Where do I draw the line?

This is probably one of my more challenging posts. It concerns a dilemma that many people are facing: how do I care for my parents in old age, especially when we’ve had a difficult relationship?

Young parents sometimes tell me that they expect their children to look after them in old age. In many societies, this seems to be a common expectation. Having heard about so many different family situations in my work, I notice a real resistance in me whenever a new parent tells me this. There is an inner voice asking: How can you bank on this?

It comes from supporting numerous clients who have struggled to reconcile this societal expectation with their own relationship with their parents. What if the relationship has been problematic for a long time? For example, clients may feel a sense of duty and obligation that sits alongside the very real and painful experience of violence or neglect. Others may have experienced a parent as predominantly career orientated and with little interest in them as children.

Sometimes, one parent left the family home early on and the relationship became estranged. In other families, parents divorced and seeing arrangements favoured one parent, leading to more and more distance with the other.

And even if there have been times when we experienced our parent as supportive, inspirational or fun to be around, what if recent interactions have been far from easy?

Clients have told me about parents suffering from dementia and gradually losing their memory, which fundamentally changes how they relate to others. Parents may no longer recall conversations they have had or agreements they have made only a few days ago. In a situation like this, it is easy for adult children to feel like their efforts are not being acknowledged.

Other clients have shared with me the hurtful experience of not even being recognised by their parent anymore and of needing to reaffirm at each visit that they are indeed their parent’s child, a fact that the parent’s mind can no longer hold on to. The sadness that comes with the acceptance of this new reality can feel overwhelming: it may seem like we've already lost our parent.

At times, it is not only the sense of being unrecognised or taken for granted. Adult children may also feel that their help is being resisted and actively undermined. They may make considerable sacrifices such as moving to live closer to their aging parent or offering a parent to move in with them and be faced with blame and accusations in return.

To some of my clients it feels like their parents are reconstructing reality, putting fiction over facts and presenting themselves as the victim. Despite their children's best efforts, they may claim that they are being abandoned, pushed into a care home or stripped of their valuables.

Sometimes, the parent’s fear of memory loss is expressed as anger and blame, and family support is perceived as intrusion, especially when the parent may have certain vices or even addictions that they are in denial about or have tried to keep secret from their children.

I recognise the parent’s struggle in these situations, the existential crisis of aging and decline and the loss of health and agency that comes with that. Nevertheless, this is very hard to take for the adult child.

Some of my clients broke contact with their parent for good reason and have lived a much calmer and more confident life without the turbulences of that relationship but now find themselves being called upon as the only relative who can help. How do we stomach all of that? Where do we go with our own anger?

And what level of verbal abuse am I putting up with as an adult child, when I have the power to leave but may feel a moral obligation to stay and support a very vulnerable older adult?

This is especially difficult when we know that our parents don't take good care of themselves. They may forget to eat and attend medical appointments. They may no longer be fit to drive or be able to manage their finances responsibly. Or they may be found by policy wandering the streets and unable to find their way home.

As a therapist, I often encourage my clients to assert themselves and to stand their ground, because especially as adults, if we don’t learn to do this for ourselves, no one else may do it for us.

I tell my clients that we don’t need to be ranted at and that we can remove ourselves from a situation where we face aggression or ridicule. I ask my clients to prioritise their mental health and to consider the long-term effects of verbal and emotional abuse.

I discuss with my clients that if what we are offering in a relationship is not appreciated, we may not want to continue offering as otherwise resentment is likely to build up inside of us.

However, when the relationship involves a vulnerable older adult who also happens to be our parent, this situation becomes a whole lot more difficult.

Some clients have told me that there is no way of not feeling guilty, whatever they choose to do. This reminds me of the struggle many parents tell me about: that there is just no perfect solution, and that no matter how much they try to balance their own needs and the needs of their family they end up feeling guilty and are left wondering how they could have done things better.

And yet, I would argue that the situation for adult children who care for their aging parents is so much harder. Different to caring for young children who we are raising to become increasingly independent, caring for aging parents means witnessing decline, suffering and a growing dependence ultimately leading to death. This can feel very heavy and hopeless.

If you are finding yourself in this dilemma of trying to figure out what role to take in the care of your parents, I invite you to take a long-term view and to imagine yourself at the end of your own life looking back. From that position, how would you have liked to have acted now to feel most content with yourself? What do you expect of yourself, and how do you want to balance care for yourself and for others?

We don’t know what the future holds, and we cannot know exactly what we may come to regret. We can only try to make good decisions for ourselves that are at the very least well considered and that weigh up different feelings, values and views that we hold.

I am aware that finding this balance is especially complicated when there is a lot of volatility: One moment, we may be our parent’s best friend or favourite child and might even experience precious moments of closeness that we didn’t experience before. And the next moment, we can become the villain who is framed as being after our parent’s money.

When our parent’s opinion keeps changing like that, we have very little to hold on to.

And even if we try our best not to take things personally and if it is clear to us that it is our parent’s aging and illness that are talking and not who they used to be when they were young and healthy, it is unlikely to leave us cold. There is something inherently disturbing in seeing our parent, who has been an authority figure for most of our life, behave so irresponsibly and in such a childlike manner.

In my professional opinion, this is one of the toughest relationship decisions to make: where do I draw the line? How do I care for my parent? How long? In what capacity? When do I need to stop? When do I need to involve others to help? When do I need to overrule my parent to ensure their own safety? When do I step aside to leave them to their own devices? And above all, can I live with myself?

As I said at the beginning, this is one of my more challenging posts because there isn’t an easy answer to any of these questions. When I am working with clients, I see my role as helping them to explore their own position, to search for balance, however fleeting, to acknowledge their feelings, be that guilt, sadness, anger or loss, and to bear witness to their suffering and that of their parents.