Coping With Post-Traumatic Caregiving

“There are only four kinds of people in the world: Those who have been caregivers. Those who are currently caregivers. Those who will be caregivers, and those who will need a caregiver.” — Rosalyn Carter

According to a 2023 AARP study, over 38 million Americans are caregivers. While we know a lot about the experiences of this group—the financial, mental, and emotional impact—what is not always clear is how they entered into their caregiver roles. Studies on stress, burnout, and compassion fatigue have identified the challenges faced by caregivers and often provide survival tips. What has not garnered the same amount of attention is the fact that many people enter this realm shell-shocked—stunned into emotional turmoil by witnessing a critical moment in the life of a loved one.

Psychotherapists, trained in assessing and providing support for trauma victims, know very well both the short- and long-term impacts of being exposed to situations that overwhelm one’s natural ability to cope. Even those who do not inhabit the world of psychological diagnoses know well that PTSD refers to post-traumatic stress disorder and that it cane be serious and pervasive in a world where traumatic events happen with alarming regularity.

Many caregivers do not have the luxury of moving into their roles along a gradual learning curve. To the contrary, they may be thrust into this role with no notice. Whether it is a loved one's sudden heart attack, stroke, or diagnosis of a cognitive disorder, many caregivers begin their journey in the wake of a traumatic event that leaves them reeling and experiencing symptoms of PTSD including:

• Unwanted upsetting memories
• Nightmares
• Flashbacks
• Emotional distress after exposure to traumatic reminders
• Physical reactivity after exposure to traumatic reminders

The unofficial diagnosis for these folks is best described as "post-traumatic caregiving," or PTCG for short. PTCG can be thought of as a precursor to PTSD with the added dimension that the triggering event has happened to a loved one and often involves a cascade of critical moments. Additionally, the random nature of the next crisis—known as “what now?” moments—and the challenge of having to juggle multiple demands sets PTCG apart from other syndromes.

The fact that most caregivers do not go on to develop PTSD is a result of multiple factors, not the least of which being the resiliency many find during crucial moments in life. That almost all will experience PTCG is the result of the natural stress response when faced with high-impact situations that rattle all areas of one's life. While psychotherapy, supported by cutting-edge techniques and possibly medications, is the standard treatment for PTSD, those experiencing PTCG are known to offer a "Where will I find time for that?” response when told to practice self-care.

While professional treatment would be beneficial, in the absence of profound dysfunction, more practical are techniques that one can practice while going about the busy-ness of caregiving. These include:

Don’t wait for someone to offer help; tell people what you need. Too many caregivers take the offer, “Call if you need anything,” as an invitation to a party they’d rather not attend, but critical moments require stepping out of one’s comfort zone—throwing up one’s hands and saying, “I’m not waving at you, I’m drowning over here!”

Put down the Caregiver’s Handbook and pick up the latest novel. Reading about all of the challenges ahead can easily re-traumatize someone and move them from anxious moments to full-blown panic attacks. Safety is the first rule of trauma recovery and allowing the mind to move into imaginary worlds helps protect it from overload.

Get “techy” with it. Old school caregivers had to rely on professionals who were often over-worked and under-paid. Today, countless websites and apps can bring experts into the home at the speed of the internet.

Create a sacred space wherever you can. Caregivers seldom have time to head off to spiritual retreats or travel to the mountains for peace of mind. Use down moments while at the doctor’s office with your loved one, time spent driving to appointments, or meal-preparation time as meditative moments by simply bringing your full attention to what you are doing. Feel free to support these moments with silent mantras, prayers, or simply recaollections of personal moments of joy.

Open yourself to the kindness of strangers. Caregivers often find that family members are either nowhere to be found or, sometimes worse, overly critical of their efforts. Many helpful encounters come out of nowhere and from people unknown. One need not be spiritual to heed the advice to “be not forgetful to entertain strangers: for thereby some have entertained angels unawares.”

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Once the caregiving train leaves the station for territories unknown, the one certainty is that the ride is going to be filled with ups and downs, gain and loss, joy, and sorrow. When arising out of trauma, caregiving becomes a practice in the awareness that one has been thrown off balance and that multiple demands are drawing on energies that, while heightened, may not be channeled in a positive direction. Since decisions during the initial stages of caregiving can have a profound impact on both the caregiver and the loved one being cared for, it’s important that these energies are managed in ways that support their enhancement and staying power. Identifying when one is dealing with PTCG allows caregivers to practice the art of caregiving and self-healing simultaneously.

To find a therapist, visit the Psychology Today Therapy Directory.