How Relationships Affect Your Physical Symptoms: A Conversation with Dr. Yana Dubinsky
Video: Watch the full session here →https://www.youtube.com/watch?v=kdZeNqoRCsA
Dr. John Stracks: I'm Dr. John Stracks, a physician who focuses on the reduction and elimination of physical symptoms using mind-body medicine methods. I'm here today with Dr. Yana Dubinsky, a psychologist who works with us at Cormendi Health. Dr. Dubinsky works with clients on a variety of issues, but her specialty is exploring relationship dynamics so that her clients can get clarity and find healing in their own relationships. She finds it extremely effective to use a relational approach, whether working with couples or individuals — and that's what we're going to talk about today.
A quick note before we get started: if you'd like to learn more about working with either me or Dr. Dubinsky, you can visit our website at cormendihealth.com.
Yana, thank you so much for being here with me today.
Dr. Yana Dubinsky: Yeah, thanks for having me, John.
Dr. Stracks: So, you also are extraordinarily interested in relationships, and you do a fair amount of couples work. Was that something you had always been interested in, even when you started training, or is that something you grew more interested in as you started to practice?
Dr. Dubinsky: I've always been interested in dyads — interested in relationships, in how people appear one way in the context of one relationship and another way in a different one. I've been curious about that. I also like kids; I've always liked working with kids, and I worked as a camp counselor growing up. But I knew I didn't want to work with kids — I knew I wanted to work with adults, and I figured that could be a way I could still help kids: if I could help the parents feel better, help them communicate and get along, the kids would be okay.
I've always had this idea that kids will be happy if mom and dad are happy — getting along, able to communicate, able to model how to navigate conflict, able to model what forgiveness looks like, what coming back together after a fight looks like. So that was my interest in starting to work with couples: trying to figure out how I could help the kids. I knew I liked kids, I just didn't want to work with them directly.
Dr. Stracks: And how much of your practice now is couples counseling?
Dr. Dubinsky: Close to half.
Dr. Stracks: You know, in the mind-body medicine world, there's a lot of attention paid to individual characteristics — people who are listening have frequently identified perfectionism, self-criticism, or people-pleasing as reasons they have chronic physical symptoms. I think there's a lot less attention paid to the effect relationships have on our physical body. Since you've been doing this work for a long time, how do you think what happens in our relationships influences our physical symptoms?
Dr. Dubinsky: Relationships bring stuff up — whether we're talking about family relationships, friendships, or a relationship with a significant other. I'll focus here on romantic relationships. Sometimes feeling disconnected can just creep into your relationship, and it can feel like something is missing. Feeling disconnected can make it hard to engage with one another, which furthers feelings of loneliness and disconnection — and that disconnection can be on your mind, creating worry, stress, and other concerns. When we feel stress, tension, and anxiety, it can manifest in physical symptoms.
It's been such an honor for me to be invited into families, invited into relationships, to help take a flashlight and look at what may be going on there — and to help name what it is that's going on.
Dr. Stracks: One of the things we think about individually in terms of symptoms is this tendency to keep our emotions inside. Do you think that gets amplified in relationships — that if you're keeping thoughts, feelings, or experiences to yourself, they can start to show up in physical ways?
Dr. Dubinsky: Yeah, absolutely. When we have a feeling, a thought, or an idea, and we don't name it, don't label it, don't share it — we keep it in — we can develop a bias. "Oh, here he goes again," or "here she does this thing again," or "he's working late again." A bias that may have started with a single feeling can grow, and we know from confirmation bias that once we have an idea about something, we start to only see what confirms it, and it strengthens the bias.
Naming it, in a way, diffuses it — it invites the other person in to how it feels for me when, say, you work late. We'll talk a little later today about some ideas for how to share those feelings, whether it's never come up before or it keeps coming up and doesn't feel productive.
Dr. Stracks: Say you're working with somebody in individual therapy and you find out there's a relationship issue causing life stress or physical symptoms for them, even if the other half of the couple isn't in the room. How would you work with that individual to try to strengthen the communication in the relationship?
Dr. Dubinsky: First we create space. The therapeutic relationship is a really unique one, with professional boundaries, and having those boundaries allows people to talk about things in a way that's just about them — because as the therapist, all I know is that individual's perspective, and that perspective is valid and it matters. In creating that safe space to explore feelings, patients are able to name them better, identify their triggers, and notice how their body may react to something they hadn't thought about.
