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How to Handle ‘Hard Feelings’ After Caregiving Ends

Guilt and emotional withdrawal can make the grieving process even more difficult

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JGI/Jamie Grill

My psychotherapy client Lydia spent years helping care for her mother with advanced cardiac disease, but when her mother died suddenly of heart failure, she was shocked and devastated. Lydia’s grief felt so overwhelming to her that she tried to shut off her emotions completely to better control herself. While her sisters sobbed loudly in the front pews at their mother’s funeral, she stared blankly at the casket without tears.

Another client, Bert, dealt with a care receiver’s death very differently. When his wife of 50 years died after a long course of metastatic ovarian cancer, he felt crushing guilt that he had not saved her. Sometimes he blamed himself for her death because he had been a smoker early in their marriage and thought that might have caused her cancer. At other times, he believed he had not taken her to the right doctors. Afterward, he withdrew from all family members and friends, saying he did not deserve to be happy if she no longer had a chance of happiness.

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Like most former family caregivers, Lydia and Bert had worked hard to care for their loved ones and were distraught about their deaths. But the ways they handled their distress worsened their and their families’ emotional pain. Lydia’s sisters were upset with her because she seemed so callous. Bert’s sons felt frustrated that their dad was needlessly beating himself up and distancing himself from them; they had already lost one parent and did not want to lose the other.

When Swiss American psychiatrist Elisabeth Kübler-Ross wrote in her popular 1969 book On Death and Dying about five stages of grief (denial, anger, bargaining, depression, acceptance), she was describing a range of possible emotional reactions over time, not telling people how to mourn. Most mental health professionals today believe there is a broad range of normal and expectable reactions to bereavement. Simply put, different individuals have different styles of mourning. Each style has its pros and cons for helping a mourner handle the “hard feelings” of sadness, anxiety and anger to eventually reach the stage of acceptance that Kübler-Ross saw as grief’s resolution.

For family caregivers, though, some mourning styles seem more helpful than others. Shutting down emotionally did not allow Lydia to avoid grieving; it delayed and prolonged the length of time she felt intense grief. Berating himself harshly did not help Bert eventually adjust to his wife’s death.

What are better ways for family caregivers to grieve? Here are some ideas:

Don’t fight the feelings

Human beings are hardwired through evolution to feel emotions under certain conditions, including falling in love, being threatened and suffering loss. These emotions have contributed to the survival of our species by spurring us to protect ourselves and seek the comfort of others. It goes against our basic grain when caregivers regard their emotions following the deaths of care receivers as signs of weakness or an impediment to getting on with life. Caregiving is about putting love into action. When caregivers finally lose their loved ones, grief comes naturally.

Trust the process

As Kübler-Ross’ model suggests, time does heal, and mourners’ feelings usually change. Family caregivers come to look back on caregiving and cherish their loved one’s memory without the intense pain they felt immediately upon their loss. This process often goes on longer than any caregiver would want — frequently one to two years. But caregivers can trust that, if they allow themselves to feel and seek others’ support for their losses, then they, too, can arrive at a place in which they can tolerate the sadness and find some solace in having had the chance to provide care.

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Expect guilt, but beware of it

It is common for caregivers to second-guess themselves and feel guilty after losing their care receivers. As in Bert’s case, they sometimes torment themselves by asking: Would she still be alive today if I had been a more loving and capable caregiver? Unfortunately, these guilty feelings are natural, too. But it is also essential for caregivers to recognize that harsh self-criticism and guilt do not bring a loved one back. They frequently block the mourning process from going forward. Caregivers who forever blame themselves often punish themselves endlessly.

Watch for signs of trauma

Some caregivers are left with intrusive, upsetting thoughts about the circumstances of their loved one’s decline and death. In their mind’s eye, they can see the care receiver, for instance, covered with tubes and wires in a hospital ICU. Those powerful images and recurring thoughts derail the mourning process, too, leaving caregivers prone to persistent grief. It may be necessary to seek professional help, starting with a primary care provider.

While there is no right way to mourn, there are advantages to some approaches. If feelings can be faced and guilt and trauma controlled, then emotional healing after the difficult caregiving years can proceed.

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