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|In Consultation - Page 2|
Learning to Collaborate
The second mediation goal is to create a process of communication and negotiation. I urge siblings to set up a listserv for ongoing dialogue about the parent's medical and logistical requirements, including postings of the latest medical progress notes, insurance-benefits statements, and bank statements. The purpose is to provide enough information that everyone can have a common understanding of the parent's needs. I suggest that they have a formal "board meeting"—in person or via conference call—at least every three months to review the parent's status, check in with one another about how each of them is coping, and negotiate the assignment of tasks.
Caregiving will be neither democratic nor equitable, I tell them: one member will probably bear the brunt of the work and responsibility. But I state my belief that what's fair in these situations is for all siblings to contribute in some manner—depending on their circumstances and availability—to the parent's care. It's then a matter of using the periodic meetings to hash out who'll do what for a parent (e.g., pay for groceries, drive to physical therapy) for a given time period, and who may step up to take over a specific task at some future point.
When Diane and her brothers and sisters began communicating on a listserv, several encouraging changes occurred. The amount of information that she shared and her obvious grasp of the complexities of the medical and insurance systems demonstrated to her siblings that their little sister had greater competence than they'd credited to her. The tone of their e-mails and phone calls to her became more respectful, even admiring. Meanwhile, the frequent exchanges among the sisters and relative silence on the part of the brothers made clearer that there was a marked imbalance in gender roles. When the sisters pressured their brothers to do more for Mom, they reluctantly agreed to visit her more often and help with some home repairs.
Letting Go of the Past
The third goal is to neutralize the legacy of past rivalries, jealousies, and hurt feelings enough to prevent them from undermining a caregiving plan. I tell siblings that it's natural for them to view each other's actions through the lens of positive and negative family interactions, but I emphasize that the emotionally charged experience of helping a failing parent usually brings out unforeseen capabilities and motivations in family members. I point out that many adult children use caregiving (consciously or unconsciously) as an opportunity to do reparative work—showing love to a parent whom they formerly neglected, or forgiving a sibling for past injuries.
"Keep the past relationships with your brothers and sisters in mind," I say, "but don't interpret all current behavior as evidence of irreversible genetic programming, twisted personalities, or unadulterated greed. Look for the signs of growth in one another." If a brother or sister persists in typecasting the others as the same old malcontents, airheads, or losers that they've always been, it's fair game, I say, for them to argue that, by clinging to old perceptions, he or she is sabotaging the siblings' caregiving team.
Because this was mediation, not in-depth family therapy, it wasn't my intent to plumb the depths of Diane's sibling relationships. Rather, in three sessions spaced months apart, I facilitated the development of a more equitable family caregiving plan and increased mutual regard among the brothers and sisters. In truth, their relationships had grown superficial and stale through the years because of lack of contact. By meeting together, learning to negotiate, and following suggestions about how they could communicate more effectively, they got to know one another better and came to appreciate each other more. Diane continued to participate actively in Mom's daily care, and her brothers and sisters began applauding her efforts. She came to acknowledge that her siblings cared for Mom in their own ways, and she was glad that they were becoming increasingly involved. In the end, their mother didn't go to a retirement community, but received more intensive help in her home because her children were working together as a team. Because of the siblings' greater collaboration, Mom thrived, and the family became stronger.
Barry J. Jacobs, Psy.D., is the director of behavioral sciences for the Crozer-Keystone Family Medicine Residency Program in Springfield, Pennsylvania, and the author of The Emotional Survival Guide for Caregivers—Looking after Yourself and Your Family While Helping an Aging Parent. He can be reached through www.emotionalsurvivalguide.com. Tell us what you think about this article by e-mail at firstname.lastname@example.org, or at www.psychotherapynetworker.org. Log in and you'll find the comment section on every page of the online Magazine section.