Avoiding Power Struggles

BY ARLENE HARDER, MA, MFT

In You and Your Loved Ones Aren't Mind Readers I discuss the importance of listening to your loved one. However, one of the most difficult parts about listening is that you may hear some things you don't want to hear (which may be one of the reasons a lot of people don't listen well). When you learn something you aren't prepared to deal with, however, you then have to decide how you will respond.

For example, you may learn that your loved one is very angry. There are certainly lots of reasons why she may be angry. The diagnosis of a terminal illness complicates daily existence as almost nothing else can. This anger may be directed at God, at others she blames for her condition (such as an employer who exposed her to hazardous chemicals that she believes responsible for a cancer) or at an older brother who introduced her to smoking when she was a teenager. Her anger may even be directed at you, her caregiver and the person who most wants to be her advocate. Consequently, although you may realize that anger is a common response to her diagnosis, trying to "calm her down" may exacerbate the situation if she feels you are trying to discount her feelings. Soon you are off and running in defense of your position and anything you say becomes tinder that ignites a new response of you-don't-understand-me, which may then be translated into you-don't-support-me — which is exactly what you hadn't intended.

Another way you can get into a power struggle is to do what many of us have a tendency to do when a loved one has a serious illness. We try to handle our own fear by attempting to control that person in those areas we believe will help her survive. Of course, we don't see our overt or subtle power struggles as a consequence of wanting to "control" the other person. We're just "giving helpful advice" or "protecting" the other person. For example, it's easy to become a nag when your loved one ignores the doctor's advice or abandons a treatment program, especially if you firmly believe that she would feel much better (and perhaps even recover entirely) if ONLY she would carefully follow the doctor's recommendations — and yours.

We realize that it is difficult to walk the fine line between encouragement that can result in having her take better care of herself and pushing your agenda to the point that you become adversaries. Therefore, if you suspect (or have been told) that you've a bit over-protective, or if you frequently find yourself in a power struggle with your loved one, we offer a few suggestions.

Your Job is to Love This Person

Always remember that your loved one, not you, has the disease. While she may appreciate your help and support, she is the one who knows how much pain and discomfort she can handle and what treatment feels right to her. It's her life. Therefore, the very best way to avoid power struggles is to realize that your job is to love this person whether or not she abides by your way of doing things. Your job is to love this person whether or not her emotional reactions are the same as yours would be under the circumstances or whether or not they are expressed as you would express them.

Never Assume Anything

If you are at odds over a particular issue, take time to notice if your assumptions are showing. For example, what might happen if your loved one doesn't follow the agreed-upon treatment plan? If you assume she has stopped because she is giving up and is afraid to say so, you may put your effort into giving her all the reasons why she should continue and how you don't want her to give up. It may simply be that this is the only way she can assert some independence in a life that seems to be out of control. Or it could be that the side effects of that particular treatment are more than she is willing to tolerate. Each specific reason requires a different kind of support and response from you. As we discussed in our introductory article on communication, gently probing for the reason is a lot better than assuming. It's also a lot easier on your relationship than nagging. When you understand what is behind the resistance, you can work together toward more realistic goals.

Advice Can Only Go So Far

What can you do when your loved one wants to follow a therapy you believe is not going to work, at least not as well as she hopes it will? In any situation it is hard to support someone when you believe that person is making a mistake. Nevertheless, while there is no guarantee that the therapy she wants to try, whether traditional or nonconventional, will be successful, it is her right to receive any available therapy she believes will work. [See A Cancer Patient's Bill of Rights.] At the same time, you certainly have a right to express your opinion. Therefore, after you have reviewed all the evidence you can possibly find, tell her, as objectively as you can, what your position is. Then be quiet. The decision is up to her. You don't need to be enthusiastic in your support, but it won't help her if you keep harping on the issue. Besides, it is possible that she may even survive in large part because she chose this particular therapy.

Anger and Other "Negative" Emotions Are Common and Essential to Health

If you were raised in a family in which strong emotions were not acceptable, you may not be prepared for the impact of your loved one's reaction to cancer, especially anger. In later articles in CancerOnline we will discuss emotions in greater depth. Here we will just remind you that anger may be the way your loved one defends herself against the stress of her diagnosis. If you too readily dismiss her anger, or if you assume you understand why she is angry, you may not discover a very a legitimate cause for which you can do something. Most of all, however, we would like to point out that research has indicated that persons who respond with anger and assertiveness tend to have longer survival rates. Your loved one doesn't have to be aggressive, but a good dose of assertiveness (even if fuel by anger) can actually help her improve her quality of life.

