Book: Coping With Your Difficult Older Parent

coping“Coping With Your Difficult Older Parent: A Guide for Stressed-Out Children” By Grace LeBow & Barbara Kane with Irwin Lebow
  • “They used the word ‘difficult,’ not so much because of the physical burden of caring for parents in a state of decline, but because of the emotional drain of trying to help parents who were hard to help. In many distances the child had distanced himself from his parents either geographically or emotionally. But now that the parents was suffering from the ravages of old age, the child was forced to step in to help and confront anew the parent he could no longer escape.”
  • Difficult behaviors
    • Dependency
      •  “cannot tolerate being alone; wants you all the time.”
      • “becomes physically ill or overtly hostile when confronted with separation”
      • “makes unreasonable and irrational demands upon their grownchildren and others.”
      • attaches himself or herself to another person (e.g., a daughter), leaning on that person for help with everything.”
      • “is unable to make decisions or take responsibility for decisions, looking to their grownchildren and others for even trivial decisions.”
      • “cannot allow himself or herself to depend on others even when you know he or she needs help.”
    • ‘Turnoff’
      • “tends to view others as all good or all bad. Sometimes the same person can be all good one day and all bad the next”
      • “is extremely negative and complains of unhappiness.”
      • “is hypercritical of others and hypersensitive to criticism or blame”
      • “is tactless.”
      • “has to be ‘right’ all the time.”
      • “is angry and hostile, while blaming others for the same characteristics”
      • “has temper tantrums, e.g. throws things, or uses abusive language.”
      • “is distrustful and suspicious, sometimes to the point of paranoia.”
      • “pushes people, or even cuts off the relationship.”
    • Self-centered
      • “has a distorted self-image, viewing self as ‘something special’ at one end, or inadequate at the other.”
      • “interprets events solely as to how they affect him or her, oblivious to the effect on others.”
      • “is insensitive to the needs of others while, at the same time, thinks of self as generous”
      • “guards his or her own turf.”
      • “is jealous of others”
    • Controlling
      • “manipulates others by the use of such techniques as guilt and flattery.”
      • “is passive-aggressive, i.e. antagonizes others by behaving passively, e.g. by procrastinating or withdrawing or by other means.”
      • “elicits feelings in others that reflect his or her own feelings such as helplessness or rage.”
      • “cannot tolerate differences in things pertaining to lifestyle, ranging from the mundane (eating, dressing) to important values (rearing children).”
      • “becomes angry and hostile when the person they are trying to control don’t behave as desired. i.e. don’t ‘heel.'”
      • “makes demand so excessive that the opposite is achieved.”
    • Self-destructive
      • “has ever been addicted to alcohol, drugs, or medicine.”
      • “has ever had eating disorders, e.g. overeating or refusal to eat”
      • “has ever behaved compulsively, such as by gambling, hair-pulling, excessive washing, etc.”
      • “has ever been accident-prone.”
      • “behaves masochistically, e.g. doesn’t comply with dietary restrictions or refuses to take medication.”
      • “has ever been suicidal or threatened suicide.”
    • Fearfulness
      • “is worrywart, anxious over real or imagined occurrences.”
      • “is subject to panic attacks.”
      • “has phobias, such as fear of crowds, germs, etc.”
      • “has sleeping problems.”
      • “behaves ritualistically and superstitiously.”
      • “has magical expectations, e.g., goes doctor shopping to look for a cure.”
      • “tends to deny the obvious , e.g. symptoms of illness.”
      • “is preoccupied with physical problems, real or imagined.”
  • A dependent mother
    • “No matter how exasperated you become with your difficult parent, anger doesn’t solve anything. It only makes you and your parent feel worse. Your parent can’t see her own shortcomings and will only see that her son has a short fuse. Even if you hold her to account and make her apologize, she won’t understand and won’t learn from the experience.”
    • “During these cooler moments, Al tried to reason with his mother to get her to change her behavior, even though it never worked. But it is just not realistic to expect someone like Bea to change a lifetime of dependent behavior. If Al is to feel better, he has to work the other side of the problem, that is, see how he can modify the way he reacts toward his mother.”
    • “If your mother is pressuring you to visit her more often than you think is necessary or desirable, decide how often you can do it comfortably. If she calls you more often than you would like, get an answering machine to take some of the calls. Your mother will not like your limits at first. She may never get used to them and may keep complaining. But stick to them anyway. They are your boundaries. For your own well-being you have to be firm about what is best for you. This is the best way you can preserve your relationship with your parent.”
