Caregivers: Valuable Assets for Society

‘My mother-in-law is suffering from dementia. I have been taking care of her since a long time and I feel very good about it. But I admit that it is exhausting. It has been months since I have gone to meet my relatives or friends, or seen a movie. How can do that? What if something happens when I am away?’     


Imagine someone saying this. Imagine who that person could be. More often than not, you’ve thought of a caregiver.

In our society, each of us knows of at least one person in a similar situation. Caregivers turn into indispensable assets for society. Till a few years ago in India, families refused to send their relatives to geriatric centers, hospices, and centers for children with disabilities. Family members mainly fall under the category of ‘informal caregivers.’ With the development of institutions and long-term stay facilities, the staffs of such institutions are also included in this category, specifically as ‘formal caregivers.’ As health care professionals, it is not only important to deal with the stresses of individuals suffering from physical or psychiatric problems but also with the stresses of caregivers.

A caretaker’s daily life is filled with tension, conflicts, and anxiety, accompanied with a variety of emotions. Long-term impact includes caregiver’s burden, that is, sleep difficulty, depression, anxiety, and loneliness. The experience of caregiving tends to be a chronic stressor  (Bevans & Sternberg, 2012). Daily hassles in a caretaker’s life include providing assistance with transport and mobility, managing schedules for medication, and communicating with medical professionals. It also requires being vigilant about signs of any health scare, motivating the ones they take care of, and facing financial issues. The demands of caring can lead to restrictions on other areas of life including work, social functioning, thus reducing the quality of caregivers’ lives.

Caregivers are impacted psychologically, emotionally and behaviorally. Their thoughts are constantly focused on the health of the patient. This can lead to psychological morbidity which would further lead to poor bereavement outcome (Addignton-Hall & Ramirez, 2006). It is also likely for caregivers to develop depression and anxiety due to constant hypervigilance toward those under their care. Emotions of guilt, fear, and sadness are most common amongst caregivers. Lack of recreation further adds to the development of health complications. Other risk factors include hours spent in caregiving, social isolation, and psychological factors of the patient (Adelman, Tmanova, Delgado, Dion, & Lachs, 2014). When caregivers undergo so many problems, why are they a neglected sector in health care?    

First, it is assumed that caretaking is a responsibility or duty which has to be fulfilled whether the caregiver is a family member or a professional. If they complain, they are ridiculed and reminded about this ‘responsibility.’ Second, caregivers are susceptible to feel guilty when they prioritize their own problems over the patient’s problems. Third, their problems are always compared to what their patients are going through and are brushed off as minor stresses. Their thoughts and emotions are rarely taken into consideration unless they develop psychological symptoms which hamper their caretaking tasks.

Given the stressors outlined above, why do people choose to be caregivers for their relatives or volunteer for a career in caregiving? Caregiving is viewed as a noble deed in society. The motivation may not be monetary benefits, praise or recognition. It is the satisfaction and pleasure they experience that is often highlighted. Although it involves many stressors, the positive responses from the patients is the main reinforcement for caregiving behavior. They can be compared to backstage workers of a play, who silently strive to make the actors look good and the play to become a success. The play can collapse in their absence. In my experience as a Clinical Psychologist, I have often realized how the absence of a ‘caring’ caregiver can hinder the improvement of patients and how resolving caregivers’ stress can accelerate the patient’s progress.

Once in a lifetime, every individual faces the opportunity to be a caregiver – by choice or by design. It is important to make this opportunity less stressful by acknowledging that it is not an easy task, appreciating their effort and involvement in caregiving, and reminding them that their life and health are not to be neglected. It is important to assess them psychologically to prevent burnout  (Coping with Caregiver Stress and Burden, 2015). As professionals, providing them with the appropriate information about the diagnosis as well as a realistic prognosis would be beneficial. For formal caregivers, job satisfaction and job stress must be assessed at frequent intervals. Self help  (Caregiving Support and Help, 2015) and support groups have also been found to be helpful.       

Rupa Kalahasthi

Broken Crayons Still Colour

My journey with visual art therapy began three years ago during a workshop when I first met Susan Bolluogh Khare, a strong advocate of person-centred art therapy. Her exhibition in Pune on The Therapeutic Value of Art showcases the role of creative art in the therapeutic process.

One’s expression through art is used to address both psychological and emotional needs of the person in visual art therapy. According to Khare, it is the artistic process that is more important than the final product. Visual art therapy uses art as a medium for expressing oneself through a creative process on the path toward self-awareness. According to Cathy A. Malchiodi in her book Expressive Therapies (2005), art therapy uses traditional psychotherapy and its techniques in union with the creative process to improve one’s psychological health and wellbeing.

During her workshops, Khare urges participants to explore the art medium slowly in the beginning, by letting them to express their feelings through lines and colours. Subsequently through active imagination or the introduction of themes, art therapists like Khare help clients explore emotions like fear, anger, and sadness to get in touch with their senses. Extending emotions to cognition, Lusebrink (2004) explored the relationship between art expression and functions of the brain. The sensory processes involved while making art activates different brain regions, and the expression of art stimulates the kinaesthetic and visual senses in the brain before processing the information through cognition. By letting clients evince themselves through art, they may come to terms with difficult thoughts or feelings that may be at the root of their problems and explore ways to cope with them.

As an art therapist, one is skilled to identify the nonverbal representations and analogies that are communicated through the art form, which might not be as easily expressed in words. Riley (2001) has also shown that many adolescents are more comfortable expressing themselves with visual art than talking about their feelings. Khare emphasizes on the interpretation of the art by the person, who gives it meaning, as opposed to the therapist explaining the piece as followed in traditional projective techniques.

Art as therapy can be employed as a clinical intervention and is effective in treating a variety of symptoms in diverse populations. Creating art as a process in the therapeutic environment offers opportunities for counsellors to build relationships with the client and explore areas that arise from the client’s artwork. The integration of art therapy and solution-focused treatment has proved effective for substance abuse as it blends cognitive and perceptual strategies (Matto, Corcoran & Fassler, 2003). Research by Northwestern Memorial Hospital (2006), found that art therapy allows cancer patients to focus on something positive and gives them something they can control. Thus the process involved in making art is not only therapeutic but helps improve their quality of life and boosts their abilities to cope with stress.

Chapman et al. (2001) found that children receiving art therapy treatment experienced a reduction in acute stress symptoms and Gussak (2009) showed that art therapy greatly improved the mood of inmates by helping them shift to an internal locus of control. Creating art together brings a different synergy to a group and provides the therapist with insight into group dynamics. As prolific as art therapy is in groups, it can also be effectively used in a one-on-one format for personal development, self-exploration, and an in-depth understanding of one’s persona.

Pablo Picasso once said that “Art washes away from the soul the dust of everyday life.” According to Khare, only when we are comfortable working with art as a medium and have explored our personal issues through art, will we be able to effectively work with others. Art therapy is truly an opportunity to explore oneself and develop skills of acceptance and empathy for the people with whom we interact in our daily lives.  

Nikita D'Souza