Angela, 56, spoke in a defeated tone: "I have no choice about caring for my mom. Everyone's depending on me. I feel trapped." She sounded more resigned than angry.
Angela's words and manner troubled me. In my 22 years of practice as a psychologist, I've heard many family caregivers use nearly identical language to describe their sense of hopelessness — stuck in duties they didn't choose, burdened by increasing demands, helpless to make changes. Worse, they tend to reject others' well-meaning advice as futile.
It's as if they feel fated to continue what they've been doing, no matter how much they're suffering. To me, they seem not just mired in their predicament but overly pessimistic — and very likely depressed.
There's no question that caregiving can be arduous. But in the past 40 years social scientists have found that people handle adversity better when they believe they have the power to make choices about their circumstances. We say these people have a sense of "agency": They feel they can be agents of positive change on behalf of their loved ones — and themselves. By contrast, people who think they lack the power of choice are likelier to drag themselves through the day feeling demoralized and diminished.
When University of Pittsburgh social psychologist Richard Schulz analyzed a 2009 National Alliance for Caregiving/AARP survey of nearly 1,400 caregivers, he found that 44 percent of respondents had reported "a lack of choice in taking on the caregiving role." These caregivers had higher levels of "emotional stress, physical strain and negative health impacts" than those who felt they could choose whether and how they engaged in caregiving.
No surprise, then, that my best advice to Angela was to increase her capacity to recognize and exercise available choices. For caregivers in general (and for Angela in particular), that one small act of willful awareness usually spells the difference between feeling steam-rollered by caregiving and actively getting ahead of its pressures.
Here are some more ideas on how to expand your own power of choice:
Choose intentionally, not passively
Even caregivers who feel burdened by their obligations admit they made a conscious choice not to abandon a loved one who is aging, ill or disabled. When I counsel members of this group, I urge them to embrace their caregiving choice as an expression of their free will. Doing so helps them feel more like actors, and less like stage props, in their family drama. It also drives home the fact that just as they chose to provide care, so too can they choose not to provide it — especially in cases where the mounting responsibilities of the task begin to overwhelm them.
Ground your choice in positive reasons
Rationales matter. Saying to yourself, "I provide care because no one else will" may strike you as realistic, but it threatens to make you resentful over time — and that's no way to sustain yourself as a caregiver. Instead, look within yourself and diagnose your motivation in a way that will keep you going, even as caregiving grows tougher:
- "I provide care because of my moral or spiritual convictions."
- "I'm the caregiver for my parent because I want to return the favor to someone who took good care of me."
- "I provide care because I want to offer an example for my children of what it means to be a loving family member."
Could you delegate certain chores?
Stepping up to a caregiving responsibility does not necessarily mean indentured servitude. The most resilient caregivers are those who decide which caregiving tasks they can tackle themselves, and which others require a second pair of hands (or more). Angela, for example, could make a general commitment to care for her mother, but — finances permitting — opt to employ home health aides to bathe and dress her mother each day. This gives the daughter the right to choose among caregiving tasks, even if her mother prefers her help for such personal needs. By defining her commitments, the daughter maintains active control over her caregiving experience. She also keeps herself from becoming helpless — and possibly depressed.
Conditions and resources change over the course of a long-term caregiving commitment. That means you'll have to fine-tune your caregiving plan periodically. Caregivers must choose among available options to meet new problems as they arise; they also must decide how to pace themselves and balance the needs of various family members. The power of caregiving choice lies in this creative process — to be nimble, determined and bold enough to decide what's best for all.
Barry J. Jacobs, Psy.D., a clinical psychologist and family therapist, is a member of the AARP Caregiving Advisory Panel.