by Nancy L. Kriseman, MSW
Resistance is a common challenge in caregiving, experienced by both caregivers and care recipients. It often reflects a desire to maintain control and cling to the familiar, especially during times of stress or adversity. Care recipients may resist when they feel their independence is being taken away, while caregivers may feel overwhelmed and uncertain about how to respond. Family caregivers can also resist, especially when there is disagreement about care decisions, leading to conflict and tension.
Care recipient resistance
Resistance among care recipients who are cognitively intact often stems from a desire to preserve autonomy and dignity. It may show up in various ways: refusing to stop driving, declining to move to a retirement community, rejecting outside help, avoiding medical care, not taking medications appropriately, or not allowing others to manage their finances.
Most people fear losing control over their lives. Chronic illness, however, can lead to increasing dependence. Many care recipients equate needing help with losing autonomy and may use denial to hold on to a sense of control.
Family therapists can support autonomy by helping care recipients identify what they can still do and adapt familiar tasks. For instance, a person who enjoys cooking but struggles to stand at the stove might use a tall chair or switch to a crockpot or electric skillet. If driving is no longer safe, suggest ride-share options or hiring a local student to help with transportation.
Many older adults fear becoming a burden, particularly financially. They may downplay or hide problems to avoid worrying their adult children, which can increase their risk of harm. For example, one client didn’t tell his children that his air conditioner had failed. Another skipped meals rather than ask for help with cooking.
Therapists can encourage families to be proactive. Suggest that adult children visit regularly or ask a trusted friend or neighbor to check in. Open, honest communication about concerns, especially about safety and well-being, can prevent avoidable crises.
Older adults, especially those over 80, often guard their financial privacy closely. Conversations about money can feel intrusive or even suspicious, as some worry their children may be trying to control or take their assets. Involving a neutral third party, such as an elder law attorney, accountant, or clergy member, can make these discussions easier. Sometimes an adult grandchild can be less threatening. Family members might also offer to cover specific costs, such as housekeeping, yard work, or minor repairs, to reduce resistance. Some families pay older grandchildren to help with chores, which creates a positive, intergenerational experience.
Change, even when beneficial, can feel unsettling. Many people find comfort in routine, and disruptions to familiar patterns may trigger resistance, even if those changes improve safety or quality of life.
Unfortunately, conversations about care often happen only after a crisis. When possible, initiate discussions before problems arise. Including care recipients in planning helps them feel respected and more in control. If they refuse to talk, try revisiting the subject later or involve someone they trust who is not an adult child.
Caregiver resistance
Caregiver resistance is an often-overlooked yet critical issue in family caregiving. It can take many forms, including frustration, fear, isolation, feelings of helplessness, family conflict, and the overwhelming pressure to “get it right.”
In working with caregivers, I’ve identified a pattern I call entrenched caregiver beliefs: deeply held beliefs that can fuel resistance and increase stress. These beliefs may prevent caregivers from accepting help or recognizing alternatives, even when those alternatives would ease their burden. Because these beliefs are often tied to powerful emotions such as guilt, fear, or filial responsibility, they can be hard to let go of.
Therapists can help caregivers explore these beliefs, uncover the emotions behind them, and begin to shift their thinking. This process can be transformative, allowing caregivers to make changes that protect their well-being while still honoring their role. Recognizing that they don’t have to do everything alone can be empowering and freeing.
When multiple family members are involved in caregiving, conflict is common, especially when there are differing opinions about what kind of care is needed and where it should take place. For example, some relatives may insist the care recipient remain at home, while others advocate for a move to assisted living. Spousal resistance is another layer; a spouse without cognitive decline may reject help or deny the need for change, even if it places their partner at risk. If a competent spouse refuses assistance, families may have limited options. However, if decisions jeopardize the safety of the spouse, guardianship may need to be considered, which is a difficult and often emotionally fraught path. In these cases, family therapy can be invaluable. Conflict is often driven by stress and differing perspectives. Family therapists can help normalize the disagreement by reframing it: Diverse opinions offer more options, not more problems.
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Finding strength in resistance
There’s no denying that resistance, whether from care recipients or caregivers, can be emotionally depleting. Many caregivers admit they’ve felt on the verge of “losing it.” But resistance can also be a pathway to growth. When caregivers and families understand the source of their resistance, it can illuminate what truly matters, what they need to let go of, and where they can find strength and courage.
Family therapists play a vital role in this journey, offering perspective, reducing guilt, and helping caregivers see that they don’t have to do it all alone. Most importantly, it can help restore hope. Even amidst resistance, families can move forward together with greater clarity, compassion, and connection.
Nancy L. Kriseman, MSW, is an Atlanta-based geriatric social worker with more than 30 years of experience providing counseling, consultation, and training to family caregivers, eldercare service providers, long-term care communities, and national aging organizations.
To find a therapist, please visit the Psychology Today Therapy Directory.
