Eight comments/questions that can change a relationship between a dad and a daughter in college..

Well, summer seems over and  many families are prepared, for the very first time, to send their sons and daughters to colleges across the country. I hope some go to the University of Wisconsin- wonderful school and they will forever be badgers. I still am.
This is a also a terrific time for fathers and daughters to revisit their relationship. Every family goes through stages that comprise its life cycle. As it goes from stage to stage, there is a transitional time in-between stages  in which important changes in relationships between family members can and do occur. This is such a time. While these changes are normative and expected, they are not always easy to accomplish or can be done with little stress or challenge. But they do happen and family members can be transformed both personally and within their relationships as a result.

 As a family counselor, I worked with families to anticipate and facilitate such remarkable changes. One change that may hopefully occur is how fathers relate to daughters who have gone away to school.

Let me stereotype for just a moment...dads and men are problem solvers.  "What do you need? How much money will it take? What can I send you? Let me do this or that for you"  Discussions about interactions, feelings, and dynamics of relationships may be passed on to moms.  If it is about hurt feelings or problems with relationships, you may direct the conversation to mom. That is the way so many men have interacted at home, so you perpetuate the system when daughters go to school. End of stereotype.

But dads, it doesn't have to be divided into actions and interactions! Now is the best time to rehearse the new you, the kind of man your daughter may not be used to, but the kind of dad you may have wanted to be all along. I see it as a growth potential for men who are also dads.

For purposes of this post, I will not discuss fathers and sons, or mothers and daughters/sons. That will be another time, after you have practiced and demonstrated that you can relate to your daughter in an equally empathic and interaction-based mode. So, dads, here are eight dynamically posed comments/questions to help you become the real you and in the process, enhance and deepen your relationship with your daughter.

Your daughter finally calls, you grab the phone ( you miss her already), but she doesn't ask for anything...she wants to talk over a problem she is having that is hurting her emotionally and causing her some sadness.  No, she doesn't need anything and you cannot fix or solve her dilemma by doing something.  You  have to be present, in this moment with her, and listen,  but really listen.
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Instead of handing the phone to mom, take a deep breath, let it out slowly, and begin.

1. Can you tell me what is happening and how you are feeling ?

2. Have you ever felt this way before?

3, How did you handle it then?

4. What is different now for you?

5. Now, tell her you know how she is feeling because you hear and feel that she is upset, hurt, and sad, or even angry.

6. Now, tell her you know what it feels like to have these feelings for they happened to you also.

7. Now, tell her that you know these feelings hurt and make her sad and also angry.

8. Finally,tell her that you are here for her, as mom is, and you, yes you, want to help her cope more wisely and feel better, regardless....

Point- If you really want to keep it just as it was, then do not attempt this. You will fail and all  in the family will feel off balance.  What I am suggesting is that with the family dynamics changing by her going off to college, you have a splendid opportunity to provide a new way of relating to her.  It also takes conversations with mom, for her support and understanding, and even her blessing.

Question-Will it be successful the first time? Maybe not- remember your daughter and wife are used to you being one way for so long that the new you may be unusual or suspect for raised eye brows etc. One dad told me in therapy that his wife was wondering if he had lots of other changes he was planning.  Another dad suggested that a conflict developed between him and mom because she was just too used to the way it was, and she didn't want the hassle of his changing; besides, she saw it as her job and he had sons to deal with better than he was doing anyway..

Finally-It is great to be a problem solver.  My wife solves problems as well or better than I do, but we try not to divide problem solving from interaction solving. Maybe, in the end, they are the same thing, but for now, how about it dads, give it a try. You are probably thinking that this really won't work.  That it is not a good idea.  Maybe to try it when she is a sophomore.

Well- Why don't you take another deep breath and...practice it, reflect on it, be more self-aware, and increase your psychological depth.  These skills may not be very popular or even promoted these days, but are really important as a family changes over time.  Maybe, as your family grows, experiences like this can make all these family changes and issues very worthwhile.

Life is always about challenges and the unexpected happening, so plan for this.  You may just like where this will take your relationship with your daughter. And who knows, maybe while you pull this off you will change in the process.  I am very hopeful for you and will cover your back.

Special thanks to Dr. Kyle Dean Pruett who originated this fascinating potential conversation between dads and their daughters in WebMD.COM. June, 2014.

