Caring for someone with mental health difficulties. A brief introduction

By | April 3, 2018

For carers . (Helping those with mental health problems)
A short introduction
Sometimes problems or issues can’t be seen. They affect our behaviour and how we respond to the person with the problem. I call them the invisible problems
The classic invisible problems are addiction, eating disorders, mental health and grief.
Just because we can’t see them physically does not mean they don’t exist or someone is pretending or weak willed

The challenge with living with someone with an ‘invisible ‘ problem is knowing how best to be helpful, keeping the relationship going without falling into the trap of smother kindness ( or indeed imprisoning) or ‘refrigerator’ response boredom with the issue and the person.
After all they are still a person you have known or know , it’s just they come with an issue that can’t be seen from the outside.
I call them invisible because from the outside the person is physically able, in most cases can do everything that you can do, and yet they cannot.
It is easy to second guess what to do if your partner, child etc has broken their foot for example. You can offer to carry things, cook even do their shopping and aid them on the path to recovery.
It’s our go to strategy in caring and looking after our nearest and dearest when some calamity has changed the relationship dynamic for while.
And broken feet do , after a time, heal. Things then mostly return to normal, and as is the course with this type of problem , eventually recedes in to the past ,mostly forgotten.
This unfortunately is not the case with conditions you cannot see.
As we so often have to adapt our lives around people with these problems , the lack of our understanding of what is helpful or not is brought to light.
I write about this, because until recently , there has always been a lack of practical advice for carers outside the medical and support professions.

Over the many years I’ve worked as an NHS counsellor and seen numerous carers, referred to counselling full of the heavy responsibilities with a lack of useful advice ( who is going to advise you on the best way of looking after an alcoholic partner? This isn’t a medical problem or a social issue, you are on your own)
Fortunately though, South London and Maudsley conducted some good research around the thorny problem of living with and helping someone with an eating disorder and developed a useful schema, which I will now further spread, as many of my carer clients were unaware that sometimes their strategies were doing more harm than good.
These I shall share with you here.
Firstly though I must reiterate something important. If you’re this ballpark situation and caught up in a relationship with caring reponsibilites then it is very important to remember a major point.
THE CARER MUST SURVIVE.
Self care and even a routine set up in the midst of what can be seemingly chaotic is a necessary tool to possess . An exhausted , problem solving carer cannot function. None of us are super human even though sometimes we are required to go the extra mile

Self care can simply be taking time out for yourself, a walk or swim if time away is a problem will do, but regularly so there is a little time for your own well being.
The SLaM Menagerie of caring styles.
SLaM researchers and psychologists developed this approach to help carers of people with eating disorders.
I believe it has a much wider application.
(to see the full paper check the reference below)
The model they developed was translated into animal styles so as to be easy to remember and apply.
Here is my attempt to distill it down to useful information.
I saw that most of us (myself included) seemed to only have a single strategy in helping people and use this one plan (probably because we ourselves were parented in this style) in every situation , like a one bladed penknife. It works the majority of the time so we keep on doing it.
There are alternatives.
Firstly lets have a brief over view of the caring/helping styles which really don’t work , thoughyou might recognise in action around you.
They have been given animal names and charracteristics
The NOT HELPFUL caring approaches.

Rhinoceros
.
The angry berating approach . This is most commonly seen around repeat behaviour and in my experience grief reactions, the “why are you still upset your dad died over a month ago now?” resposnse
I suggest this is a lack of emotional intelligence at play and sits on the bored/angry threshold of carer responses.
It makes all problems worse.

Ostrich

Here is a denial that anything is wrong or has changed, the completer and utter avoidance of a new situation.
Also a get out of any responsibility strategy.
This doesn’t help at all.

Kangaroo

The smothering carer, the complete opposite of the ostrich. In taking over the life of the person you are looking after, they have been reduced to the infant dependency . On the surface the ‘you stay where you are, I’ll get that or sort that out for you looks like generosity and kindness personified. The side affect is that learned helplessness and victimhood are being constantly reinforced. It may make the carer feel good ( sacrifice, martyr syndrom etc)
BUT it does not help in anyway a path to some sort of recovery.
It is of course a very easy trap to blindly walk into from the carer’s side.

Jellyfish

I have only met a few carers in this mode, though perhaps that was enough. This sees the carer take centre stage , the issue is about them , guilt is the engine and wanting to be involved and powerful seem to be important.
Caring often involves not really knowing what to do at the time and feeling a bit useless. This is not generally how we approach our lives so the wish to reassert usefulness can drive us to being the most important person in the dynamic of caring.
Jellyfish is thought to be the emotional response , but way too much.
Again I reiterate stay away from doing this if you are helping someone.

THE USEFUL ROLES

Usefulness around the invisible problems is difficult. Mostly addictions, grieving, mental health issues, illnesses make all of us feel useless.
I have yet to meet anyone who is comfortable in that position.
So, what to do?
The suggested strategies are about letting the cared for express some agency in their life. It is their responsibility to recover. They are the only ones who can facilitate change or recovery. Not carers.
Caring in these circumstances involves 3 strategies

Mountain Rescue Dog

Crisis management. This has been called the mountain rescue dog approach. Here we turn up sort out the immediate crisis, make sure all is back to a reasonable place and then depart.
This enables you to take a step back and allows them to get their feet back on the ground and solve the problem their way. It’s their responsibility to look after themselves, rather than handing their issues onto someone else

Harbour Dolphin
Nudge is the second component. This in the menagerie is termed the Harbour Dolphin, nudging the boat into safer channels and being aware of the risks in deeper waters.
Again after your intervention is done , it is now better to allow them some space

Finally, in this collection there is

Terrier

This has also been typified as Terrier behaviour, a constant, though not nagging, herding into a safer place

This is the best we can do .
I know that caring is hard miles, that we can get trapped in a strange and not useful co- dependent relationship , where the carer does all the hard work.
If we care for someone without a plan ,we can also become part of the problem , and not notice it because of the urgency of the tasks at hand.
I hope this helps to at least enhance your awareness of choices and pitfalls in caring for someone with invisible problems

If you wish to read more I suggest you have a look at SLaM ‘s PDF here, complete with a worksheet.
http://thenewmaudsleyapproach.co.uk/media/animal_analogies.pdf

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