Yes, Caregivers Need Therapy Too w/ Lisa Kendall LCSW, CSW-G

Summary:

This episode of the podcast "Care Lab," features Lisa Kendall, a social worker and clinical gerontologist. The discussion centers on the challenges and experiences of caregiving, exploring when therapy or other support may be beneficial for caregivers. It highlights the importance of recognizing caregiving as a natural part of life, the diverse resources available to support caregivers, and the need to normalize caregiving in society and policies.

Key Takeaways:

 
• Recognizing Boundaries in Caregiving: Caregivers should support without feeling responsible to "fix" everything, maintaining personal boundaries.
• Need for Caregiver Support: There is a spectrum of support available for caregivers, from therapy to support groups, depending on the caregiver's needs.
• Navigating the System: Understanding options like Medicare for therapy coverage and the importance of finding a suitable therapist can ease the burden for caregivers.
• Normalizing Caregiving: Society needs to better integrate caregiving into life expectations, similar to parenting, including through supportive policies and workplace accommodations. 

Transcript:

Emilia Bourland
Hi, welcome to Care Lab.

Dr. Brandy Archie
It's Care Lab Day! Hey, I'm so glad that we are able to be here on a Friday and have a good conversation. We got Lisa Kendall back!

Emilia Bourland
That's right. And I'm really jazzed for this one, especially after our last guest that we just had on. I think this is such an appropriate conversation that we are about to have. I'm super excited to have Lisa back today. Just in case you all missed the first episode with Lisa, which obviously you should go back and listen to just as soon as you're done with this episode, let me give a little intro for her.

Dr. Brandy Archie
Go back and listen.

Emilia Bourland
So Lisa Kendall is a social worker and a clinical gerontologist who served care partners and elders for over 40 years. And I know you can't believe that, because if you're watching on YouTube, Lisa has like the best skin. I mean, this is a young looking woman. So I don't know, 40 years? Okay. So she's been doing this for over 40 years in a variety of settings.

Dr. Brandy Archie
She started when she was five. That's all. She started when she was five.

Emilia Bourland
In addition to her work as a caregiver, counselor, coach, and psychotherapist, Lisa is a popular educator who speaks internationally about grief, trauma, and wellbeing for the whole care team. We're so excited to have you back on today. Thank you so much for joining us, Lisa.

Lisa Kendall
Thank you both for having me back. I've been looking forward to this for a while and I'm just thrilled to be here. Thank you.

Emilia Bourland
So you know, we always start with a little icebreaker question. Are y'all, and Lisa, we're gonna make you go first. Are you ready? Okay, okay. So my question for everyone today is what has been a really hard lesson for you to learn in anything, like in your life, but what's been a really hard lesson for you to learn?

Lisa Kendall
Yes.

Lisa Kendall
Hmm. That is a great question and it's really related to the idea of being a care partner or a caregiver. And it's related to the idea of being somebody who works in this field. And the hardest lesson for me to learn, and it's something that I'm still working on, is how to support someone without

feeling like you have to take on the responsibility or fix it for them. Right? So I think people in the helping professions can really sometimes just get those boundaries muddied up. And that's a tough one. How to support without sort of taking over whatever it is the person needs help with.

Emilia Bourland
Mm.

Lisa Kendall
That's a tough one, yeah.

Dr. Brandy Archie
It needs like constant reminder. You like you know, you know that you know it here, but just like making it happen here. Cause that's the same for my thing. My thing is knowing that I'm not supposed to be doing everything by myself and like the people in my life are going to be like, girl, you don't do nothing by yourself. You got a whole village of people helping you. And that is 100 % true. but in my heart, I feel like I should be able to do all the things.

masterfully and do it all well all the time, right? And so then there's a constant like reminder to myself to be like, that's not true. The truth is you're supposed to do it with help and everything's not going to get done at the same time. And that is 100 % fine. So that's the thing that always has to like replay in my brain.

Lisa Kendall
I think that's a huge one. That would be such a close second for me, Brandy. It really would, yeah.

Emilia Bourland
Yeah, that's basically my same answer as well. It's like, I'm just by nature a very, very independent person. like, as a child, I had to be very independent. My mom was sick really early in my life growing up. like, I became independent. I like really own my independence. And like, that's an important part of who I am is feeling like I should just be able to do everything on my own and not do it with help. And so that's been, I think, the hardest.