"We're all just walking each other home." Eight Misguided Beliefs About Care Giving That Lead to Burnout and Fatigue

It was Ram Dass who said .." We're all just walking each other home." This statement seems to be a very beautiful metaphor: that by being a giver of care, we can all assist others in their journey home, to what ever and where ever that home is.  To a home that hopefully is a return to health, but sometimes not, to a home that is one of renewed spirit, but sometimes not, to a home of  living with and through chronic illness, or to a home no longer on this earth.

For those who are mourning the loss of someone they love, for those suffering from pain and grief, and for families struggling with finances, emotional, turmoil, and chronic stress, their days are filled with isolation, loneliness, alienation from others,and a lack of constancy in values and shared beliefs. They feel disconnected and suffer greatly in silence.

If people are receiving care from others in their family or professionals,or that care is often from non-family members who frequently travel great distances, a dysfunctional system may be constructed that puts them all, care givers, receivers, and their families, in peril.

While care givers may be professionals in their field, many of us are family or friends or simply people with a desire to care for those who need care and caring. Some of these people, professional or volunteer, care for those in their final journey all the way home to their death. They may also continue to provide care for the remaining families and those most affected by the loss.  And yet, the givers of care should never perceive their work of care and caring as not requiring support and guidance and deep reflection if they are to not burn out or become impaired themselves.

The psychological sciences have explored the components of care giving, and I have also been the receiver of care and a giver of care. I would like to offer eight beliefs that are counter productive to effective care giving. . There may be more than these eight, but certainly not less. Some may substitute others for these eight, but the intrinsic value is in conversation and exploration of them. It has been my honor to facilitate sessions for givers of care in which we explored the nuances of their experiences and shared beliefs and wisdom gained by giving care and caring. Some of these eight  have come directly from these groups.

They are not in any special or rank order of importance, but appear as I think about and reflect on them. They are independent, but are mutually interdependent on each other, for if we fail to understand one of them, all of them can become more problematic to our care of others for they  prevent us from truly walking them home. In preventing us from this important and yet difficult  task, we hinder our own body, spirit, and sense of connection to others.
                                                                *****************
1. Do what is asked of you immediately. Never think about any other demands or responsibilities you carry. Sense the apparent immediacy of the request and try to fulfill it immediately. Don't think, just do.

2. Attempt to complete all that is needed or asked of you by yourself. Never allow yourself to think about or ask for assistance. Feel the need to do it all alone and respond only to that feeling.

3. Never take a day off. Never even think about a day off. Be possessive and see yourself as the one and only person available and capable.

4. Never ask for help! Ever...It is a done deal as far as you are concerned.

5. Disregard your own health and welfare. Never see a physician, or heaven forbid, a therapist trained in how to help you navigate this journey you have constructed.

6. Don't vent! Never complain or seek someone to think this through with. They will confuse you and maybe just get you thinking differently, and this is unacceptable.

7. Give up everything you enjoy in life. Never reward yourself or replenish your emotional battery. Deny your needs completely. Do nothing that brings you joy or pleasure, alone or in the company of those important to you.There will surely be time, someday, to think about yourself, but certainly not now.
                                                   
8. If you have a family, disregard them. They will soon feel disconnected from you and the support they could give if you were ever there for them by being there for yourself...

                                                                     ****************

What we have discussed here seems so obvious, so elementary, that it would not be important to talk about and share. But it is. Look at yourself a little bit more clearly and if you are within the eight beliefs by your actions, now is the time to consider another path, another route to your care giving. Mostly, seek the guidance of a mentor skilled in the various beliefs and behaviors of care giving. Change is available.

While I struggle with whether I have taken the words of Ram Dass too far, or misinterpreted them, I believe that if we are to fulfill our purpose and intention of giving care, there are a number of beliefs that can and will hinder our care and cut short our value to others in this important and difficult work. For in fact, "We're all just walking each other home."

What Do Our Elders Fear?

What do our elders fear?  A fictional Tom Booker in “Horse Whisperer” replied “Getting old and getting useless.” But we know there is more.  Much more.  Professor Alan S. Wolkenstein has spent the last thirty years treating and mentoring elders with physical and emotional losses, written and published about them, researched, reflected, and thought with them.

