Care for Caregivers
(Column: Ask the Therapist)
Rita Seiden, C.S.W., Ph.D., Executive Director, Park Slope Center for Mental Health
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Caregivers for the mentally ill come in a combination of forms: paid, unpaid, central, incidental. So, you can be a paid worker and encounter a particular individual only incidentally, or you may be the primary caregiver. You can be a family member or friend who lives with the mentally ill person, or who only sees the person from time to time, or somewhere in between. The stresses for both paid and unpaid workers are similar in important ways, but also dissimilar in the safeguards that are built in for the caregiver. For all types of caregivers, consideration of several critical issues is important to both the caregiver and the person cared for.


How different are we from those we care for?

The normality-crazy continuum is just that, a continuum for more-or-less normal to more-or-less not so normal. We may "function" at higher levels in some areas of our lives and not in others. People may find us credible across areas of life because we are employed or have some other achievement. People who are mental health consumers struggle with being discredited even in areas of their lives where they "function" simply because they are seen as "crazy" and therefore generally incompetent. Thus undiagnosed people are given more credit than they may deserve, while diagnosed individuals may have to struggle to be credible on things that they know. The reality all along the continuum is that we can be a mix of abilities -- in some places quite functional, in others, not. When caring for others, we must remember that we have our less functional areas and our blind spots, and that those we care for need to have their areas of high functioning acknowledged. We must also remember that we have good days and not such good ones, and that when we are stressed our functioning is compromised -- not unlike those we care for.


Boundaries

Those of us who care for others have trouble setting limits on ourselves, or on those who depend on us. Caregivers sometimes think of this lack of boundaries as generous, but it is important to know that this kind of "generosity" can be infantilizing, too familiar, and not helpful. We need to know what we can do, what we want to do, and what is possible. And, it's O.K. to share that information with those we care for. Boundaries help those we care for to recognize their own strengths, it teaches them to be realistic, and it helps us continue to be able to do our caregiving.


Respite

Caregivers need to take a break. Mental health workers need to take their vacations, leave the office at a reasonable time, and generally know their limitations. Family caregivers need to be "off duty" on a regular basis -- by finding substitute caregivers, and by assessing realistically whether the person in their care really cannot live without the caregiver. Without relief the caregiver begins to look, act, and feel like the person who is being cared for. Both workers and family members are likely to overestimate the mentally ill person's need to be cared for by them; and underestimate the ability of others to provide adequate care.


Saving the Caregiver

Above all, caregivers must save themselves, and keep that as a fundamental rule. If you feel overextended, overwhelmed, and like you are not functioning the way you usually do, it is essential that you consider respite and boundary issues. While the person cared for may not need you exclusively, or as much as you may think, they probably still will suffer from our inability to continue to care, if adequate attention is not given to the the relationship between the caregiver and the person cared for.
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