distress. Assumptions are the opposite of open communication; they remain unsaid and often expand to include thoughts that are unrelated to the initial feeling. They fester and grow and prompt actions that are a mystery to the other person, who then reacts in a way that causes confusion and distress. The only antidote to this is talking about what you are thinking before the situation gets out of control and damage is done to the relationship. In the (censored) words of my patient, assumptions truly are the mother of messes.