caregiving

Emotional abuse, Family Issues, Relationships, Uncategorized

“Nearly 1 in 3 children have been physically abused, while 1 in 5 have been sexually abused, and 1 in 10 suffer criminal neglect (CDC). Nearly 1 in 10 witness family violence (Safe Horizon). Half of the men who abuse their spouse also abuse their children. In cases when only one parent is abusive, the other parent will often permit the abuse or refuse to believe it. Half of homeless youth are running from abusive situations, many because of sexual abuse. […] Some parents continue to abuse their children into adulthood, while others only abuse them when they are young or for a certain period of time. Other parents leave their children in the care of relatives and re-emerge years later. Or raise their children in loving homes, only to disown them for coming out as gay, trans, or marrying outside of their religion.

That leaves millions of adult children to grapple with the decision of whether or not they should provide support to their abusive or estranged parents when they become ill or elderly.

One study of 1,000 caregivers found that 19% had been abused as children and 9% had been neglected. Caregivers of abusive parents were more likely to experience signs of clinical depression.

Some people make peace with their abusive parents, but that doesn?t mean there will ever be a healthy relationship between them.” — Michelle Daly for The Caregiver Space, Aug 11, 2015

21st century Western culture has some very, VERY conflicted ideas about elder care, especially in palliative stages of mental or physical decline.

“Can she really turn her back on an elderly, ailing parent?

That would violate a deep-seated social and cultural understanding (even, in many states, a legal obligation). Your parents did the best they could for you; when they’re old and need help, you do the best you can for them. But physically or emotionally abusive parents have already violated that convention. Is there still an ethical duty to assist them? Even “filial responsibility laws” requiring adult children to care for parents make an exception for those whose parents abandoned them or otherwise did some injury.” — Paula Span, for The New York Times, October 20, 2011

“We know relatively little about how many adults become caregivers for abusive or neglectful parents, or about why they choose to ? or not to. But thanks to a recent study, we can see that those who report having endured childhood maltreatment are more vulnerable than other caregivers to depression when tending to their abusive parents.

The researchers divided their sample into three categories: those with no history of childhood abuse or neglect; those who had been abused and were caring for their non-abusive parent; and those who had been abused and were, to borrow the study?s memorable title, ?caring for my abuser.? They also compared caregivers neglected as children with those who were not neglected.

Those who had been abused or neglected were more likely to have symptoms of depression ? like lack of appetite, insomnia, trouble concentrating, sadness and lethargy ? than those who had not been. No surprise there, perhaps.

But the link was strongest for the third category. ?The key was caring for the abusive parent,? said the lead author, Jooyoung Kong, a doctoral candidate in social work. Years later, ?they are still affected. They?re more depressed.? — Paula Span, for The New York Times, January 20, 2014

I have previously written about families as “sick systems”; the more work I do within family systems, the more convinced I become that what we are taught to believe MUST be our strongest instinctive bond is often the deliberate OR unwitting author of some of our society’s deepest and most damaging trauma. The sense of unhealthy fusion into the abuser’s care seems to have little concern for gender or birth order of the caretaking adult child(ren).

The sense of obligation and loyalty to dysfunctional family structures is a difficult thing to address when it feels like it’s rooted bone-deep in our values. As a therapist, I always start a line of questioning there: are these actually YOUR values, or are these something you were told SHOULD be your values (and if that’s the case, we have to wonder: WHO told you these had to be your values? My odds are always on the abusive elements themselves, or at least those who implicitly condone or support those systemic elements). Standing by our abusers is similar in reasoning to why women in particular tough it out with domestic violence; it’s why adult children succumb to implicit or explicit pressure to involve themselves with aging or palliative parents in the elders’ decline. We feel we SHOULD. It’s that simple. And it’s that complicated.