The best lesson that I ever learned was that I needed to get help with lots of things and that asking for help made not just my life better, but honestly, like the people around me, it made their lives better too, because I could actually do a better job at the things that I'm really good at, you know? But it's been the hardest lesson for me. And honestly, like I learn it over and over and over again. I'm sort of famous for like, I got this. Like really, do you?

Let's talk about that.

Dr. Brandy Archie
Thank

Lisa Kendall
It's a big one and I think it ties in with what we're talking about today, right? Like I'm a caregiver, do I need therapy? And the answer isn't an automatic yes. Caregiving is a normal life stage, right? But there are some issues, there are some things that may happen and for sure, if you're at all like any of us,

Emilia Bourland
Hmm.

Lisa Kendall
and you're over giving or under receiving care, under valuing or not taking advantage enough of opportunities to accept help, then you're likely to throw yourself out of balance and that's a sign that you might need some support, not necessarily therapy. We can talk about all of that, but there are supports out there and just like there's a whole

range or spectrum of needs or intensity of issues that we may have, there's a whole spectrum of resources for people who are looking for support and willing to accept it. Sorry, go ahead.

Dr. Brandy Archie
Actually, would you dig into that a little bit? What would make you be like, okay, this is happening so we just need some support. This is happening so we need XYZ, this is happening, maybe we should consider going to therapy.

Lisa Kendall
Yeah, I was thinking about that to get ready for today. I've worked in a lot of different roles supporting caregivers, including as a psychotherapist. Not everything needs a licensed therapist. There are lots of different kinds of support, including a geriatric care manager who can help you find services, including a support group, which isn't necessarily a clinical thing that's going to help you with depression or anxiety, but certainly may support you.

in your journey to healing if that's something that you're dealing with. So I was rethinking about like as a therapist, I have short forms that help us screen for depression. I have forms that help us screen for anxiety. I have all these kinds of things. think that's not what people need. What people need is this one little document that I have seen around for almost the whole 40 years plus that I've been in this work.

guys have surely run into it somewhere. It's called the caregiver stress test. And it's just a simple little thing. I do not know who created it. And if any of your listeners do, please let us know. This has been floating around and repeated on people's websites and in people's classes over the years. But this caregiver stress test, and I pulled up a copy so I could see it, has a couple of different questions. And then you answer them. Is it seldom true?

Emilia Bourland
Mm.

Lisa Kendall
sometimes true, often true, or usually true. And these are the questions that they have. I'm going to take a sip of water here. Because I find I can't get enough water. I find I can't get enough rest. These are questions for caregivers to answer for themselves. I don't have enough time for myself. I don't have time to be with other family members besides the person I care for.

I feel guilty about my situation. I don't get out much anymore. I have conflict with the person I care for or with other family members. I cry every day. I worry about having enough money to make ends meet. I don't feel I have enough knowledge or experience to give care as well as I'd like, or my own health is not good.

The way we score this little instrument is we say that if the response to one or more of these areas is usually true or often true, it might be time to look into getting some support and help for the care receiver and help in taking care of yourself. Now, I can tell you when I've shared this tool with people, sometimes the first reaction is almost a sardonic laughter, like,

Yeah, I don't have enough time. You know, like, ha, ha, ha. Of course I don't get out much anymore. But then seeing it in writing, seeing how many of those things you check can honestly give you a feel for how much help you might need. And it can lead to having that conversation about where you might need some help. So just.

Emilia Bourland
Yeah. Obviously I'm not resting. Yeah.

