Caregiving in the context of Previous Trauma - Caring for the Abuser

Caregiver Sally called to share that transitioning into her caregiving role has been very difficult. She recently began caring for her father, James, who has advanced Alzheimer’s dementia and was previously cared for by her late mother. Sally disclosed a history of verbal and physical abuse from her father during her childhood, which has made caregiving emotionally overwhelming. When first contacted about HottoCare, she experienced an anxiety attack and was unable to respond for weeks. Sally is currently dealing with depression, PTSD, and anxiety related to her caregiving role, describing it as something she feels "forced" to do. She is in counseling and actively processing her mixed feelings.

In situations where there was/is a history of spousal or parent-child abuse and that family caregiver naturally resents the caregiving or is triggered emotionally, we can help them identify someone else who can provide caregiving, even if it means pursuing a court appointed one or earlier placement into a facility. A key piece is helping them see caregiving as a choice they can walk away from. We should encourage them to seek a therapist to help them process their feelings of obligation, figure out their boundaries, and decide how much care they want to give. We can then support by connecting to legal process or to identify facility placement.

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Empower the caregiver by emphasizing caregiving is a choice: "I hope it brings some comfort to know that caregiving is a choice not obligation. When you figure out how much care taking you agree to take on or not, we can help with XXX"

For very emotionally difficult situations, redirect by emphasizing a trained therapist: "I can see you're having a tough time processing a very difficult situation and this is where having a trained professional, like a therapist will be critical. Know that caregiving is a choice and a good therapist will help you figure out how involved you decide you want to be in care or not."

Redirect by sharing what you can manage: "I'm so sorry about this, I can't imagine the pain it has caused. We would like to help you with this, what's the biggest thing you would like us to do for you?" “As you sort out the role you decide to take in caring for your parent, what we can help with is: 
1) Placement options - choices for care facilities
2) Financial and Medical decision-making - appointing someone else or a legal entity to take these over if you are not comfortable doing so, or if you decide to take a step back from caregiving"

In communication, remember your OARS (at least OAR, less so summary). Active listening and affirming/validating the caregiver's feelings will likely be a large part of your visit, and your treatment.

Other tips:

• Ask if the caregiver feels their own current safety may be an issue
• With the revelation of significant past trauma, the most important thing to do is to offer statements of empathy and support. Acknowledge that it’s really helpful that they had the courage to tell you.
• Emphasize that they have control and agency in the process. If they elect to continue caring for their abuser, let them know that it is OK to set boundaries and it is not necessarily “all or nothing.” (For example, hiring help to bathe a person who've sexually abused them)
• Emphasize the importance of practicing self care (see caregiver self-care resources). This is important for all caregivers but especially so for this population
• Explore the family situation. You can gently encourage them to reexplore boundaries if there are siblings or other close relatives. The caregiver may be working on assumptions that they set for themselves or are simply are not true.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8490312/?utm_source=chatgpt.com

-YT 06/25