A middle-aged daughter thought she was doing a good job of caring for her mother. Then came the moment when her mother's physician, of all people, suggested that the daughter see a psychologist. She scheduled a meeting with me, then entered my office with obvious hesitation.
"My mother's doctor thinks I'm losing it," she confided.
"You're not crazy," I assured the woman from the outset. "But you are stressed out from caring for your mom. So think of this as an emotional checkup rather than psychotherapy."
Relief lit up her face.
Relatively few caregivers take the initiative to seek out formal ongoing therapy. A loved one's illness may have left them feeling anxious and sad, but most caregivers turn to family, friends or faith to find a way to cope. Even those who develop a more serious mental health problem, such as major depression, may be reluctant to leave their caregiving post long enough to see a professional. Or they may subscribe to old-fashioned stigmas about seeing a "shrink."
But there's another way to get the help they need: consultation.
Caregivers consult with case managers about support services. They consult with elder-law attorneys about living wills. Why shouldn't they also receive brief coaching on the psychology of caregiving?
More and more mental health professionals are setting up consultation services that caregivers find palatable. These sessions — sometimes one-time meetings, sometimes ongoing meetings held as needed — are part education, part evaluation and part pep talk. Caregivers learn about the stressors that arise most often in caregiving. This knowledge helps them take steps to remain emotionally resilient through the months and years of sacrifice that caring for a family member often entails.
My meeting with the daughter mentioned above was typical. After she related her story about caring for her mildly demented mother, I provided basic information about the normal range of feelings — from joy to sadness, gratitude to resentment — caregivers may experience. When I mentioned that some caregivers berate themselves for having any negative feelings, she nodded but said nothing. When I suggested that caregivers who are kind to themselves are better equipped to handle caregiving duress, she looked down as if I was describing her own self-critical tendencies.
I then explained that what caregivers believe — about their loved one's illness, about the meaning of caregiving, about accepting help — strongly affects their psychological coping mechanisms.
As the daughter and I talked, it became clear that some of her beliefs strengthened her caregiving ability. For example, she had no misconceptions about dementia. (That's not true of all caregivers; some of them blame their loved ones for "bringing this on yourself" through smoking, drinking or other lifestyle choices.) She saw caregiving as a difficult task but also as a chance to give back to her mother. But accepting help from others, the daughter told me, might make her seem less devoted to her mother. That concerned me, because it raised the specter that she would never reach out for support. To avoid caregiver burnout, I suggested, she might want to reexamine this belief.
As I do in many caregiver consultations like this one, I laid out the four relationships that have the biggest impact on caregiver coping:
1. the caregiver's relationships (good or bad) with the care recipient;
2. the caregiver's relationships with members of his or her immediate family;
3. the caregiver's relationships with extended-family members and community/church members;
4. the caregiver's relationships with health care and social-service professionals.
A caregiver can increase his or resilience, I told the daughter, by drawing upon the goodwill of all these relationships. She and her mother had always gotten along well, the daughter reported, and she trusted the physicians and other professionals they were working with. She also explained she had a loving family, with little past or present conflict. But, consistent with her reluctance to accept help, she had held off asking immediate or extended-family members to assist her in caring for her mother. "Think about tapping those relationships," I urged her. "That sort of caregiver support is crucial."
The daughter left my office that day with several new coping strategies. I gave her the option of making another appointment but didn't hear from her for another two months, when she called to talk further about how best to handle her caregiving stress. At this time, she meets with me periodically to brainstorm means of bolstering herself psychologically through this period of caregiving. I feel less like her psychotherapist than her coach, suggesting strategies and cheering her on.
Note: Not every mental-health professional is knowledgeable about caregiving. Among those who are, not all provide consultations. Your local Area Agency on Aging may be able to provide referrals to psychotherapists who do caregiver consultations in your community. For AAA contact information, visit eldercare.gov.
Barry J. Jacobs is a member of the AARP Caregiving Advisory Panel.