Setting Limits...
By: Patty Levell,

Caregivers often get swept into meeting other's needs at the expense of themselves, without even realizing it. This cannot be sustained for long before your ability to cope begins to diminish, to the detriment of all parties involved. Fatigue, sadness, anxiety, increased levels of frustration make their way into your life. Often, those who are taken care of can become unrealistic in their requests and fail to recognize the caregiver's needs. To avoid this situation, it is important that caregivers protect themselves by establishing limits on what they are willing to do and the behaviors they are willing to accept.

Establishing limits is a two-part process.

First, carefully consider what your own needs are in terms of personal time, physical self-care, psychological self-care, entertainment and efforts with your loved one. Are you currently fulfilling these needs as you wish? Recognition that you have the right to meet your needs is vital to your ability to establish limits. You need to consider which of your loved one's needs or wants you are willing to meet yourself. Oftentimes, caregivers forget that they have a choice. For example, they may feel guilty if they don't cook for the ill individual all the time. They may fear the ill member's anger if they don't provide money for them. They may believe that their loved one's bedroom won't get cleaned, or be cleaned well enough if they don't do it themselves.Eventually you may just be feeling too tired to even fight about it. If you are over-extending yourself you may be giving your loved one's needs and wants too much emphasis at the expense of your own. Setting limits on your actions and on the behaviours you are willing to accept from your loved one is the change you need to put in place in order to strike a healthier balance in your life. The decision to apply more limits is only half the job.

The second part of the task involves encouraging your loved one to avoid undesirable behaviors in place of more favourable ones and respecting your own boundaries. This request for change can be challenged by your own feelings of guilt, fear and protectiveness...What is important is that you evaluate your expectations and make sure they are realistic. It is also important to convey your confidence in your loved one's abilities. Communicate to them that their mental illness does not completely alleviate them from your expectations of acceptable behaviors at home and in society at large. Now is the time to set out explicit guidelines detailing your expectations and seek out creative solutions in order to avoid assuming all of their needs.

Here are some guidelines to follow for setting limits:   

Take time to look at the problematic behaviors (violence, sleeping patterns, isolation, messiness, drug use, failure to seek-out/follow treatment, rudeness, etc). Now divide them into 3 categories:

a) absolutely unacceptable (i.e. violence),

b) those you require a change in ASAP, the important goals (i.e. following treatment)

c) those you would like to see change in but can live with for the moment (i.e. messiness).

At this point, consider what impact these behaviors have on yourself. Are you in physical or psychological danger if the behavior in question continues? What is the stress it places on you and your family? Take into account how your loved one would cope in the event that you are no longer able to care for them. Think about how you can encourage their cooperation.  

Having taken the time to seriously consider the behaviors in question, come to a decision about what new limits need to be established with your loved one. Recognize that following through on communicating your expectations will demand your commitment and your energy. Initially, focus on one behavior or perhaps a few so as to promote success. You need to be strategic in choosing what to focus on.   

In order for individuals to make change in their behavior, a concrete plan needs to be set in place. All parties need to understand the behaviors expected and the consequences that follow, should they not be fulfilled. The plan may be more effective if it is put in concrete terms in the form of a contract developed with your loved one. Think carefully about the choice of the consequences, since they may need to be implemented. If possible, set « natural » consequences that follow from behavioral transgressions. For example :  physical violence could naturally result in the individual having to face the authorities, and messiness could result in excess articles being removed so that the room could be kept clean. 

Follow through with the contract. If the behaviors are changed, then great! If they are not, be sure to follow through on the pre-determined consequences. Take time to evaluate progress and acknowledge the changes that are made to give your loved one ample motivation to continue working towards improving themselves, modifying their behaviors and further establish their autonomy.  

Establishing limits both in terms of acceptable behavior and what one is able to do can be a great challenge. What limits to set is seldom crystal clear, and one's instinct is often to provide help whenever possible. It is important to realize that sometimes helping does not help, even though it may be very uncomfortable to not come to the rescue. Also you may need to keep in mind that failure to help yourself first may eventually result in you're being unable to assist your loved one. In the end, limits help everyone.