In looking at the advice and support available online to caregivers of abusive elders, there are some frustrating limitations placed on those who can’t afford to hire in professionals to provide the service the adult child(ren) don’t feel safe providing themselves. Suggestions of placing the ailing elders in some kind of long-term care, or hiring a care manager or non-familial legal guardian, often require the adult caregiver have the financial means to pay for these services. Even with the privilege of that kind of financial security, there may be more resentment for assuming that financial burden than alleviation of guilt for not doing the work themselves. It’s a Catch-22 that strains a lot of adult-elder relationships even in the best of circumstances.

Beyond the potential for financial burden, when these adults do take on the responsibility for some or all of that abusive eldercare, what’s the invisible price tag? Fear of decline and death may exacerbate the elder’s abusive behaviours that caregivers remember from childhood, triggering a whole new round of the abusive cycles. At best these might be simply awkward and uncomfortable, or at worst escalating (for example) as adult children now in role reversals begin to exercise their new powers in retaliatory fashion. Attempts to repair and reconcile are emotionally perilous if the elder abuser is still in denial about owning their actions or the impacts–both intended or otherwise–of their actions. Especially if the caregiver is an only child and feeling trapped on the hook of providing care or support even from a distance for an unrepentantly abusive elder, there will be precious little safety for them in this situation.

If the members of the sickened family system can step outside those old habitual patterns and fears, there might be a chance to reconcile old issues. That is an exceptionally large “IF”, however. Holding onto the hope of reconciliation can be costly; the risk of reoffence is high, therefore so is the impact of newly-redamaged or repeating disappointment or reopened wounds. Therapy can help keep a balancing, observational eye on the caretaking relationship as the situation develops. We implement a series of self-assessments and situational assessments for the caregiver, and we give explicit permission to consider alternatives. We also use therapy as a safe(r) place to vent frustrations the caregiver will preferably choose not to vent on the ailing parent. The venting space also allows the caregiver to give voice to feelings and experiences an otherwise-supportive spouse may have trouble hearing or managing for themselves, especially if the eldercare situation extends over long periods of time without respite from the care… or the abuse.

There are no clear-cut paths to “right” or “wrong” in caring for abusive elders, especially if the adult child is facing any amount of obligation-driven guilt. The sentiment “blood is thicker than water” fills a family system with a sense that the entitlement of some members to mandatory loyalty is more important than the individual mental and emotional health of other members. Often this sense of entitlement involves considerable upheaval to the caregiver’s life: relocating temporarily or long-term to be closer to ailing elders, or moving parents closer to the caregivers; full or partial financial support; intervention and/or advocacy with the parent’s medical, therapeutic, or palliative care providers; estate planning and management; acute or ongoing family mediation. All of these tasks bring their own levels of turmoil to a relationship already pockmarked or undermined by unresolved abusive behaviours, past or present.

As with any survivor of abuse, emotional support is key. Permission to consider options outside the struggle to fulfill a sense of obligation is also important. Recognizing the signs and symptoms of caregiver burnout is a big part of supporting adult caregivers under any condition (and this also applies to those supporting the caregiver, who may burnout in their own support processes). Unpacking a sense of helpless entrapment and layers of familial guilt are work best done in therapy, even if it’s not going to be a quick process. Families will always be our most complex systems, and the ties of embedded obligation among the most difficult to unravel.

Emotional Intelligence, Relationships, Uncategorized

It was reading bell hooks’ “All About Love: New Visions” that first introduced me to the idea of substituting care for love, specifically in the realm of substituting caregiving/caretaking in place of true intimate (romantic) love, in platonic friendships, and in familial relationships as well. The ideals of caring, caregiving, and caretaking seem indelibly intertwined in our culture, bound up in the complex realms of the transactional nature of emotional attachment, trading often-exorbitant emotional caring labour for the perception of security and protection. But it has become apparent in the course of numerous conversations lately, both in and out of the counselling office, that the issue is far more complex than a simple substitution of “care for love”. And it has been dawning on me over the past few weeks that we’re looking at a kind of emotional labour crisis in which expectations are tied to nebulous definitions for caregiving and caretaking , with emotional boundaries potentially being trampled in many directions at once.

