New Thinking for Effective Caregiving A Conversation Between an Occupational Therapist and a Caregiver’s Coach (Part 2)

July 28, 2010 at 6:32 am Leave a comment

Learned Helplessness – (continued from Family Wellness Part 1…)

This topic of family dynamics is so rich, Debra. Are there other ways in which you encounter and work with family dynamics?

Sure. For instance, when there’s a disability issue, there almost always needs to be a shift in family dynamics, because our goal is client empowerment.  The client’s roles and responsibilities may have been changed due to the illness, injury or disability, while other family members may have to take on new roles and responsibilities. These changes are both sources of possible stress on the family dynamics. These stresses require a shift in family dynamics or the family runs the risk of promoting helplessness in their loved one.

As the OT, I do a lot of family training around the client’s ability, showing family how independent the client is, or can be.  I find many times family members aren’t nearly as patient as I am with my client. They may have to watch their loved one struggle taking off a shirt or tying a shoe. Ideally, to truly help the person without taking over, getting dressed may take two hours. But that might not work for the family. We want the client to be as independent as possible, so we have to get it across to the family member that sitting on your hands can be helping. It’s important to give the client the time that they need.

It can be a critical choice; either the family member does a task faster, OR they support their loved one in working toward independence. Doing everything for the disabled loved one promotes what we call “learned helplessness.” It doesn’t help the client to be as independent as possible. We need to meet everyone’s needs, or at least find a compromise that works.

This pattern of learned helplessness can be compounded by a family’s culture.  Especially in transgenerational households, people are more family oriented, helpful (at times to a fault,) and they may have specific habits, roles and responsibilities to which they are accustomed. Out of love, the family may want to do everything.  It may just be an inherent part of their culture.  As OTs we have to be respectful of the culture, yet still be an advocate for the wellness of the client. We draw a balance and try to teach them new ways of being loving.

That’s beautiful Debra, and such a challenge. This comes up regularly with caregivers. I find it helpful to teach them about the distinction between helping, fixing, and true service. Rachel Naomi Remen (Clinical Professor of Family and Community Medicine at the UCSF School of Medicine) spells out the difference between fixing, helping, and serving in her book, “My Grandfather’s Blessings.” To sum it up briefly here, chronic helping supports the helplessness or neediness of the other, and fixing presupposes that the other is broken. Though helping, fixing and serving can look alike to the observer, the inner experiences differ. Over time, fixing and helping are draining, while service is renewing. When we serve, our work sustains us.

Robert K. Greenleaf, gives us the litmus test to know whether we are truly serving our loved ones. “Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous?”

So really, Debra, we’re talking about helping caregivers to reinterpret their role, changing it to a partnership with their loved one in a way that empowers them, helping them to grow and to be as independent at possible. This idea of reinterpretation comes up often during caregiver coaching sessions. What other kinds of reinterpretation crop up in your work with clients? (to be continued…)

—Holly Whiteside, caregiver’s coach & advocate, is author of “The Caregiver’s Compass: How to Navigate with Balance and Effectiveness Using Mindful Caregiving.” She invented Mindful Caregiving tools during her caregiving decade by applying to herself the life coaching principles that she had been teaching others. Find her book at, or learn more at Holly can be reached at


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New Thinking for Effective Caregiving: A Conversation Between an Occupational Therapist and a Caregiver’s Coach (Part 1) New Thinking for Effective Caregiving: A Conversation Between an Occupational Therapist and a Caregiver Coach (Part 3)

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