Protecting Intimacy While Family Caregiving
By Barry J. Jacobs, Psy.D
The 70-year-old husband whose wife suddenly has had a stroke is at first full of resolve and tenderness. He means to make good on his wedding vows and demonstrate his love after 45 years of a good marriage by protecting and caring for her during her time of need. But, after three years of caregiving, he is fulfilling the obligations of those vows but not the spirit. He continues to help her get around the house and feeds her but now regards her resentfully as a source of chores rather than as the wellspring of his happiness. He has long since stopped confiding in her about his feelings for fear that doing so would only upset her. Their relationship seems to be circumscribed by the drudgery of the day’s arduous caregiving tasks. All sense of intimacy—emotional or physical—has vanished from their marriage.
Not all long-term caregiving families experience a diminution of love among family members. For some, providing care to a loved one is so meaningful an endeavor that their relationships deepen; they cherish each other more, not less. But, for many others, caregiving itself becomes anathema to intimacy. Their actions become motivated more by obligation than love. Feeling entrapped by those obligations and whipsawed by resentments and guilt, they wind up distancing themselves emotionally from their ill or disabled family members to whom they’re ostensibly devoting their lives.
As a clinical psychologist who has worked with families coping with illness for nearly 20 years, I’ve struggled to help relatives protect the intimate bonds among them as a means of preserving their quality of life and capacities for coping with adversity. To be truthful, I usually only partially succeed. Because illness alters the balances of give-and-take between members, it changes their relationships usually for the worse. But I’ve developed several strategies that are helpful for some families:
- Know what caregiving entails and talk about how to spread around the responsibilities. Family members who communicate with one another about what the sacrifices of caregiving means to each of them and negotiate as just and equitable a caregiving plan as possible do a better job of preserving mutual respect and affection. The sense of working on a caregiving team gives everyone a greater feeling of being heard and supported.
- Keep caregiving in perspective—as only one part of the family’s story. As compelling and consuming as a loved one’s needs may be, they shouldn’t define who the family is. Other members’ needs must also receive the family’s attention and resources. It’s when people feel cared for that they’re willing and able to give love in return.
- Make sure the ill family member can give something back. There is nothing as destructive to the intimacy in families as the loss of reciprocity. The well family member who gives and gives ultimately becomes depleted and resentful. The ill family member who receives without the opportunity to give back feels like a burden and is prone to guilt and depression. No matter how limited the ill family member is, I ask him to give something back to his caregiver, even if it’s only acknowledgement and gratitude. For the wife who had a stroke, I’d urge her to find some way of taking care of her bedraggled husband. Perhaps she could listen empathically to his woes. Perhaps she could scratch his back. It will be her best chance to encourage him to regard her as his spouse again, with all the love, commitment and mutual concern that the term should imply.
There are many corollaries to each of these strategies. I explore them at length (as well as six other essential tasks for family caregiving) in my new book, just published by Guilford Publications (see title below). For more information on it, please see my website. To read a sample chapter, click on the cover of the book below or go here.
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