When Chronic Pain Becomes the Third Thing in Your Relationship

By, Naina

There's a particular kind of exhaustion that doesn't end when you leave the office. It follows you into the car, into the commute, into the garage where you sit for an extra few minutes before walking through the door. If you've ever done that — parked and just stayed — this episode is for you.

Ingrid Johnston is a licensed marriage and family therapist in Seattle specializing in chronic pain, couples in conflict, and the place where those two things meet. She developed chronic pain herself after surgery, spent over a decade trying to fix it, burned out her practice in 2022, took a three-month sabbatical, and found something close to remission on the other side. Not by doing more. By doing less.

That's the thread that runs through everything she shared in this conversation.

The Effort That Makes It Worse

Ingrid describes two kinds of pain: nociceptive pain, which comes from an actual injury — a cut, a break, a disease process — and neuroplastic pain, where the brain misinterprets sensations as dangerous even when no acute injury is present. Pain, she explains, is a danger signal. Neuroplastic pain is what happens when that signal keeps firing after the threat is gone.

For over a decade, she was running from doctor to doctor, trying the perfect workout, optimizing every input. The frantic energy of the search was itself keeping her system in a state of danger. When she stopped and came back to basics — feeling her feet on the ground, orienting to her environment, asking what sounds fun today instead of what might fix it — her system began to settle. Answers came. Providers were more useful. The feedback loop shifted direction.

"The whole orientation switched," she said, "from finding the perfect thing that would fix it to just what brings connection and calm and safety back to my system."

This matters for the tech and high-achiever audience specifically: the same driving, striving, intensity that built your career is the wrong tool for getting out of burnout or chronic pain. It isn't giving up to stop using it. It's choosing the right instrument for the problem.

Chronic Pain as the Third Thing

In couples work, Ingrid uses a frame borrowed from systems theory: the triangle. Two people in a relationship form a dyad, and often a third thing enters to stabilize the anxiety between them. That third thing can be something healthy — a shared hobby, a child, a TV show you both love. It can also be chronic pain or burnout.

When pain becomes the organizing force of a relationship, both partners develop their own relationship with it — not just the one carrying it. The partner without pain may be lonely, quietly resentful, trying to help and not knowing how. The partner in pain may feel like a burden, ashamed of who they've become, unsure how to reach for someone when they feel that bad about themselves.

Neither person has usually named any of this out loud. The fights are about the dishes, the weekend plans, the small daily logistics. What's actually happening is that one person's pain has restructured the entire system — and until someone names it, the conflict can't make sense.

"The moment you name it," Ingrid said, "is often the moment the conflict makes sense for the first time."

Using emotionally focused therapy, she works below the surface of what couples already know — the frustration, the caretaking, the surface-level resentment — to access what's underneath: the loneliness, the unspoken need, the reach for connection that's gotten buried under pain management and logistics. For the person in pain, that often means confronting shame. For the partner, it often means finally saying what they've been quietly carrying.

Where to Start This Week

For a couple running on fumes, Ingrid's first instruction is to look at the environment. Not to schedule a difficult conversation. Not to process everything. Just: is there a table you can sit at together? Clear it off. Light a candle. Set a ten-minute timer. Share one high from the day and one hard thing. That's it.

Or start even smaller. Hug when you come home. Hold hands when you're walking. Physical contact communicates safety to the nervous system directly — it doesn't require words, and it doesn't require either person to be at their best.

For the person sitting in the garage who can't make themselves go inside: orient to where you are. Look at your surroundings with genuine curiosity. Feel your feet on the floor of the car. Acknowledge what your body is carrying without trying to fix it. Make a short list of what brings your system a sense of safety — a cup of tea, a hug, a few minutes of quiet — and let those be the first things you do when you walk through the door.

None of this is a solution. It's a dose. And doses, Ingrid is careful to say, are the point. You build capacity for vulnerability in small increments, not all at once. The sabbatical, the bigger repair — those come after the system has learned it can tolerate small moments of ease without collapsing.

Burnout, chronic pain, and relationship disconnection are not three separate problems to solve in sequence. They're one system, and they move together. The way back isn't more effort in a different direction. It's a different orientation entirely.

Listen to the full episode

To learn more about Ingrid Johnston's work with chronic pain and couples, visit ingridjohnstontherapy.com or connect with her on LinkedIn.

If burnout, chronic illness, or relationship strain is something you're navigating, I work with clients one-on-one at Peakworks Counseling. Learn more at peakworkscounseling.com/services.

Subscribe to Systems Check wherever you listen to podcasts. And please — take care of your system.