Lisa Kendall
looking at this document a little more closely, if people are crying every day, that might be a referral directly to a therapist. If people are worried about not having enough money to make ends meet, then maybe they need a different kind of referral. So again, I talked about that spectrum and there are different kinds of supports for people, but it's not

I guess what I want to say is it doesn't hurt to start with therapy, and it's OK if you don't start with therapy, if that makes sense. mean, you can always start just by checking in with a caregiver support group, whatever you're comfortable with. If you're not a group person and you think you're willing to talk to somebody one on one,

then what I'd love to do if I had my magic wand, I would like take away the concern and the stigma about talking to a therapist. Because honestly, I know from my own experience in going to see a therapist and from being on the other side of the couch, so to speak, being a therapist, people find it difficult to go tell their story.

for the first time to somebody that they've never met. And it can be hard, and especially if they've had experiences with therapy that weren't very helpful in the past. And I hear people a lot say, I just don't want to tell my story again. I just, I've told it so many times. So there are barriers that I want to just be honest and upfront about. I don't want to be all like, yeah, call a therapist. But caregiving

Even though it is natural, it is normal, there are joys connected with it, and we want to help, we want to do a good job with it. The reality of our culture is that there are some built-in barriers and stressors to it. We know that our

Lisa Kendall
Our society is different than it was even 100 years ago. Family members have moved across the country and we just don't have as many relatives close by. And most families, if there's two partners in the household, everybody's working and the finances are tight for people. there's just a lot that gets in the way of being able to say,

Yes, we can give care, we can do it with a full heart and know that there's like a built-in support system because my sibling, my cousin, the niece or nephew that just lives down the block can come over and help. there's, know, the houses used to have a sick room off the kitchen where people would stay if they didn't feel well. And that's where at the end of life, a lot of older relatives might've stayed. People live longer now.

And they live longer because of the wonderful medical technology that we have. But that also means that people's needs and lives are more complex. So caregiving has become more skilled, if you will, and can last longer. So I'm talking about a lot of stuff. And let me just pause and let you guys ask me some questions about where you want to go with the conversation. I guess I really just want to say that.

Emilia Bourland
Mm.

Lisa Kendall
Therapy can help with a lot of very practical things as well as helping you process how you're navigating that sea of emotions and frustrations and things that are coming up for you. It's not always needed and it can feel hard to do it the first time, but I think it's a remarkable resource for people.

if you're willing to give it a try.

Dr. Brandy Archie
I have a couple of questions, but I'll just give one to start. One thing that you said twice already that I think we don't hear enough is that caregiving is natural. I feel like mostly it feels like, I don't know, slapping the face might be too hard of a word, but just it feels like it's sometimes out of the blue. You're not expecting it. And that it's a new thing that you gotta add that you're not prepared for maybe.

In the same way that we might be like, if you have kids, you know, they're going to grow up. You know that they're going to change your roles as they get different ages. And when they leave the house, you expect that because you know, that's what the pathway is. And in a similar yet different way, we don't expect caregiving to be part of our path in life. Maybe as we get older and the people in our lives get older. And so I guess my question to you is, are there any ways that you've seen people maybe

expect it better or understand that it's natural or like ways to make it not be so much of a shock, I guess.

Lisa Kendall
Yeah, it's a wonderful question and I think a really good insight. And I'll just briefly say that I think the cause is that we have this focus on productivity and adulthood in our culture. And we've kind of gotten divorced from the natural rhythms of life that include elderhood and dying. And we just don't want to look at that. And so.

We've cut that part of our lives out in the same way that we're divorced in a way from the natural world around us. We're divorced from our own natural life cycles, right? So culturally, we've just created this void where natural aging has happened. But to answer your question, I have been working with caregivers and in the attempt

to try to get people to think about it earlier in a lot of different settings for a long, long time. Back in the late 80s and early 90s, I was very privileged to work for an organization that had contracts with Fortune 500 companies. And I actually got to do one of the pilot sites for their caregiver education program. And we were doing this nationally. And we hoped that people would

come to these classes and that they would be better prepared. I don't know what the statistics are on that, if it has changed much in all of the years since then. What are we talking, 40 years since then? 35 years. So I'm not sure. I suspect, just Lisa's opinion, that we're so focused on surviving the moment, getting

whatever piece of information we need and dealing with the little fire that's right in front of us, that if we don't need to deal with it right now, we tend not to. So I think it's a hard one. And I'm not sure what the answer is. think we can, all of us as providers and educators and people who are talking about this in the media need to continue to talk about how do we reach people and do that education.

Emilia Bourland
Mm-hmm.