Sometimes patients come in and say, "Oh, I was so mad when she did this," and I'll ask, "What did that feel like in your body?" And I often get, "Oh, I was just so mad, I didn't even think about it." And then, "Oh yeah, I guess my hands were really clenched." So we can talk about what their body was telling them — they knew they were angry, but sometimes they don't realize their fists are clenched until we look at it together.
I also often share with patients that we don't have remote controls for other people. Of course we want one — we want to make people see it from our perspective, or do it differently, or do it better — but individual therapy can offer clarity about what is ours and what isn't. Once you have that clear line — "this is where I end, this is where my partner begins" — you realize there's a lot you can do on your part, and that influences the whole relationship.
Dr. Stracks: Right, because I see a lot of people who say, "Look, I don't have the problem — they have the problem. If they were more present, kinder, more patient..." How do you work with that, when somebody says, "I'm doing my part, but they're not"?
Dr. Dubinsky: If it's just an individual person, we really clarify what that boundary is. Usually what happens is that the way they've been communicating — the way they feel when their partner is being unkind or gone a lot — comes out as a lot of accusation, a lot of blame: "you do this, you do that." There are two perspectives, and even if your perspective is objectively correct, you still need a way to express and articulate that to someone else, because we don't have the remote control — which would be so handy.
Dr. Stracks: It would. Have you seen people make real improvement in their relationships based on things they're doing individually with you?
Dr. Dubinsky: Yeah, absolutely. Relationships are a dance — and that's not my word, that's Harriet Lerner's, from The Dance of Anger, which is my favorite book to recommend, because she takes some very basic concepts and describes them beautifully. Thinking of a relationship as a dance made sense to me immediately — because if I'm dancing with someone and we're used to dancing a certain way, and I don't like that dance anymore, I can change how I dance. But at first, they're not going to like it — they'll want me to change back, to dance the way we used to.
Being able to do your part of the dance, and understanding that changing how you dance is going to impact the whole dance, is how I've seen this work — having the clarity to explain and express what it's like for me when you're yelling at the kids, or working so much, instead of just trying to convince you that you need to change or do better.
Dr. Stracks: One of my favorite relationship stories: I was working with a patient who had bought a Tesla, was super excited about it, but realized it just didn't work for him because he drove all over the Chicago area and kept running out of battery on the highway — it would take nine hours to recharge. So he went to his wife and said, "Honey, I've got a great idea — you take the Tesla, and I'll take your car." She said, "No, I like my car." He was super frustrated. I asked him how he felt, and he said, "I felt like she was making a mistake." I said, "Great — let's take a look at this." I've got a wheel here with lots of feeling words, and I said, "Let's see if we can find 'you're making a mistake' on this feelings wheel."
Oftentimes we have our wishes and thoughts, and we just project them onto the other person. When I helped him identify that he was actually frustrated, a little embarrassed about having bought the car, and uncertain about what to do next, he went back to his wife and shared that — and it totally defused the situation. They were able to work it out. But as long as he kept thinking "it's her fault," there was nowhere to go with that. He was trying to convince her to see it his way because it made sense to him — and he may even have been "correct," if there were some objective measure of right and wrong, which there isn't. What mattered was that she was the one he needed to communicate with in a way she could understand.
Dr. Stracks: You also do a fair amount of couples work. How does that change the dynamic, when both halves of the couple are in your office — or on Zoom — talking with you?
Dr. Dubinsky: I find it to be really efficient. Both halves of the couple feel heard. As a couples therapist, it's different from doing two individual therapy sessions — in a couple's session, my patient is the relationship. Neither person individually is my patient; their relationship is. From that lens, it's not about convincing one person who's right or wrong — it's about helping the relationship be seen, and figuring out what each half needs.
I think couples therapy is really efficient because, instead of someone telling me what happened, I can see it happening. We can hit pause and say, "Here's what I'm hearing — let's try that again, but with this," and they get to practice it experientially, instead of me just telling them, "Do this, and it'll feel different."
Dr. Stracks: So if people watching haven't been to couples therapy and don't have a good sense of what it looks like — say both people are sitting there, and one says, "They need to do more of this," and the other says, "I already do that" — how do you work with that, when both halves aren't seeing things the same way?
