Giving caregivers the tools to cope

This article is part of Public Health in Action, a new series from Harvard Public Health and The Studio that examines mental health programs across the U.S. that produce results.

I am a clinical supervisor at the Inland Caregiver Resource Center, a nonprofit social services agency that works with senior citizens and with family caregivers who tend to be seniors, mostly 60 and older. Some of them are experiencing a difficult transition to retirement or stresses from downsizing and moving to new homes. They are often in the “sandwich generation,” new to being a caregiver, and have limited resources.

We work with people in their homes or meet them at community centers. We see a lot of caregiver burnout—people so busy taking care of a loved one that they don’t have time to care for themselves—and signs of depression. We wanted to address these issues, and PEARLS had a model for helping people problem-solve and improve well-being. It seemed like a natural fit.

PEARLS gives people techniques to break down problems into pieces they can resolve. They often recognize a change in their mood—they’ve felt down or in a funk—and can identify what is causing that shift. We work with seniors to teach them the model, which gives them a sense of control: They can decide and have say so over their problems. One key skill for people is learning how to slow down their thought processes and focus on each part of the model. You’ll see it click for them once they understand it.

We use the language of caregiver burnout to start conversations because there is often stigma around mental health services. If you ask them, “Are you depressed?” they’ll say, “Whoa! I’m not depressed.” But they are used to hearing about caregiver burnout, so we ask them, “How is your burnout presenting itself?” They might say it’s affecting their sleep or they’re overeating or not eating.

I was in the first group at Inland to train with PEARLS; we were three counselors and a supervisor, as well as a few other staff members. It’s a very structured program—there’s lots of tracking, and lots of paperwork; the training was intense, comprising two 8-hour days. It was all in English, and we work with a population that is majority Spanish-speaking. So the first couple of years we were building the plane while flying it: We had to figure out how to translate the materials, or how to adapt the parts of the program where people have to write, since some of our clients aren’t literate. The PEARLS team has monthly calls where we could check in and ask questions, and the team was flexible and encouraging, telling us it was ok to translate their materials.

The translation work wasn’t always straightforward: For instance, do we say “perlas” for “PEARLS?” Because it’s an acronym. When we translated the Patient Health Questionnaire-9, a standard tool for measuring depression, we had to decide what Spanish word to use where the questionnaire says “down, sad, or hopeless.” “Sad” in English translates to “desanimado,” but I wanted to go to “triste,” which is more down to earth, more “home Spanish” than formal Spanish. It’s a word that resonates with people. It took a while to translate the practices, too—to develop techniques to work with monolingual Spanish speakers. We were seeing successes with our English-speaking or bilingual population, so we knew it was working.

We have found that because our titles are “PEARLS counselors,” people think it is counseling or talk therapy. This is not talk therapy. We also don’t do what social workers often do, which is give people answers. We might spend an hour talking through a situation before the real problem comes out. That can be discouraging for people; they’re hoping you will give them resources, and we’re working to get them to find their own solutions.

Many of our seniors are in our programs because they are caring for a loved one. If they’re doing PEARLS when that loved one passes away, it makes a world of difference for them. They have rapport with their PEARLS counselor, which gives them support. They also get to prioritize problems to work on and talk through things like managing the process, allowing for grief, or making room for self-care and compassion.

I really love it when they have what I call the “lightbulb moment,” where they start doing things they enjoy again.

Top image, source image: FG Trade / iStock

Jennifer Lopez: Courtesy of Jennifer Lopez