    • “He has limited his face-to-face interactions to one per week, and in his intermediate phone calls he has adopted a new attitude. He responds positively to his mother’s complaints. He says what he can do, not what he cannot do, and he doesn’t feel guilty about it. Most importantly, Al is not able to empathize with his mother’s underlying feelings of misery rather than addressing the content of the issues between them.”
  • The mother who gets sick when her son goes away
    • “The no-win blame game. It would be easy for Morton to get angry and blame his mother for spoiling his vacations or blame himself for letting her get away with it. As we said before, don’t fall into this no-win blame-game trap. It doesn’t work.”
    • “You have to take care of your own needs. Of course, Morton knows that he has to get away on vacation every once in a while. The question is how to do it without taking it out on himself and his mother.”
    • “There is no substitute for understanding. As we indicated earlier, the only effective way to improve the situation is to come to terms with your parent’s behavior and change the way you behave toward her. The first step is to understand something about why she behaves as she does.”
    • “When you tell your mother you are going away for a weekend, something within her tells her that you will never return, even though on an intellectual level she knows quite well that when the weekend is over you will reappear just as you always have. This throws her into a panic and causes her symptoms.”
    • “If you are going away for a short time, such as a long weekend, just don’t tell her that you are going away. Call from wherever you are and pretend that you are home, tired out, or not feeling well. Nobody likes to tell someone a fib, even a little one, especially to their mother. But this tactic will protect your mother from being attacked by her own feelings, if only temporarily, and will allow you to get the respite you need.”
    • For longer trips, “have to tell the unvarnished truth.”
    • “The first thing to note about this conversation is that it took place ust before Morton left on his trip. This give Rose a minimum amount of time to get all nerved up. Then he told her his itinerary and when he was going where. He told her he would keep in touch and he arranged for substitute visitors during his absence. He didn’t tell her this, but he also arranged for some extra attention from the people at the retirement residence.”
    • “He knows he can’t make her complaints go away. But he can offer her his comfort.”
  • Later life dependency
    • “The emotional recovery time from a move, illness, or death of spouse can take a year at the least.”
    • “Unlike dealing with a parent with lifelong dependency, you can use reason with your parent.”
    • “Don’t tell your parent what to do.”
    • “For Sylvia’s daughter to push her mom to shower and bathe herself would not be well received. Convincing her mother to accept a nurse’s aide was an effective way of introducing a neutral third party.”
    • “Take care of yourself. Do what you think is reasonable and try to keep from taking on more than you can comfortably handle.”
    • “You can explain your decision to your recently dependent parent and discuss it with her, something that is less likely to work when your parent has been dependent all her life.”
  • The world in black and white
    • “A mother alienates all her children by her ‘black-and-white’ view of the world.”
    • “Seeing the world in black and white is called ‘splitting.'”
    • “Splitting, like extreme dependency, come from a feeling of abandonment”
    • “Splitting is a matter of self-protection.”
    • “These examples show that people with a tendency to split can do so often and repeatedly. They may turn against a grownchild or other person overnight and then switch back to acceptance with no apparent provocation, a mood shift that reflects the emotional instability of someone with a difficult personality.”
    • “If this description fits your parent, you can expect her to go into her split mode automatically when threatened by separation, and you can expect to become the ‘bad guy’ no matter what you say or do.”
    • “Recognize that people with all-or-nothing personalities have trouble interacting with more than one person at a time. They feel safer in one-to-one relationships. Interacting with two people at once will invitably lead to splitting her positive and negative feelings between the two. Keep your relationship one-on-one as much as possible, avoiding a three-person traid.”
    • “You can’t argue rationally with a splitter.”
    • “Don’t argue; validate.”
    • “Let your parent know that you are there for her.”
    • “And so she validated her mother by responding sympathetically to her without agreeing or disagreeing with the substance of her remarks.”
    • “But keep in mind that sometime nothing works. Don’t blame anyone. Your parent is driving to behave this way because of something going on inside her beyond her control. It’s not your fault, and it’s not hers.”
    • “Under any circumstances, make a move to another city or even a change in housing in the same location can be a source of great stress to the older person. But when your mother has been difficult all her life and you have estranged yourself, it is easy to see how such a difficult situation can turn into a family crisis. That’s why it is so important to get help before the situation reaches a crisis stage.”
    • “Give your parent some choice in the hiring process by having her interview the prospective helpers. This will remind her that the helper is hers and not yours.”