There’s a commmon refrain I hear in two variants in both platonic and intimate relationships alike:
Variant 1: “I do all of these things for you, and you never acknowledge or appreciate them!”
Variant 2: “So-and-so keeps stepping in to try and do things for me or fix things for me that I never asked for and that I don’t want, that don’t meet my needs, then gets angry at me and calls me ungrateful [etc.] when I say, please don’t do that anymore!”

Either of these sound at all familiar?

After I’d listened to a friend recently describing an interaction with a friend of theirs along the lines of variant #2, it occurred to me to wonder about how we perceive care, both in terms of what we receive and in what we do for or offer (give to) others. The more I thought about it, the more it seemed like a major difference between the act of GIVING care versus the act of TAKING care, though part of the problem in sussing out the nuanced differentiation is that culturally, we seem to use both terms interchangeably.

For a clearer sense of potential differences, we can start with the basics of linguistic construction. There is a significant difference in how we perceive the acts of giving care to others, and taking care from others. We tend to see both as kind and noble acts, imbued with good and helpful intent. So from the start, I look at the actions involved:

When I GIVE something, is it an offering, a gift, or an imposition? Does the receiver have the right of refusal? Do I assume consent or do I seek it implicitly? Do I actually know for certain if what I am offering is something the recipient wants or needs? How did I validate that knowing?

When I TAKE something from another person, including their care about something, do I have their consent to do so? Do I know that what I’m doing is desired on their part? How have I confirmed or validated that knowledge with them?

In listening to the perspectives of people on whom caretaking in particular has been perpetuated, what becomes clearer in my mind is the notion that the caretakers often seem more motivated by the appearance of taking care, of being seen as “the good friend/partner/spouse/etc/”, and being validated as such, than by doing what the intended recipient of that caring behaviour might actually desire. The biggest flaw in the process when I’m listening to either side describe how these situations unfold, is a lack of explicit discussion and consent around what would be helpful TO THE RECIPIENT of the caring action. Caregivers will more often be inclined to ask first, then act: “What can I do to assist you?”; caretakers will often be more inclined to act first, then get upset if the action is not responded to as enthusiastically as imagined: “Oh I’ll do this really cool thing for X to make them feel better!”

The thing about caretakers is the hidden agenda aspect, often tied to an almost self-destructive behavioural pattern that pushes the caretaker to levels of self-sacrifice in the pursuit of something in return that may never have been consented to by the relational partner(s) in question.

In a nutshell, caretaking is a hallmark of codependency and is rooted in insecurity and a need to be in control. Caregiving is an expression of kindness and love. — Elizabeth Kupferman, RN, LMHC, LPC

Caring = giving to another from love, for the joy of it – as a free gift

Caretaking = giving to get love, giving with an agenda attached, giving yourself up

Even though the actions of caring and the actions of caretaking might look exactly the same, the intention behind each is totally different, so the energy of the actions is also completely different.

Sandy is a caretaker. She is constantly doing things for others – sometimes because they ask her to and other times because she believes that is what they want and expect. The problem is that Sandy often abandons herself to give to others, and then expects others to give back to her and fill the emptiness within her caused by her self-abandonment. — Dr. Margaret Paul

Looked at this way, caretaking becomes a fairly toxic form of transactional affection, one that abnegates both self-care and healthy, effective communications processes. It often rests on a presumption that the caretaker knows more about what the recipient wants or needs, or believes they “know what’s best for them”. And when we break down how that presumptiveness works in most relational dynamics, we often find that it has less to do with the recipient at all, and almost everything to do with how the caretaker will be perceived for the act of taking that care.; in short, it’s more about making themselves feel good or look good because they did what they believe to be the right thing, rather than asking the recipient and risking having all efforts and energies diverted by the recipient not accepting the care as intended.

