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Mixed Messages Complicate Caregiving

Meetings can help everyone stay on the same page

spinner image Parent adult child in conflict

Every Sunday night, my former client Anna became exasperated when her 85-year-old mother, Lillian, had her once-a-week phone call with Anna's brother, Don. With Anna, Lillian was perennially sour, complaining of pain. But on her calls with Don, she sounded chipper and contented. Anna stewed that her mother felt entitled to dump her negative feelings on her all week but then shared only positive feelings with her son.

Part of the reason, as Anna well knew, was that her mother had always favored her brother and wanted to please, not worry, him. The fact that it was the dutiful daughter, not the distant son, who nowadays took care of her didn't change that.

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But Lillian's seemingly split personality and contradictory communication also reveals something about human behavior: All of us pick and choose what we say to whom and when because we have different relationships with different people and want to make different impressions on them. You may give one person the encyclopedia version of what you did that day and another the CliffsNotes. You may be emotionally expressive with a family member in one moment and sullen with another the next. You reserve the right to change your story or shade it various ways for different audiences.

These inconsistent messages can be confusing under ordinary circumstances but make family caregiving much more complicated. When an aging parent gives diverging accounts of herself to her adult children, it can inflame the natural tendency of rivalrous siblings to disagree about what that parent's condition and needs are. Caregiving works best as a team sport. For family members to work together in concerted fashion, they need to start with the same basic information and a common vision. Receiving different reports from a parent undermines that.

Without becoming mind readers, how can family caregivers sort through a care receiver's messages to figure out what she truly needs? Here are some ideas:

Listen for impression management. When an aging parent looks you in the eye and tells you how she really feels, you are likely inclined to take it for the literal truth. An alternative is to hear it as a part of the truth specially edited for you based on your relationship with her and the impression she may be trying to make. It's not that that parent is consciously trying to mislead you. It's more likely she subconsciously intends to protect you from worry so you can focus on your own life or, possibly, incite your worry to keep your attention riveted on her.

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Compare and contrast. If you don't assume she is telling you the literal truth, then you won't assume she is giving the identical message to all family members. You also won't assume that if they have different impressions than you, it is because they are wrong or are in denial or aren't the parent's close confidant the way you are. It then becomes imperative to compare notes with others to learn what they've heard. The point isn't to catch the parent's discrepancies but to gain a sense of the complexities of interpersonal communication in these situations and the need to investigate more fully how that parent is functioning.

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Confer regularly as a team. One way to develop consensus about your parent's condition and caregiving needs is to use frequent group texts or have at least quarterly conference calls in which each family member reports her perceptions. Then, as a group, determine what you know for sure and what's still unclear. Then create a plan to try to gain greater clarity by talking with physicians and other professionals about your parent's status or having a different kind of conversation with that parent.

Comfort, don't confront. It isn't usually useful to confront a parent about her contradictory messages to different family members; that may make her upset and defensive. Instead, meet with her one-on-one or in small groups — not in a large group in which she may feel ganged up on — and tell her that all of you have been talking about how she is doing and that you want to make sure she is living her life in the manner she wants. Then ask her how that ideally would be and what you can do to help her live that way. The message you are conveying to the parent is threefold: We are in this together and are communicating with one another regularly. Together, we want to support you with the right services. Let's plan together how to figure this out as well as possible.

Your parent won't stop trying to manage the impressions she makes. None of us ever does. But you will have established a common framework by which you can work more effectively and harmoniously together.

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