  • Negative and other turnoff behaviors
    • “If you find yourself too angry to utter empathetic words, then try saying something like, ‘Let’s not fuss over this.’ It’s amazing how simple act like this can defuse a tense situation and let you start afresh.”
    • “As we just saw, anger is often natural reaction of a grownchild to a negative parent. And if the grown child gets angry, so will the parent, and the verbal fisticuffs that follow will do no one any good.”
    • “Avoid the trap of doing things with and for your parent that are most likely to bring out her negativity. Pick activities that are most pleasurable for her and for you.”
    • “Another piece of advice we give grownchildren in these situation is: Attend to yourself. many grownchildren are so intent on focusing on what they can do to make their parent happier that they forget about attending to themselves.”
    • “Keep your visits with a negative parent short.”
    • “You may have to override your parent’s objection to outside help if the risk is too high.”
    • “When you decide to step in over a parent’s objection, get the cooperation of family, friends, and outsiders.”
    • “If nothing works or family members disagree over the level of risk involved, then the approach of last resort is to call in Adult Protective Service, a division of your local social services department.”
    • “Adult Protective Services workers do not strong-arm older adults into institutions. They try to work cooperatively with their clients and follow general principles, including:
      • the client’s right to self-determination. Competent adults are entitled to decide where and how they live.
      • the use of the least restrictive alternative in treatment and placement.
      • the use of community-based services rather than institutionalization, wherever possible.”
    • “If more drastic action is called for, your state’s Department of Motor Vehicles may be able to help. In some states a doctor’s letter can initiate a license renewal examination before the old license has expired. If the state takes yoru parent’s license away, then they are the bad guys, not you.”
    • “Betty’s dad has the right to decide how he lives, even if it looks to everyone else that there is a better way. Unless there are risks of self-neglect or self-abuse, no intervention is indicated. But that does not mean Betty has to play by his rules. Even though she can’t force him to move, she should recognize there are other ways of helping her father while, at the same time, relieving the stress on herself. One thign she can do is see what her community has to offer in the way of services for seniors. She can provide him with this information and, if he agrees, she can make arrangements for services such as home-delivered meals, and errand and transportation services.”
    • “If you are not sure whether to step in, step back and get your bearings.”
    • If so, hire a neutral third party–a care manager–to weigh the risks and advise you.”
    • “Evaluate the risk to your parent’s safety. If the risk is high, step in; if not, step back. If you can’t evaluate the risk, get professional help. If you do step in, get family members to talk to your parent one-on-one, or, have a family planning meeting with the parent. If your parent is closed to all discussion and reasoning, try bringing in someone to help with a specific task, such as food shopping. As a last resort, call in Adult Protective Services.”
    • “Instead, learn to react to her criticism with a new nondefensive, noncriticcal strategy. The next time your parent criticizes you for something, take a deep breath and let her criticisms roll off your back.”
    • “These criticisms are a projection of her own profound sense of inadequacy. She gets rid of these feelings by convincing herself that those around her have worse imperfections. So she engages in one-upmanship, in which she puts others down–especially those closest to her. This is how she copes with her world. And when you get defensive, her feelings of inadequacy are intensified. It follows that if you ride with the punches and don’t criticize back, then she will be more confident and let up on you a bit.”
    • “You can’t talk your parent out of being suspicious. But you can support whatever she is feeling, whether she is scared, unsettled, or upset.”
    • “You may hesitate to use these sympathetic phrases because it may sound like you are encouraging your parent’s paranoid beliefs. On the contrary, your parent feels frightened and needs to feel that you are on her side. Comments such as these will have a quieting and comforting effect. Don’t underestimate their importance.”
    • “If you understand why your parent turns people off, you will treat her differently. Even a small shift by you can make a big difference in her.”
  • Self-centered behaviors
    • “A narcissistic person needs constant propping up to feel good about himself.”
    • “When a person with a healthy sense of self-worth accomplishes something, be it small or large, he takes satisfaction for his accomplishment within himself. He certainly enjoys having others praise him for what he has done, but he doesn’t require this praise to feel good about himself. On the other hand, the person with unhealthy narcissism cannot take satisfaction in his accomplishments without the adulation of those around him.”
    • “Underneath the inflated ego lies a vulnerable and hypersensitive self.”
    • “Since right underneath this inflated exterior lies a vulnerable and hypersensitive self, they easily feel the deep emotional wounds when criticized.”
