Coping with Post Traumatic Caregiving

According to an  AARP study, over 40 million Americans are caregivers.  While we know a lot about the experiences of this group—the financial, mental and emotional impact—what is not always clear is how they entered into their caregiver roles. Studies on stress, burnout and compassion fatigue have identified the challenges faced by caregivers and often provide survival tips.  What has not garnered the same amount of attention is the fact that many people enter into this realm shell-shocked—stunned into emotional turmoil by witnessing a critical moment in the life of a loved one. 

Psychotherapists, trained in assessing and providing support for trauma victims, know very well both the short and long term impacts of being exposed to situations that overwhelm one’s natural ability to cope.  Even those who do not inhabit the world of psychological diagnoses know very well that PTSD refers to post traumatic stress disorder and how serious and pervasive it is in a world where traumatic events happen with alarming regularity.

Many caregivers do not have the luxury of moving into their roles along a gradual learning curve. To the contrary, many are thrust into this role with no notice.  Whether it is the sudden heart attack, stroke, diagnosis of a cognitive disorder etc., many caregivers begin their journey in the wake of a traumatic event to a loved one that leaves them reeling and experiencing many of the symptoms of PTSD to include:

  • Unwanted upsetting memories
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

The unofficial diagnosis for these folks is best described as post traumatic caregiving, or PTCG for short.  PTCG can be thought of as a precursor to PTSD, having the added dimensions that the triggering event has happened to a loved one and often involves a cascade of critical moments.  Additionally, the random nature of the next crisis—known as “what now?” moments—and the challenge of having to juggle multiple demands sets PTCG apart from other psychological syndromes.

That most caregivers do not go on to develop PTSD is a result of multiple factors, not the least of which being the resiliency many find during crucial moments in life.  That almost all will experience PTCG is the result of the natural stress response when faced with high impact situations that rattle all areas of life.  While psychotherapy, supported by cutting edge techniques and possibly medications, is the standard treatment for PTSD, those experiencing PTCG are well-known for the “where will I find time for that?” response when told to practice self-care. 

While professional treatment would be beneficial, in the absence of profound dysfunction, more practical are techniques that one can practice while going about the busy-ness of caregiving.  These include the following:

  1. Don’t wait for someone to offer help, tell people what you need. Too many caregivers take the offer, “call if you need anything,” as an invitation to a party they’d rather not attend.  Critical moments require stepping out of one’s comfort zone—throwing up one’s hands and saying “I’m not waving at you, I’m drowning over here!”
  2. Put down the Caregiver’s Handbook and pick up the latest novel and lose yourself in it.  Reading about all of the challenges ahead can easily re-traumatize and move one from anxious moments to full-blown panic attacks.  Safety is the first rule of trauma recovery and allowing the mind to move into imaginary worlds helps protect it from overload.
  3. Get “techy” with it. Old school caregivers had to rely on professionals who were often over-worked and under-paid. Today, there are countless websites and apps that can bring experts into the home at the speed of the internet.
  4. Create a sacred space wherever you can.  Caregivers seldom have time to head off to spiritual retreats, travel to the mountains for peace of mind etc. Use the down moments while at the doctor’s office with your loved one, the time spent driving to appointments, the preparation of the next meal as meditative moments by simply bringing your full attention to what you are doing at the moment. Feel free to support these moments with silent mantras, prayers or simply recalling personal moments of joy.
  5. Open yourself to the kindness of strangers.  Caregivers often find that family members are either nowhere to be found or, sometimes worse, overly critical of their efforts. Many helpful encounters come out of nowhere and from people unknown.  One need not be spiritual to heed the advice to “be not forgetful to entertain strangers: for thereby some have entertained angels unawares.” 

Once the caregiver train leaves the station for territories unknown, the one certainty is that the ride is going to be filled with ups and downs, gain and loss, joy and sorrow.  When arising out of trauma, caregiving becomes a practice in the awareness that one has been thrown off balance and that a myriad of demands are drawing on energies, that while heightened, may not be channeled in a positive direction.  Since decisions during the initial stages of caregiving can have a profound impact on both the caregiver and the loved one being cared for, it’s important that these energies are managed in ways that support their enhancement and staying power.  Identifying when one is dealing with PTCG is one way caregivers can practice the art of caregiving and self-healing simultaneously.