Caring for Difficult Adults

Caring for Difficult or Toxic Adults

Difficult care recipients can be excessively demanding, angry, manipulative, or critical. Caregivers may respond with anger, guilt, or exhaustion. Depression, anxiety, anger, and pain can drain caregivers who must interact regularly with toxic individuals (i.e., those who are abusive, belligerent, or combative).

In some cases, toxic individuals are so difficult to deal with that a CSA would typically talk instead with their representatives. For example, an elder law attorney may want to work not with a toxic senor, but with an adult child of the senior, to discuss important matters such as power of attorney or conservatorship. The following counsel offers advice for caregivers and professionals who work with toxic older adults (Dykes, 2000):

  • Respect that toxic seniors must initiate their own healing process. They cannot be “fixed.”
  • When encountering a toxic senior, first acknowledge to yourself your own hurt or disgust. Then put it aside and get on with the work you must do with that person.
  • Center yourself. Clear out your own feelings.
  • Accept toxic seniors where they are. When you recognize the behavior for what it is, you can better understand the person you are dealing with and tailor your response.
  • Questions are less helpful than listening and observation.
  • Never lie to toxic care recipients. Mean what you say.
  • Be gentle but strong. Set firm limits; stick to them.

Setting and Maintaining Boundaries

In her book Working with Toxic Older Adults: A Guide to Coping with Difficult Adults (1999), Gloria M. Davenport writes:

Surrounding toxic adults with steadfast boundaries and love means to be there, to be a presence but detached and free from seductive toxic hooks and games. It means setting personal limits and boundaries. It means loving yourself enough to quell your own fears and defenses, enabling and empowering your to sustain objective support.

Boundaries are “psychological fences” because they define emotional limits. They delineate what is “in bounds” and what is “out of bounds.” In healthy relationships, boundaries act as operational parameters that outline how the caregiver/care recipient relationship works. Boundaries perform critical functions, including:

  • Helping caregivers define what they will and will not accept in their behavior and the behavior of their care recipient
  • Assisting caregivers in defining and respecting their “no’s”
  • Reminding caregivers of their responsibility to behave consciously
  • Helping caregivers get priority needs met – in order to set boundaries, it is vital for caregivers to rank their priority needs
  • Outlining the framework for how they will connect and share their energy with the care recipient
  • Telling others who they are

Expressing Love through Setting Limits

It is vital that caregivers keep themselves in the equation of their own lives. Because caregiving is a difficult endeavor and often requires extraordinary commitment, energy, and time, caregivers can ignore their own needs. Over time, as they become absorbed in the care of their recipient, they can cease to demonstrate concern for their own well-being. In their loving devotion to the recipient, they can become increasingly unloving to themselves.

One important way that caregivers can express concern for their own needs is to establish and maintain loving limits. Loving limits requires establishing flexible and changeable boundaries. Loving limits requires that people honestly give care. Loving limits requires that caregivers actually act authentically by speaking their truth without blame or judgment.

Caregivers who discount their own needs eventually burnout. Anger and frustration often accompany this phase. Burnout can develop when (a) boundaries have been ill-defined or nonexistent, and (b) open, honest, and direct communication with the care recipient has not occurred.

Setting loving limits requires that caregivers understand the difference between needs and wants. Needs are the essential requirements for life. Wants are the “it would be nice if” sorts of experiences. Conscious caregivers strive to meet each of the fundamental needs. Most caregivers find it impossible to meet every care recipient’s wants without ignoring their own needs

Boundaries define emotion and behavioral limits. They act as operational parameters that define how caregiver-care recipient’s relationships work. Boundaries are personal prescriptions that delineate what an individual will and will not accept in their own and others’ behavior. Ill-defined or nonexistent boundaries setup the caregiver for unnecessary problems and powerful negative emotional responses.

If boundaries are unclear or nonexistent, it is possible to change the situation and establish clear and reasonable boundaries.

  • Explore the reality of what is. Are you comfortable with the boundaries you have established? If so, congratulations. If not, read on.
  • Determine if boundaries are weak, inconsistent, or nonexistent. Decide where boundaries (if nonexistent) need to be established or (if weak) strengthened. If inconsistent, ask yourself, “Why am I vacillating?”
  • Ascertain the care recipient’s authentic needs. Are you meeting his or her needs? How many wants are you meeting? Are you meeting your own needs?
  • How are you feeling? Are you often angry or frustrated? Do you feel burned out? If so, something in the caregiving routine must change. Caregivers cannot continue indefinitely when they are feeling strong negative emotions. Ask yourself where the emotions are coming from. Look at the situations that elicit strong emotions. These are probably areas where you will choose to establish stronger, more consistent boundaries. Remember, boundaries are often felt out rather than figured out. Listen to your feelings!
  • Determine a plan of action for setting boundaries and maintaining them. Have a face-to-face, heart-to-heart conversation with the care recipient to discuss what is and is not working and why things need to change. There are three important aspects of this communication: First, define what is happening; second, describe how you are feeling; and third, define what you need to change to feel better. Explain how the two of you need to openly address issues and problem-solve situations together. Describe your relationship as a partnership.
  • Take a personal time out on a regular basis (at least once a day). Scan your body, your mind, and your emotions. Answer this question: “How am I doing today?” follow it with “What do I need to do differently to improve my well-being?”
  • Give yourself permission to change your routine. If your guilt buttons are consistently getting pushed, and you cannot give yourself this vital permission, seek professional counsel. Caregivers who love their care recipients and also love themselves will be healthier and more at peace as they strive to honor their caregiving roles.

    The information above is reprinted from Working with Seniors: Health, Financial and Social Issues with permission from Society of Certified Senior Advisors® . Copyright © 2009. All rights reserved.