Dr. Dubinsky: What helps is finding a way to share how you see it. You're exactly right that this is usually how it comes up — "well, she does this, and I do that" — sometimes even using a pointed finger, because that's what people do. So we review some ground rules, starting with the word "you." We talk about how it feels — and everybody gets it immediately — when somebody tells you "you did this," it doesn't help you stay open and hear it. It makes you want to get defensive, just like if I came at you with my finger, you'd want to push it away. That's how it feels when someone uses the word "you."
So I offer some guidelines. It's hard, of course, when emotions get heated and things come up — people just want to say, "Yes, but he did do this thing." I offer them a chance to say it differently, using the feelings wheel we mentioned, and a stem sentence: "I feel [blank] — name the feeling — when you [blank] — describe the behavior — because [blank]" — offering a little meaning. Three-sentence chunks are one of my favorite strategies.
What usually happens is if I just want to tell you how upset I am, I'll talk for four or five minutes. That's a lot of information for you to receive, integrate, and understand — and then I stop and look at you, and you don't say anything back, because I just talked at you for five minutes. You have a lot of reactions, but you don't know which one to share. But if I just said three sentences, "I feel sad when you work late most nights of the week, because it feels really lonely," and then stopped — you'd actually have a chance to engage with me, and I'd feel heard.
Dr. Stracks: Do people get to practice that in your office, with each other?
Dr. Dubinsky: They do. One thing I notice is it immediately slows things down. If I just want to tell you how wrong and unkind you are, I'm going to go quickly — I'll escalate. I hear people's voices and rate of speech go up. Then I say, "Okay, try it in three sentences," and what I notice immediately is their voice gets deeper, they start talking slower, because now they're thinking, "I have three sentences — what do I want to say?" When your voice gets deeper and you talk slower, your heart rate slows down, your nervous system relaxes. And when we're not in fight-or-flight, we can hear better — our frontal lobe opens up. If we're activated, we can't really hear what's being said.
Going back to where we started: if we're in fight-or-flight all the time, we're more likely to have physical symptoms — headaches, back pain, and more. As the nervous system calms down in the relationship, that's one of the ways physical symptoms calm down too.
Dr. Stracks: Can we do a quick role play to show people what this looks like?
Dr. Dubinsky: Sure. What's our topic?
Dr. Stracks: Driving. I'll be the driver, you're in the passenger seat — the listener may have some experience with this. Let's role-play what it usually looks like, and then how it can be diffused.
Role play — version one:
Dr. Stracks (as driver): Okay, so I'm driving, and you just did a crazy turn.
Dr. Dubinsky (as passenger): I did not.
Dr. Stracks: Yes, you did.
Dr. Dubinsky: No, I didn't — I put on my blinker.
Dr. Stracks: Oh my goodness, I don't — what do you — you always do this, you are super unsafe, we have kids in the car, you probably didn't even see that pedestrian.
Dr. Dubinsky: All right, fine — if you can't drive, I'll just get out and you can drive. That's fine.
Dr. Stracks: Great — so now the kids are activated, because now mom and dad are yelling at each other. We're assuming this is a mom-and-dad situation, but they're tense — even if they were headed somewhere nice, like a park date, everything gets crumbly.
Role play — version two:
Dr. Stracks (as driver): Okay, here I am driving, and you did the same turn.
Dr. Dubinsky(as passenger): Oh my gosh, I'm having such a hard time right now — I'm feeling so unsafe.
Dr. Stracks: Why are you feeling unsafe?
Dr. Dubinsky: I just saw that pedestrian that I don't think you saw, and I feel so scared when you drive like that, or when you're on your phone, because I worry you'll make a serious mistake that costs us — my heart is racing right now, this is not good. I feel really sad, like we're driving to the forest preserve and I'm shaky and nervous, because this could have ended so badly — we could have ended up at the police station, or the hospital. I want to ask if I can drive — I think it would help me focus, so we can get to the park and have a nice afternoon.
Dr. Stracks: That actually might even be helpful — I've got texts coming in from work, so why don't you drive and I'll finish up before we get there.
Dr. Stracks (out of role): What I think is great about this role play is — we ended up in the same spot, I get to drive — but I noticed both of us were talking slower, and I was just talking about myself. I didn't tell you that you're an unsafe driver, I didn't use any absolutes like "you always do this," the way I did the first time. I was able to stay calm because I was telling you what my experience was.
Dr. Dubinsky: Some viewers may be thinking, "That would never happen in our car." I'm here to say it can — and it can happen quickly.
Dr. Stracks: That was my thought too — that this is a role play, and you and I do this professionally, and we also have our own relationships, so we've had practice with all of this. But can couples really change from one version to the other, and how quickly?