 As we age, we are prone to lose: loss of connections with loved ones, family, friends, important social and cultural roles, changes in health status, and especially a loss of continuity of beliefs and values. Such loses create sadness, grieving, and lamentations that  affect how elders  make their  way in the world, their expectations, their beliefs about spirituality and sometimes even about God. So many that I have worked with suffer from such deep emotional pain that fulfilling their goals and dreams seems to be for them no longer possible.  Assessing these loss-grieving and eventual journeys to eventual transformation through newly designed “Quality of Life” parameters can offer us an in-depth lens to more meaningfully understand them, more wisely engage with them, and more keenly impact our clinical and direct services with them.

Elders need people they can rely on, trust, and believe in. They need professional caregivers they can rely on, trust, and believe in. How can we best train ourselves and our learners and students to be such people for them? Since our work with geriatric populations is difficult and very important, let us continue to seek the knowledge, skills, and intention to be of service to those entrusted to our care.

Come along as we explore the journey of elders to better understand them and enhance their efforts to cope with their emotional challenges and physical obstacles.  A society is oftentimes measured by how it treats its very young and very old; the challenge to care for them and care for ourselves is a worthy challenge.

Taking a Look at the "Sandwich Generation"

A significant component of any comprehensive and holistic health care assessment includes a Quality of Life evaluation of patients, especially among our elderly: how they attempt to cope and adapt with the tasks of their age, regardless of illness, inhibited activities of daily living (ADL's), their ongoing physical and emotional losses, grief experiences and lamentations, and finally,their ultimate transformation as elders.


The Family Life Cycle, consisting of anticipated stages of family life, tasks required by the family and its members to complete, and skills needed to accomplish these goals is also available to facilitate the evaluation process.²   

In other words, families move through predictable stages by utilizing specific skills to accomplish appropriate tasks. By not having 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 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. Within some families, they become “stuck” at a particular stage because of their inability to move ahead and individuals in the family are hampered in their efforts. In other words, each person’s needs within the family may be enhanced or inhibited by their family’s successes or limitations in meeting their family’s goals and objectives.  In the psychological sciences, we refer to these phenomena as independent and interdependent variables.

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.

The stage that includes the sandwich generation is Stage 3, or 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 role

                  Career changes

                  Bodily changes
                  Changes in relationship to their aging parents: from children to degrees of care                             giving, evaluating parents for quality of life, safety, and future security

                                                     SANDWICH GENERATION 

The sandwich generation is an important facet of this stage of the family; for the children  are hopefully becoming (in many ways) independent while the elder-parents are becoming more dependent. 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 own children. They can perceive themselves as being emotionally insecure and sometimes even greatly inadequate in caring for either their parent(s) or 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. Many tell me that neither their children nor their parents have much faith in their abilities or even in them. 

The last stage in the family life cycle we have named "Later Years: Retirement to Death
Tasks: Acceptance of change
            Bodily changes
            Coping with probable loss of partner
            Deal with realities of living arrangements
            Importance of intergenerational and social contacts
            Maintaining Integrity of Self
            Maintaining a life of meaning and purpose 

(It is understandable that conflicts and turmoil can envelop a family when confronted with such different and varied stages, especially when they are happening simultaneously.. Many families simply lack the skills and knowledge to enhance these stages. However, many families get through them with a minimum of conflict and with much success and therefore deeply enjoy the fruits of these stages.)  

            
           

                                                               THE BIG TALK

So many adult-children have to focus on  uncomfortable discussions, or “The Big Talk”, of serious challenges, such as a probable need for living arrangement changes for their parent(s).
Let us focus on this particular challenge because it exemplifies many such issues confronting a family. This need for living arrangement changes 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, decline in evaluating critical issues, 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 can oftentimes 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”³.

The process of selling a family home, with its myriad of memories and sense of earlier family stability, and then moving to an assisted living facility or adult community is not an existential experience in itself. It oftentimes follows a period of major losses by parent(s) and emotional grieving that can tax both the elder parent(s) coping and adapting skills and the resiliency of their adult-children.

While Quality of Life is of great importance in all stages of the Family Life Cycle, it has special significance (and requires special attention) in the stage that also illuminates the particulars of the sandwich generation. We know that it affects adult-children, their families, and their elder-parent(s). We also believe that inter-generational strength can come from its greatest struggles: if the family gives itself what it needs to safely navigate its difficulties, and uses the wisdom gained from its experiences.

Ernest Hemingway once said “The world breaks everyone and afterward many are strong in the broken places.” ⁴ While I believe some of us, but not all, are so negatively affected by our experiences, I 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 and can cautiously guide a family through these difficult times.

