| Dedicated caregivers intuitively know the value and importance
of their roles. Caregivers, however, face real problems and pitfalls
which can be dangerous. Caregiving not only can be, but actually
is a stressful occupation.
Many studies report high incidences of "burnout" in both
the formal or informal care-providing professionals. Burnout is
a complex phenomenon, with three major components: emotional exhaustion,
depersonalization and reduced personal accomplishments.
Emotional exhaustion is a depletion of emotional resources, creating
a feeling that one has nothing left to give. Depersonalization is
the development of negative and insensitive attitudes about the
care-receiver. Reduced personal accomplishments for the caregiver
create a devalued sense of self resulting in no life beyond caregiving.
If burned out, the caregiver runs a real risk of becoming ill, engaging
in an increased use of alcohol or drugs, and causing family and
marital strife. Burnout will always affect the caregiver and care-receiver
relationship. Burn out can develop from the emotional demands made
on the caregiver.
The care-receivers may frequently be worried, anxious, and confused
about what is happening. They may be embarrassed about their dependency
and perhaps deny the truth about their condition. Because of their
own emotional and physical state, care-receivers may become impatient,
angry, and abusive; complain excessively. They may also make unreasonable
demands. Unfortunately, the caregiver is the target of this abuse.
The nature of the care-receiver's problems can also contribute to
the caregiver's burnout. Some illnesses or disabilities are so severe
and their prognosis so poor that the caregivers develop a profound
sense of helplessness and frustration, viewing caregiving activities
as a meaningless "drop in the bucket". This is a particular
liability for those care providers who deny the reality of the care-receiver's
situation and who continue to labor under what some researchers
label a rescue fantasy.
Caregivers and care-receivers may have communication problems.
Both may be unable or unwilling to express their true thoughts and
feelings about each other and their respective situations. Health
problems are invariably emotionally charged, particularly if they
involve bad news. The need to "cover up" may lead to an
unintended, yet real conspiracy of silence between individuals.
The communication process may, in turn, become little more than
a chronic exercise in diversion. When this happens, both the caregiver
and care-receiver are intuitively aware of the process, but may
feel powerless to change it. In that case, the interrelationship
becomes ambivalent; physical closeness coexists with psychological
distancing.
Burnout is a behavioral manifestation of stress. One behavior associated
with burnout is the so-called "mea culpa" reaction. Even
when caregivers recognize that the stressful nature of the work
originates from the situation, they will still engage in self-blame.
"If I really had measured up to the task, I should have been
able to handle it", many caregivers lament. Consequently they
experience a sense of personal failure, a loss of self-esteem and
an emotional state of depression or helplessness.
Caregivers tend to explain problems by looking at the care-receiver's
disposition rather than the situation. This may also negatively
affect their feelings for the ones they care for. No matter how
loved or respected, the care-receiver begins to be derogated and
criticized, and as the situation progresses, the caregiver may even
become indifferent or callous. Believe it or not, this situation
is essentially a normal one. There are aspects in the helping relationship
that promote and maintain this phenomenon. Primary and foremost
among these is the fact that the care-recipient is a person with
problems or deficits. No matter what their assets, it is the negative
side of the care-receiver's current condition that the caregiver
sees and tries to address.
A second aspect, already alluded to, is the fact that the care-receiver
may actually devalue and criticize the caregiver's help. Without
sufficient positive feedback from the care-receiver, the caregiver
may engage in counter-aggressive behavior.
Finally, the depersonalization of the care-receiver may be an
unconscious attempt by the caregiver to create emotional distance.
If the care-receiver is a loved one, this distance is often used
as a buffer to cope with feelings of grief or depression at the
prospect of an eventual loss.
How, then, is one to cope with the stresses of the caregiver role?
Since much of the emotional exhaustion caregivers experience is
people-related, one approach is to "get away from it all"
- at least temporarily. Thus caregivers may regenerate their energies,
enthusiasm and sense of mission. Simply stated, the feeling of being
overloaded with responsibilities can be reduced or eased through
techniques of temporary social withdrawal. Placing the care-receiver
for a time in a respite program to enable the caregiver to vacation
or accomplish other duties can be an effective healing strategy.
When others assume the caregiving role at regular intervals, it
enables the caregiver to look forward to those blocks of time as
his own. The real problem emerges with those caregivers who feel
so compulsively duty-bound to their charge that even a short respite
fills them with guilt and apprehension. However, anyone incapable
of setting limits and taking breaks will have a very short life
expectancy as an effective caregiver.
For some caregivers, getting together may be as effective as getting
away. Caregivers can be extremely good support and sources of strength
for each other. By learning how other caregivers handle certain
situations, how they feel towards their care- receivers and what
kind of inner conflicts they struggle with, members of such peer
groups learn from one another and feel less isolated. Frank and
explicit exchanges of experiences and thoughts give participants
encouragement, strength and reassurance that they are not alone
in what they do and feel.
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