Five Foundation Skills for the Resilient Caregiver by Janet M. Cromer, RN, MA, LMHC

Life Changes are a constant learning process after brain injury.

Caregiving is a partnership.

A caregiver is a partner.

That’s true for both the survivor and caregiver or care partner. Whether you are a new caregiver or a seasoned pro, there are five foundation skills that can enhance your health and resilience: 1)  Embrace self-compassion. 2) Counterbalance the stress response. 3)  Live mindfully. 4)  Construct sustaining connections. 5)  Express your creativity. Studies have shown that cultivating these skills, and others, can help reduce the risk of burnout and compassion fatigue. Self-compassion is the gateway skill because it empowers us to prioritize self-care. Carlos cares for his wife who has a brain tumor. He showers Maria with compassion and kindness while encouraging her to talk and feed herself. He criticizes himself harshly for not being able to take away her sorrow or pain. He imagines a caregiving judge holding up a low score card, like the mean judges on the TV dancing shows he watches. So, how can a caregiver shift from neglect to self-compassion? Dr. Kristen Neff, in her book Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind, describes self-compassion as having three components:

  • Kindness
  • Recognition of our common humanity
  • Mindfulness

Kindness means that we actively soothe and empathize with ourselves, much as we would with a friend who is going through a rough time. One of the most healing changes to make is to replace your inner critic with an inner mentor to guide you on your journey. You can visualize an inner mentor by remembering a trusted friend, colleague, or family member in whom you could confide. Imagine that person’s presence and voice as he or she listens and responds to you with compassion and wisdom. Carlos visualized his Uncle Alfred smiling warmly as he said, “Ah, Carlos. You show Maria so much love. You’re a top-scoring husband! Relax and enjoy your time together.” Self-compassion heightens self-respect. One way this might manifest is in setting healthy boundaries. Have a conversation with the person you care for about how you plan to show each other respect through your communication and behavior. Another core component of self-compassion is our shared humanity. This means that you take pride in all that you contribute to the person you care for and others. You take responsibility for what you can, but also forgive your mistakes. It’s a relief to realize that we are only human, with the talents and limitations that implies!

Reverse the stress response

Caregiving is stressful

Be a mindful caregiver

The second foundation skill is to counterbalance the stress response. The stress response evolved as a brilliant survival mechanism meant to give you the power to fight off a threat or run for your life. This response starts automatically, whether the perceived threat is physical or emotional, real or imagined. The chemical and hormonal activation that the body and mind undergo is meant to subside within a few hours after the danger ends. Contrast a few hours with the weeks or months of unremitting stress that some caregivers experience. That may be one reason caregivers have higher rates of chronic illness than non-caregivers. First, learn to identify your personal stress triggers and signals. What sets you off? How do your body and mind react? Margaret said, “When I have to argue with my husband to take his blood pressure pills, my whole back knots up and I want to scream at him.” Her husband always likes dessert, so Margaret decided to quietly offer him the pills before serving the cake. Awareness empowers you to intervene early. Think of ways to prevent or minimize how often your trigger happens. Learning ways to elicit a more relaxed state of being pays off in health dividends. Proven techniques include meditation, mindfulness, yoga, tai chi, time in nature, and repetitive exercise such as swimming laps. Margaret joined a yoga class to relax her back and ease her mind. The hypervigilance that results from caring for another person round the clock is particularly dangerous. Margaret hired an aide to help out two nights a week so she could rest. Schedule daily respite breaks, and do whatever it takes to get away regularly.

Take the mystery out of mindfulness

Meditation  reduces caregiver stress.

The third foundation skill is to live mindfully. Does this mean that you have to withdraw from the world and meditate for hours a day? Not at all! Mindfulness means being in the present moment as fully as possible without judging or exaggerating your feelings or experiences. It means being aware of both the good and the difficult, and being open to new approaches. There are many forms of mindfulness meditation. You can find classes, books, and CDs to guide your practice. Sitting quietly and focusing on the flow of your breath is an effective way to start. Early in the morning, set a positive intention for your day. Build in “peak moments” of small sensory or emotional pleasures and give them your full attention. Carlos bit into a ripe peach and savored the fragrance and juice. Throughout the day, do a body scan to release tension and attend to a hidden emotion. At the end of the day, list three things that you did well.

Construct connections

holding handsThe fourth foundation skill is to build sustaining connections. Avoid the isolation that can trap caregivers and contribute to stress and compassion fatigue. Think about what you need from friends and helpers at this juncture, and what you can contribute to a relationship. Be honest. Then train people in how to help you. Do you want someone to listen while you vent, or help you problem solve? Margaret asked a young neighbor to look up information on the Internet for her. Cultivate relationships with people who share your experiences, as well as those with a different perspective who can help you grow. Call on a professional counselor to heal trauma, explore intense emotions, or learn adjustment skills. One of the advantages of trusting supporters is that we are less likely to keep dangerous secrets. Brain injury caregivers can witness, or be the target of verbal outbursts, substance abuse, or physical aggression. Sometimes we hide these problems out of fear or shame, but the first priority must be to keep everyone in the family safe. A volatile person or situation is a signal that an emergency assessment and plan of action are needed. When Carlos confided that Maria scratched his face, his doctor arranged a medical check-up for Maria as the first step.

Express yourself

Expressing your creativity in as many ways as possible is the fifth foundation skill. You might write a journal or blog, draw or paint, or tell your story to raise awareness. Creativity invites you to claim ownership of your narrative, integrate emotions, and gain a new perspective. Getting absorbed in a hobby or fun activity is a proven stress buster! Carlos noticed that when he strummed his guitar and sang, he felt at peace instead of worrying. Whether you paint a landscape, cook up a pot of chili, or build a bookcase, you’re in control of the process and the outcome. You have something to show for your time, and you get better at that skill. For these reasons, creative pursuits have the potential to counterbalance some of the uncertainty and lack of control caregivers feel in helping a person live fully after a brain injury.

About the Author

Janet Cromer, RN, MA, LMHC is a psychiatric RN and the author of Professor Cromer Learns to Read: A Couple’s New Life after Brain Injury. Janet speaks nationally on family and professional caregiver issues including stress resilience, traumatic stress, compassion renewal, seasons of caregiving, and creativity and healing. See more at  

Special Collection on Brain Injury Journey

Special Collection on Brain Injury Journey

Source: This article is posted with permission from Brain Injury Journey – Hope, Help, Healing, Vol 1, 2014.

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