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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.⁵  It is not surprising that family conversations about the possibility of changing residences invoke such high degrees of emotionality for all of the family...

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1.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.
2. 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.
3. Small, Jeffrey. The Breath of God. West Hills Press. New York. 2011.

4.  4. Hemingway, Ernest. A Farewell to Arms. Scribner’s.New York, 1929.

5.     5.   Wolkenstein, M. Evan. A Quality of Life Wheel: A Tool for Reading, Understanding, and Living. Ravsak. Summer,2012.

See also:

Wolkenstein, A., Wolkenstein, ME., and Simona, K. The Card: An Educators Encounter with Cancer. Family Medicine. 2004. 36(2), 137-140.

Wolkenstein, Alan S. and Wolkenstein, M. Evan. Signposts of the Cancer Journey. Coping with Cancer Magazine. 2009. January-February. 

Wolkenstein, Alan S. An Odyssey Within Prostate Cancer; For Men and Their Partners. Ortho-Centacour Biotech-Caregiver Section. www. myprostatecancerroadmap.com

Professor Alan S. Wolkenstein, MSW,  is trained in both Sociology and Psychiatric Social Work. He is retired Clinical Professor of Family Medicine at the University of Wisconsin School of Medicine and Public Health. He last served as Professor of the Behavior Sciences Consultation Service for Concordia University of Wisconsin, where his students and faculty knew him as Prof.

Alan is a veteran of 35 years of teaching, education, and research in graduate medical education and is nationally recognized as an expert in the education of physicians and health care professionals in human behavior and family dynamics. He also had a private practice in which he worked with individuals and families struggling with health issues, difficult relationships, and elders attempting to find balance and focus in a world that is often perceived as harsh, unpredictable, and unforgiving.

 Having lived with and through cancer and being a senior himself, gives Prof a personal perspective to work with individual and families negotiating their way through life's multiple experiences and challenges.

Twelve Questions to Consider When Thinking About a Retirement Community with Life Long Services

       


      Twelve Questions to Consider When Thinking About a Retirement Community 
                                                      with Life Long Services

When a family with an elder or an elder him or her self begins to think about and have conversations with their family about moving to a retirement or independent living community with life long services, these conversations may become uncomfortable and anxiety provoking because they consist of making major changes in home, relationships, and even in family dynamics. We already know that everyone seems to have a slightly different opinion, for those involved directly the stakes are very high, and previous attempts to have such conversations may have not turned out very well. People can feel unsure of themselves and the elders may experience that their own wishes may be disregarded by their children who push for changes to insure a more safe and healthy environment.
This may be the first time adult children have seen their parent (s) unsure of themselves, possibly afraid of the future, and even angry or refusing to participate in these talks. It seems that no matter what is decided, many feelings may be hurt and someone will feel disregarded and not appreciated for their wishes.
Many situations like I have described simply do not occur. An elder wants to move on or a family comes together with a unified plan that seems positive and helpful to the whole family. Then the issue is where to look, how to assess, and when to choose a place. For many others, the situation is confusing and there seems to be no way to satisfy all, and in the end, no one feels or experiences satisfaction.  If an elder moves into a retirement community following this scenario, the likelihood of a successful adjustment is deeply compromised. Both situations seem to require some professional intervention. The first to assist a family in choosing a place, and secondly, to help the family sort through the levels of conflict and mentor the family to a better path to choose for themselves.
I have listed a number of questions to be used as a working outline in maneuvering through both scenarios. Each requires input and shared conversation with a guide or mentor to monitor and direct the conversations and the powerful emotions they generate.They are not listed in any rank order of importance, but as they come to my mind as I have worked with elders and families during these potentially troubling and stressful times. A always, take with you what seems most helpful to your special situation.....

1. Costs and how they will be paid for. Remember that the highest cost establishments may not be the most rewarding one for you or your family. Many have entrance fees that may or may not be refundable in some degree if you leave or pass on. All require fees for their services and some take medicare: get the facts down right. But higher cost is not always indicative of better service and dedication to you. You will also need facts about their financial health to guarantee their viability.

2. Location, location, location. How far is it from your family and friends? Can you get back to your established places for services, restaurants, theater, clubs, church, synagogue? Are you planning on establishing all these in your retirement community once there, or will you split your time? Remember than connection with important persons in your life is a definite component of good Quality of life.

