***Expert Q&A: Caregiver Burnout

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Q: My ailing mom has come to live with me, and it's taking a toll on my marriage. How can I find a balance?

A: Medical advancements have allowed us to live longer but not always better. Just ask families who are caregivers to ailing parents or partners. Even if the job is an act of love, the responsibility erodes energy, patience and good will.

When I returned home to care for my dying mother, I was shocked at the horrid thoughts that went through my mind. "Can't she just sleep for the rest of the day and skip eating," I said to myself. Mealtime's just so tough to watch." And that was one of the milder thoughts.

And then I stumbled upon something that almost instantly recharged my love and endurance: I gave myself permission to be frustrated and angry and to think unkind thoughts. I would whisper to myself: "It's okay. It's normal to have mixed up feelings of sadness, anger, and resentment." As I carried her tray of Jello and fruit up the stairs, I dreaded the post-clean up of my mother's insistence on feeding herself. I muttered some horrid words and then followed them with my new chaser: "It's okay. It's normal to feel this way. This job isn't easy." Within seconds, tears of love came to my eyes, and I felt more loving.

That year I quit my job, gave up my apartment, and moved hundreds of miles to care for my mother in her home. I have never regretted it. I learned a lot about care-giving, and later I worked with clients who were the chief caregivers for ailing family members. Here are some tips to reduce burn out that have worked well for my clients.

1. Expect a mix of contradictory and unpleasant feelings. Very few partners or parents are perfect. At its easiest, love has to struggle to overcome the other person's quirks. At its most difficult, love has to reckon with past hurts and dashed hope.

2. Give yourself permission to feel angry and to think negative thoughts. Caregiving requires a great deal of patience, acceptance and generosity. You are not a bad person if you say to yourself--or even others--words such as, "Just go, Dad. Just let it go and say good-bye." All of my clients who were primary caregivers voiced these sentiments. Seeing their parent or partner struggle just to sit up or walk to the bathroom tore at my clients' hearts.

3. Have a good cry. Holding back your tears is not a sign of strength. Real strength is the ability to honor a good cry and to know that you can recover from it. In fact, research shows that the composition of tears of sadness contains biochemical toxins. Crying is a way to cleanse your body of harmful substances that can zap your energy and sour your mood. Most of my clients were surprised that even a minute of tears was potent enough to recharge their batteries.

4. Have a good yell. Go ahead--get out in the field, the beach, mountains or in your car and have a private yell-fest. One of my clients was so angry that she grabbed the huge phone book and tried to rip out a chunk of pages. When nothing happened, she fell back onto her bed and laughed. "I guess I was less angry than I thought. It was so hard to rip up those pages, and the effort that it took calmed me. I wasn't afraid of my feelings anymore."

5. Have a good talk. Some of the caregivers were able to talk to their ailing family member about the illness and the difficulty of caregiving. Others made sure to carve time out to speak with their religious leaders or good friends. Talking out your thoughts and feelings has long been known for its curative affects.

An added bonus is that the experience keeps you connected to your social support network. Research repeatedly shows that supportive friends and family are necessary for reducing feelings of depression, loneliness, fear and anger. Recruit them as your extra set of eyes and ears so they can observe when you are in need of help, too. Tell them ahead of time that you need them to check in on you and tell you when they see you in trouble emotionally.

6. Have a good write. Keep a journal. Don't censor yourself. Writing, like talking, is also curative. You can review your words, chart your changes and learn about yourself.

7. Maintain a personal life. Do not let everything drop. The clients who functioned best maintained a schedule-although an altered one. They became inventive and flexible about meals, laundry, housework and driving to every child's event. They learned the importance of giving up on perfectionism. "So what if the sheets are folded just so," one client said. "I never realized how stupid that was." They talked to family members about the changes in family life. They expected their children to help in the care of Grandma, for example.

All my clients gained a perspective on life. They made sure to dedicate time to relaxing, being with friends and other family members and carving out even forty-five minutes a day to their own interests. "It took me ages to finish a book, but I rarely skipped a day," one of my clients said. "It saved my sanity."

Finally, make sure you reserve time with your healthy family members and healthy partner. Don't let your marriage take a back seat so far away that your partner just may as well sit in the neighbor's car! Don't go a day without hugging, kissing or touching. During your tea break, call or text your partner and leave loving-even sexy-messages.

8. Keep up your health. Eat wisely, work out and go to the doctor when you are ill. If you find yourself bingeing or eating too little, go get help immediately. Call someone from your social support network and ask for assistance. If you can afford it, pay for extra care. If there is a Hospice in your area, call them, too. They might have free or inexpensive services. Also, contact the major organizations such as The American Cancer Society or your local social service agencies such as departments of elder care.

9. Face your own fears of death and dying. Watching someone else's body and mind fail naturally forces you to ponder your own fate. Don't push down these fears. Use them to push you to clarify your goals and give you a sense of purpose in life.

10. Square up with your ailing partner or relative. Think about what you would like to say or ask the person. If possible, ask the person to talk to you about your relationship. What would they like to change or apologize for? Don't expect miracles. Movies are filled with heartfelt, last minute reunions of the soul. Yet, you still might have a few things to clear up. Find ways to talk about hot topics that are not explosive. For example, instead of leading with accusations and anger, tell the person right away that you forgive him or her but that you still need to talk about a few things. The granting of forgiveness has a huge impact on reducing defensiveness.

However, there are parents and partners who just can't come around. One of my clients discovered the depth of her sister's emotional impairment when she tried to air her hurt feelings to her. "My sister just didn't get it, just couldn't say the words 'I'm sorry.' It hurt me to see how limited she was. It made me realize how awful our home life really was. But, still, I was glad I took care of her."

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