Lisa Kendall
and talk to them. It's a problem that is pervasive and it also feels linked to me to the shortage that we have of geriatricians, doctors who deal with older age. The shortage we have of social workers, only 4 % of social workers specialize in gerontology. That's not nearly enough. The general

shortage that we're going to have as we move forward. We're already dealing with it in health care and especially as our population ages. So it's a huge issue and I wish I had an answer for it because I would build it right into the school curriculum. And some schools are doing that. When I lived in Ithaca, New York and I was associated with the Ithaca College Gerontology Institute, they had programs in the local high school.

to try to educate kids about aging. I don't know what the long-term impact of that is, but I hope that it will be a more natural acceptance and understanding and really even an embracing of both the value and the qualities and all of the gifts that aging can bring us, as well as preparing people to deal with the challenges. And for that interdependence,

that we're all struggling with, over giving and under accepting of care.

Emilia Bourland
just like add on or piggyback on that just a little bit in really thinking about this normalization of the idea of caregiving, specifically, you know, as we have an aging population, like caring for our parents, caring for our grandparents, caring maybe even for for spouses, right? Like, I think that it's so important to your point, Lisa, that we keep talking about it, but that we also keep talking about it in a way that, yes, acknowledges

that there are significant challenges associated with these things, but also like just, yeah, this is also just life. We take care of people the same way we raise our kids. Someday we might have to take care of our parents. We probably will. And that even though it's hard, it's just a part of life that we accept and that we can find value in and we can even celebrate. think, I do think that

And you're right. This is such a big issue. There's not like a magic button that we're going to press or like one solution that's going to get us there. But I think, you know, talking about employers and how employers are working to help empower their own workforce for these caregiving challenges, aside from like, how are we really in a practical way?

doing that and normalizing it to say, know, so-and-so might need to take a sabbatical for 18 months to go care for someone, where they are just caring for someone. we have, obviously we have FMLA, we have, there's more and more paid maternity leave and paternity leave, and all those things are wonderful and they're necessary.

Where are we getting on the other end of the spectrum to make these things possible? heard, I was listening to how I built this the other day, which was one of my favorite other podcasts. And there is an interview with Paul English who started Kayak. And one of the things, this really stood out to me, one of the things that he did mid-career, he basically stopped working and cared for his dad who had dementia for a year and a half. He was a full-time caregiver. How many people...

Dr. Brandy Archie
My favorite too.

Emilia Bourland
in his position would do that. But he did it in this way that felt so, it felt so obvious and natural and normalized, which is why like that struck me as we were having this conversation. Anyway, it's cool episode for people if they wanna listen to that. Just plug another podcast here, but sorry. Anyway, getting back to the point. Go ahead, Lisa.

Lisa Kendall
No, you said something so important and it is two ends of that spectrum, right? It's like our internal awareness and sort of local cultural embracing of the idea of caring for each other. And that's the society we want, I think. I think we want to be able to love our neighbor and to take care of each other and to care about.

to care about each other. And then at the other end, there's the policy stuff. So somebody who maybe can't afford to take off 18 months, there are countries that help you with that. And even within the United States, there are policies where folks can be reimbursed if they're the hands-on caregiver for an older relative who needs help.

But there are other places where that's just not available. There are places that specifically say you can't be a spouse or an adult child or a grandchild. You have to be a stranger. So I have nothing against strangers. In my mind, that's extended family that we just haven't met yet. But it seems like a disincentive to helping support family caregivers when we cut them out of these kinds of programs.

Dr. Brandy Archie
I mean, because how weird would it sound if you couldn't use a daycare program in, like, it was like, you can't, somebody else is supposed to take care of your kids. Like, you're not allowed to do it and somebody else is supposed to. Like, we would feel strange about that, right? Like, it's okay to have daycare, but primarily, you're the person doing it, right? Because you're a kid. And so I think that's just another good example of how we've kind of cut that part of our lifespan out of our.

legislation, the way we think about things and the way we set up our society, which makes it seem strange or unique that he took 18 months off to care for his dad, right? I have another question to switch the topic slightly. And that is, since you're talking about like payment and legislation, what if we do one access therapy? Like what are people's options as far as like...

Is it covered by most insurances? Do I need to check? Is it mostly out of pocket? How do I deal with that? Like, what's the logistics around that?