(This is also an excellent example of how David Wexler’s broken or distorted mirror syndrome works, up to and including the caretaker “acting out” when the perceived care attempt is rejected, declined, or received less than perfectly.)

If we are genuinely moved to take care from the shoulders of another, we should first consider the following questions:
1. Do I really have the capacity to take on this effort?
2. Do I have the recipient’s consent to engage in this act?
3. Have I verified that my choice in actions is, in fact, both desired by the recipient and likely the most effective action option available?
4. Is there some way I can *give* care and support to the recipient so they learn to effectively manage this care themselves?
5. Am I aware of looking for something specific in response to taking this care away from the other person? How will I feel or respond in the absence of that expected feedback? Is the other aware of my expectation?

Sometimes it’s hard to be honest about who the process is intended to benefit, simply because outwardly the efforts are all directed at alleviating stress or strain from another. But it’s hard to be on the receiving end of caretaking when those efforts are NOT helpful, not effectively directed at what we know our own needs to be. It’s like receiving that awkwardly-unattractive hand-knit Christmas sweater from Aunt Agatha: you know she means well and thought you’d really appreciate it, but it’s not anything you’d ever wear and goes with nothing else in your closet. Really, that gift is more about Aunt Agatha’s wanting to make and gift that awkwardly-unattractive Christmas sweater, and less about her thinking of you and what would truly fit with your personal style and needs. Caretakers want you to want their gifts as much as they want to gift them, and that is the set of strings that comes attached to that care: I want you to validate me and my efforts for having done the thing, whether this was a thing you wanted done or not.

How do we deal best with those we recognize as caretakers, especially if those efforts are beginning to strain the relationship?

First, recognize there are probably a number of different boundary violations happening beneath the surface. If you’re on the receiving end of a caretaker’s attention, there may need to be some discussions around what is welcome and what is problematic, in terms of what you appreciate and welcome in terms of “helpful” intents.

Secondly, if you suspect the caretaking isues are in your court, consider the following symptoms:

What are some of the signs that you may be caretaking?

  • Others often accuse you of crossing personal boundaries, or meddling. But you believe you know what?s best for others.
  • Other people?s ability to take care of themselves seems unlikely. So, you tend to solve their problems without first giving them the chance to try it themselves.
  • Solving other people?s problems comes with strings attached, expecting something in return (whether unconscious or not). After all, you sacrificed all your energy and time for them.
  • You constantly feel stressed, exhausted, frustrated, and even depressed.
  • Needy people are drawn to you like a magnet.
  • You?re often judgmental.
  • You don?t take care of yourself because you think that?s selfish.

— Nancy Ryan, MA LMFT, Relationship Therapist

Helping others is a great thing, but helping others to the detriment of ourselves and our own needs, especially if our internal programming leads us to believe that self-care is “selfish”, is problematic. That’s the point at which the caring process lands in jeopardy; we take care of others because we now NEED THEM TO CARE FOR US, because we cannot allow self-care to render us “selfish”. It’s a big, nasty, self-propelling downward spiral if left unaddressed or unmanaged. Those are the kinds of invisible expectations that rapidly unbalance any kind of relationship. So from a therapeutic perspective, we have to draw gentle attention to both the “selfish” narratives and find a framework in which to reprogram those, but we also need to make clear and observe the expectations, to get those articulated and negotiated like any other relational need; without clear consent attached to the expectation, we have little recourse for getting the underlying needs met by our partners.

It seems time to make sure there’s clarification about the terminology, as a starting point. There is a considerable difference in how we perceive something being given, versus something being taken. If you want to GIVE care, then make the offer, and make it in good faith, with no strings attached. If you find yourself more inclined to TAKE care of (or from) others, then perhaps it’s worth some self-observational reflection to determine how and why that happens, and what’s the real intent behind the taking.

(And don’t substitute either for authentic intimacy and love; but for more on bell hooks’ far more articulate thoughts on *that* subject, read “All About Love”.)