A Little Patience and Goodwill Can Go a Long Way

If you take a closer look at your disagreements, you may discover that many power struggles are related to temperament traits and other personality characteristics (either yours or hers) that have gotten you both into trouble long before cancer entered the picture. Perhaps you have a need to prove you are intelligent. Perhaps she has a tendency to jump to conclusions. None of these old communication patterns are going to help you both get through treatment and beyond. In fact, now may be the time to develop some new, positive communication skills. You can start with the decision that when you catch yourself being impatient, sarcastic or giving a lot of advice, you will take a ten-minute break. It is more important (and more effective in the long run) to handle your own impatience rather than trying to change your loved one.

Therefore, we end this article with a final suggestion. Remember that kindness, patience and love will defuse almost any power struggle. If you both make a commitment to express these qualities, your relationship will be strengthened for whatever you have to face on your journey with cancer.

©1998, Revised 2002, Arlene Harder, MA, MFT

ANOTHER ROAD TO TRAVEL

If you and your husband have celebrated anniversaries for a quarter century or more, you have undoubtedly survived a few crises along the way. When your spouse is diagnosed with a serious illness, from stroke to cancer, you may realize that this new situation is something you didn't want but, like those other crises, you will face together, even if the diagnosis is not good. If you are newly married, you have had the rug pulled out from under you just as you're beginning to adjust to one another. If you recently started what you hoped would be a good friendship with someone who now has been given the diagnosis of a disease with an uncertain outcome, the difficulty in building a deeper relationship under these circumstances may tempt you to withdraw.

No matter how long your relationship has lasted, it is not surprising that the diagnosis of a life-challenging illness creates distress precisely because it threatens the physical and emotional foundation of a relationship on which you depend for nurturing love and support. Nevertheless, while you may not appreciate it at this time, these illnesses often provides a catalyst for working on issues that would otherwise get shoved under the rug. In fact, the Chinese character for crisis, as you may have heard many times, contains symbols both for "danger" and for "opportunity." You can choose to view this crisis either as a threat to your relationship or as an opportunity to strengthen it.

Therefore, in many ways the experience you are going through is like a journey that requires your relationship to take a detour, to travel along another road. There are, of course, detours in almost all relationships, although in this particular one the road may be a bit rough. However, when you must go someplace you didn't plan to go, sharing the trip with someone you love not only helps, it can also enrich and expand your life in ways you never expected.

As you first begin dealing with the reality that illness has intruded into your life, your attention is focused on decisions and arrangements for treatment. All your energy goes into adjusting daily life so you can take care of what must be taken care of.

After a while, however, unfinished personal business and differences of opinion start to intrude. Imagine, for example, that a timid woman who, shortly before her husband's diagnosis of colon cancer, was just beginning to be assertive. Now she feels she doesn't dare state a counter opinion because she is afraid her "negativity" will distress him. It may not be many months, however, before her resentment in always "giving in" builds to the point that either she blows up inappropriately or turns her stress inward and develops a physical problem.

In other words, after awhie, you will discover that you and your partner or friend are pretty much the same people you were before the diagnosis. You each carry your personality styles, coping skills and individual temperaments wherever you go. If your loved one tended to be quiet and submissive prior to illness, you may need to encourage him to stand up for his rights as a patient. If he was stubborn, argumentative and loud, you'll probably need to smooth the waters when he gives the doctor and nurses an unnecessarily rough time.

There will be many problems revolving around the illness itself. However, other issues will arise that have nothing to do with illness. Consequently, sometimes you will need to adjust your reactions because of illness and others times in spite of it. The trick is learning to recognize the difference.

In this regard you are fortunate if you have had a good experience with a counselor and know the value of talking out your issues with a professional or trained peer counselor. An objective therapist, especially one who knows the dynamics created by life-challenging and chronic disease, can help you sort out your feelings so you don't either get buried under a not-uncommon load of caregiver's anger, anxiety, guilt, blame, fear, resentment, bitterness and regret — or dump all of that on him.

©1997 Arlene Harder, MA, MFT, Revised 2002