My husband moved back to his mother's house several states away a year ago to help her prepare to move, and then things went downhill. His mom fell, needed rehabilitation, and now says she wants to stay in her own home. For months my husband or I traveled to see each other (I work full-time and need my job and insurance); lately, we're not even doing that. Our marriage had some issues, but I thought we could work through them. I don't know if my husband is using his situation with his mother to distance himself from me. How do I tell how much is caregiving and how much is about our marriage?

It's difficult to separate how much caregiving affects our marriages and how much it simply brings to light issues we already had in our life. You're not alone, though -- many couples drift apart over long-distance caregiving. Would they have grown apart anyway, or was it what I call "caregiver fallout," as if our marriages are a casualty of a war?

Ask that question of yourself candidly, as if you were a very good friend -- someone who wouldn't judge you (or your husband, for that matter). You probably already know the answer.

If the answer is “Yes, I believe he's avoiding our marriage,” then take a deep breath and begin to figure out why --- and what you want.

If you believe your marriage is worth saving, look for ways to nurture the relationship. Suggest that you take a long weekend away together to recommit to your relationship coming first. This doesn't mean that he doesn't love his mom, or that you don't. But when the two of you married you started your own family. And that has to come first -- in your hearts, in your minds, and in your actions.

Then spend the time alone together pouring your heart out and starting to get back to the couple you were. Make a list of all your favorite memories, from crazy or funny adventures to poignant or difficult times you helped each other through. Consider marriage counseling, too: After growing apart for a while, it's tough to figure out how to grow back together, and a good therapist can help.

Try not to view this situation as a battle between you and his mom. It's about the two of you, not her. Your husband probably feels torn and isolated -- the two women he loves are at odds. If you help contribute to her care, that shows him that you care and gives him another chance to open up to you.

Although you can make caregiving part of your life without sacrificing your marriage, somebody's going to have to change their living situation -- either you, him, or his mom. You and your husband need to sit down and decide what's best for the two of you. It's honorable that he wants to make sure Mom's cared for, but she can receive excellent care in either city. So take that off the table for a minute. Where do the two of you want to live? Likewise, there are ways to get decent insurance coverage besides your current job. I'm not saying to quit, but to keep your mind open to all the options, including moving to be with your husband.

If you two instead decide it's best to move his mom, then consider your options in that respect. She might not like the choices, but everyone has to adjust. I know it sounds cold to emphasize again that you and your husband must look to your future. I hope that someday my own children will be as considerate of my emotional needs as my physical ones -- but that they will also be considerate of what's right for everyone involved. I truly don't want them to put me first, above all else. That's not healthy for any of us.

If, however, your husband has already made up his mind not to reconcile, know that there's little you can say or do can change this. So you'll want to prepare yourself squarely for that possible outcome, too. I realize it’s probably not your preferred scenario. But as scary as it is, I promise you will survive. What's more, good will come of it.

Sometimes we have no other choice but to let something we love go. What's usually hardest isn't change itself, it’s our resistance to change.

By thinking the various outcomes through and facing your worst fears, you’ll find that you’ll be okay no matter what happens. You have to value you: You won’t cease to exist, you’ll go on, you'll create a good life, better than the one you have now.