In yesterday's New York Times, Tara Parker-Pope wrote about a study on marriage and whether it is healthier to be married than single. There is a well-established notion that married people are generally healthier than their unmarried counterparts. But a study out of Brigham Young University sought to delve deeper into the issue, asking whether it is enough just to be married to reap health benefits, or is it the quality of the partner relationship that matters?

Based on the comments, it seems most people who read this article dismissed it as obvious. Most people assume that a bad marriage is probably not better than being single. And although the study talked about negative versus positive interactions as a way to measure the marriage benefit, this didn't seem to provide usable information for most readers. The study sheds light on an important connection between attachment relationships and emotional health, but it didn't go far enough to be helpful.

As a couples therapist, I thought this was a missed opportunity to help couples understand why unpredictability in relationships is so damaging to a person's health and the importance of attachment as a method of understanding and predicting marital security and happiness. The article states that it is the unpredictability of a partner's reaction to her spouse that takes its toll on physical health. Unpredictability breeds anxiety, confusion and sometimes fear. When partners do not feel safe that they will be heard and recognized by their spouse in a positive manner, they may deny or repress their feelings instead of sharing them openly and honestly. They also fail to learn how to manage conflicts with their spouse which usually causes a build-up of resentment and a deterioration in communication over time.

As clinicians, we identify patterns of early attachment in the couples who come to us for counseling. These patterns are often unconsciously repeated in intimate relationships, creating conflict, because it is in these early relationships that we learn how to understand ourselves in relationship to others. Partners with insecure or ambivalent patterns have difficulty being open with each other and supporting each other's independent desires, thoughts and dreams. They do not confidently and securely lean on each other, or feel confident that their spouse will respond to their emotional needs in a reliably positive and affirming manner. At the same time, they are strongly attached to their spouse investing endlessly in finding strategies of connection.

Instead of being a reliable source of comfort, trust and safety, relationships become hard work and unstable because there is chronic anxiety about the partner's possible reactions. The heightened nervous system response increases stress and anxiety leading to higher blood pressure, cardiovascular disease and other stress-related symptoms. As the article points out, a partner who is unpredictable (sometimes supportive/sometimes attacking) is often harder to live with than a partner who is always negative. One can adapt to a negative partner with coping skills that improve self-regulatory functioning. An unpredictable partner keeps everyone on their toes.

Help for couples in ambivalent marriages is by working through each partner's early attachment relationships with important caregivers, where the crucibles of human behavior are shaped. By uncovering patterns of attachment as children, each partner will come to recognize how these patterns are repeated in their marriage. By investing in this work, spouses can heal early attachment wounds and build a foundation for a strong marriage that can carry them into healthy old age.