Statewide Meeting NASW 2012
Accepted Proposal
Alan S.
Wolkenstein, MSW, LCSW
800 W.
Dandelion Lane
Mequon,
Wisconsin, 53092
262 243
5489
Title:
The View from My Window: Looking at the Sandwich
Generation
There will be a time for every
family in which they do not seem to know what is important to do and what is
not. At other times, they know what is important to do, but are unable or
unwilling to do so.1 Maybe, this is such a time for your
intervention in behalf of the family…
Extended Abstract:
A significant component of any comprehensive and holistic
health care assessment includes “Quality of Life” of patients and clients. The
best of the bio-psychosocial models of care include a definitive and easily
integrated psychological sciences (Social Work) evaluation and assessment of a client’s
quality of life.
Among our elderly, such an assessment is especially necessary.
Our ability to recognize, understand, empathize, and provide problem-solving
experiences for and with them focuses on enhancing their attempts to
successfully cope with the tasks of their age: regardless of illness, inhibited
activities of daily living (ADL's), their continuing losses and grief
experiences, and ongoing transformation as elders.
The Family Life Cycle, consisting of anticipated stages of
family life, tasks by the family and its members to complete, and skills needed
to accomplish these tasks frame our Quality of Life review.2
Families move through predictable stages by utilizing
specific skills to accomplish appropriate tasks. Without the necessary coping
and adapting skills, families may be forced to move ahead regardless of whether
they completed their tasks or not. Many of these families become problematic and
dysfunctional by not being able to really do well in any subsequent stage(s),
and thereby become deficient in meeting individual family member needs, goals,
and aspirations.
We had defined five initial stages
of the family. Subsequent evaluation revealed that there may be more than five,
but unlikely be less than five stages. Variations that alter stages and their
tasks can include: severe family problems, permanent marital separation,
divorce, widowhood, remarriage/blended families, and single parent-hood, late
in life family development, alternative lifestyles, traumatic social/cultural
events, war, depression, and natural disasters.3
Our session will focus on the stage that includes the interdependent
components of the sandwich generation is called “The Transitional Years
(Children becoming non-dependent to leaving home).
Tasks:
Launching children
Reevaluation of roles: evolution from parents back to partners as
their
primary roles
Possible
career changes
Body changes
Learning/enhancing skills to cope and adapt to changing
circumstances
Sandwich generation*
*The sandwich generation is an important facet of
this stage of the family, for children are becoming more independent and
elder-parents are becoming more dependent on their adult-children. This is
potentially a time of very emotional and anxiety producing experiences.
(Difficulties here spill over into other important areas and have a negative
impact on achieving family tasks and on overall family stability). Not only for
the elders themselves, but for their adult-children, who describe feelings of
being "caught" by the differing and opposite needs of their parent(s)
and their children. They can perceive
themselves as being emotionally unprepared and sometimes even feel inadequate in
caring for both their parent(s) and their children: not only because of the
difference in needs, but in their real or imagined lack of skills and
experience-based wisdom to be effective.
The Pew Research Center offers the following numbers to
highlight our discussion. One out of eight families (regardless of their own
needs and coping concerns), with adult-children as parents, between the ages of
40-60 provide some form of care of their own aging parents. That is about 10
million of us! In addition, 7 to 10
million provide assistance to their dependent parent(s) by long distance. And,
that 65% of all home care assistance is still provided by families. Go
Families!
The National Alliance for Caregivers reports that over 43
million of us look after someone age 50 or older, and not necessarily a member
of the immediate or extended family. That number has jumped almost 30% since
early 2000. The issue is not that we do not care. We do care about and for our
elders. Our challenges are more complicated and frequently difficult to fully
understand: they generate the dynamics of this session.
Let us choose one loss and subsequent grieving issue for
this session: An emotionally tough and anxiety
provoking conversation between aging and more seemingly dependent parent(s) and
their adult children is the uncomfortable discussion of the probable need for
living arrangement changes for their parent(s).
This need generally follows a number of potential-loss
experiences by the parent(s). Loss of a partner, significant changes in health
status, degrees of declining mobility, loss of income, changes in social
status, financial setbacks, and loss of important family and friends due to
death or moving away, are some of their losses of great significance. They
respond with deep grieving to these losses, especially if there is no respite
between them and little chance to try to re-balance their lives and cope with
both their losses and their grieving.
This may be the first time adult-children witness
their parent(s) becoming afraid, anxious, and emotionally unsure of their own
future. Elder-parents are facing a new world for themselves, one of different
rules and expectations. It is also a world in which their dependence on their
adult-children intensifies, and the adult-children may also share the same
insecurity and anxiety. We know they may share feelings and emotions of anger,
great sadness, and fear. They may soon come to realize that their lives will
never be quite the same again, and suddenly, the future for all in the family
is the “potential unknown”4.
