With all due respect to Thomas Wolfe, we do go home again. Somewhere in the middle of our lives, when we imagine we have finally achieved the proper balance of closeness and autonomy vis-a-vis our parents, or have accepted that we never will, many of us find ourselves at our parents' doorsteps again as they age and begin to need our help. Before we actually face this juncture, we think we know what it will be about: the term "sandwich generation," after all, has become our culture's shorthand for the frantic efforts of midlife children to juggle parent care with the rest of their already overbooked lives. We expect this era to be about time crunches and Medicare-speak and scrutinizing long-term care brochures; we think to ourselves, Okay, this is not going to be fun, but it's doable; we can get through this.
Then Mom breaks her hip, or Dad develops glaucoma, and it all becomes so much more complicated than anybody ever bargained for. Suddenly it becomes clear that Mom can't live safely in her own home anymore and you realize, with a sinking heart, that no way can you invite this woman to live in your house; you imagine that Dad's fading eyesight is a manageable problem until you realize that you are the one who has to face him down and wrest his driver's license from him, rendering this once seemingly-indestructible father smaller and more helpless than either one of you can bear.
We find out, in short, that this whole caregiving business is not just about mapping out a geriatric game plan; it is also about reengaging with the most profound and influential attachment of our lives. And while it is wrenching enough to face a parent's decline when one's filial bond has been strong and satisfying, the demands can feel truly unbearable when it has not.
Undeniably, this is prime family therapy territory, replete with many of its grand themes a major transition in the family life course, the struggle to resolve old family-of-origin business, the lurking specter of intergenerational transmission. Yet, astonishingly, the field of family therapy has largely absented itself from the struggles of older families. Nearly every major treatment model was originally developed primarily around the concerns of married couples or of younger parents and their children; even recent considerations of the "aging crucible" of the family life cycle have not spurred many clinicians to focus on this passage in their practices.
As the demographic revolution roars inexorably toward us—within just 30 years, one in five U.S. citizens will be elderly—nearly all therapists will soon be working with substantial numbers of aging families, whether or not they ever consciously choose to. The question at hand, then, is how can this juncture in the family life cycle be transformed from an emphasis on adjusting to loss and disappointments to a focus on growth and possibility?
Part of the answer may be found in the work of a family therapist who operates with the conviction that the very inescapability of impending mortality offers aging families a powerful spur to move beyond lifelong, misery-inducing patterns. Flipping the old decline-and-grieve model on its head, they work with quiet persistence at this intersection of last chances and the mutual yearning for connection that often lies beneath the surface of this final parent-child encounter—a yearning that is frequently muffled but is rarely, if ever, utterly snuffed out.
To an observer, it looked as though family therapist Terry Hargrave had plucked his new clients from a classic fairy tale: the sort that pits the archetypal Good Daughter against her Bad Mother. Trouble had begun a few months earlier for 52-year-old Peggy and her 77-year-old mother, Grace, when Peggy arranged for her widowed, increasingly frail mother to move from her apartment to an assisted-living complex closer to Peggy's home. While Peggy admitted to Hargrave that she had never enjoyed a close bond with her mom, she hoped that once she had the opportunity to nurture her mother, Grace would appreciate her efforts and the two could develop a warmer connection. But Peggy's mother had other ideas.
From the moment she moved into her new efficiency apartment, Grace aggressively rejected her daughter's every effort to demonstrate her caring. When Peggy would come to the facility's common dining room to eat lunch with her mother, Grace would talk animatedly with other residents, behaving as though her daughter were invisible. Whenever she phoned her mother for a chat, Grace would answer in bored monosyllables. One afternoon, Peggy dropped by Grace's apartment with a surprise gift of flowers; her mother scornfully tossed them into the trash in her daughter's presence. As Peggy recounted these painful rebuffs to Hargrave, he struggled to make initial sense of the situation. This daughter seemed the very model of filial rectitude; why was Grace responding like Cinderella's stepmother on a bad day?
Another family therapist might immediately hustle this miserable pair into a joint session; Hargrave, however, chose to initially work with Grace alone. If you witnessed one of these encounters, moreover, you might well wonder whether therapy was taking place at all. Grace, an elegantly dressed woman with the posture of a monarch, cast a skeptical eye on Hargrave as he conversationally inquired about her life, much as though he were chatting her up at a dinner party. As she rather grudgingly began to dispense bits of her past, Hargrave showed genuine interest, nodding and evincing quiet admiration for how she had handled various life situations. One is tempted to respond: So cut to the chase! Do something here!
But he is, this Amarillo, Texas, clinician will tell you. Hargrave's 14 years of working with aging families has convinced him that if a therapist misses this critical step of joining with an older family member, "nothing else will ever happen." Typically, in Hargrave's experience, elderly people are initially somewhat suspicious—even hostile—toward the whole notion of psychotherapy, both because they grew up in an era that believed therapy was for people who were mad as hatters and because they are more accustomed to keeping private matters private than are their offspring. "But," says Hargrave, "if a therapist instead begins with an attitude of genuine interest in whatever slices of life an older person is willing to share, you give yourself the only chance you'll get to establish a therapeutic alliance." Once a clinician takes the time to listen to the journey of struggle and accomplishment that infuses every elder's life story, Hargrave explains, "you will never patronize that person again."