    • “Narcissistic people are typically unemphatic, controlling, and opinionated.”
    • “It helps when you give up futile attempts to try to satisfy your narcissistic parent.”
    • “Stop power struggles.”
    • “Avoid situations that put you in conflict with your parent. Get others to help, and spend your time in less conflictual activities.”
    • “Make it clear what you can and cannot do, in a constructive and nonthreatening way. And make sure the timing is right.”
    • “Be as honest as possible while helping your parent safe face.”
    • “Always be kind and considerate.”
    • “Assure your parent that even though she can’t live with you, you nevertheless care about her.”
    • “Be straightforward. Open up a discussion if your parent is hinting around about wanting to move in with you.”
    • “Don’t be defensive. Defensive explanations always lead to counterdefensive arguments.”
    • “Listen and respect your parent’s reactions while you are persistent and clear about your position.”
    • “Mom, I’d like to be like Sophie’s daughter, but you and I know I’m not like her. I tend to get irritable and short-tempered when I don’t have my way or my space. It’s never worked when we are together for too long. We will both be happier living in separate places.”
    • “As you know, Ben and I have just sent our last kid off to college. It’s important for the two of us to be alone in our own home now. But Ben and I would love to have you nearby.”
    • “If your parent has always been self-centered, chances are she will remain this way.”
    • “If your parent is limited as a caregiver, don’t put her in positions that require nurturing.”
    • “Her own needs are so great, she has no capacity for understanding the needs of others.”
    • “Your parent may develop illnesses (somatize) as a way of dealing with inner conflicts. These illnesses are real, not imaginary. Be patient. A geriatric psychiatrist can help your parent with her emotional symptoms. Your parent may have some hang-ups about psychiatrists. Be careful how you introduce the subject.”
    • “You don’t have to run away from your self-centered parent. You don’t have to give in to her insatiable needs. THERE IS A MIDDLE WAY.”
    • “Be creative. Find constructive ways to satisfy your parent’s need for attention.”
  • The controlling personality
    • “No matter how miserable your parent’s controlling ways may make you feel, remember that she feels worse than you do. She is suffering from early life experiences that get stirred up in the present. Controlling those on whom she depends on is one of her most powerful ways of defending against this depression.”
    • “Rather, they were probably simply victims of their own limitations.”
    • “Don’t let your controlling parent pit you against your siblings. Whenever possible, take action in concert with other close relatives.”
    • “One tangible thing he might do is make a ‘This Is Your Life’ poster with photos and stories featuring his mother and place it on her door or some prominent location acceptable to the home for everyone to admire. This will help her feel better about herself as the nursing home staff becomes acquainted with her life over the earlier span of years when she felt productive. At the same time it will bring plenty of positive attention to boost her self-esteem.”
    • “Help your parent find acceptable ways to feel special.”
    • “Another approach he might take is to talk to the home about giving his mother a special job, such as placing the flowers on the dining room tables. Since she likes to be first in the dining room, she could be seated first in return for her work.”
    • “Keep yourself out of control battles between your parent and others.”
    • “Try humor as a way of responding to the control freak. Or else try responding with a light touch.”
    • “If your parent doesn’t respond well to humor or lightness, then you might try to be direct with gentleness and reassurance.”
    • “I’m me, and you are you. It’s happening again. Let’s change the subject. You and I each have our own special ways. Different strokes for different folks.”
    • “No matter what you do or say, there is no guarantee that your parent will be accepting of your differences. If she doesn’t leave it at that. You don’t want to end up a control freak like your parent.”
    • “The choice of being controlled or being in control is yours.”
    • “Assure your parent that you will be there for her, but on terms that are acceptable to you.”
    • “A skilled professional can help you to identify your hot buttons and learn to be less reactive.”
    • “If your parent lives a distance away, a care manager in your parent’s location can ease the burden on both of you.”
    • “If reasoning has ever worked in the past, then this is the first approach to try. What have you got to lose? If it doesn’t work, drop it and try again another time.”
  • Self-abuse and depression
    • “We suggested another approach that is sometimes successful: letter-writing. Unlike verbal communication, a letter allows one to frame an argument that can sink in over time without being interrupted by an instantaneous negative emotional reaction.”
    • “The first part explains how much the mother means to the person; the second part, how the person is affected by the mother’s current behavior; and the third part, the kind of relationship that the person would like to have with her.”
    • “The symptoms of Alzheimer’s disease and depression can be similar. Get a professional diagnosis.”