Dr. Dubinsky: It can happen in individual or couples therapy. You asked earlier what someone married to an erratic driver is supposed to do — they can't make their partner a safer driver. But with that individual, if we take the first role play as something happening in individual therapy, we could work on how each person contributes to the situation. It was an unsafe situation — and how one person responds could either escalate it (kids start screaming to distract the parents from fighting, which escalates things further) or diffuse it. Just pointing out "you always do this" doesn't help someone become a safer driver — but working with even one person can change the dynamic.
Let's reverse it — say you're my individual patient, and you say, "My wife is such a backseat driver, I'm a super safe driver, get in the car — she's always telling me the kids are in the back seat, watch out for this, you're always doing that — I know what I'm doing, I know they're my kids too, I know I'm being safe. How can I make her stop?"
The same way — if you're driving and someone points something out, you have a choice in how you respond. You can get defensive ("no, I'm a safe driver"), or you can hear it differently — "I'm hearing that you feel unsafe," or own your own feelings, "I feel really hurt and blamed when you say I'm not doing my best." In either case, try to keep your voice down, or maybe you do need to pull over — because in the heat of the moment, sometimes you can't access the right words if your heart is racing from being yelled at, or from yelling. Maybe while driving, you focus on soothing your own nervous system so you can contribute to the interaction a little better.
Dr. Stracks: One more time — how did you take responsibility for your own feelings in that second role play?
Dr. Dubinsky: Using the stem: "I feel [scared] when you [drive fast, or check your phone while driving], because [it makes me feel unsafe, because of the kids]." I moved the focus from you to me. It's much easier to respond with compassion than aggression once someone hears "I feel scared" instead of "you're such an unsafe driver" — because as soon as people start pointing, we want to defend. But hearing "you feel scared" makes me want to enter the conversation, not just defend myself.
Dr. Stracks: So what you're saying is that no matter the relationship, we each have our own part to play in how we communicate, and that affects the overall dynamic — no matter who the other person is.
Dr. Dubinsky: That's right.
Dr. Stracks: Are there other communication strategies you think are useful for couples?
Dr. Dubinsky: I think that's a big one, but there are three more I want to spend a little time on — so people watching can think, "What's one thing I can take away and try today?" Pick one and try it today.
The first is talking at our partners instead of with them. People want to get everything that's been done to them off their chest — my husband calls it "the airing of the grievances." It feels good, but it's not helpful, because talking at someone can trigger a flooding response. Flooding is what happens when we get overwhelmed — like an overstimulated baby who can only turn their head away to control the stimulation. As adults, we still have those markers: heart rate goes up, we might sweat, feel tense, and then we can't focus or really hear. Sometimes I'll see someone slowly turn their chair away, or put their head down — that's their body's way of shutting down, saying "I'm feeling flooded." It's not that your partner doesn't care or doesn't want to listen — their body is reaching a threshold, and everyone's threshold is different. I can talk about feelings all day; someone else might not be able to. So I need to be mindful of what my intensity can do to someone with a different threshold.
So — how do we talk with someone instead of at them? Three-sentence chunks, like we discussed, slow you down and make you more thoughtful about what you want to express. Talking about yourself, avoiding the word "you," and avoiding absolutes — saying "you always do this" invites a defensive "no, I don't," because none of us always do anything. Even "often" or "a lot of the time" is much better.
Dr. Stracks: Is that the same as the "I feel [blank] when you [blank]" structure you mentioned earlier?
Dr. Dubinsky: It doesn't have to be — if you know the feeling you want to share, that stem can help organize your thoughts. But even just saying something in three sentences, then stopping and letting the other person respond before saying more, already makes a big difference. In our house, with my partner and our kids, we've used talking sticks — sometimes just a kitchen spatula — as a signal for whose turn it is to talk, in small chunks, before passing it to the other person. Our kids have even used it on their own when they've been fighting. It's been really helpful for making clear whose job it is to talk and whose job it is to listen, in small segments, so nobody gets flooded and overwhelmed. It's a simple tool, but I think it's genuinely hard to do at first.
Dr. Stracks: It's amazing you've been able to implement that at home. I bet it was hard at first.
Dr. Dubinsky: For sure. People want to prepare their rebuttal while the other person is still talking — "I can't wait till you're done, I'm going to tell you exactly..." — and then you're not really listening. I think that's why the talking-stick technique helps: it keeps people from talking over each other and tunes them in to what the other person is actually saying, so they can understand what's being shared. If your partner is just preparing their rebuttal while you talk, that's where couples therapy can help — giving both people a directive they can each be accountable for.
