Wednesday, January 16, 2008

The First Three Psychospiritual Levels of Family Caregiving

In a previous blog I mentioned that it seemed like the issues caregivers came to see me about fell into seven distinct categories of distress. This blog describes the first three; I'll post descriptions of the other 4 levels later this week:

Level One: Physical Survival

This is our foundation, what we need to survive. The problems caregivers have on this level always seem to revolve around money, adequate housing and physical health. They might have addictions stemming from their desire to escape their lives or act as if they are incapable of taking care of themselves on the physical level. Some people even become dependent on doing caregiving because they use the patient to supply them with housing and other basic needs.

My task with these caregivers is to help them find the resources they need to learn stand on their own two feet. I might suggest a family meeting to help the family divide caregiving responsibilities in a way that allows the primary caregiver to go back to school, get a part-time or full-time job or develop a plan that will help them separate their caregiving decisions from issues of personal survival. This is essential to create a foundation of support for both the caregiver and the person who depends on their assistance.

Level Two: Emotional Safety

The biggest problem for these caregivers is trouble with emotional boundaries. They might find themselves blown off-course by their patient’s emotional reactions and spend all their time jumping through hoops to keep the peace instead of making space for their own needs or desires. Or, conversely, they might put up such high barriers to protect themselves that they become isolated, untrusting, judgmental or depressed. They fear someone will try to take advantage of them in some way and turn away help that other caregivers jump at the chance to get.

My task with these caregivers is to help them create emotional safety either through learning to set appropriate limits or by learning to take small emotional risks. Both of these caregivers benefit by joining support groups where they get the nurturing needed to develop trusting relationships and the support to take care of themselves. For others I might recommend a self-help book, sessions with a therapist or a class. I also like to help people remember that emotional safety stems from enjoyment of life and encourage them to plan pleasurable activities every day.

Level Three: Self-Esteem & Personal Power

Caregivers struggling on this level may have every advantage in terms of money, respite assistance and family involvement but fret over every decision for fear of making a mistake. They repeatedly say that they need to make a change but do nothing because they fear it won’t work. They believe they are powerless to change the status quo.

Other caregivers go to the opposite extreme. They attack every challenge as if on a battlefield and overcompensate for their fears by compulsively staying in action. They find it hard to tell the difference between emergencies that require such superhuman effort and situations where slow relaxed progress would do the same. They antagonize people who might otherwise help and exhaust themselves through overwork and repeated stress.

My task as a family consultant on this level is to help people use their power in a balanced fashion with realistic action plans. We focus on baby steps and the reassurance that it is okay for things to be less than optimal even for long periods of time. I try to help people trust that slow steady progress that allows for adequate rest, time and attention for other aspects of one’s life can be more effective in the long-run than burning oneself out with frantic attempts to fix everything that’s not quite right.

This blog was an excerpt from my book The Spiritual Journey of Family Caregiving. Now available through

No comments: