About Adam
In a recently published blog, What is Caregiver Guilt?, our team asked the question: Considering all the demands that come with caregiving, who’s caring for our carers?
Adam Birch is among a growing number of professionals in Australia offering support services tailored specifically to the needs of caregivers. He’s spent the past 6.5 years working at Carers WA, a non-profit organisation striving to improve the lives of carers.
As a counselling team leader for Carers WA, Adam provides therapeutic support to caregivers through counselling, workshops, carer support groups and presentations at carers conferences. He has a Bachelor of Psychology degree as well as a Master of Counselling degree, and he’s focused the entirety of his career on community-based not-for-profit agencies.
Ask an Expert: Adam Birch
The CareSide: Is caregiver burnout real? What does it look like?
Adam Birch: Absolutely. Carer burnout may come in many forms, and the most common are physical and emotional fatigue, stripping the person of their usual verve and energy. Often, we can lose our ability to be compassionate because we have spent everything we have to give.
TCS: Caregiving can produce a wide range of emotions — good and bad. What are some of the most common emotions you encounter in carers?
AB: I wouldn’t separate our emotions into good or bad, I would say our emotions are our emotions. They are indicators of what’s going on for us. For instance, I may feel anger towards someone I love because they aren’t listening to me. Social norms may say I should not express this emotion. A result of repressing this anger may mean it blows up elsewhere on someone that wasn’t involved, or it can lead to my own health issues. Now, if we think for a second about why I felt angry, it is because I wasn’t being listened to. So that anger may mean I need to step away for a second until I can collect myself and be present with compassion. Anger doesn’t always mean I need to attack something, it could mean I need distance from the thing that is leading to me feeling that emotion.
The most common emotions for carers I see range from guilt, frustration, overwhelm, sadness, anger, resentment, grief, love, joy, contentment, and even excitement.
TCS: Do you find that guilt is a common emotion among carers? If so, why?
AB: Of course, guilt is ubiquitous among carers because it’s a primary way in which we attach and connect with each other. There has to be some kind of feedback mechanism for us to maintain the relationship so we don’t experience separation or disconnection. Carers often experience guilt when they want to do something for themselves because they ‘should be focusing on the person who is needing care’ or ‘it’s selfish’. If we continue down this path, avoiding the feeling of guilt, we end up burning out and needing to be cared for ourselves. As I mentioned earlier, emotions shouldn’t be avoided—our emotions need our understanding.
TCS: Carers Australia is an organisation that represents and advocates for the country’s unpaid carers. Their data reveals that more than one-third of primary carers have a disability—twice the rate of non-carers. Why do you think that is?
AB: I’m not surprised by that statistic. In fact, I wouldn’t be surprised if the trend continues. Let’s think of caring like this: generally, people who need care have a disability and/or other health conditions which may require a lot of care. The intensity of that care burns people out and, as a result, carers’ own needs end up getting neglected. This neglect often exacerbates underlying health issues. It’s worth mentioning that carers do not do this to themselves intentionally. There is a quote from Viktor Frankl which highlights this feedback loop: ‘What is to give light must endure burning’.
Like burning a candle, caring for others comes at a cost. We provide a warm glow to others; however, in doing so we burn down our own wax.
TCS: When should caregivers seek professional help? Is there a tipping point, and are there signs caregivers can notice before they reach that point so they can remain proactive?
AB: Many carers—especially ones who feel guilty for thinking of themselves—will often put off seeking help because ‘others may need it more’. While we don’t need to compare ourselves in this way, preventative care is best. Rather than waiting to burn out, would it not be better to come in with an open mind about things you may be able to change in your life that may assist you on your journey?
If you are a carer reading this, take time to think about yourself for a second. How is your health? What do you have personal time for? When was the last time you had a break? Don’t be afraid to seek out assistance. Not all support means seeing a professional therapist—local community groups, friends or family, exercise and meditation can be great sources of strength as well.
TCS: Why are you (and providers like yourself) personally invested in the health and wellbeing of caregivers?
AB: Simple: because we care. I’d rather contribute towards a community where people are seen and heard—where their hard work is acknowledged and understood. Carers are often people who go unacknowledged, simply because they are the ones in the background holding everything together.
TCS: How do you approach counselling for caregivers? What is your style?
AB: This is a hard question to answer but I’ll do my best to describe my approach. I would say that I’m a trauma-responsive, interpersonal therapeutic practitioner with a focus on the existential processes of the person. If you remove the fancy words and the jargon, it means I focus on the person and the inter-related systems around them that shape them into the position they are in today. I do my best to listen and understand where they are coming from and where they want to go next.
TCS: A caregiver reaches out and wants to meet with you. However, they’re hesitant because they’ve never done counselling or therapy before. What can they expect to begin with, and how might their treatment evolve over the subsequent weeks and months?