The second strategy is starting soft. If we start soft, we have a better shot at keeping the conversation soft and open. Starting harsh might mean starting with an accusation or blame. Starting with the feeling helps prevent flooding your partner and helps you stay focused on what you're actually trying to say.
The third is escalating too quickly. I see this often, which is why I picked it — a conversation starts about something small and seemingly unrelated, but quickly escalates into something totally different, until you're covering ten topics just to prove a point about, say, taking the dishes out of the dishwasher, and suddenly you're talking about in-laws and a vacation from ten years ago. It's really hard to track. To prevent that escalation, fight what you're fighting about — anything else that comes up deserves its own time. Find another time to talk about it; don't try to mix it all in. That's hard, because in the heat of the moment things come up quickly, so deep breathing, staying calm, and practicing all of that helps us recognize when we're getting further afield from what we're initially arguing about — and, even in individual therapy, resisting the urge to bring in another example, even if it illustrates your point beautifully. Find another time. Fight what you're fighting about.
Dr. Stracks: One of the most common questions I get — and we've touched on this — is people saying, "I'm perfectly happy to work on the relationship, to change things, but my partner has no interest in this." Any thoughts for people who feel the relationship needs to move in one direction, but their partner seems satisfied with the way things are, or uninterested in changing?
Dr. Dubinsky: I think it's important to understand the difference between not being interested and being afraid. When somebody doesn't want to go to therapy to work on the relationship, a lot of the time there's something they're afraid to discover. Usually one person makes the appointment, and when they both show up, I'll ask each of them why they're here — sometimes I'll hear, "Because he made me," or "she gave me an ultimatum," and we work with that.
If that person wasn't successful getting their partner into therapy, and I'm working with them alone, I think it's important to find compassion for what might be going on for the other person — what's happened in past conflicts that might make them not open to coming to therapy — and then work individually on what you can impact, staying mindful of where you end and your partner begins. Can you find some satisfaction in the relationship by showing up differently yourself?
Dr. Stracks: It's like when people ask me about physical symptoms and aren't sure if it's physical or psychological, or they have an injury, and ask how mind-body techniques can help. My answer is often: we don't know how much can change, but if you start using these mind-body strategies, you may find things get a lot better than you'd imagined. You're saying the same thing here — that even when it feels hopeless, there are always things we can do to change how we communicate and interact in the relationship, and we don't know how much that can shift things — but often, what we do ourselves can shift the dynamic more than we'd imagine. Even something small, like coming home today and talking in three-sentence chunks and stopping, will feel different — my guess is you'll have someone actually listening to you, because it feels different.
Anything else you want to say to people listening and thinking about these topics — relationships and how they impact their own health?
Dr. Dubinsky: Relationships are everywhere — at work, with our families, with our friends. Even though today we've focused on romantic relationships, some of these same skills apply to building stronger social connections. I know there's been a lot of conversation about the pandemic and how it's impacted social anxiety and left people feeling disconnected — and that also has physical manifestations, because it brings up worries, concerns, and stress. Connecting with someone by being open creates a kind of pull to want to spend time together. So talking about yourself, sharing your feelings, being as authentic as you can, and showing up as who you are will also help in situations that feel socially anxiety-provoking.
Closing
Dr. Stracks: Thank you. We're going to end our conversation there for today. Thanks so much for being here and sharing your experience, your insight, and your wisdom — I know how much my patients, both here and over the years, have appreciated getting to work with you, your kindness, your insight, and your excellence, and how grateful we are to have you as part of our practice.
Dr. Dubinsky: Well, thank you for having me. Cormendi Health has been a wonderful place, both to share this with patients and for patients to come in and feel better.
Dr. Stracks: If anybody out there is interested in working with Dr. Dubinsky or with me, you can contact our staff at cormendihealth.com — we'll get back to you with all the details you need. And thank you to everybody listening. Every time we record another webinar, I'm reminded how lucky and blessed I am to be part of this community of people working on healing in brave and creative and cutting-edge ways. With that, we'll end — everybody, take care.
Dr. John Stracks practices mind-body medicine via telehealth nationally and internationally. To learn more about working with Dr. Stracks or the Cormendi Health team, visit cormendihealth.com. You can find more interviews on the Cormendi Health YouTube page.