Setting Limits to Caregiving

When people confront an ocean of need, they feel anxiety. Some run for their lives; others jump in and drown. Both reactions are rooted in the inability to stay separate and set limits in a healthy way that balances generosity with self-preservation.

After my mother had a series of small strokes and was increasingly unable to take care of herself, I felt overwhelmed by her neediness. She was going to a dozen different doctors who were not communicating with each other; she was losing weight and constantly complaining of nausea; she had stains on her clothes; she couldn’t remember her keys or that she had just found them; she couldn’t remember if she had sent her rent check or not; she couldn’t remember if she had taken her medication or not; and she couldn’t remember my husband’s name or my birthday. She called me all the time—to ask me the same questions over and over. My sister said it was my mother’s anxiety; she often felt angry toward her. My sister is the oldest child and her anxiety about drowning in my mother’s neediness made her feel so overwhelmed that she needed to withdraw from my mother. She could hardly bear to visit her. In addition, my brother rarely visited and never indicated when he was going to. I felt guilty and frightened.

 What could I do? I felt that my only alternatives were doing nothing at all or letting her take me over (i.e., live in my house; change my relationship with my husband and my children; interfere with my work, my friends, and my routines). I had to face a new phase in my own development. For a long time I dealt with my mother by trying to keep my distance. During high school and college I imagined whom I would go to for help if I got pregnant—my mother was definitely out. When I was in college I had mononucleosis and I was in the university hospital. I did not tell my mother. As a young married woman, I never talked to her about anything personal that mattered to me. It was easier to report on facts of my children’s lives (i.e., Jason has a cold or Matthew got an A on his English paper) or day-to-day activities and events in my life (i.e., I spoke to my cousin or I went to the dentist). My withdrawal from my mother was a result of my insecure attachment to her—and that remained inside of me, sometimes consciously and sometimes unconsciously.

The early insecure attachment creates a wish to be comforted and a wish to run away from danger. The problem is that the person from whom you want comfort and the person who is dangerous is the same person—that creates an often life-long conflict. The mother you yearn for is the mother you withdraw from; the mother you are afraid of is the mother you cling to. Children with school phobias offer a good example of this paradox—the inability to leave home is often a response to a perceived threat from the parents. Thus withdrawal and clinging are two different anxiety responses resulting from an insecure early attachment to the mother.

Ever since I returned to New York from college in California at age twenty-one, I took a minimalist approach to seeing my mother. I saw her and spoke to her as little as possible. My sister enjoyed shopping with her, but I never did. I never felt good about myself in my mother’s presence because I was always struggling with yearning for her to be what she could never be and being angry with her for being unable to be that. I guess what I wanted her to be was a mother with whom I could feel like a good daughter. But that was not possible.

About two years ago I realized that my mother could not take care of herself. She forgot to make entries in her checkbook, although she had been a crackerjack bookkeeper when I was a girl. She could add a long list of numbers in her head and never lose track of the total. Now she couldn’t figure out where to enter the amount of the check. Her clothes were dirty and she was steadily losing weight. I had been denying it. But I couldn’t deny it any longer. I had to find some way of helping my mother cope with living while maintaining my own life—bringing a cup to relieve some of her feeling of helplessness, but not drowning in her neediness.

Setting limits is difficult for most people—it’s a common problem in many areas of our life, not just caregiving. It’s hard to say “no” or “enough” without feeling guilty. It’s difficult to tell a friend she can’t borrow money or tell your son he can’t have another toy he can’t live without. I had a terrible time toilet training my older son. One of my friends used to console me by saying: “Don’t worry, by the time he gets married he’ll be toilet trained.” The more you project your own neediness on to someone else and then identify with the person to whom you are saying “no,” the harder it is to do it without feeling bad about yourself. I would start off feeling like a separate adult and saying: “Okay, now you’re going to use the toilet.” As soon as Matthew started yelling that he didn’t want to use the toilet, I would start identifying with him. How can I force him to do what he doesn’t want to do? I’ll be acting like my mother. I’ll wait until he wants to use the potty. Except he never got to that point. He was three years old and they wouldn’t let him into nursery school in diapers so I went to a child psychologist for help. She said: “Your son does not have a problem. You do; you are not like your mother. You can tell him he is going to wear underpants and throw out his diapers and he will be fine.” I followed her advice and he never had an accident again. She made it clear to me that the problem was all mine. I was so afraid of being like my mother that I couldn’t set limits and stick to them. I couldn’t distinguish between being sadistic and helping my son master a developmental task that would make him feel better about himself.

If we feel needy and deprived because we have an insecure internal attachment to our early mother then it is hard to say “no” or “enough” to somebody else. People who have difficulty saying “no” often get angry at people who ask them for anything. After all, asking them for something sets off their conflict. Thus, setting limits with needy elderly parents can be extremely difficult if we are needy ourselves—which we usually are if we had needy parents. We vacillate back and forth between identifying with their neediness and feeling we have to save them; and feeling angry at them for needing so much from us and wanting to run away so that we do not drown. Adults with a secure attachment do not feel “needy”—or are able to work their way out of that feeling fairly quickly. They have needs, of course, but they are not “needy.” The feeling of being needy is a feeling of desperation for someone else to save you and to provide sustenance. In addition, it easily gets projected on to other people so it’s had to stay clearly separate. Caregivers who have an internal sense of secure attachment have secure boundaries and have less difficulty saying “no” or “enough” in a way that does not necessitate hitting the other person over the head with it or running away from a person who is needy. They can say: “I wish I was able to do that for you, but unfortunately I’m not.” But that does not come naturally for many of us. We have to remind ourselves that when we confront an ocean of need, all we need to do is bring a cup.
 

Roberta Satow is Chairperson of the Department of Sociology at Brooklyn College and a practicing psychotherapist in New York City. She has written numerous articles on sociological and psychoanalytic subjects that have appeared in numerous journals and magazines such as Partisan Review and Psychology Today. This article is an excerpt from her new book: Doing the Right Thing: Taking Care of Your Elderly Parents Even if They Didn’t Take Care of You (Jeremy Tarcher Publishers,2005).  
 

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