Three Sources of Communication Break-Down in Caregiving (and Three Antidotes)
Photo by: @danavo, Upsplash
Breakdowns in communication are among the top reasons my caregiver/care partner clients have listed when I’ve asked them what motivated them to seek individual counseling with me. In this post, I’ve tried to distill many of the communication issues clients have shared with me into a few, digestible categories. And, even better, I’ve tried to offer strategies for alleviating these communication roadblocks all together. My hope is that you’ll come away with a different perspective or something new you can try that will restore a bit of peace in your caregiving relationships.
Number 1: You Know What They Say About Assumptions
Yes, we all know the saying about what happens when we assume, and yet, we do it all the time! Why? Well, we’re human and our brains are designed to solve problems and find patterns and to learn from experience. Yet, we forget that our experience and judgment are fallible or at the very least, incomplete. For example, have you ever assumed that because someone was short with you that they were angry with you and then found out that their behavior had nothing to do with you? How often has your own behavior toward others had little to do with them? Yet we still think we are great judges of what the behavior of others means.
Without curiosity or investigation, we assume what someone’s behavior means and, even worse, we then feel and act based on those assumptions.
How might this look in caregiving? Clients caring for older parents have shared their feelings of resentment that their parent spends a lot of time complaining or talking about regrets from the past. The assumption is: I think when I’m old, I’ll be grateful and happy having my kid care for me and I’ll love being around my grandkids. My dad’s anger/negativity must mean that he isn’t grateful for what I’m offering and must mean he prefers not to try to “be happy.”
Now, this could be true. Maybe your father is bitter and doesn’t appreciate your care or sacrifice. AND…are there other alternatives to explain his behavior? Is there a way to find out what he really thinks and feels?
If you assume, without asking or considering alternatives, that your dad is just bitter and unappreciative, how might your approach to caregiving change? How might your own emotions and behavior be affected? You can see the ramifications of acting on assumptions.
The Antidote: Curiosity!
Is it possible your dad is in a stage of life where he’s processing the content of his life and trying to come to terms with regrets and perceived mistakes? Is it possible he’s grieving his own life?
Imagine being in the final years of your life.
Most, if not all, of your friends have died or live too far away to visit. Or you never made time to make close friends, because you were raising a family and working non-stop most of your life. Your partner of 30-40 years has died. Your career is over. Your independence is gone, too.
The things you once loved to do, the thing that helped you cope with depression and anxiety and anger in the past: hiking, camping, going on long drives, playing poker, fishing…you either can’t do them anymore or you are reliant on others to organize them for you. Maybe you can’t even walk on your own anymore or can’t see well enough to read or watch a movie.
We like to think that when we get old, we’ll be ready for it and we’ll be a “good” old person, one who accepts our station in life with dignity and wisdom and peace. But you know what? We don’t stop being human when we’re old and sometimes we still get angry and depressed and lonely. Imagine how lonely it must feel to be the only one left who remembers your lifetime of memories. Imagine having no one to whom you can say, “remember the time when?”. And though I don’t condone (at any age) that we take out our anger on others, we all do it sometimes. Have you ever had a bad day and snapped at your family when you got home?
So, if you imagine for a moment, that your parent or the person for whom you’re caring is going through something difficult, how might your approach change? What if, when your dad started complaining about something from his past, instead of trying to “shake him out of it,” or take it personally, you approached with curiosity and said “It sounds like you have a lot of regrets. What would you have wanted to do differently?” Or “Dad, I’m sure it’s hard being stuck here every day without being able to do whatever you want whenever you want. I’d be annoyed too. Is there anything I can do to make it easier on you?”
Caregiving is not just taking care of the body, but also the mind. Part of caregiving is being with someone as they come to terms with old age, chronic illness/disease and ultimately, the end of life.
Number 2: Emotional Overwhelm
An analogy for emotional overwhelm that has stuck with me over the years is the bucket analogy. Think of each of us having an emotional bucket. Inside this bucket we place our fears, anxieties, and stressors. As our bucket fills, our ability to tolerate distress lessens and lessens. If the bucket gets too full, it spills over. This often results in emotional overwhelm. For you, that might mean explosive anger, or feeling that you can’t stop crying, or a panic attack or even emotional numbing, which can include alcohol or other drugs.
You’re a caregiver, so I’ll venture a guess that you know all about emotional overwhelm. When you are overwhelmed, whether by your caregiving duties or a combination of life events and circumstances, how is your caregiving affected? Do you become more sensitive to criticism by your manager or co-workers? Do you feel less connected to others? Is it harder to see the person for whom you’re caring as another complex human being and not just a set of tasks to get over with? As another person who wants something from you when you feel you have nothing left to give?
When we are overwhelmed, the logical, decision-making part of our brains gets hijacked by the primitive, emotion-focused part of our brain that just wants to keep us alive. This is why, when our buckets are too full, we end up making big mistakes. As a caregiver this might mean making medication errors, leaving doors that are supposed to be locked, open, leaving stoves on, or in worst case scenarios, acting in abusive or neglectful ways.
The Antidote: Know and Plan!
