Healthy relationships are often a source of support and provide a sense of worth and belonging. They allow us to learn new things about ourselves and others.

In medical school and residency, many trainees must move across the country for their education and leave their loved ones behind for a time. This distance can strain romantic relationships in particular.

Long-distance relationships (LDRs) are possible, but they require flexibility, communication and patience. Below, I interviewed a physician who shared her own experience in an LDR during medical school and training, a psychologist with expertise advising long-distance couples, and a couples therapist. Read on for their guidance on effective and empathic communication, digital awareness and addressing jealousy. You can also read this essay by Brian Le, DO, on maintaining an LDR  while working strenuous hours.

Catherine Shanahan, MD: Her LDR experience in medical school and residency

Catherine Shanahan, MD, a retired family medicine (FM) physician, shares some notable features of her long-distance relationship during medical school and residency. She and her now-husband, Mike, both worked in the Air Force; however, they weren’t fully stationed together until after Dr. Shanahan finished her FM residency. She stresses the importance of trust and communication in an LDR. 

What does a strong foundation look like and how can you tell you have one?

Trust is big—you need to know you can have open and difficult conversations together. If you are irritable with each other, you trust each other enough that it could be because one of you is sad because you miss the other person. Be honest with your feelings and identify why you feel irritable. To endure the inconvenience of an LDR, I had to trust that my now-husband was as committed to the relationship as I was. Sometimes we’d call at a bad time and one person would feel disappointed that the other was distracted. Being understanding of that challenge is important. 

Does communication change after prolonged time apart and if so, how did you both navigate through that?

My relationship was pre-FaceTime, texting and email, so I was only able to communicate with Mike through written letters. It felt like a form of journaling. It was expensive to talk on the phone, since cell phones hadn’t yet become prominent in the 1990s. Mike was often deployed overseas and did not have a personal phone or dedicated landline. When we did finally reunite, we needed to adjust to the other person being there. 

What things did you not take for granted in the time together that you think most people do take for granted?

That you can actually be with that person physically, eat dinner and sit in the same room, make plans and enjoy everyday things. 

Do you have advice you want to share for others in an LDR during medical training?

Be kind and patient with yourself because it is hard. LDRs aren’t for everybody, and they test relationships. Maybe if it doesn’t work out, then it wasn’t meant to be.

Bailey Bryant, PsyD: Advice on digital living, jealousy and inner awareness

Bailey Bryant, PsyD, a licensed clinical psychologist and founder of Hello Mental Health in Cincinnati, shares her own insights and advice.

Sometimes in an LDR, partners get into this cycle of constantly living their lives digitally. What are the consequences of being on FaceTime all the time? 

We may feel disconnected from actual life and the present moment. We tend to not be as happy when most of our lives exist on screen. Try to find a balance between maintaining a connection with your partner while being present in your physical space.

Any advice on how to work with a partner who may be jealous of your achievements as a medical student or resident?

If you have big aspirations and your partner has a strong sense of self, they may not feel threatened by your achievements but instead feel inspired by them. If they are jealous, encourage them to lean into things that bring them confidence or self-assurance. Giving them praise for the things they do well is great. It’s important for both partners to recognize that a career is one way to exercise greatness, but it isn’t the only way. 

How can someone develop an inner awareness to figure out if an LDR isn’t working?

It’s easy to have blind spots about the relationship if you’re wrapped up in your busy schedule. When you do finally pause, you might realize that things have started to shift because you haven’t attended to them consciously. Having a regular mindfulness or self-reflective practice, such as journaling and prayer, can help you develop the skills to tune into how things are really going.

You can also do regular check-ins  with your partner about how the relationship is going, how the two of you can do better, etc. Upon entering that conversation, it’s important to set an intention that is warm, curious and compassionate, instead of creating a container for venting and blaming. Go in when you’re both feeling calm, cool and collected. Be very careful not to punish the other person when they say they need a moment. 

It’s important to know when to take breaks during conversations, but what happens when someone with an anxious attachment style feels abandoned?

An anxious attachment style typically develops in early childhood when a primary caregiver provides inconsistent caregiving or is not attuned to the child’s needs. Adults with an anxious attachment style may feel insecure about their worthiness of love and require regular reassurance. Because of this, whenever the fear of abandonment is triggered, it can be overwhelming.

If you know you have a partner who has an anxious attachment style, saying things like, “I love you, we are good. I am taking a minute for myself, not taking time away from you,” is very beneficial.

How do you do couples therapy when two people live in different states?

Typically, the therapist needs to be licensed in both states. However, if each state is a PSYPACT participating state and the therapist is a psychologist, the therapist may only need to be licensed in one state.

Rachel Taylor, LCP: Advice on love languages, communicating and making time for your partner

Rachel Taylor, LCP, is a licensed professional counselor specializing in couples therapy and discussions surrounding intimacy. She shares how emotional and physical intimacy can be impacted in LDRs and how couples can overcome barriers to them.

How can couples connect with each other if one partner has a demanding career?

Preparation and maintenance: When you are going into a career that is time-intensive, look at your calendar day-to-day and think about how you’ll show up at home. What does the person need to do for a healthy separation between work and home life? Sometimes, it looks like changing your clothes. Talk to your partner about how much time you’ll need alone before being present with them.

In relationships, there can be a lot of quantity time. In a demanding program, it’s about the quality time you spend with your partner. Love languages show how you want to be loved and love others. If we have less time and energy to spare, it’s important to prioritize our partner’s love languages during that time.

Some love languages, like physical touch, are difficult to prioritize in an LDR.

Eventually, there is a radical acceptance that LDRs are going to look different than in-person relationships. Set aside time for dinner together, say good night right before sleeping, then wake up and say good morning. You can plan visits. If one partner is in a different field with more flexibility, they can fly to the other.

If one partner has an anxious attachment style while the other has an avoidant attachment style, how can they work with each other?

An avoidant attachment style typically develops in early childhood when a child does not receive adequate emotional support from a primary caregiver. Adults with an avoidant attachment style often struggle to give and receive emotional support. They may withdraw from intimacy, need a lot of space or fear losing their autonomy.

If you operate from the premise that your partner is doing the best they can with their ability, then that partner is usually trying to communicate in a way that feels good to you. It is your responsibility to offer feedback and guidance to help them adjust.

My takeaway

Throughout these interviews, I found that all three of the people I talked with stressed the importance of communication and learning the skill of explicitly explaining your thoughts. We might think we are great communicators until we find holes. While LDRs may pose unique challenges, similar to how any relationship will have its own challenges, learning to adapt and grow in ways to help the relationship flourish may bring you closer to your partner.

Related reading:

Being a mom in med school: How I make it work

6 tips for maintaining a long-distance relationship in med school