3. Ask about their values and commitment to each person. Get this from the people you talk with, not the brochures they send out. While it is good to talk to folks who are available to talk and share their experiences there, the system will probably have you speak with the most satisfied members. Ask for a list of complaints they have received and dealt with.  Seek a place that shares your values about what is important in your life and maintaining a high quality of life: continuity here is also important in your quality of life.

4. Now ask how what are their consistent strategies for  these core core values and how are they implemented?

5. What are their practices to incorporate you or your loved into the their system and the group of other people in the community?

6. How will they assist you or your loved one in coping and adapting to their environment. You or your loved one may find it more complicated and anxiety provoking to move through the process of adjusting there. Who are the staff and what are their qualifications to do this with you or your loved one?

7.  Are there regularly scheduled assessments of how you or your loved one is coping and adapting? Who are the people and what are their qualifications?

8. Many people and families seek out a place following a serious loss to them: death of a loved one,  illness, financial problems, diminished ability to provide activities of daily living (ADL'S). Attempting to adjust now can strain an individuals ability to cope and adapt. How will the community provide care and counseling?

9. Most people have some degree of ambivalence and uncertainty about such an important move. Who is there to smooth the way and champion their concerns?

10. What family counseling services are available to your family? Not all of us have made our amends with our family, dealt with the issues that cause us strife and worry, and resolved any family guilt or anger between members.

10. Try not to select by religion alone. You may find the system falls far short of meeting your needs. While many families share they receive much comfort if the community is of their religion, it is not a guaranteed successful placement by itself.

11. Do not let them confuse a busy schedule and keeping you or your loved one busy with the possible need for in-house counseling that is part of the regular costs. If it is an additional expense, then it seems to me that it is not a built in need that the administration is viewing as a normative cost to them and necessary for enhanced quality of life for some members.
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12. Your health is crucial. How do they incorporate physicians,nursing, and allied health services into their system?

I have listed for you 12 questions and concerns that are important. There are certainly more and some may be equally as important or more important that any on this list. Think for a moment what they might be for you or your loved one. You may be surprised how these questions and concerns bring new ones to the surface that you may have not thought of.

What if you began to re-think about you or your loved one remaining in their home? What services would they need and accept to accomplish this? Where would the funds come from? Is this just a stop gap measure, and if so, may this stop gap measure give all the family the time to breath easier and simply be as it is. Would this be reasonable for family with many different opinions and for elders that may perceive this as an intrusion into their home by strangers which solidifies their sense and awareness of growing frailty and needs?

Consider a consultation by a specialist during this challenging time. Someone who has the experience and expertise to guide you and your family with and through this process....sitting down with this person can illuminate a path that you may not have thought of, and provide guidance to see you through....

Lastly, many families come through this family life cycle event easily, many do not. It is not unusual for the latter and I want to try to reassure you that help is available for you and your family. There are many fine people in the community to serve you. Take the chance and the opportunity and call for an appointment.

I wish you and your family well.

Alan S. Wolkenstein, MSW
Clinical Professor of Family Medicine (Ret.)
University of Wisconsin School of Medicine and Public Health
Wolkenstein and Associates, LLC
Mequon, Wisconsin, 53092
Alan.Wolkenstein@gmail.com

Waiting as a Clinical Skill

It seems we seldom need an immediate outcome. Most of the time, there is a waiting period. The same is true of important test results and effects of medical treatment.

What role can you play in assisting your patients to “wait”? What skills do you need? Who will best help you in developing these skills?

Waiting is also about us.

In the spiritual tradition, help us gain this fleeting moment of waiting before we speak. It is from the silence gained from waiting that we can reach into our deepest sense of wisdom to comfort those we care for.

May We All Learn....

May we all learn a gentleness that transcends force and melts any hardness yet found in our hearts. Then shall we be responsive and sensitive to the needs of patients and their families, and may we always be responsive to their suffering.

For all those who struggle vainly for our attention

And those who shrink from our touch

For all those whose faces we forget from one encounter to another

And for those who never seem to find a resting place

For all those whose ambition exceed their skills

And for those whose early promise has dimmed to small achievement

For all those whose minds are clouded or weak

And those who are burdened with broken bodies

For all those who wait in great pain

And those who wait for news that will never come

For all those who feel unloved, with no one to love

And all those left behind, alone, and isolated

For all those who are deprived by the callousness of others

And all who have lost their hearts by situations they are not responsible for

To all these people and their families, may we always respond with open hearts, deepest empathy, and the fullness of compassion through loving- kindness.”