Lisa Kendall
I'm so glad you asked that and I did a little bit of checking because I thought I had heard that recently there was a change in Medicare to expand coverage for the kinds of providers that you could see for therapy. Up until pretty recently, you could see a doctor, a psychiatrist, you could see some nurse practitioners, you could see psychologist or a licensed clinical social worker.

But recently they expanded that to include marriage and family therapists. They're beautifully trained clinicians and also licensed professional counselors. They are now included under Medicare. So if you're older and you have Medicare, you can go for therapy and Medicare will cover it. Let me just say there is a difference between traditional Medicare and the Medicare Advantage plans. Medicare Advantage plans are really like

private insurance. You might have to get pre-approval. You might have your sessions limited. You will almost certainly have a copay for those. But traditional Medicare, when I had my clinical practice up and running, I left it a couple of years ago to do my own care partnering. I love traditional Medicare because there was no limit on the number of sessions. You didn't have to get pre-approval.

Traditional Medicare plus a supplemental plan. So like I have traditional Medicare and I have AARP is my supplemental plan. There's no copay other than the copay you pay at the beginning of the year for all of your care. It is phenomenal coverage for mental health services, also known as behavioral health services. Insurance plans are required to cover it, but you know, there's always these little loopholes, so you want to check.

You might want to check through your, if you are working, your employee assistance program. They have some sessions that can help you. Those are also good for just helping you figure out, you need some longer term therapy with somebody and who can do that? If you are paying out of pocket, you can always ask about a sliding fee scale. Most people are willing to do that. And there are some new models for providing therapy that seem to be helpful for folks that are uninsured or underinsured.

Lisa Kendall
Programs like the online programs. I'm just going to name one. I'm not endorsing it. I don't get a kickback or anything, like BetterHelp is one of the better known ones. I think that's like a subscription kind of a thing. You pay monthly and then you can have sessions that you schedule throughout the month for that service. So those are new kinds of programs. And how you find those is you can call the office for aging.

in any community, they have a mandate under the Older Americans Act to provide information and referral services. If there are clinicians in the community that specialize in aging and elder care issues, they may be able to tell you. There's also on the Psychology Today website, I think it's just psychologytoday.com, you can put in your area.

Nowadays, a lot of people are doing teletherapy. So put in your state if you're willing to do video therapy and your insurance and your issues. And they will sort for you the clinicians in your community that are taking clients. Hospital social work departments are also good resources if you're looking for somebody who knows both

who, if you're looking for therapy therapy, they both know the therapists in the community and folks who may be a little more knowledgeable in aging and elder care issues, disability issues, chronic illness issues. I do want to say that one thing we were talking about earlier is sort of the frustration of the system, right? Probably half of my clients or half of the struggle of my clients in my private practice was

navigating the system and just dealing with health insurance and dealing for their loved one, dealing with the frustrations and problems built into the system. So that's one part of that. And the other thing that I wanted to say about that is that caregivers, now I just lost it. Never mind. I'll come back to it. I lost whatever I was going to say.

Emilia Bourland
Hahaha!

my gosh, that's the story of my life, Lisa.

Lisa Kendall
Story of my life, every five minutes I lose something.

Emilia Bourland
Hey, do have a question for you kind of following up on that. So paying for a therapist is one thing. I think the other challenge that people really have is finding a therapist that they really feel comfortable with and trust. That is so hard, especially when, you know, one of the, it can feel really awkward to sit down with someone you don't know and like, just tell them everything that's going on. That's a big.

barrier and mental hurdle to overcome. do you have any advice to offer in terms of like, how do you find a therapist that's really a good fit for you?

Lisa Kendall
Yeah. I think the first thing is if you're getting word of mouth referrals, that might help a little bit. And just sort of checking in with yourself, do you feel like you would prefer in-person or video visits? Do you feel like you would prefer a male or a female? you need somebody who is LGBTQ plus friendly or allied? It's OK to ask for that.

And it's really OK to ask for a consultation, maybe even 20 minutes on the phone, just to get a sense of the person. And it's OK to go for a visit or two to see if you click. Because usually we have a sense if we like somebody or don't like somebody pretty quickly. And there's no harm, no foul if you just say, I think I'm looking for something else. And that's OK.

