When the family member we are trying to care for is critical, impossible to please or emotionally abusive, long-standing family dynamics are often to blame. I’m not talking about an elder who is suffering from chronic pain or has little control over their moods and behaviors because of Alzheimer’s disease or another type of dementia. In those cases, it is clear that we need the help of professionals to find a solution, like palliative care for symptom relief or a memory care unit that specializes in dementia behaviors. What I'm referring to are children who after a historically toxic relationship, are now in a position where they need to make care decisions for an abusive family member.
Many members of AgingCare’s Caregiver Forum post about caring for abusive elderly parents. Aging—and the problems that come with it—often makes a toxic parent even more intense. A frail parent may no longer be able to lash out physically, but that loss of control sometimes makes their tongue an even stronger weapon.
Yet, it is natural for adult children to love their parents and want to ensure proper care for them as they age. The little kid inside of us most likely still wants our parents’ approval. When we are denied that validation, even as adults, it hurts. If you had a difficult childhood and troubled relationship into adulthood, how do you care for abusive parents without incurring additional psychological harm? How do you provide adequate care despite their ongoing criticism and abuse?
The Importance of Setting Boundaries with Toxic Parents
Many mental health professionals would suggest “detaching with love.” Detaching is a method of setting boundaries to protect yourself by creating emotional distance from the actions of another. According to the Hazelden Betty Ford Foundation, this technique was initially established by Al-Anon, a mutual support group for families and friends of alcoholics.
While detachment with love has traditionally been applied in situations where a loved one is struggling with addiction, it can also be used in other contentious relationships—especially those with individuals who have mental health disorders like borderline personality disorder (BPD) and/or narcissistic personality disorder (NPD). By giving up the notion that you can control a dysfunctional person’s behavior, you stop allowing them to control your emotions and behaviors. It is hard and takes practice, but detaching works for many.
When you acknowledge that you cannot control or satisfy a toxic individual, you stop enabling them. They are then left to deal with the consequences of their decisions and behaviors. Conversely, the person who has been pushing your buttons will start to see that these old triggers no longer elicit the desired reactions: making you anxious, fearful or angry. Detaching with love means that you affirm your love for the person but also make it clear that you will not tolerate being manipulated with fear, obligation or guilt. This strategy is more about self-preservation and choosing not to participate in problems that are not yours than it is about tough love.
Randi Kreger, international expert on the effects of BPD and NPD on friends and family members, and co-author of Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder, stresses the “with love” component of detaching.
This excerpt from one of Kreger’s workbooks illustrates how detaching involves a delicate balance of caring without participating in the emotional dramas a parent creates:
“Detaching with love is not a way of treating someone one else, judging them, controlling their actions, or implying approval or disapproval. If the world were a store and someone came up to you looking for the auto parts section, detaching would be like saying, ‘I’m sorry, but I’m not the salesclerk. I don’t know where the auto parts are; perhaps you can find a salesclerk at the customer service counter.’ It’s not saying, ‘Let me find out for you,’ and it’s not snapping, ‘Do you see me wearing a uniform? No? Then leave me alone!’ ”
Arranging Respite Care While Setting Boundaries
You must be clear and steadfast when setting boundaries with aging parents because they will probably resist these changes at all costs. If your loved one continues to complain and act out just to test your resolve or manipulate you, tell them you will make other arrangements for their care until you both cool off.
Detaching from someone you provide care for is significantly more complicated than other situations. In many cases, a caregiver cannot simply walk away without potentially endangering their parent’s welfare. This step takes some planning, especially if Mom or Dad requires a high level of care. You may need to arrange for adult day care, in-home care services or even a temporary stay at a long-term care facility. Once you have back-up care in place, you can manage care by calling or visiting on an as-needed basis.
The main objective is not to waver. If you tell this person that you are setting boundaries, arranging for outside help and leaving them for a time, then do it. A marked absence and clear commitment to your own well-being may be enough of a reality check for your loved one, but, in some cases, their behavior may be too deeply ingrained. All caregivers need regular respite care to see to their own physical and emotional health. Those with complicated family dynamics are no exception.
Know When to Say “No” to Caregiving
One thing to be aware of is that this damaging cycle causes many abused children to become abusers themselves. Put an end to this problem by setting clear boundaries, calling in reinforcements when you need them, and recognizing when it is time to let others take over as primary caregiver—either temporarily or permanently. You don’t want to be a person who “loses it” after enduring lifelong hardship.
Returning abuse is never the answer. If you recognize these feelings surfacing in yourself, get help immediately. Stop the cycle by arranging for someone else to take over. Work out a solution with another family member or a professional caregiver, or consider placement in a long-term care facility. If your situation is truly intolerable and you are reaching your limits, social services or a geriatric care manager can step in to ensure your loved one’s safety (and your own).
In severe cases, it is best for a non-family member to take over providing care and making decisions. You can visit and assist as much or as little as you see fit without subjecting yourself to additional mistreatment. This is a difficult step, but, in some cases, it’s the only way to protect yourself, get your loved one the care they need and end the cycle of abuse.
Handling Dementia Care and Abusive Behavior
It is important to note that Alzheimer’s disease and other types of dementia can complicate difficult caregiving dynamics even further. Some dementia patients who have a history of being verbally and/or physically abusive may continue these patterns throughout their illness, while previously nurturing individuals may exhibit uncharacteristically violent or manipulative behavior as their cognitive status declines. There is no way of predicting how a loved one will act because these progressive conditions manifest differently in each person and the symptoms change over time.
Since memory loss and impaired logic, judgement and impulse control are hallmarks of many kinds of dementia, detaching with love may not be completely successful in these cases. This approach may help a dementia caregiver create healthy emotional distance with their parent, but it is unlikely that Mom or Dad has the cognitive ability to understand, remember or respect the adult child’s boundaries. Dementia eventually renders individuals incapable of controlling their moods and behavior, making informed choices, and understanding the implications of their words and actions.
If a dementia patient’s behavior is detrimental to a caregiver’s mental or physical health, then arranging for alternative care providers either intermittently or permanently is likely the only option. A professional guardian or public guardian can be appointed to manage an incapacitated senior’s care and finances in cases where a family member cannot or will not step up.
Seek Counseling for Past and Present Abuse
Therapy can help enormously if you find yourself in this situation. Toughing it out or placing your parent in the care of others and then feeling guilty about it won’t help, but exploring the roots of these problems may. A professional can help you work through past trauma and learn to handle current and future issues in a healthy manner. They can also guide you through the detachment process.
Setting and maintaining personal boundaries could help you weather caregiving in a safe and sane manner or enable you to step back and let someone else take over these responsibilities. Caring for elders is hard enough when they are just cranky or demanding because of advanced age, loss of independence and mounting health issues. When they are truly abusive, caregivers should not expect to embark on this journey without extra emotional and practical supports.