The dynamic process of the need to consider selling a family
home, with its myriad of memories and sense of earlier family stability, and
then moving to a down-sized apartment, adult community, or assisted living facility
is an excellent subject to reflect on. It is certainly not an existential
experience in itself. It oftentimes follows a period of major losses by the parent(s)
and emotional grieving that can tax both the elder parent(s) coping and
adapting skills and the resiliency of their adult-children.
We will also offer a number of scenarios based on
different individual/family styles of interacting and coping with potentially
distressful situations. We hope to
outline a number of situations and then ask participants to act out the
interactions, reflect on them, seek new hypotheses, and plan to incorporate
important components into their skill set.
Ernest Hemingway once said “The
world breaks everyone and afterward many are strong in the broken places.” 5
While we believe some of us, but not all, are so negatively affected by our
experiences, we also believe that the most difficult experiences can make us
stronger than we were before. Sometimes, but not always, we need assistance
from guides and mentors. Both elder-parents and their adult-children can
benefit from consultation with an experienced Elder Family Therapist who has
already traveled these same paths, or has much thoughtful experience in working
with such families, and can cautiously guide a family through these difficult
times. While we know it affects adult-children, their families, and their elder
parents, intergenerational strength is possible as a response to its greatest
struggles. However, the extended family must give itself what it needs to safely
navigate through its difficulties. We believe that a family can reinvent itself
through choosing a different path to follow, rather than accepting its course
as inevitable. Then there is the opportunity for them all to grow, achieve
goals and wishes, and grow stronger as a family.
Unfortunately, what can happen is that losses in elder
continuity (the home and its sense of belonging), and losses in elder
connections (important persons in their lives) impacts negatively on all other
parameters of Quality of Life among our elders.6 It is not surprising that family
conversations about the possibility of changing residences invoke such high
degrees of emotionality for all of the family...
1.
Kidd, Sue Monk. The Secret Life of
Bees. Penguin Books. New York. 2002.
2.
Wolkenstein, Alan S., Lawrence,
Steven L., and Butler, Dennis J. Teaching Family: The Family Medicine Chart
Review. Family Systems Medicine. 3(6), 1985, 171-178.
3.
Wolkenstein, A. and Butler, D.
Quality of Life Among the Elderly: Self Perspectives of Some Healthy Elderly. Gerontology
and Geriatrics Education. 1992, 12, 59-68.
4.
Small, Jeffrey. The Breath of God.
West Hills Press. New York. 2011.
5.
Hemingway, Ernest. A Farewell to
Arms. Scribner’s. New York, 1929.
6.
Wolkenstein, M. Evan. A Quality of
Life Index. Unpublished Thesis. JCHS of the Bay. San Francisco,
California.2011.
Ouline: 95 minute workshop
10 minutes:
Intro and reasons for attending session
35 minutes:
Exploring concepts of the Sandwich Generation
Case examples
35 minutes:
Development of new hypotheses of strategic interventions
15 minutes:
Feedback and Evaluation
Connection to Theme:
Sharing ideas of care of the Sandwich generation from this
group and developing new treatment techniques energizes us by including the valuable
experiences and skills of us all.
Style:
Highly interactive through use of adult education
principles, experiential education, and reflective learning.
Learning Objectives:
- Exploring
concepts of the Sandwich generation as part of the Family Life Cycle.
- Assessing
the loss-grieving-transformation of our elders as a means to facilitate
meaningful guided conversation between them and their adult-children.
- Appreciating
the change of residence as not an existential experience, but following a
series of losses and deep grieving of elders.
- Facilitating
the use of self as a mentor and guide for both elders and their adult-children.
- Using
case scenarios of differing individual/family dynamics to “practice the
practice” of this work.
- Learning to emotionally acknowledge that there
is no magic wand to quickly making things easier for those in the Sandwich
Generation.
Bio:
Professor Alan S. Wolkenstein, MSW, LCSW, is Clinical
Professor of Family Medicine at the University of Wisconsin School of Medicine
and Public Health (Ret.), and Senior Educator and Consultant-Wolkenstein and
Associates, LLC. .Alan is a veteran of over 30 years of teaching, education,
and research in graduate medical education, and is nationally recognized as an
expert in the education of physicians in human behavior and family dynamics. He
also has a 40 year private practice in which he guides individuals and families
struggling with health issues, dysfunctional relationships, and attempting to
find balance and focus in a world that is often perceived as harsh, unpredictable,
and seemingly unforgiving. Nevertheless, we all have “inner voices” that can
direct us towards using our deepest inner wisdom to guide us through the
challenges of life.
