Through­out my years work­ing in remote health care, I’ve met many rur­al and remote health work­ers who have shared their sto­ries about strug­gles main­tain­ing inti­mate rela­tion­ships. Long hours, geo­graph­i­cal iso­la­tion, on-call sched­ules, and phys­i­cal dis­tance from part­ners can strain even the strongest relationships.

The impact of phys­i­cal distance

Peo­ple in inti­mate rela­tion­ships often share every­day rit­u­als to main­tain connection.

These acts of con­nec­tion may go unno­ticed as they are usu­al­ly so ingrained in dai­ly life. Shared evening meals or morn­ing walks with the dogs are exam­ples of ​‘rit­u­als’ that help main­tain and build con­nec­tion with inti­mate partner(s).

Health work­ers in remote areas often face sep­a­ra­tion from their part­ners due to FIFO arrange­ments or tem­po­rary con­tracts. This phys­i­cal dis­tance can ampli­fy feel­ings of lone­li­ness and uncer­tain­ty in the rela­tion­ship, as every­day rit­u­als to main­tain con­nec­tion
are dis­rupt­ed and some­times impossible.

Even sim­ple, non-ver­bal com­mu­ni­ca­tion, like a hug at the end of the day, can­not be repli­cat­ed through phone or video calls, leav­ing part­ners reliant on ver­bal com­mu­ni­ca­tion through screens or phones. How­ev­er, we know this doesn’t cre­ate the same feel­ing of con­nec­tion that phys­i­cal touch does.

Emo­tion­al exhaus­tion
For those liv­ing togeth­er in rur­al and remote areas, the chal­lenges can be dif­fer­ent but sim­i­lar­ly impact con­nec­tion. Work­ing in high-pres­sure, resource-lim­it­ed envi­ron­ments can leave peo­ple feel­ing emo­tion­al­ly drained after a day at work.

This exhaus­tion can lead to with­draw­al from oth­ers, leav­ing lit­tle ener­gy for mean­ing­ful con­nec­tion. As a result, part­ners may feel neglect­ed and even sim­ple rit­u­als, such as watch­ing a film or cook­ing a meal togeth­er, can slow­ly fall away.

Social iso­la­tion
Social iso­la­tion is a sig­nif­i­cant issue for those liv­ing in small, remote com­mu­ni­ties. Health work­ers and their part­ners may strug­gle to estab­lish sup­port net­works, with oppor­tu­ni­ties for social inter­ac­tions extreme­ly limited.

Sup­port and val­i­da­tion from social net­works are cru­cial when expe­ri­enc­ing rela­tion­ship chal­lenges. With­out the oppor­tu­ni­ty to sit down and debrief with friends or fam­i­ly, issues in the rela­tion­ship can com­pound, lead­ing to feel­ings of resentment.

Part­ners who relo­cate with health work­ers may expe­ri­ence a loss of pur­pose if they are not employed, com­pound­ing their isolation.

More­over, the lack of oppor­tu­ni­ties to ​‘date’ your part­ner can make it dif­fi­cult to main­tain and strength­en emo­tion­al connections.

Strate­gies for connection

Dr John and Julie Gottman’s 40 years of research into man­ag­ing rela­tion­ships offer valu­able, user-friend­ly tools for main­tain­ing con­nec­tion with inti­mate part­ners. Their approach empha­sis­es build­ing an emo­tion­al ​‘bank account’ of pos­i­tive inter­ac­tions and man­ag­ing con­flict in a healthy way.

1. Build­ing a strong emo­tion­al foundation

Main­tain­ing a sol­id emo­tion­al foun­da­tion
is essen­tial for health work­ers in rur­al and remote areas, espe­cial­ly when phys­i­cal dis­tance sep­a­rates part­ners. Small, con­sis­tent ges­tures, like send­ing thought­ful mes­sages or shar­ing the highs and lows of the day, can sig­nif­i­cant­ly bridge the emo­tion­al gap. Sim­ple texts like ​“I miss you” or ​“I’m proud of you” can rein­force emo­tion­al bonds dur­ing phys­i­cal separation.

The free Gottman Card Decks app is a great tool for engag­ing in deep­er con­ver­sa­tions and main-tain­ing emo­tion­al con­nec­tion. Using prompts from the app dur­ing Face­time or phone calls can help part­ners stay emo­tion­al­ly engaged, even with sig­nif­i­cant geo­graph­i­cal distance.

2. Turn­ing towards instead of away

Gottman’s con­cept of ​‘turn­ing towards’ a partner’s ​‘bids’ for con­nec­tion is key to main­tain­ing inti­mate rela­tion­ships. Bids can take many forms, for exam­ple, send­ing a fun­ny meme to your partner(s) or sim­ply ask­ing, ​“How was your day?”

The State of the Union meet­ing, a week­ly check-in rec­om­mend­ed by the Gottmans, pro­vides a struc­tured way for cou­ples to reflect on the week, express appre­ci­a­tion, and address con­cerns. Ded­i­cat­ing just 15 min­utes week­ly to this can help part­ners stay emo­tion­al­ly con­nect­ed and strength­en inti­ma­cy, even when phys­i­cal­ly apart. See below for details.

