I have a confession to make: I resent driving my 82-year-old mother to visit her husband, my demented stepfather, at the smelly, crowded and unpleasant nursing home where he now is confined. On the 20-minute ride there, I grip the steering wheel and silently seethe. I'm irritable while she and I try to have a comprehensible conversation with him. I can't wait to get out of there.
On the way home, however, the first flickers of guilt start to take hold. Who am I to complain about this inconvenience, I ask myself, when my mother is experiencing so much loss? Shouldn't I — a psychologist specializing in alleviating the heartache of family caregiving — have greater maturity and tolerance for being a family caregiver myself? I feel so ashamed about my grouchiness that I try to make up for it by stopping to buy my mother ice cream. I promise her that I will drive her to see him again soon.
See also: Caregiving Resource Center
Once home and on my own, though, I revert to stewing angrily. Why should I have to feel guilty, I grouse to myself, when I just sacrificed my afternoon to please my mother? Even if I were a sourpuss, isn't the fact that I'm driving her good enough? I shudder with dread at the memory of promising her yet another nursing home trip.
These feelings are not just a matter of caregiver reluctance. There's a large part of me that wants to help my mother, is proud of the commitment I've made to her, and feels pleased when she feels pleased. What my alternating emotions reflect is caregiver ambivalence — a volatile mixture of contrasting feelings about the hard work of caring for ill, disabled or needy family members that often leads to reactive cycles: Anger triggers guilt, which can then stir up fresh anger. Or, to cite another example, sadness about a care recipient's condition can spur worry and fretfulness about how best to help him. But then feeling frantic and frustrated can lead to hopelessness and deep sadness once again.
Such ambivalence takes a psychological toll on many family caregivers. Fraught with conflicting feelings, they are often in a state of inner tension that contributes to their high rates of insomnia, burnout, depression and anxiety. Whipsawed by vacillating emotions, they derive little contentment from knowing that they are doing the difficult but right thing for their ailing family member.
What can family caregivers do to minimize the uncomfortable and debilitating effects of caregiver ambivalence? A few ideas:
Accept that you may have different feelings about caregiving at different times. It is normal to have a range of emotions about the work that you're doing and the sacrifices you are making over the months and years of caregiving. Few caregivers are gung-ho all the time. All of us experience flagging energy and morale at various points. No one benefits if you beat yourself up for lacking constant calm or cheerfulness.
You may even hate caregiving at times and rue the day you committed to it. These, too, are normal and expectable emotions. They don't necessarily mean that you feel antagonistic toward the person for whom you're providing care. They may just mean that you don't enjoy the dirty work that caregiving commonly entails — for instance, helping toilet a loved one or sitting endlessly in doctor's office waiting rooms.
Accept that you may have different feelings about the care recipient at different times. Not all relationships between a caregiver and care recipient were perfect pairings prior to the care recipient's need for care. Some spousal caregivers had long-running, lousy marriages. Some adult children felt angry at perennially critical or controlling parents. Even in good family relationships, there is often some measure of annoyance or conflict. Family caregivers bring this old ambivalence into their experience of caregiving and, as you should expect under the new duress, consequently feel ambivalently about the care recipient now. This is normal as well. Caregivers should spare themselves harsh self-judgments for it.
Gauge your feelings to better guide your caregiving. When family caregivers accept the natural ambivalence of caregiving, then they are more comfortable, less reactive and better able to sustain themselves. But they also need to frequently gauge the intensity of their feelings. Caregivers who are overwhelmed all the time with sadness, anger or anxiety — or who have come to feel mostly hatred for the care recipient — need to review their caregiving plans. At the least, they may need to solicit more support from others and say no to or limit tasks that severely stress them. (I've cut back on driving to the nursing home.) At the most, they may need to stop caregiving altogether by creating alternative arrangements. Your emotions are justified. Accept and trust them.
Originally published March 2013