    • “Depression is highly treatable.”
    • “Consider psychiatric day treatment centers for parents who are self-abusive or need stabilization after hospitalization.”
  • The problem of fearfulness
    • “Then there are those people who are not ill but are afraid they will become ill. In its most extreme form it is called hypochondria, the disorder that causes its sufferers to be preoccupied with the details of their bodily functions and he possibility of having disease.”
    • “A care manager in your parent’s locale can act as your surrogate and arrange for the needed help.”
    • “Dig into your parent’s background to understand the basis of her fearful personality.”
    • “Don’t try to diagnose your parent’s problems. That’s what doctors are for.”
    • “If you do not have much choice in your parent’s community, arrange for a geriatric psychiatrist located elsewhere to act as a consultant for your parent’s doctor. Information about trained geriatric psychiatrists can be obtained from the American Association for Geriatric Psychiatry”
    • “PTSD is the clinical name given to the reactions suffered by a person who has been subject to life-threatening experiences such as physical and sexual violence, war, criminal acts, natural disasters, and sudden loss of people or possessions.”
    • “Studies of PTSD have shown that its psychological legacy does no always follow immediately after the stressful events; in fact, many years may elapse before symptoms are noted. Nor does the passage of time necessarily heal the trauma.”
    • “Understanding helps you control your anger.”
    • “Understanding helps you begin to feel sympathy for your parent.”
    • “Understanding helps you to let go of unrealistic hopes.”
    • “Many grownchildren come to us and say, ‘My mother makes me feel guilty all the time, ‘ as if the mother has the problem. We help our clients see that the problem of feeling guilty or not feeling guilty is a choice of the grownchild.”
    • “You will like yourself and your parent better when you learn to live your life the way you choose rather than be controlled by your parent’s reactions.”
  • Loss, grief, and mourning
    • “Repressed grief reactions leading to full-blown depression and threats of suicide can surface months or even years later, often on holidays and anniversary dates.”
    • “If your parent shows no grief it’s because she can’t grieve. It’s part of her personality difficulty.”
    • “It doesn’t work to try to talk her out of her depression.”
    • “Watch for signs of grief in your parent’s comments.”
    • “Encourage your parent to air her feelings.”
    • “Sometimes reminiscing well help your parent grieve. A helpful technique is to pull out some old photograph albums and help your parent talk about the old days both good and bad, about the days of courtship and marriage, and other special family events.”
    • “At the same time as you are being sympathetic to your parent, be sympathetic to yourself. For example, if your parent’s reaction at a time of loss is to cling to you or make excessive demands, decide what you can reasonably do and what is too much. Setting limits in this way will be best for both of you in the long run.”
    • “First: Gain some understanding of the basis of your parent’s uncontrollable grief. Second: Act toward her in ways that neither shut off nor add fuel to her grief. Third: Involve your parent in meaningful projects and activities.”
    • “Hugo’s inability to make decisions was perhaps unique to the particular circumstances of his life. He tried to avoid his grief over the loss of his dear wife by moving on to a safer place. Yet he couldn’t follow through for fear that the next place might bring further loss and further grief.”
    • “Therapy helps people mourn, no matter how old they are.”
    • “Similarly, a parent who has just lost a spouse might accept the idea of bereavement counseling or, if that is too much, of simply talking to someone about his sleepless nights.”
  • How to keep from being difficult yourself
    • “As Al comes to accept his mother with her limitations, he has a double reward. Not only will he ease the burdens and stresses that the relationship with his mother has placed on him, but he will be better prepared for his won aging. Recall how in the last chapter we described old age as the time when we look back on our lives and come to terms with it. The greater our capacity to mourn our losses, the more satisfactory is this summation process. Thus the greater Al’s capacity to mourn his losses now when he is middle-aged, the better prepared he will be later when he is older and the losses multiply in number and severity. Not only will he interact more satisfactorily with his wife and children and others around him, but his own aging process will be more successful. He will be serving as a model for his children and later generations.”
    • “Successful mourning requires a balanced view. The more you are aware of your mixed feelings about your parent, the less susceptible you are to have the problems spill over into your everyday life and replayed in your current interactions.”
    • Activities to help with transition:
      • “renewed old friendships
      • did volunteer work
      • reprioritized their work and personal time
      • undertook a program of exercise and diet
      • returned to earlier hobbies and interests
      • caught up on their reading and took vacations
      • just did nothing as a way of regrouping”

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