3. Man­ag­ing con­flict with compassion

Con­flict is nat­ur­al and healthy in any rela­tion­ship, but in the con­text of rur­al and remote health work, con­flict in rela­tion­ships can be exac­er­bat­ed by iso­la­tion and stress. The Gottmans iden­ti­fy destruc­tive behav­iours, known as the Four Horse­men – crit­i­cism, con­tempt, defen­sive­ness, and stonewalling – that pre­dict rela­tion­ship breakdowns.

In remote set­tings, where com­mu­ni­ca­tion may already be strained, it’s essen­tial to be mind­ful of these behav­iours. Instead of crit­i­cis­ing, part­ners can use ​‘gen­tle start-ups’ to address issues. For exam­ple, say­ing, ​“I feel lone­ly when we don’t talk at the start or end of the day,” is more con­struc­tive than, ​“You nev­er make time for me.”

Reg­u­lar check-ins help pre­vent unhealthy con­flict from esca­lat­ing and pro­vide a space to express frus­tra­tions with­out let­ting them build into more sig­nif­i­cant issues. Acknowl­edg­ing your partner’s per­spec­tive and tak­ing own­er­ship of your role in the con­flict can also help de-esca­late actu­al or poten­tial tension.

4. Nur­tur­ing shared meaning

Gottman ther­a­py stress­es the impor­tance of cre­at­ing a shared sense of pur­pose. This might involve dis­cussing long-term goals or rit­u­als that rein­force the rela­tion­ship. Set­ting mutu­al goals, such as plan­ning trips dur­ing time off, helps keep the rela­tion­ship future-focused.

Even small rit­u­als, such as watch­ing the same TV series or read­ing the same book and dis­cussing it dur­ing a phone call, can main­tain a sense of togetherness.

5. Repair­ing ruptures

Pro­longed sep­a­ra­tions or mis­un­der­stand­ings can lead to avoid­ance and emo­tion­al dis­con­nec­tion. The Gottmans high­light the impor­tance of repair attempts – actions that re-estab­lish con­nec­tion after conflict.

These might include humour, an apol­o­gy, or sim­ply acknowl­edg­ing the strain both part­ners are feeling.

For exam­ple, a part­ner might say, ​“I know things have been tough late­ly, though I’m com­mit­ted to mak­ing this work. Let’s fig­ure out how we can do bet­ter togeth­er.” Small ges­tures like these rein­force com­mit­ment to mak­ing the rela­tion­ship work.

Seek­ing support

Exter­nal sup­port may also be invalu­able. Pro­fes­sion­al coun­selling can pro­vide tools to nav­i­gate rela­tion­ship chal­lenges, whether in-per­son or via telehealth. 

Also, the CRANAplus Bush Sup­port Line is a free ser­vice avail­able 24/7 to sup­port health­care work­ers, their fam­i­lies, and the emerg­ing work­force with per­son­al, as well as pro­fes­sion­al, challenges.

Remem­ber, main­tain­ing a rela­tion­ship isn’t just about cop­ing with chal­lenges; it’s also about cel­e­brat­ing your strengths and how far you have come in your relationship(s).

Ref­er­ences

1. Park­er, S., Fruhen, L., Bur­ton, C., McQuade, S., Love­ny, J., Grif­fin, M., Page, A., Chikritzhs, T., Crock, S., Jor­rits­ma, K., & Esmond, J. (2018). Impact of FIFO work arrange­ments on the men­tal health and well­be­ing of FIFO workers.
2. Gottman, J. M., Cole, C., Cole, D. L., Chambers,
3. A.L., Lebow, J. L., & Bre­un­lin, D. C. (2019). Ency­clo­pe­dia of Cou­ple and Fam­i­ly Ther­a­py. In (pp. 1212 – 1216). Springer Inter­na­tion­al Pub­lish­ing. https://​doi​.org/​1​0​.​1​0​0​7/978 – 3-…
4. Ben­son, K. (2024). How to Strength­en Your Rela­tion­ship with State of the Union Meet­ings. The Gottman Insti­tute. Retrieved 29^th Decem­ber from https://​www​.gottman​.com/​b​log/s…
5. Gottman Cou­ples Ther­a­py: The Sci­ence of Last­ing Love. (2013). Eau Claire, WI, PESI Inc.

Lau­ra Berry is a reg­is­tered nurse with more than 13 years of expe­ri­ence in men­tal, sex­u­al, and repro­duc­tive health. Lau­ra is also study­ing to become a Nurse Prac­ti­tion­er and is a ded­i­cat­ed advo­cate for build­ing and main­tain­ing a sus­tain­able rur­al and remote health­care work­force. Lau­ra has com­plet­ed Gottman Ther­a­py train­ing and advanced edu­ca­tion in psy­cho­sex­u­al ther­a­py. She brings an in-depth under­stand­ing of evi­dence-based strate­gies to help indi­vid­u­als and cou­ples nav­i­gate rela­tion­ship chal­lenges, build resilience, strength­en com­mu­ni­ca­tion, and fos­ter a deep­er appre­ci­a­tion for one another.