Conscious Choice: Self-Care For Caregivers

November 1996

Self-Care For Caregivers

by Patricia Katherine Novick

The holiday season, when social and cultural mores expand the expectation of caring and attention to relationships, offers a microcosm of the world of the long-term caregiver, for whom there is no end to the giving. Outside the holiday season, these stresses are even greater because they are ongoing and involve prolonged periods of extreme caregiving. It is difficult for anyone to sustain this difficult and draining role. The requirements of a constant caregiver require a strength and capacity for caring that stretches even those with the most generous holiday spirit.

At some point in our lives most of us will become caregivers for aging parents or aging or disabled loved ones. Often this role comes on without warning or preparation. The caregiver role is extremely stressful; its adverse health consequences are well documented. When a parent or loved one becomes in need of long-term care, relationships shift. A parent may come to seem like a child. Chronic depression displaces good spirits in a formerly fun-loving partner. Physical and emotional limitations place you into a new and confusing relationship with a loved one.

For working professionals, the added responsibilities of increased household chores, doctor visits, insurance forms, administering medications, massage, and morale-boosting strain an already high-stress life. Few people have the training of a hospice nurse. How many of us have acquired the skills associated with helping in the fight for life? Who knows, until it happens, what issues to consider, or when it is best to let go of a loved one?

In the face of these overwhelming issues, many caregivers expose themselves to repeated stress without any relief. They forget to take breaks and vacations or do other things that replenish their batteries, like exercise, massage, and meditation. In general, they put the needs of the other above their own needs and forget to replenish their own supply of energy — until there isn’t any more left. They experience burnout, a feeling of depersonalization and general futility regarding life.

The best way to avoid such burnout is to plan moments of relief from the constant demands of giving care. Out of a sense of responsibility, if nothing else, every caregiver should find opportunities to stimulate the immune system, regain perspective, and enrich the spirit through small, pleasurable activities.

Preparing for care giving — and for taking care of yourself as the while giving care to others — will someday be recognized as essential, like training in infant care. In the meantime, current caregivers can offer empathy and advice for coping with the challenges of this role. I interviewed a number of caregivers, and here are some of their suggestions:

• “I get off the bus two stops before my house and walk the rest of the way home, just noticing what is around me.”
• “I get up early and work out. I feel energized by it and can wake my partner up with a fresh happy face.”
• “I read poetry to my dad. We both enjoy it and I feel replenished by our time together.”
• “I purchase small amounts of ready-made gourmet food and add it to basic rice or pasta. It saves time and my partner and I feel like we’re having special dinners which cheers us both, without any extra work.”
• “I schedule my day much more carefully and am more aware of the small amounts of time I have for myself. I do a relaxing meditation when I am in the shower. I try to double up on my regular activities like eating walking, bathing with meditation and stress reduction techniques.”
• “I have become an expert on breathing techniques. Relaxation training is a useful way for me to cope with things I can’t change. Instead of complaining and getting mad about all the additional household tasks I have, I practice deep breathing throughout my house cleaning activities.”
• “I have a comfortable chair where I sit and drink chamomile tea, which my grandmother gave me as a child. It gives me just the relief I need to provide nourishment to my partner.”
• “I break down my tasks into several small acts of care rather than training to climb the whole mountain at once. I make a game of it — trying to figure out how many small tasks I can get into one large one.”

Therapists and writers on the subject of caring for the caregiver have additional suggestions. In The Four-Fold Way, Angeles Arrien suggests “cradling work” as a way for caregivers to attend to their own health and well-being. Cradling work requires that you lie on your back and place both hands over your heart. Silently, you acknowledge the character qualities that you appreciate about yourself, acknowledge your strengths, acknowledge the contributions that you have made and continue to make to the other. You also acknowledge the love given and the love received. In this way, you reenergize yourself as a caregiver and renew your commitment to the caregiving task.

Dr. David Sobel, who wrote the book Healthy Pleasures, suggests that caregivers should surround themselves with small rewards that mean something to them specifically. Even a joke book, a glass of wine, a bunch of fresh flowers — any of these small indulgences enliven caregivers and people under stress.

John Wellwood, author of Ordinary Magic, suggests that caregivers stay in touch with the knowledge that there is more to life than we usually acknowledge. He asserts that it is important to avoid confinement by repetitive tasks, limited activities, and habitual thoughts. Life contains many dimensions; they race beyond the familiar and enrich the moment.

The outstanding Buddhist spiritual teacher Thich Nhat Hahn says, “All of us, children and adults, are beautiful flowers. Our eyelids are exactly like rose petals, especially when our eyes are closed. Our ears are like morning glories listening to the sound of birds. Our lips form a beautiful flower every time we smile. And our two hands are a lotus flower with five petals.” If you become a long-term caregiver — and even if you don’t — the important practice is to keep that “flowerness” alive and present, not only for your own benefit, but for the happiness of everyone.

When my daughter, Alison, was three, she developed fevers of undiagnosed origin, which did not respond to antibiotics. I spent several months with her in the hospital, and in her room at home. I was on the verge of madness from fear and stress. At the time, I received no advice on how to take care of myself while I cared for Alison. I remember feeling guilty whenever I took time for myself, not allowing myself to experience anything of joy or even pleasure out of a feeling that to do so would be unjust to my suffering, endangered child.

To obtain some relief I would go down into the basement of our house and position my exercise bike under the place where her bed was located on the second floor. I donned a Snoopy helmet and scarf and rode for her life. At the time, I saw it as my secret madness; now, from my research in Shamanism, I have learned that studies link the experience on exercise bikes and the brooms that witches and other healers use to enter an altered state.

Through this hilarious, almost post-modern instinct, I’d also taken on the characteristics of a power animal, in this case Snoopy, to help in the healing of my child. The Shaman takes on the characteristics of a power animal often in the healing ritual. Remember — trust your instincts: the rituals you create for yourself or the other can aid in the healing for both yourself and the person in your care.

Pushing impulses down below consciousness; losing personal boundaries; giving in to self-neglect, exhaustion, apathy and even depression are all potential dangers for any caregiver. The cost to your own wellbeing, not to mention the implicit desperation that is conveyed to the loved among being cared for, is not worth it. A few small actions of the type I described above may replenish your caregiving energies, to your own benefit and that of the person you care for.

Patricia Katherine Novick, Ph.D. is a therapist in private practice.

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