At times when she talked about her mother, 57-year-old Elaine wore a look of exasperation, even scorn. “She wasn’t there for me and my two younger sisters when we were growing up,” she said during one of our therapy sessions. “She was too busy partying and running around. Our grandmother was our real mother.”
Elaine had dealt with her anger toward her mother for years by keeping an emotional and geographic distance, living over a thousand miles away. But then her mother began having small strokes and, as the oldest child, Elaine felt it was her duty to move back to her hometown to take care of her. Her mother’s behavior during the caregiving years, though, made her angrier than ever. “She orders me around like I owe her something,” she said. “I don’t owe her anything. She didn’t raise me.”
Clearly, not all family relationships are happy ones. As with Elaine, caregivers who had a bad past with care receivers may have an emotionally fraught present with them, especially if caregiving requires frequent, hands-on contact and unending hours in the tight confines of a parent’s home. It’s true that old wounds may heal if a spirit of consideration, cooperation and even forgiveness takes hold. But it is also as likely that those wounds will be reopened by fresh clashes and pain will be inflamed anew. That would make it all the more challenging for even the best-intentioned caregiver to hang in there with providing care.
How can family caregivers with complicated relationships with loved ones find ways to commit to caring without risking more hurt? Here are some ideas.
Rely on morality, not sentimentality. It is all right to admit that the relationship has been mostly bad rather than romanticize it as the affectionate bond it never was. That means caregivers need to find other compelling reasons to justify the hard sacrifices they are making. If asked why they give care, many will point to their moral and spiritual values — saying, for example, “This is what a daughter should do” or “I believe in helping those who are suffering.” Elaine saw caring for her mother as her way of doing God’s work in this world. Those high-minded motivations are often enough to carry caregivers along even in the face of a care receiver’s renewed hostility.
Don’t seek confirmation of the past in the present. We tend to see people as unchanging, even incorrigible, and then interpret their current behaviors through the lens of our past experiences with them. But that may set us up for misunderstanding what is really going on in the present. For instance, if a parent was mean to us when we were children, then we may experience her agitation due to dementia now as more of the same old meanness. It is better to try to separate past from present and regard today’s behaviors as largely disease-related symptoms. That may reduce the sting we might feel in response to vile outbursts.
Detach emotionally but practice compassion. Health care and social service professionals balance being caring toward clients with observing them neutrally and not feeling personally aggrieved by what they say or do. It is unrealistic to expect caregivers to fully adopt the professional’s stance when dealing with their own family members. Yet, as Elaine eventually realized, there is something in the professional’s detachment that can be beneficially imitated. When it dawned on her that her mother was now frail and often confused, she made believe she was her mother’s aide, not daughter, providing competent care for her in a sensitive manner even as her mother aimed barbs at her at times. At the end of most of her visits, “professional” Elaine was able to go home with an unperturbed mind.
Give up hopes for fairy-tale endings. When the relationship between caregiver and care receiver has been historically bad, many caregivers self-protectively approach caregiving with low expectations but have hopes nonetheless for better interactions. Some even dare to hope that they’ll finally win a parent’s love and admiration — what I think of as a fairy-tale ending to transform the bad into good. In my professional experience, such endings are rare. The caregiver who strives too hard for them is usually disappointed yet again. It is better to temper those hopes and accept the relationship’s long-standing limitations. By the time her mother died, Elaine never received her fair due in appreciation. But she had the solace of knowing she’d provided what help she could and had been true to herself through doing the right thing.
Barry J. Jacobs, a clinical psychologist and family therapist, is a member of the AARP Caregiving Advisory Panel and coauthor of the book AARP Meditations for Caregivers (Da Capo, 2016). Follow him on Twitter @drbarryjjacobs and on Facebook.