You don't have to go back. it's fine. And as a therapist myself, I would love it if somebody would say, hey, I just don't think this will be a fit. I would love more. And I always ask in the first session, can you tell me about previous therapy what worked for you and what didn't work for you? And what are you looking for? And I hope that other therapists are doing something like that themselves.

But you generally get a sense if you like somebody or don't like them or like their style. I like hearing if somebody prefers a more directive approach or if they just want somebody to listen. It helps me know how much to keep my mouth shut.

Dr. Brandy Archie
I'd also throw in there too, that like we've said a couple of times of how challenging it could be to talk to somebody new about really personal issues about yourself and what you're dealing with. But you can also think about it the other way in that this person is unbiased. And so if you have these same conversations with a family member or a friend, they have some form of bias. Either they're on your side because they're your friend and they don't know what's going on in the other parts of your life or they're thinking about,

my, person is having trouble. How can I help them like physically do something now they're feeling sad or less than because you're, you just want to talk about it and they're feeling like they should be doing something about it. And so I personally felt pretty liberated to talk to somebody completely new to me about the things that were going on in my life, because I didn't want to burden anybody else and have any of their biases show up because we have relationship. And so that helped to

it's still like a small bit scary to say things to random people. But as a person who's an occupational therapist and people talk to me about things and I don't know anything about them really, I could tell you that the therapist is just doing their job, you know, essentially, and they're not judging you and people spill all of the things on them all the time and like, this is what they're here to do. So I like to think about it from that angle, because that's a, even though it's scary, it's also still a benefit.

Emilia Bourland
Yeah.

Lisa Kendall
Yeah, thanks so much for saying that because that is one of the biggest reasons to go to a therapist. If you have friends, that's a level of support and friends. I always like to think about the Eden Alternative talks about how care is anyone or anything that helps you grow. So friends that help you grow, great. And they have a role and they have a place.

That's one place in that care partner team that you're building for yourself. And you may absolutely need, and especially for care partners of loved ones, you may need a place where you can say the things that feel too weird or too shameful to say to somebody else. I can't tell you how many times people have said in

confidence and you know things that they feel so ashamed about that really they shouldn't it's normal if they have a loved one who's been suffering for a long long time it's normal to have the thought I I just know that death will be a relief for them and for me that's a normal thought but when people have that thought they feel so much shame about it and being able to talk about that and to get the reassurance

Emilia Bourland
Mm.

Lisa Kendall
that that's okay to have that thought, but to have a place where you can speak it safely and not have somebody feel like you're a bad person, you're a bad partner, you're a bad daughter. That's a powerful thing. And friends have their own experience and biases. Therapists do too, but honestly, they have been trained to not bring them into the therapy room. And when they notice that they might be tempted to do that,

They are supposed to run right to their supervisor and work that out in their own version of therapy. So yeah, they're trained to deal with that stuff, even the stuff that feels taboo. And yeah, you should be able to say anything in there.

Emilia Bourland
Lisa, thank you so much for being on CareLoud again. You are truly like, you're just a beacon of light in the world and we don't have all the answers, but I think that as long as there are Lisa Kendels in the world, we're all gonna be A-okay. So thank you so much for being on again.

Lisa Kendall
Ugh.

What a lovely thing to say. Thank you. Thank you both for having me here. I love talking with you. I love just talking with your audience. And let me know. I'll come back any time.

Emilia Bourland
We would absolutely love to have you. Brandy, you wanna take us home this time?

Dr. Brandy Archie
Yeah, so if you guys made it to the end of this episode, we are so grateful for you. So please also like, subscribe, leave a comment, give us some feedback we want to hear from you and give you content that works for you or that you want to hear from and CareLab a few topics for you. Plus, when you do all of that, it helps other people who need to hear our conversations hear them too. So do that and then make sure you tune in next week for another episode of CareLab.

Emilia Bourland
All right, we'll see you next time right here on Care Lab. Bye.

Dr. Brandy Archie
Bye.

Lisa Kendall
Bye bye.

 
Do us a favor and subscribe to the CareLab podcast on YouTube, Spotify or Apple Podcasts! It will help others find our conversations and grow the community and you’ll stay updated with the latest insights and expert advice on elder care.