The Seven Psychospiritual Dimensions of Family Caregiving
by Sheryl Karas M.A.
Last week I had three phone calls from caregivers in almost identical situations. They were all adult children in their 50s who had moved a demented parent into their home to better manage their care. The patients had similar problems and the caregivers were in the same income bracket and had similar levels of support. However, the cases couldn't be more different. One person was in crisis mode, and desperately spent her time putting out fires the other caregivers did not even detect. Another was outwardly calm and was clear-headedly collecting resources so she could be the most loving caregiver she could while keeping her life intact. The third was depressed. She didn't want to be a hands-on caregiver but took on the role because everyone else in her family expected her to do it.
Family caregiving isn't a simple process of determining what a patient needs and providing it. All kinds of deeper personal issues come to the surface and make the process much more complicated.
Over the years I've noticed that my clients' problems seem to fall into distinct categories which I now think of as separate but related realms of personal development. The levels are:
1. Physical Survival,
2. Emotional Saftey,
3. Self-esteem & Personal Power,
4. Love,
5. Communication,
6. Perception & Imagination, and
7. Spiritual Belief & Purpose.
A caregiver lost in basic survival never talks to me about love or issues of spiritual morality whereas those who have their physical needs well in hand often do. On the other hand, there are caregivers who only speak to me about love and spiritual purpose while their physical health suffers and their finances are in a shambles. I've come to believe that physical, emotional, and spiritual health depend on maintaining balance in all these areas of life. In this article I'll be exploring caregiving through the lens of each of these seven dimensions.
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 that 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 kinds of caregiver benefit greatly by joining support groups where they get the nurturing needed to develop trusting relationships and the support they need 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 learn to use their personal power in a balanced fashion through coming up 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.
Level Four: Love
When our physical and emotional safety is assured and we have the willpower we need to make a plan of action and follow through, the most natural result is a desire to make loving decisions. Unfortunately, caregivers can be so concerned about doing what is loving for their relative that they forget to do what's most loving for themselves. Caregivers who struggle on this level appear to willingly throw their lives away in order to provide the level of care they believe is right. They do the self-care needed to stay physically healthy but never make time for their deepest heart's desires. Eventually, however, this can lead to severe depression and illness can become the result.
These caregivers need acknowledgement of how loving they are and support to continue acting from a place of love. But, spiritually, they need to hear that refilling their own cups so they can give freely of their reserve is ultimately the most loving act for all.
Level Five: Communication
Love doesn't do much good if you can't communicate it. Caregivers struggling on this level complain that nobody really listens to them when they say what they need or report horrible family conflicts stemming from miscommunication or lack of communication on their parts.
I do a lot of coaching with these caregivers around how to communicate in ways other people can hear it. I also encourage people to spend time listening to their inner voices so they can be clear about what they are asking for. Spending time each day in solitude, in prayer or meditation or by using art therapy, journal writing and other forms of creative expression can work wonders. Other people can benefit from conflict resolution workshops or support groups where they are encouraged to feel comfortable expressing their feelings and asking for what they need.
Level Six: Perception & Imagination
I'm always surprised by how often caregivers allow themselves to be straight-jacketed by nothing more than illusion. A person living in the lap of luxury, making more money than I've ever even imagined for myself, will tell me he can't afford to pay for services while a person in a run-down trailer park living on a tiny fixed income gives me a big donation check. There are caregivers who tell me that their severely demented relative couldn't possibly be so badly off because "look at how good he looks" and others, dealing with only the mildest of memory loss, who insist their relative should no longer have their independence.
How a person perceives him or herself can also get in the way of healthy caregiving. Whenever caregivers see themselves as inadequate in some way their stress level and depression scores go way up. If they see themselves as prisoners every caregiving task becomes a hated symbol of oppression; if they see themselves as playing the role of guardian angel every caregiving task becomes a source of pride. Sometimes the biggest task is to help people see things from a different perspective.
Level Seven: Spiritual Belief & Purpose
Because caregiving entails so many moral issues, many caregivers inevitably talk to me about the role spirituality plays in their lives. Studies have shown that spiritually oriented people have significantly lower levels of stress and my experience as a family consultant bears this out. Some people tell me their lives are blessed to be able to share so much love and to be of service to the people in their lives. They tell me times are hard but God never gives them more than they can handle. When I ask these caregivers to fill out a standard depression scale their scores are often the lowest of any caregiver I meet despite caregiving situations that rival clients with the highest scores. I am always humbled by how even the frailest elderly caregivers can be so strong and determined when buoyed by spiritual devotion. It is hard to ignore the value of such empowering beliefs.
Essentially, this level is about life purpose. Caregivers who operate from a sense of purpose have a clarity about their actions that is almost startling. They know that caregiving gives them an opportunity to fulfill that purpose and use my services to gather the resources they need to accomplish their chosen task. Others believe their deepest purpose lies elsewhere and choose to do what they can do as caregivers while maintaining adequate time and energy for their true callings. All caregivers who operate from a place of commitment to their highest goals tend to make choices that are empowering, clear and decisive.
Full Circle
It's wonderful to be full of inspiration and higher purpose but if that purpose stays in your head and is never realized in physical reality it doesn't do much good. We have to use all the abilities we develop along the way. We envision where we want that higher purpose to take us (Level Six) and communicate our hopes and dreams to others as we make our decisions and plans (Level Five). We gather community to support our heart's desire (Level Four) and use our willpower to follow through on our intentions (Level Three). We find healthy ways to enjoy the process of getting to our intended destination (Level Two) and use all the physical resources at our disposal to bring our ideas to fruition (Level One).
That brings us full circle and makes it clear, I hope, that one level is not more important than the others. They all work together. They all are paths for personal growth and development, and caregiving, within this framework, is the perfect catalyst for this to happen.
Caregiving Articles
A new version of this article can be found in Sheryl’s latest book The Spiritual Journey of Family Caregiving.
Caregiving Articles
© Copyright 2007 Sheryl Karas & Paul Hood