Know when your bucket is getting too full
But, how do you know when your bucket is getting full? The signs and symptoms are different for each of us. Maybe it’s a tightness in your chest, maybe it’s not sleeping well for a few nights or noticing that you’ve stopped making time for exercise, maybe it’s the thought “if one more thing happens, I’ll snap”.
For me, when my bucket is getting too full, I have a hard time sleeping, I tend to procrastinate more on tasks, I crave junk or comfort foods and I tend to feel increased irritability.
Take the next 5-10 minutes to think about what signs usually signal you that your bucket is getting too full.
Make a plan for reducing the contents of your bucket
Once you know what the signs are that your bucket is getting too full, you can make a plan for what steps to take.
What might the plan be? If your bucket is filling with new changes or responsibilities at work, maybe you can talk with your supervisor about your concerns. Could you say, “I wanted to talk with you because this job is important to me and I could use some direction on how to meet these expectations. I have X hours allotted for Y tasks and these tasks typically take me Z hours. Is there a better way I could be doing this?” If your supervisor is not open to talking with you or is demeaning or dismissive, that is a bigger issue that I can’t address here. But hopefully that’s not the case and they will appreciate your initiative in asking for guidance.
If you’re caring for your spouse or adult child at home and your bucket is filling with caregiving duties that are drowning out the rest of your life, let’s start with the big rocks in the bucket. The big rocks are the things that take the most effort and time. Maybe one is cooking or keeping the house clean. Or maybe it’s actively managing medications or other treatments that require near constant attention. Is there anything you can delegate? Do you have other family members or close friends who have offered to help, but you just felt too guilty to take them up on it? Take them up on it. You can’t do this alone. If your bucket is always full, it will spill over. And that could take the form of a heart attack, sudden or frequent illness or stroke. Then where will that leave the person for whom you’re caring?
Take the next 10-15 minutes to write about what things are filling your bucket and start brainstorming a plan for delegating (or even dropping) some tasks. Do you HAVE to vacuum every day? Do you have to make everyone breakfast or lunch? Or can you make some grab-and-go items once in a while?
Now take 5 minutes to reflect on what things you enjoy that you haven’t been able to do. See if you can add any of those things back to your life on a regular or semi-regular basis. The things we enjoy can also help create more space in our bucket allowing us to carry more.
Number 3: Battle of Wills
You’re caring for your mom who has Alzheimer’s disease or another form of dementia. You want to help her bathe every Tuesday and Thursday morning. It’s Tuesday morning and…she doesn’t want to bathe right now and in fact, tells you that she just took a bath. You argue with her, correcting her by telling her that she has not had a bath in a week. She tells you you’re crazy. You go round and round and both end up exhausted both physically and emotionally. Mom still hasn’t had a bath and you are at your wits end. Does this sound familiar?
I love analogies, so I’ll share another one. The battle of wills is like a tug of war. When you pull, what does the other person do instinctively? Well, if they’re playing the game right, they pull back. But what happens if you let go of the rope? The other person falls backward, right? Because there’s nothing to pull against.
The Antidote: Practice Letting Go
No, I don’t want your mom to fall backwards! But I do want you to drop the rope. Stop pulling.
For those with Alzheimer’s disease or other forms of dementia, bath time can become more and more difficult for them because they may not remember the purpose of baths or showers, feel uncomfortable being naked in front of you, and upset at their loss of dignity and independence. Or maybe throughout their lives they always bathed at night, not morning. They may not be able to say what they’re feeling or understand what they’re feeling, but they know it’s not pleasant or good. Check out these tips for bathing from the National Institute on Aging. So, yes, you do have to help mom get a bath a couple of times a week, but maybe there are new tactics you can try that won’t end in battle.
In other caregiving instances, “pick your battles” might apply. For example, you’re caring for your dad who’s in his 80s and has heart problems. He decides he really wants to have a couple of his favorite beers while he watches a football game. You fear that the alcohol could interfere with his heart medication, so you tell him no. Hmmm…how does that go over? What might it be like to be an adult at the end of your life, who has made his own decisions forever, to be told by your own child that you can’t have a couple beers? Unless a doctor has told you that there is a high likelihood that two beers could kill or cause irreparable damage...let the man have his beer!
As Atul Gawande writes in his book, Being Mortal (an exploration of the shortcomings in the way we respond to aging and end of life care),
“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives” (From Being Mortal: Medicine and What Matters in the End, by Atul Gawande).
The passage above has stayed with me over the years. As caregivers, we aren’t just here to keep a person safe and alive as long as possible, but to help them live the best life possible under the circumstances. So maybe them having couple of beers or eating that bowl of ice cream or staying in pajamas all day once in a while isn’t so bad in the grand scheme of things.
If you’ve read any of my other posts, you know I’m also a huge proponent of self-care. And I’m a firm believer that self-care should be part of any plan for coping with the stress of caregiving. Check out my blog post about compassion fatigue and burnout in caregiving to learn more about what you can do to care for yourself as you continue the important work you do.
And, as always, if you haven’t heard it lately: thank you. Thank you. Thank you. The work you do, often feels unseen, but it is seen. I see it. The person or people for whom you care see it and feel it. Your family sees it. Families with loved ones in the senior communities, hospices and hospitals see it. You are important and we need you!
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