And indeed, Hargrave became conscious of a growing sense of respect for Grace as she began to tell him of her childhood in a large, working-class family in Philadelphia, the loss of her two baby sisters during the Spanish influenza epidemic, her late teen years as a struggling vaudeville dancer, then her difficult young motherhood as the wife of an itinerant orchestra leader during World War II. He also gleaned an early clue to a major family issue when Grace told him emphatically that within one's family, "there is nothing worse than a pain in the can"—that is, a burden to others. How intriguing, Hargrave thought. Here this woman was behaving like a five-star pain in the can toward her daughter, yet she feared it more than anything. "Have you ever been a pain in the can to your children?" he asked. Grace hesitated, losing her legal, stiff-backed composure for the first time. "I don't know," she answered softly.
By now, Grace was willing to trust Hargrave with the emotional underside of her life story. She told him how, as the oldest child, it had been her job to keep peace in her family, an impossible task in a household dominated by constant marital battles, as well as her mother's penchant for taking out her fury on her children's bodies, including Grace's. When Grace, at age 16, announced that she was leaving home to join a traveling vaudeville troupe, her mother begged to accompany her. Horrified, Grace refused and fled alone. But no sooner had Grace begun her new life, her parents split up, and the guilt-ridden Grace abandoned her itinerant dance career to move back home with her mother. In Grace's experience, whenever she tried to be free and have a life, her mother somehow pulled her back into her orbit, insisting that Grace be responsible for her happiness. With tears in her voice, she told Hargrave: "These are hurts that I just can't shake."
Hargrave looked at the open, sorrowful face of the woman sitting across from him, who only a few sessions earlier had seemed so queenly and coldly controlled, and felt an almost visceral shift of sympathy. Now, he got it: For Grace, family ties—especially a mother-daughter bond—carried a heavy load of daughterly responsibility and torment. To some degree, Grace was no doubt pushing her daughter away out of her own terror of closeness. But perhaps Grace was somehow also identifying with her daughter. If Grace allowed Peggy to take any measure of responsibility for her, was Grace terrified that she would become her own mother—the ultimate "pain in the can" who would tie her daughter down and ruin her life? Was it possible that Grace was trying, in a backhanded, brutally twisted way, to be a good mother? The moment had arrived, Hargrave knew, for this hurting mother and her equally distressed daughter to begin talking to each other.
Shortly after their final session, Grace invited Peggy's family to her apartment for dinner a gesture she had never made before in her life. Afterward, Peggy reported to Hargrave that the evening embodied "the whole reason I wanted her here, close to me." After a simple meal of baked ham and potato salad, the entire family Peggy, Grace, her son-in-law and her two grandchildren sat together leafing through old photo albums, while Grace regaled the grandchildren with some of her adventures as a vaudeville dancer, traveling the United States and Canada during the Great Depression. "This is how intergenerational legacies get transformed," says Hargrave. "Grace's grandchildren now have the chance to experience a different way of being a family people giving to each other, enjoying each other's company, connecting. With luck, those young people won't have to put distance between themselves and their own children."
Hargrave is convinced that the recognition of an older person's continuing capacity to give to their families is absolutely critical to successful work with older families. "In our culture, we assume that the older person has nothing to offer because we equate 'doing' with active, instrumental activities," he says. "Look at the old people our society holds up as heroes—the 90-year-old jazz pianist, the 80-year-old marathoner—people who, in most cases, are engaged in midlife or even young-adult activities. That's not aging for most people; it's our fantasy of never aging. It makes it massively difficult for older people to feel of worth."
What we need, believes Hargrave, is a new vision of meaning and value in a person's elder years. "Show me the older parent with a broken hip and vision problems who can still be an emotional resource to his or her family," he says. "Someone who gives of their wisdom, their love, their time with their children and their children's children. That's a model of real, successful aging." It is also, Hargrave is convinced, the linchpin of late-life connections that can sustain both parent and child.
At this moment in the family life cycle, perhaps the most vital work therapists can do is to help families begin to separate the necessary losses of this crossroads from the culturally inflicted ones. Rather than reinforce society's equation of the particular dependencies of aging with wholesale elder impotence, clinicians can help families move tentatively toward a new mutuality, one that encompasses not merely an adult child's caregiving but also an elderly parent's continuing capacity to parent in whatever ways he or she is still able. Not all parents and children can manage such late-life reciprocity, of course; for some, it is much too late to learn to trust; for others, the nature of a parent's illness may preclude truly mutual giving.
But for countless others who are struggling to do the right thing in the wake of a parent's frailty and wonder why everybody feels so rotten, the effort to help both children and their parents do something both simple and daunting—nurture each other—may shift the experience from a long night in hell to an endurable sorrow. It won't make Mom or Dad immortal; the medical bills will still arrive in the mail. But in this last chance before there are no more chances, both parent and child may experience an unlatching of the heart that neither would have suspected, this late in the game, was still possible.
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Tags: Alzheimer | Alzheimer's | Alzheimer's Disease | caregiver | caregivers | caregiving | death | elderly | getting old | love | love and relationships | Marian Sandmaier | old age | parent help | Parenting