AB: We have an intake process in which people get to say what they’d like to talk about in counselling, select whether they want face-to-face counselling or something over the telephone or the web, that kind of thing. From there we discuss if they are new to counselling, what they might want from the process and if there are aspects of their caring role they would like to change.
Generally, the process is a collaborative one between the counsellor and carer. Sometimes people come in wanting a safe space to talk about their feelings outside of their usual environment and find it useful to have things reflected back so they can determine where they might want to explore next. I strongly encourage anyone who hasn’t been to therapy before to be up-front with what they want and to let their counsellor know if it isn’t working for them. Having counselling sessions doesn’t mean anything is ‘wrong’ with you, it’s an opportunity to open up and explore your needs.
If you don’t want to talk about some things, or if you are worried about how you might be perceived by the counsellor, let them know that and ask yourself what it might mean for you. Over time, carers begin to understand themselves better and work on ways they can make space for themselves in their lives.
TCS: On the topic of reaching out — how can a caregiver go about finding the right therapist for their unique needs and situation? In other words, what qualities do some therapists have that make them good matches for caregivers?
AB: This is a difficult question because finding the ‘right’ plumber, electrician, doctor or any service can be a challenging one. Sometimes you don’t know and you have to take a leap of faith, and if it doesn’t go well, you try again. It helps if people know what works for them and what doesn’t.
For instance, a carer found it challenging to talk to me because I was younger and they weren’t sure if I could empathise with their perspective. However, we continued and in the end, they found it to be an incredibly rewarding experience. Overall, let people know what you need—sometimes adjustments can be made, other times you may need to go with what you have.
In general, carers may be looking for people who understand that sometimes caring isn’t something they can ‘just stop’ or take a break from. A therapist who understands that the carer is their own person—with their own needs—and prioritises those needs whilst keeping the other family members in mind is crucial.
TCS: Can you give us an example of a time when counselling/therapy made a positive impact on the life of a caregiver? What were the primary issues, and what was the outcome?
AB: Here are a few examples:
- An individual was grieving the loss of their partner due to dementia. Through the process of counselling, they began to come to terms with their grief and loss.
- One individual spent their entire life caring for others and always putting their own needs last. Through counselling, they found the strength to advocate for their own needs and scheduled some time for themselves to relax without interruption.
- Another individual was struggling with ‘not letting their parent down’ when they found they needed to place their parent in an aged care facility because of the high needs involved. Although challenging, they were able to accept the adjustment without feeling it was their fault.
Even if there isn’t a tangible outcome, many people find value and positive change in having a space for themselves, where they are seen and heard. That can make a huge difference for many people.
TCS: Counsellors and therapists often emphasise that they have ‘no connection’ to their clients or the people they care for. Can you explain why that unaffiliated third-party guidance is important?
AB: Boundaries are important, and because our relationships with our loved ones can run deep it’s helpful to have someone outside of our usual relationships providing guidance. It is often easier to connect with someone new as you have no prior relationship to be entangled with.
Put it like this: I’m a counsellor, so I make an effort not to counsel my friends and family. A counsellor is there to help you navigate what is going to work for you, and when we don’t have those boundaries we can end up treading on other people’s lives without realising. In general, boundaries like that help keep people safe. It’s important they understand the sessions with their counsellor are confidential, with a few exceptions of course which the counsellor discusses during the intake process.
TCS: Outside of counselling sessions, what are some other tools, resources and organisations caregivers can utilise to help them maintain their own health?
AB: So many other things in life aid us and bring us strength: community groups, sports, social activities, time to ourselves, religion, exercise and outdoor activities. Rather than list more, I would encourage people to search local community directories or health directories for things that may assist. We can get bombarded with what we ‘should’ do to maintain our health—the thing I would like people to do is reflect on what they feel they need the most right now and start there.
TCS: If family members (or friends) are providing care to someone they love and find themselves feeling collectively burnt out, can it be beneficial for them to attend counselling together as a group?
AB: Sure, up to a point. For me, it depends on whether the individuals in the group/family are generally providing a similar level of care and whether they are open to a group process.
For example, I had two family members caring for a parent, yet they had different grieving processes and different experiences about the parent. One was always pitted against the other so the therapy became about resolving conflict rather than jointly working through the burnout. It depends on the people and it depends on the process, it’s not like something can start in this way and move into different spaces. Often you can have two parents caring for a child and they are looking for ways to work together so they can care better. That’s often effective.
TCS: How can caregivers avoid the temptation of comparing themselves and their situation to others?
AB: Drawing comparisons is typical of the human experience. I would say let’s not avoid something that we naturally do, let’s be mindful when it happens and not put as much weight behind the comparison. Focus on you, rather than what others have that you don’t, or extra burdens you have that others don’t. What do you want to do about the things in your life?
TCS: What is one thing you want all caregivers to know?
AB: That carers are valuable beyond belief, and that carers also need care, too.
If carers are interested I recently did a presentation at the Carers Conference 2022 for how carers can stay motivated and engaged. See the link below:
