When the Past Affects Present Caregiving

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Overcoming past family issues when providing elder care can be challenging

Imagine a pair of middle-aged sisters — Jane and Joan — racing to the hospital after their mother, Esther, has a major stroke. Both realize they'll need to care for her in the months of recovery ahead.

But the sisters' relationships with Esther have been very different over the years. Jane, like Esther, has a reserved manner; the two have always related comfortably with one another. But Joan's temperament is highly sensitive; she has always felt that Esther misunderstood and disappointed her.

Other family members will expect Jane and Joan to be equally committed caregivers. So will the many health care and social service professionals who are soon to be involved in Esther's care. But can the sisters really care for their mom in the same way? Because of their different relationships with her, they are likely to have different reactions and motivations. Jane might thrive in the caregiving role as a way to give back to her mother. Joan might regard it ambivalently — as another way her mother has taken more from her than she gave. Then Joan will feel judged by others when she is less devoted than her sister.

According to family therapy pioneer Ivan Boszormenyi-Nagy, we subconsciously keep tallies in our relationships — who has done what for whom over time. As a result, our past interactions with family members powerfully shape our responses to calls for care. When those times come, the Janes of this world have distinct advantages: A history of love and loyalty is usually a harbinger of loving and loyal caregiving. The Joans face greater challenges: A history of feeling neglected generally creates resentful caregivers.

It is not impossible to transform our relationships during the caregiving years. But we have to be aware of how the past might affect how we approach and endure the self-sacrifices caregiving requires. How can caregivers best contend with their histories? Here are some ideas.

Heed your past, but try not to be held captive by it. There is survival value in remembering past hurts; it helps us to take steps to protect ourselves from being emotionally or physically injured again. But our recollections aren't trapped in amber; we have the capacity to reinterpret those memories with insights and perspectives gained later in life. For example, Joan will never forget the slights from a mother who she experienced as standoffish. But seeing Esther now made vulnerable by her stroke may help Joan regard her mother with more empathy and to soften some of her painful memories.

Focus on what's positive from the past. Relationships are rarely all bad or good but a mixture of satisfying and frustrating parts. Even if your relationship with an aging parent has been mostly sour, there may be aspects that are positive or at least instructive. For instance, Joan may have felt put off by her mother but may also have observed how attentive Esther was to her own mother, Joan's dear grandmother, when she was failing toward the end of her life.

Make decisions based on your values, not old scores. Some family members decline to participate in caregiving because they didn't feel loved by the person who now needs care. That refusal feels very much like tit for tat — a narrow kind of justice based on the limitations of one flawed relationship. Other family members agree to participate in caregiving not because they felt loved by the care receiver, but because they look at it in a more big-picture way — they believe we should all help one another.

Living that value through caregiving doesn't completely erase the pain of a flawed past relationship. But it affirms that you are not so hamstrung by old hurts that you can't rise above them and be the kind of person you wish your parent, sibling or whomever you're caring for had been.

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