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The experiences of mid-life daughters who are caregivers to their mothers : a phenomenological study King, Mary Tiara (Ti) 1990

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THE EXPERIENCES OF MID-LIFE DAUGHTERS WHO ARE CAREGIVERS TO THEIR MOTHERS A PHENOMENOLOGICAL STUDY By MARY TIARA (TI) KING B .Sc .N . Lakehead Univers i ty , 1986 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in THE FACULTY OF GRADUATE STUDIES (The School of Nursing) We accept th i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA August 1990 © M a r y T iara (Ti) King , 1990 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of Nursing The University of British Columbia Vancouver, Canada DE-6 (2/88) ABSTRACT Many m i d - l i f e daughters are primary caregivers to the i r e l d e r l y mothers. However, in most research studies daughters have been grouped with other caregivers; thus, the daughters' experiences have not been s p e c i f i c a l l y i d e n t i f i e d . Without th i s information nurses w i l l be unable to adequately a s s i s t m i d - l i f e caregiving daughters to a t t a i n the i r optimal levels of hea l th . The phenomenological research method was the methodology used to e l i c i t the experiences of the m i d - l i f e daughters. The phenomenological method was congruent with the feminist perspective - - the conceptual framework - - which guided the study. The feminist perspective e lucidated the importance of e l i c i t i n g not only the v i s i b l e caregiving experiences of the m i d - l i f e daughters, but also the ir in terna l experiences — the ir fee l ings — and the meanings they gave to the i r experiences. The researcher recru i t ed subjects for the study through a daughters-of-aging-parents program which was held at the Women's Resource Centre in Vancouver, B r i t i s h Columbia. In order to c o l l e c t the data, the researcher interviewed the subjects . Congruent with the phenomenological method, data c o l l e c t i o n and data analys is ran concurrently throughout the study. The conclusions that the researcher drew from the f indings of th i s study include the fo l lowing: at the s tar t of a caregiv ing daughter-mother r e l a t i o n s h i p , a daughter is very responsive to the needs of her mother; when a daughter r e a l i z e s that she is s e l f - s a c r i f i c i n g herse l f in order to care for her mother, she becomes less responsive to her mother's needs and focuses, instead, on caring for herse l f ; a daughter who is able to ident i fy her own needs and then act on them Is able to care for her mother and herse l f in a manner that meets both the i r needs; a daughter experiences a number of emotions while providing care for her mother; a daughter uses the l o g i c a l process of working towards healthy d i f f e r e n t i a t i o n in order to counterbalance her emotional r e a c t i v i t y , and a daughter who success fu l ly counterbalances her emotions with log ic discovers her basic s e l f and becomes an e n t i t y d i s t i n c t from, yet interdependent with, her mother. iv TABLE OF CONTENTS Page ABSTRACT i i TABLE OF CONTENTS iv LIST OF FIGURES v i i ACKNOWLEDGEMENTS v i i i CHAPTER 1: INTRODUCTION TO THE STUDY 1 Introduction 1 Background to the Problem 1 Conceptualization of the Problem 8 Problem Statement 10 Purpose of the Study 11 Research Question 11 Definition of Terms 11 Mid-Life Caregiving Daughter 11 Caring 11 Experiences 12 Enculturated Individual 12 Assumptions 12 Limitations of the Study 12 Summary 13 CHAPTER 2: LITERATURE REVIEW. . 14 Why Examine the Experiences of Mid-Life Daughters Who Are Caregivers 14 Research Studies Which Address -the Experiences of Mid-Life Daughters as Caregivers 18 Final Theoretical Summary 26 Summary 28 CHAPTER 3 : METHODOLOGY 29 Overview of Researcher's Use of the Phenomenological Research Method - A Qualitative Approach 29 Selection of Participants 33 Selection Cr i ter ia 33 Subject Recruitment 34 Characteristics of Participants 36 Data Collection and Analysis 37 Data Collection 37 Data Analysis 39 Ethics and Human Rights 40 Summary 41 CHAPTER 4: RESEARCH FINDINGS 42 How the Caregiving Relationship Begins 45 The Outer-Centered Point on the Continuum of Care.. 47 V Knowing Mother and Her Needs 48 Responding to Mother's Needs . . . . . . 50 Deferring to Mother's Needs 53 Summary. 55 The Transition Phase Between the Outer- and the Inner-Centered Points on the Continuum of Care 55 Inner Confl ict , Emotional Turmoil, and Distancing 56 Hitting the Wall 61 Summary 6 2 The Inner-Centered Point on the Continuum of Care.. 62 Recognizing My Fantasies 63 Grieving For My Fantasies 66 Identifying My Needs 69 Summary 70 The Transition Phase Between the Inner-Centered and the Ethic-of-Care Points on the Continuum of Care 71 Action on Needs 72 Inner Conflict Generated by Action on Needs... 75 Summary 76 The Ethic-of-Care Point on the Continuum of C a r e . . . 77 Summary 82 The Logical Process of Working Towards Healthy Differentiation from Mother.. 83 Gaining Control Over My Emotions 83 Techniques Used to Gain Control Over Their Emotions. 8 3 Resources Used to Gain Control Over Their Emotions 86 Systems Used to Gain Control Over Their Emotions 87 Outlets Used to Gain Control Over Their Emotions . . 88 Summary 88 Managing Challenging Situations 89 Techniques Used to Manage Challenging Situations 89 Resources Used to Manage Challenging Situations 92 Unsuccessful Attempts at Managing Challenging Situations 92 Summary. 9 3 Legitimizing Mother's Behaviour 93 Using History to Legitimize Mother's Behaviour 93 Using Generational Trends and Expectations to Legimitize Mother's Behaviour 95 Using Multigenerational Effects to Legitimize Mother's Behaviour . . . . . . . . 96 Using Recent Losses to Legitimize Mother's vl Behaviour 96 Summary. 96 Learning About and Understanding Mother and Self 97 Summary 101 What Faci l i tates the Daughters in Their Caregiving Role 102 Faci l i tators that Centered Around Mother.. 103 Faci l i tators that Center Around Daughters and Mothers 104 Faci l i tators that Center Around Daughters 106 Faci l i tators that Center Around Others . . . . 108 Summary 110 CHAPTER 5: DISCUSSION '* I l l Conceptual Framework I l l Inner Conflict and Turmoil and Health-Promoting Behaviours 113 Role Transition and Reversal as a Source of Inner Conflict 114 A Daughter's Perception that Her Mother Should Contribute More to the R e l a t i o n s h i p . . . . . . 116 Intergenerational and Personal Differences in Attitudes and Values 118 The Logical Process of Working Towards Healthy Differentiation From Mother 122 Summary 138 CHAPTER 6: SUMMARY, CONCLUSIONS, AND IMPLICATIONS FOR NURSING 140 Summary of the Study 140 Conclusions 144 Implications for Nursing 145 Implications for Nursing Practice 145 Implications for Nursing Education. 148 Implications for Nursing Research 150 Summary.. 151 REFERENCES 152 APPENDICES 160 Appendix A: Letter of In i t i a l Contact 161 Appendix B: Trigger Questions 163 Appendix C: Participant Consent Form 164 v i i LIST OF FIGURES Figure Page 1. The Continuum of C a r e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 s v i i i ACKNOWLEDGEMENTS I would l i k e to thank the very spec ia l women who took part in th i s study. By e luc ida t ing the ir own l i v e d experiences so openly and a r t i c u l a t e l y , they have i l luminated and enhanced the l i f e experiences and the understanding of those around them. In add i t i on , these women have reaffirmed my b e l i e f in the complex nature of the informal caregiving r e l a t i o n s h i p . I would also l i k e to extend my thanks to the members of my thesis committee - - C h a i r p e r s o n and Professor A l i son Rice , and Professor C l a r i s s a Green, and Professor Carol J i l l i n g s — for sharing the ir very profess ional expertise with me, and for the i r ongoing in teres t , excitement, and support during the completion of th i s pro jec t . CHAPTER I INTRODUCTION TO THE STUDY Introduction In the near future, the number of Canadians 65 years of age and over w i l l increase dramat ica l ly , and the majority of these older ind iv idua l s w i l l be women who are l i v i n g alone. As women advance in age, they commonly need some support in order to remain l i v i n g in the community, and the majority of th i s support i n v a r i a b l y comes from informal sources, such as family and f r i ends . However, l i t t l e research ex is ts about tht experiences of informal careg ivers , s p e c i f i c a l l y , of the mid-l i f e daughter who provides care for her aging mother. There is need for research in t h i s area, because the m i d - l i f e daughter-mother caregiv ing re la t ionsh ip is more common than any other intergenerat ional informal support system (Fischer , 1986; Brody, 1981; Horowitz, 1981; Mederer, 1982). In order to expand our understanding of the experiences of m i d - l i f e daughters as careg ivers , we need to gain a better understanding of the perspectives of m i d - l i f e daughters. The aim of th i s study is to examine the experiences of m i d - l i f e daughters who are caregivers to the ir mothers. Background to the Problem Between 1981 and 2031 i t is predicted that the number of Canadians 65 years of age and over w i l l increase from 10% to 21% of the t o t a l population ( C o r e l l i , 1986). Most very old people are women (Brotman, 1982) . Current ly a woman of 65 2 years can expect to l i v e for 19 more years; a man can expect 15 more years of l i f e (Hees, 1987). Therefore, women outnumber men in the older population and the r a t i o of women to men widens with age (Ory, 1985). At age 75 years and over women outnumber men by 180:100, and at age 85 years and over the r a t i o i s 229:100 (Brotman, 1982). Since they outnumber men, older women are more l i k e l y than older men to be widowed and, because most older people and the i r ch i ldren prefer independent l i v i n g arrangements, nearly 50% of older women over 75 years of age l i v e alone (Ory, 1985). Although most seniors do not require any spec ia l health serv ices , some need assistance to enable them to continue to l i v e in the community, while others have needs which can only be met in i n s t i t u t i o n a l set t ings (Van Home, 1986). In the community, informal or family support systems provide more assistance to elders than do formal or profess ional organizat ions . Estimates suggest that 80% of a l l care provided to e l d e r l y members of soc iety comes from informal sources, such as family and fr iends (Chappel l , S t r a i n & Blandford, 1986). Of the elders who receive formal or profess ional care, 80% receive informal care as well (Chappell et a l ) . Over the next 40 years the number of e l d e r l y people with a c t i v i t y l i m i t a t i o n s w i l l double, r e s u l t i n g in an even greater need for both informal and formal care services (Ory, 1985), 3 T h i s growth w i l l put even more p r e s s u r e on i n f o r m a l and formal care p r o v i d e r s . And, wi thout the care g i v e n by i n f o r m a l suppor t sys tems, many more e l d e r l y people w i l l p r o b a b l y be f o r c e d to leave t h e i r homes and enter i n s t i t u t i o n s (Brody, 1981; C a n t o r , 1980; Shanas, 1979). T h i s move may serve to p l a c e even more p r e s s u r e on the a l r e a d y s t r e t c h e d formal care sys tem. In a d d i t i o n , t h i s move may push many e l d e r s to d e s p a i r . However, i t i s important to r e a l i z e t h a t the f u n c t i o n s s erved by f a m i l y members i n the i n f o r m a l system cannot be r e p l a c e d by i n s t i t u t i o n s i n the formal system ( L i t w a k , 1985). P o s s i b l y because they r e a l i z e t h i s , many c h i l d r e n , as c a r e g i v e r s , go to g r e a t l e n g t h s to a v o i d the i n s t i t u t i o n a l i z a t i o n of t h e i r e l d e r l y parent s (Shanas & Maddox, 1976; Robinson & T h u r n h e r , 1979; York & C a l s y n , 1977). The f i l i a l r e s p o n s i b i l i t y i n h e r e n t i n i n f o r m a l systems emerges from the c o n t i n u i n g attachment of the c h i l d r e n to t h e i r parent s and from c u l t u r a l e x p e c t a t i o n s . I t i s not s u r p r i s i n g , t h e n , t h a t w i t h i n the i n f o r m a l suppor t sys tems, c a r e g i v i n g i s more l i k e l y i n the mother-daughter r e l a t i o n s h i p than i n any other i n t e r g e n e r a t i o n a l r e l a t i o n s h i p ( F i s c h e r , 1986; Brody , 1981; H o r o w i t z , 1981; Mederer , 1982). Chodorow (1974), when d e s c r i b i n g t h i s mother-daughter at tachment p r o c e s s , s t a t e d t h a t w i t h i n any g i v e n s o c i e t y , f emin ine p e r s o n a l i t y comes to d e f i n e i t s e l f i n r e l a t i o n and c o n n e c t i o n to o ther people more than does mascu l ine 4 persona l i ty . S p e c i f i c a l l y , mothers tend to experience the ir daughters as more l i k e , and continuous with, themselves. Correspondingly, g i r l s , in ident i fy ing themselves as female, experience themselves as l i k e the i r mothers, thus fusing the experience of attachment with the process of i d e n t i t y formation (Chodorow, 1978). G i r l s have a basis for empathy b u i l t into the i r primary d e f i n i t i o n of s e l f ; a g i r l has a strong basis for experiencing another's needs or feel ings as her own (Chodorow, 1978). In contrast , mothers experience t h e i r sons as a male opposite, and boys, in def in ing themselves as masculine, separate the ir mothers from themselves, thus c u r t a i l i n g the ir primary love and sense of empathetic t i e (Chodorow, 1978). The f indings of many previous and famous studies posited what we f e l t was sound developmental theory; however, we now r e a l i z e that the nature and s ign i f i cance of women's psychological development has been long obscured and shrouded in mystery, because a number of these previous developmental studies had a male bias ( G i l l i g a n , 1982). In the i r accounts of the moral development of c h i l d r e n , Piaget (1965) devoted only four b r i e f entr ies to g i r l s and Kohlberg (1958, 1981) studied boys only. Because of th i s male b ias , the milestones of childhood and adolescent development in psychological l i t e r a t u r e are markers of increasing separation and Indiv iduat ion , and women's f a i l u r e to separate is viewed, by d e f i n i t i o n , as a f a i l u r e to develop ( G i l l i g a n , 1982). 5 However, females do not f a i l to develop, they simply develop d i f f e r e n t l y than males do. Chodorow (1978), wr i t ing about the masculine bias of psychological theory, argued that women do not have weaker ego boundaries than men; they simply have a basis for empathy b u i l t into the ir primary d e f i n i t i o n of s e l f in a way that boys do not. Because they are parented by a person of the same gender, g i r l s emerge with a stronger basis for experiencing another's needs or fee l ings as one's own. G i r l s come to experience themselves as less d i f f e r e n t i a t e d than boys, as more continuous with and re lated to the external object-world, and as d i f f e r e n t l y oriented to the i r inner object-world as w e l l . Chodorow's (1978) theory appears to be substantiated by research f indings . Fischer (1986) interviewed 11 e l d e r l y parents - - nine mothers and two fathers - - who had been recent ly discharged from h o s p i t a l , and whose average age was 80 years , and the i r 15 adult caregivers - - 11 daughters, two sons, and 2 daughters-in-law - - whose mean age was 45 years. F i s c h e r ' s f indings suggested that 80% of adult daughters with c h i l d r e n are substant ia l help givers to t h e i r mothers. Cohler and Grunebaum (1981) studied three generations - -grandmothers, mothers, and daughters — in four American f a m i l i e s . They found that just as women learn from e a r l i e s t childhood to be p a r t i c u l a r l y responsive to cues from others, so they are also taught to respond in an a c t i v e , i n t u i t i v e , and empathetic manner to the needs of others . In add i t i on , 6 the i r f indings , from interviews and paper-and-penci1 quest ionnaires , suggest that from e a r l i e s t childhood a daughter is s o c i a l i z e d into an undi f ferent iated and interdependent r e l a t i o n s h i p with her mother, and that th i s r e l a t i o n s h i p continues into adulthood as the daughter becomes a mother herse l f . The daughter's ro le i s further supported in adulthood by the increased complementarity of the ro le p o r t f o l i o of the two generations, inc luding the convergence of interests and sentiments of the older mother and the adult daughter. However, the i n t e n s i t y of th i s r e l a t i o n s h i p may la ter d imin i sh . Low (1978) studied the re la t ionsh ips between American adult daughters and the ir mothers, and found that the in tens i ty of the i d e n t i f i c a t i o n of daughters with t h e i r mothers diminishes great ly af ter 40 years of age. An in teres t ing f ind ing , as th i s diminished in tens i ty may occur at the same time that an e l d e r l y mother begins to require care . Because women predominate among the e l d e r l y and among the caregivers of the e l d e r l y , old age can l a r g e l y be defined as a women's issue (Reinharz, 1986). Caregiving daughters are character ized as "women in the middle" because they are middle-aged, are in the middle generation, and have mult iple competing r e s p o n s i b i l i t i e s (Brody, 1979). The whole framework of informal services for the e l d e r l y depends l arge ly upon women's labour, inc luding the i r unpaid labour in the home and the ir voluntary labour in the community (Finch & Groves, 7 1982). Although the economic and s o c i a l processes underlying each caregiv ing s i t u a t i o n may be somewhat d i f f e r e n t , the processes are a l l re inforced by c u l t u r a l designations of women's s u i t a b i l i t y for c a r i n g , and car ing ' s close r e l a t i o n s h i p to mothering (Finch & Groves, 1982). This i s seen most v i s i b l y in assumptions about the care which women w i l l provide for r e l a t i v e s in the family s e t t ing (Finch & Groves, 1980; Land, 1978). Government p o l i c i e s may re inforce these assumptions by supporting a household s tructure which serves to replenish the working population while maintaining women as a reserve labour force (Mcintosh, 1978). Although car ing is assumed to be women's work, research resu l t s do not suggest that caring for a parent is an easy task. Caregivers make personal s a c r i f i c e s (Robinson & Thurnher, 1979), and they often fee l g u i l t , resentment (York & Calsyn, 1977), and h o s t i l i t y (Si lverstone & Hyman, 1982). In a d d i t i o n , they fee l burdened and stressed, and general ly have low morale (Fengler & Goodrich, 1979). Caregivers describe themselves as being p h y s i c a l l y and emotionally drained (Farkas, 1980). It is not uncommon for family members to give up t h e i r jobs in order to provide care, and for the i r own health to deter iorate (Brocklehurst , Morr i s , Andrews, Richards , & Laycock, 1981). The caregiving role of an adult c h i l d is dra in ing ; therefore , adult ch i ldren are p r i o r i t y targets for 8 i n t e r v e n t i o n s t o s t r e n g t h e n t h e i r c a p a c i t y t o a s s i s t the e l d e r l y ( C a n t o r , 1983). In an attempt t o d i s c o v e r ways of s t r e n g t h e n i n g i n f o r m a l c a r e g i v i n g c a p a c i t i e s , a t t e n t i o n i s now b e i n g d i r e c t e d t o the dynamics of the h e l p i n g s i t u a t i o n (Brody, 1981; G i b s o n , 1981). However, r a t h e r than l o o k i n g a t the needs of each c a t e g o r y of c a r e g i v e r s , r e s e a r c h e r s and p o l i c y - m a k e r s have tended t o group a l l c a r e g i v e r s i n t o a s i n g l e c a t e g o r y ( C a n t o r , 1983). T h i s g r o u p i n g p r a c t i c e i s not s a t i s f a c t o r y because i t has tended t o obscure the d i f f e r e n c e s among the v a r i o u s groups of c a r e g i v e r s and the t y p e s of s t r e s s t h a t the members of each group may be e x p e r i e n c i n g ( C a n t o r , 1983). J u s t as c a r e g i v e r s d i f f e r -- t h e y may be spouses, c h i l d r e n , o t h e r r e l a t i v e s , f r i e n d s , and n e i g h b o u r s — so do t h e i r needs and r e l a t i o n s h i p s w i t h the e l d e r p e r s o n ( C a n t o r ) . Only by e xamining the c h a r a c t e r i s t i c s and s t r a i n s of each group of c a r e g i v e r s can we p r o v i d e i n t e r v e n t i o n m o d a l i t i e s which s t r e n g t h e n and maximize t h e i r i n d i v i d u a l c a p a c i t i e s t o c a r e f o r the e l d e r l y ( C a n t o r ) . C o n c e p t u a l i z a t i o n of the Problem Because the r e s e a r c h e r wants t o come t o u n d e r s t a n d the women's p e r s p e c t i v e s by l i s t e n i n g t o t h e i r own s e l f - r e p o r t e d e x p e r i e n c e s (Marpherson, 1983), and because the r e s e a r c h e r w i l l , t h e r e f o r e , v a l u e the women's e x p e r i e n c e s as t h e y t a l k about them, a f e m i n i s t p e r s p e c t i v e w i l l be u t i l i z e d . A f e m i n i s t approach a t t e m p t s t o c r e a t e s o c i a l c o n s c i o u s n e s s , s o c i a l t h e o r y , and s o c i a l p o l i c y which w i l l 9 improve the l i f e chances of a s p e c i f i c group (Reinharz, 1986). Feminist theories serve a dual purpose - f i r s t , they offer descr ipt ions of women's oppression and second, they offer prescr ip t ions for e l iminat ing i t (Macpherson, 1983). The feminist perspective i s based on the assumption that p o l i t i c a l , economic, c u l t u r a l , and s o c i a l forces are important determinants of the human experience (Macpherson). In th i s p a r t i c u l a r instance the human experience is the m i d - l i f e daughter's caregiving experience. The feminist perspective w i l l be f l e x i b l e enough to incorporate the uniqueness of each woman's experience and s t i l l encourage the i d e n t i f i c a t i o n of common themes as shared phenomenon. The m i d - l i f e daughter's caregiving experience is influenced by the s o c i a l i z a t i o n process during her upbringing, and by c u l t u r a l processes and i n s t i t u t i o n s , such as motherhood and the family . The experience i s also influenced by economic forces such as the perception that c a r i n g , as women's work, should take precedence over other types of work (Lewis & Meredith, 1988). Yet, car ing is unpaid and voluntary work. And i f the daughter stops doing paid work she may suffer serious damage to her economic future as she may be unable to f ind reemployment and may lose her benef i t s . F i n a l l y , the daughter's experience is also influenced by the p o l i t i c a l l y based perception that e l d e r l y women with daughters make few claims on the government and that i t would, therefore , be counterproductive i f the government separated ind iv idua l s from 10 the i r k i n , because th i s separation would increase the need for more profess ional services (Townsend, 1957). Because of these s o c i a l , c u l t u r a l , economic, and p o l i t i c a l forces , some women may experience a l imi ted world cons i s t ing of voluntarism, housework, l i v i n g to meet the needs of others, and s a c r i f i c i n g the i r education and careers (Reinharz, 1986). The need to care for older women within fami l ies places new stresses on women who are present ly employed outside the home (Reinharz, 1986). The lack of recogni t ion given to the unpaid work women do in car ing for the family and home extends into the lack of recogni t ion for m i d - l i f e daughters who provide care for the ir e l d e r l y parents (Reinharz) . This lack of recogni t ion is detrimental to the fabr i c of our soc ie ty , because the capacity of women to respond to the needs of others in an a c t i v e , i n t u i t i v e , and empathetic manner is a ,competence of p a r t i c u l a r importance for both family and s o c i a l order (Grunebaum, 1980). The kinwork and community work that women do keeps re la t ionsh ips and soc iety a l i v e . Problem Statement Many m i d - l i f e daughters are primary caregivers to the ir e l d e r l y mothers. Yet, in most research s tudies , daughters have been grouped with other caregivers; thus, the daughters' experiences have not been s p e c i f i c a l l y i d e n t i f i e d . Without th i s information, nurses w i l l be unable to adequately a s s i s t m i d - l i f e daughters who are caregivers to a t t a i n the ir optimal 11 l e v e l s of h e a l t h . Purpose of the Study The purpose of t h i s study i s to explore what m i d - l i f e daughters, who are c a r e g i v e r s to t h e i r e l d e r l y mothers, experience. Research Question The r e s e a r c h q u e s t i o n i s "What do employed and married m i d - l i f e daughters experience as c a r e g i v e r s to t h e i r mothers?". D e f i n i t i o n of Terms For the purpose of t h i s study, these terms w i l l be d e f i n e d i n the f o l l o w i n g manner. M i d - L i f e C a r e g i v i n g Daughter A " m i d - l i f e c a r e g i v i n g daughter" i s an a d u l t woman who occupies the l i n e a l p o s i t i o n between her l i v i n g mother and her own c h i l d / c h i l d r e n , and who provides care f o r her mother. Ca r i n g " C a r i n g " i s a process In which some kind of emotional attachment, generated from the dynamics of k i n s h i p , i s i n t e g r a l l y mixed i n t o the labour of tending (Lewis & Meredith, 1988). Throughout the c a r i n g process the m i d - l i f e daughter d e l i v e r s emotional, p r a c t i c a l , l i g h t p h y s i c a l , and/or m a t e r i a l a s s i s t a n c e to her mother. The nature of c a r i n g changes over time i n response to s o c i a l , emotional, and p h y s i c a l t r i g g e r s (Lewis & M e r e d i t h ) . 12 E x p e r i e n c e s " E x p e r i e n c e s " a r e c o n s c i o u s events (Webster, 1987) d e r i v e d from the n a t u r e of the mother-daughter r e l a t i o n s h i p , and from the p r a c t i c a l i s s u e s and l e v e l of p r e d i c t a b i l i t y s u r r o u n d i n g the c a r i n g p r o c e s s (Lewis & M e r e d i t h , 1988). E n c u l t u r a t e d I n d i v i d u a l An " e n c u l t u r a t e d i n d i v i d u a l " i s one who has been c o n d i t i o n e d by, has a d j u s t e d t o , and has i n t e g r a t e d w i t h the c u l t u r a l norms of the s o c i e t y i n which the i n d i v i d u a l l i v e s (Funk & W a g n a l l s , 1989). Assumptions There a r e a number of assumptions i n h e r e n t i n t h i s s t u d y . F i r s t , because m i d - l i f e d a u g h t e r s a r e l i v i n g the e x p e r i e n c e of c a r i n g f o r t h e i r e l d e r l y mothers, t h e y can speak t o and d e s c r i b e the e x p e r i e n c e . The second assumption i s t h a t the way people t a l k about t h e i r l i v e s i s of s i g n i f i c a n c e ( G i l l i g a n , 1982). The t h i r d assumption i s t h a t m i d - l i f e d a u g h t e r s a r e w i l l i n g and a b l e t o t a l k o p e n l y and h o n e s t l y , t h e r e b y g i v i n g an a c c u r a t e account of t h e i r p e r c e p t i o n of r e a l i t y . The f o u r t h a ssumption i s t h a t the language t h e y use and the c o n n e c t i o n s t h e y make r e v e a l the w o r l d t h a t t h e y see and i n which t h e y a c t ( G i l l i g a n ) . F i n a l l y , i t i s assumed t h a t the r e s e a r c h e r , i n o r d e r t o l i s t e n e f f e c t i v e l y , i s a b l e t o b r a c k e t any p r e c o n c e i v e d i d e a s . L i m i t a t i o n s of the Study One l i m i t a t i o n of t h i s s t u d y i s t h a t i t i s r e s t r i c t e d t o m i d - l i f e daughters l i v i n g within the C i t y of Vancouver and, therefore , does not r e f l e c t the experiences of m i d - l i f e daughters l i v i n g elsewhere. Other l i m i t a t i o n s are that these are married, white, Caucasian m i d - l i f e daughters, who have supportive networks, who have the i r own means of t ransporta t ion , who have middle- to h igh-c lass economic s tatus , and who chose to p a r t i c i p a t e in a women's support group. F i n a l l y , these f indings were gathered at a p a r t i c u l a r moment in h i s t o r y , the sample of par t i c ipants was smal l , and the m i d - l i f e daughters were not selected to represent a large populat ion. Summary Chapter one highl ighted the lack of information about m i d - l i f e daughters who are caregivers to t h e i r mothers, and the reasons why more research on m i d - l i f e daughters is needed This chapter also contained the'conceptual framework which guided th i s study, the problem, purpose, and assumptions of the study, and some l i m i t a t i o n s of the study. Chapter two contains the l i t e r a t u r e review that is pert inent to the research study. CHAPTER 2 LITERATURE REVIEW Introduction The l i t e r a t u r e review is in three sec t ions . The f i r s t sect ion of the review out l ines why i t is important that the experiences of m i d - l i f e daughters who are caregivers be examined. The second sect ion of the review presents, in chronologica l order, some of the studies that have examined the experiences of m i d - l i f e daughters as careg ivers . The t h i r d sect ion of the review offers some summary rat iona le surrounding the need to examine the experiences of m i d - l i f e daughters who are caregivers to the i r mothers. Why Examine the Experiences of M i d - l i f e Daughters Who are Caregivers There are many reasons for examining the experiences of m i d - l i f e daughters who are caregivers to the i r mothers. One reason is that between 1921 and 1981 l i f e expectancy at b i r t h increased by over 18 years for women; consequently, the l i f e expectancy of females born in 1981 (79 years) i s seven years longer than that of males born the same year (Parliament, 1987). Because women are l i v i n g longer, more m i d - l i f e daughters may be c a l l e d upon to care for t h e i r mothers. Another reason is that the e l d e r l y are current ly outnumbered n a t i o n a l l y by more than four to one by those 24 years of age and under; however, because of the f a l l i n g b i r t h r a t e , the dec l in ing immigration of young adults and longer 15 l i f e expectancy, the over 65s are catching up in numbers ( C o r e l l i , 1986). Therefore, one day the number of older women requ ir ing care may outnumber the number of m i d - l i f e women ava i lab le to care for them. A t h i r d reason re lates to current day trends. Ory (1985) explained the effects of these trends on the resources of mid-l i f e daughters. Ten percent of community-residing adults aged 75 to 84 years need the help of another person in one or more of seven basic phys ica l a c t i v i t i e s of everyday l i v i n g , and the percentage increases to over 33% of the population for those 85 years of age and o lder . The sheer aging of the population over the next 40 years w i l l double the number of persons with a c t i v i t y l i m i t a t i o n s , most l i k e l y r e s u l t i n g in an even greater need for both informal and formal care services (Ory). Ory (1985) also stated that trends toward increased longevity w i l l r e su l t in more four- and f ive-generat ion fami l i e s , and the esca la t ing numbers of older elders w i l l create a need for increased assistance from aged spouses or , i f they are unavai lable , from younger caregivers who are themselves aging. It i s of import to note that the majority of older elders w i l l be female because as older women are l i v i n g longer, and as they have married men older than themselves, they are four times more l i k e l y than men to become widowed (Gee & Kimbal l , 1987). In a d d i t i o n , Ory (1985) stated that trends such as a dec l ine in family s i z e , high rates of divorce and remarriage, 16 and i n c r e a s e d geograph ic m o b i l i t y are l i k e l y to d i m i n i s h the p o o l of people a v a i l a b l e to s u s t a i n o l d e r f a m i l y members i n the community. S p e c i f i c a l l y i n r e l a t i o n to women i n the middle g e n e r a t i o n Ory s t a t e d t h a t there i s a l r e a d y a squeeze on t h e i r t ime and r e s o u r c e s , and i n c r e a s e d l abour f o r c e p a r t i c i p a t i o n among midd le -aged women may p l a c e an a d d i t i o n a l burden on them ( O r y ) . The f o u r t h reason to examine the e x p e r i e n c e s of m i d - l i f e daughters who are c a r e g i v e r s to t h e i r mothers i s t h a t , l i k e c h i l d r e a r i n g , meet ing the dependency needs of a f r a i l parent i s e x t r e m e l y demanding, both p h y s i c a l l y and p s y c h o l o g i c a l l y , on women. However, u n l i k e c h i l d r e a r i n g , i n which the c h i l d ' s emot iona l and p h y s i c a l dependence g r a d u a l l y d i m i n i s h e s , p a r e n t c a r i n g i n v o l v e s the c a r e g i v e r i n meet ing the s u s t a i n e d or i n c r e a s i n g p h y s i c a l and emot iona l needs of the o l d e r person ( A r c h b o l d , n . d . ) . The c a r e g i v i n g process does not become e a s i e r over t i m e . The r e s p o n s i b i l i t i e s remain the same or g r a d u a l l y , and perhaps u n p r e d i c t a b l y , i n c r e a s e . Who knows what k i n d of impact these r e s p o n s i b i l i t i e s have on the q u a l i t y of l i f e of a c a r e g i v e r ? In t h i s r e g a r d i t i s o n l y i n r e c e n t y e a r s t h a t s e v e r a l i s s u e s r e l a t i n g to the i n f o r m a l c a r e g i v e r ' s burden have a r i s e n , i n c l u d i n g i s s u e s s u r r o u n d i n g the demographics and h e a l t h p r o f i l e of the aged p o p u l a t i o n , the a v a i l a b i l i t y of p o t e n t i a l c a r e g i v e r s , the major c h a r a c t e r i s t i c s of ongoing c a r e g i v e r b e h a v i o u r s , and the in tended and unintended 17 consequences o£ c a r e g i v i n g behaviours (Ory, 1985). In response to these i s s u e s , s t u d i e s are beginning to examine the nature and extent of such c a r e g i v e r burdens among d i f f e r e n t p o p u l a t i o n s , and the f a c t o r s a s s o c i a t e d with p e r c e i v e d as w e l l as a c t u a l c a r e g i v e r burdens (Ory, 1985). However, a f i f t h reason f o r examining the experiences of mid-l i f e daughters who are c a r e g i v e r s to t h e i r mothers i s that although s t u d i e s are beginning to examine c a r e g i v e r burdens, i t i s ev i d e n t from the l i t e r a t u r e search t h a t r e s e a r c h e r s have tended to group v a r i o u s types of c a r e g i v e r s i n r e s e a r c h s t u d i e s , and onl y a l i m i t e d number of the s t u d i e s found focus s o l e l y on m i d - l i f e daughters c a r i n g f o r t h e i r mothers. Lang and Brody (1983) s t r e s s e d t h a t l i t t l e i s known about the e f f e c t s of the dramatic demographic trends and changes i n women's l i f e s t y l e s on the c a r e g i v e r s themselves. Lang and Brody suggested t h a t other questions r e q u i r i n g i n v e s t i g a t i o n ar e : "What are the experiences of o l d e r 'women i n the middle'?", those women who respond to i n c r e a s i n g parent-care r e s p o n s i b i l i t i e s at a time when they themselves are among the younger o l d , and "How do i n d i v i d u a l s t y l e s vary as 'women t r y to balance the competing demands of t h e i r r o l e s as wives, mothers, daughters, and employees?". And a f i n a l reason f o r examining the experiences of mid-l i f e daughters who are c a r e g i v e r s to t h e i r mothers i s that i t i s e v i d e n t from the l i t e r a t u r e search t h a t the s t u d i e s a v a i l a b l e are predominantly B r i t i s h and American and few 18 Canadian s t u d i e s appear t o have been u n d e r t a k e n . In a d d i t i o n , a l t h o u g h r e s e a r c h e r s i n the U n i t e d Kingdom have s t u d i e d dependent i n d i v i d u a l s and t h e i r c a r e g i v e r s f a r more e x t e n s i v e l y than r e s e a r c h e r s i n Canada have, B r i t i s h knowledge about dependent people i n the community remains p a t c h y , and knowledge about the numbers and c h a r a c t e r i s t i c s of the c a r e g i v e r s who are m a i n t a i n i n g these dependent people i n the community i s even l e s s r e l i a b l e ( P a r k e r , 1985). I t does appear t h a t , i n o r d e r t o c a r e f o r dependent i n d i v i d u a l s , c a r e g i v e r s e x p e r i e n c e l o s s e s or r e d u c t i o n s i n e a r n i n g s , l o s e o p p o r t u n i t i e s f o r p r o m o t i o n s , and s u f f e r i n c r e a s e d e x p e n d i t u r e s ( P a r k e r , 1985). Research S t u d i e s Which Address the E x p e r i e n c e s of M i d - L i f e Daughters as C a r e g i v e r s The f o l l o w i n g r e s e a r c h s t u d i e s are p r e s e n t e d i n c h r o n o l o g i c a l o r d e r . Robinson and Thurnher (1979) i n t e r v i e w e d 49 a d u l t c h i l d r e n who c a r e d f o r e l d e r l y p a r e n t s over a f i v e y e a r p e r i o d , and c o n c l u d e d t h a t c e r t a i n s t r e s s o r s a r e e v i d e n t . The s t r e s s o r s i n c l u d e i n c o n v e n i e n c e , c o n f i n e m e n t , f a m i l y a d j u s t m e n t s , changes i n p e r s o n a l p l a n s , competing demands on t i m e , e m o t i o n a l a d j u s t m e n t s , u p s e t t i n g b e h a v i o u r , the p a r e n t seeming t o be a d i f f e r e n t p e r s o n , work a d j u s t m e n t s , and f e e l i n g s of b e i n g overwhelmed. Robinson and Thurnher's r e v i e w of the l i t e r a t u r e r e v e a l e d t h a t s l e e p d i s t u r b a n c e s , p h y s i c a l s t r a i n , and f i n a n c i a l s t r a i n s are o t h e r s t r e s s o r s . R o s e n t h a l (1980) s t u d i e d f a m i l i e s and i n t e r g e n e r a t i o n a l 19 re la t ionsh ips in the context of aging. A random sample of 458 people aged 40 years and older (one t h i r d were aged 70+) was interviewed in Hamilton and Stoney Creek, Ontar io . Seven in ten older women l i ved in the same c i t y as did a c h i l d . The f indings suggested the fo l lowing. Both in middle age and la t er l i f e , people continue to express commitment to f u l f i l l i n g family ob l iga t ions . Middle-aged c h i l d r e n worry about the i r aging parents and are concerned about the ir own a b i l i t y to provide the kind of care the ir parents might need. E l d e r l y widowed women have more frequent contact with ch i ldren than do other older people. Distance l i m i t s the exchange of some types of p r a c t i c a l help but does not l i m i t exchange of emotional support, advice , f i n a n c i a l help, or help in c r i s i s . Distance is a lso not associated with di f ferences in the extent to which ch i ldren worry about the i r aging parents. Rosenthal stated that women in t h e i r f i f t i e s and s i x t i e s may be coping with heavy family r e s p o n s i b i l i t i e s re lated to aging parents, the d e c l i n i n g health of t h e i r spouses, the p o s s i b i l i t i e s of having grandchi ldren, and/or a c h i l d ' s mari ta l breakdown. In a d d i t i o n , Rosenthal cautioned that expectations or p o l i c y that looks to ch i ldren as a major source of support for the e l d e r l y must recognize that a substant ia l minority of e l d e r l y persons lack ch i ldren and an equal minori ty has only one c h i l d , implying a resource that may be e a s i l y overburdened, l imited by dis tance , or disrupted by divorce or even death. Rosenthal's study is in t ere s t ing ; however, i t d id not describe 20 the subjects , for example, the proportion of male and female caregivers and whether or not they were employed. Cantor (1983) interviewed 111 American e lders , the majority of whom were women, and the ir careg ivers . Twelve percent of the caregivers were friends and neighbours, 19% were other r e l a t i v e s , 33% were spouses, and 36% were middle-aged c h i l d r e n , mainly married women with f a m i l i e s . S ixty percent of the married women with fami l ies were employed. Cantor's f indings included the fo l lowing. Emotional s t r a i n is pervasive across a l l groups of caregivers; however, the c loser the f i l i a l bond the greater the amount of s t r a i n experienced by the careg iver . Spouses are at the greatest r i s k of s t r a i n , followed by adult c h i l d r e n . The amount of cont inual day-to-day involvement compounds the impact on the careg iver . Although strong f a m i l i a l t i e s and close bonds of a f f ec t ion are present, lack of mutual understanding and/or intergenerat ional di f ferences are often reported. The caregivers in the study handle the dilemmas of c o n f l i c t i n g demands and interpersonal s t r a i n not by denia l of r e s p o n s i b i l i t y , but through considerable personal s a c r i f i c e s . The greatest depr ivat ion occurs in the sphere of personal des ires , i n d i v i d u a l i t y , and s o c i a l i z a t i o n . Cantor (1983) found that adult ch i ldren suffer a m u l t i p l i c i t y of r o l e s . Their job performance is affected by the emotional s tress and the time pressures involved in providing primary care to an older person. An overwhelming 21 concern of the adult ch i ldren is the ir a b i l i t y to obtain information on community resources, e s p e c i a l l y dependable, i n -home serv i ce s , and to obtain the necessary help . Often the adult ch i ldren who are seeking assistance for t h e i r e l d e r l y parents are involved in time-consuming, bureaucratic d u p l i c a t i o n of e f f o r t . Various groups of caregivers were included in Cantor's sample; therefore , the focus was not s o l e l y on the experiences of m i d - l i f e daughters as careg ivers . Lang and Brody (1983) interviewed 161 American m i d - l i f e daughters regarding the nature and amount of help they provided to the i r e l d e r l y mothers. Eighty percent of the daughters were married and 60% were employed. The daughters were 40 to 66 years of age and they had an average of 3.7 ch i ldren each. The f indings of th i s study suggest that each m i d - l i f e daughter gives , on average, 8.6 hours of help, or the equivalent of one day's work, to her mother each week, and that an e l d e r l y mother's need for help increases with her advancing age. Each week, m i d - l i f e daughters in the i r f o r t i e s provide an average of three hours, and those in the i r f i f t i e s provide more than 15 hours, of help to t h e i r mothers. This r e f l e c t s the s i g n i f i c a n t c o r r e l a t i o n between the ages of the daughters and mothers, as well as the fact that the need for help general ly increases with advancing age. When the dependency needs of the i r e l d e r l y parents increase , most adult c h i l d r e n respond, despite other r e s p o n s i b i l i t i e s they may have to spouses, c h i l d r e n , work, and grandchi ldren. And f i n a l l y , when c a l l e d upon for help, the daughters who are the p r i n c i p l e source of these needed services are l i k e l y to be in middle age or ear ly old age themselves. Many types of caregivers and caregiving s i tuat ions were grouped together in Lang and Brody's (1983) study, inc luding mothers l i v i n g with the i r daughters, mothers l i v i n g independently, married and unmarried daughters, and employed and unemployed daughters. In add i t i on , the daughters came from various ethnic backgrounds. Lang and Brody concluded that i t is necessary to f ind out what women in the middle experience as they t r y to balance the competing demands of t h e i r ro les as wives, mothers, daughters, and employees. Robinson (1983) out l ined the development of a caregiver s t r a i n index with 85 spouses, family , f r i ends , and neighbours who provided care to recent ly hosp i ta l i zed ind iv idua l s over 65 years of age. Of the 85 careg ivers , 18 were daughters or daughters- in- law. There was a s i g n i f i c a n t c o r r e l a t i o n between being employed and the caregiver s t r a i n index, suggesting that family members who have demands c o n f l i c t i n g with car ing for e lders are apt to experience s t r a i n . This study included both daughters and daughters- in- law, and the e lders were in the hosp i ta l and not in the community. S t o l l e r (1983) interviewed 753 American elders l i v i n g in the community, and t h e i r informal careg ivers . S ix ty percent of the elders were women. Nearly hal f (47%)" of the caregivers were adult c h i l d r e n . Twenty-four percent of the adult c h i l d r e n were daughters and 22% were sons. S ixty-nine percent of the daughters and 83% of the sons were employed outside the home. Of the daughters, 71% had ch i ldren l i v i n g within the i r households. S t o l l e r ' s (1983) f indings suggest that daughters provide more hours of help to elders than do sons. In a d d i t i o n , employed women cope with the add i t i ona l r e s p o n s i b i l i t i e s of paid employment by lengthening the ir t o t a l work week, rather than by reducing the i r car ing serv ices ; conversely, employed sons reduce the ir car ing services by an average of 22.9 hours per month. S t o l l e r suggested that l i t t l e a t tent ion has been given to the middle-aged woman who must juggle the competing ro le demands of employed worker, mother, and caregiv ing daughter. H i l l (1984) interviewed 50 married Canadians — 48 women and two men. Each of them was e i ther providing care and accommodation for an e l d e r l y r e l a t i v e or had done so within the past three years. H i l l stated that the t y p i c a l s i t u a t i o n was a daughter car ing for her mother. The f indings suggest that daughters experience g u i l t and resentment; they desire both pr ivacy and a change in the i r l i f e s t y l e s . H i l l concluded that services to meet the emotional needs of caregivers are an important component of any support services system. There are two l i m i t a t i o n s of th i s study. One l i m i t a t i o n is that both male and female caregivers comprised the sample. The second l i m i t a t i o n is that the research was done both on caregivers 24 who were present ly providing care, and on those who had provided care in the past and whose r e f l e c t i o n s , therefore , depended a.great deal on the i r memories. j Brody, Kleban, Johnsen, Hoffman, and Schoonover (1987) interviewed 150 famil ies from P h i l a d e l p h i a . Each family included a widowed, e l d e r l y , n o n i n s t i t u t i o n a l i z e d mother rece iv ing care from a married, m i d - l i f e daughter. Two-thirds of the daughters had c h i l d r e n at home. Each of the m i d - l i f e daughters provided a weekly average of 21.4 hours of care to her mother. Half of the m i d - l i f e daughters were employed and hal f were not. P r i o r to the study, some m i d - l i f e daughters had terminated the ir employment in order to care for the ir mothers. During the study, some of the remaining daughters e i ther considered terminating the ir employment or a c t u a l l y d id reduce the i r working hours. Brody et a l . found that the women who terminate the i r employment score lower on the mental health measure than those who do not. Lewis and Meredith (1988) interviewed 41 B r i t i s h m i d - l i f e daughters who had ceased car ing for the ir mothers within the l a s t 10 years. The mothers had l i ved with the daughters. The m i d - l i f e daughters were e i ther married, widowed, d ivorced , or s i n g l e . Lewis and Meredith's f indings included the fo l lowing. Some daughters, as careg ivers , experience mental health breakdowns, health problems, g u i l t , b i t t erness , uncertainty , resentment, impatience, and weight l o s s . In a d d i t i o n , eight m i d - l i f e daughters r e t i r e d from work to care for the i r mothers, and f ive took less demanding jobs. F i n a l l y , Lewis and Meredith found that the daughter assumes f u l l r e s p o n s i b i l i t y for the e lder , and that the contr ibut ions of kin and fr iends decrease as the condit ion of the elder de ter iora tes . Some of the daughters in Lewis and Meredith's (1988) study complained that the i r car ing r e s p o n s i b i l i t i e s had prevented them from gett ing married or advancing in the i r careers . However, i t is d i f f i c u l t to draw simple cause-and-ef fect conclusions about t h e i r s i t u a t i o n s . Lewis and Meredith stated that one l i m i t a t i o n of th i s study was that due to i t s retrospect ive nature the researchers had to judge the extent to which the daughters had re interpreted the i r car ing experiences. Archbold (n.d. ) d id a phenomenological study of 30 middle-aged, American women. F i f t een of the women were care providers and 15 were care managers. Forty percent of the women were married. Sixty-seven percent of the care managers and 20% of the care providers were employed. Each of the women cared for one parent and 84% of the parents in the sample were women. The f indings of th i s study suggest that a majority of care providers l i s t nursing care , bathing, t o i l e t i n g , feeding, food preparat ion, home maintenance, and housekeeping as the caregiv ing a c t i v i t i e s they r e g u l a r l y perform. Half of the care providers could not i d e n t i f y any benefits of careg iv ing . Their responses e l i c i t e d comments 26 r e f l e c t i n g sad res ignat ion , t i r e d f r u s t r a t i o n , and h o s t i l i t y toward the i r parents. Care providers i d e n t i f y decreased freedom, a lack of pr ivacy , constant d a i l y i r r i t a t i o n , and g u i l t as the major costs of careg iv ing . Many care managers in Archbold's (n .d . ) study described the f r u s t r a t i o n of endless phone c a l l s and interviews to accomplish the assessment of community resources. The care managers i d e n t i f i e d invasion of personal time, career in terrupt ions , and f i n a n c i a l burdens as the main costs of parentcaring. Data c o l l e c t i o n and data analys i s were not well described in th i s study; however, Archbold concluded that caregivers represent a large and increasing group of vulnerable women in our soc ie ty and should be viewed as an "at r i s k " populat ion. F i n a l Theoret i ca l Summary According to Johnson and Spence (1982) knowledge of the important d e t a i l s of adult c h i l d - o l d e r parent re la t ionsh ips i s just beginning to surface . The f i n a n c i a l , emotional, p h y s i c a l , and other costs to the adult c h i l d can be s i g n i f i c a n t , and the lack of role models for both generations can further in tens i fy the pressure (Johnson & Spence). The adult must sometimes tread a fine l ine between the ro le of adult as helper, chauffeur, confidant , and the ro le of c h i l d (Johnson & Will iamson, 1980). Although adults are often aware of the tensions in the i r re la t ionsh ips with t h e i r parents (Johnson & Bursk, 1977), they may perceive the tensions as being uncontrol lable and subject to change only with the death of the parent (Johnson, 1978). In reference to pressures on the "woman in the middle", Brody (1981) stated that to an extent unprecedented in h i s t o r y , ro les as caregiv ing daughters to dependent older adults have been added to the daughters' t r a d i t i o n a l roles as wives, homemakers, mothers, and grandmothers. Recently, d i scuss ion of the unique problems confronting adult daughters have begun to appear in the l i t e r a t u r e (Brody, 1978). The need to focus s o l e l y on the unique experience of adult daughters appears to be supported in the l i t e r a t u r e . Lang and Brody (1983) stated that in the context of caregiving to the e l d e r l y , the word ' fami ly ' most often means the women in the family , and that a balanced understanding of the caregiv ing s i t u a t i o n should include the perspective of both the caregiver and the care rece iver . Lewis and Meredith (1988) concluded that profess ional helpers miss the problems experienced by those who immerse themselves in c a r i n g , doubtless because car ing women appear to be committed to the i r car ing a c t i v i t i e s , and to be 'coping' with the i r caregiving r o l e s . The f indings of Goodman's (1986) l i t e r a t u r e review suggest that an i n t u i t i v e response by health care profess ionals is u n j u s t i f i a b l e ; the various innovative schemes should be c a r e f u l l y evaluated and the needs of both carer and dependent accounted f o r . F i n a l l y , Parker (1985) suggested that before developing services which they bel ieve w i l l help 28 carers , profess ionals must f i r s t discover what caregivers themselves would pre fer . Therefore, knowledge of both the caregiver and the care receiver is c r i t i c a l i f p r a c t i t i o n e r s , planners, and p o l i c y makers are to base t h e i r approaches and expectations on r e a l i t y , rather than on the myths and biases that too often cloud at t i tudes about family behaviour toward the old (Lang & Brody, 1983). Knowledge s p e c i f i c to the experiences and perceptions of m i d - l i f e daughters who are caregivers to t h e i r mothers remains l i m i t e d . The aim of th i s study is to examine t h e i r experiences and perceptions. Summary This chapter was comprised of three sect ions . The f i r s t sect ion of the chapter out l ined reasons why i t i s t imely to study the experiences of m i d - l i f e daughters who are caregivers to t h e i r mother. The second sect ion of the chapter out l ined research studies which have included m i d - l i f e daughters who are caregivers to t h e i r mothers; The f i n a l sect ion of the chapter explained why a study of th i s sort would be b e n e f i c i a l , both in easing the pressures and tensions of the m i d - l i f e daughter's caregiv ing r o l e , and in contr ibut ing to the work of health care p r a c t i t i o n e r s , planners, and po l i cy makers. CHAPTER 3 METHODOLOGY Introduction Chapter three begins with an overview of the phenomenological research method, a q u a l i t a t i v e approach. It a lso out l ines the process for se l ec t ing the subjects , the s e l ec t ion c r i t e r i a , the process for r e c r u i t i n g subjects , the c h a r a c t e r i s t i c s of the subjects , the data c o l l e c t i o n and data analys i s processes, and how the researcher protected the e t h i c a l and human r ight s of the subjects . Overview of the Researcher's Use of the Phenomenological Research Method, a Qua l i ta t ive Approach The q u a l i t a t i v e approach offers a broad in terpre ta t ion of the ef fects of caring for dependents; i t h igh l ights the complexity of the problem (Goodman, 1986). One q u a l i t a t i v e approach is the phenomenological research method, an induct ive , descr ip t ive research method (Omery, 1983). The task of the phenomenological research method is to invest igate and describe a l l phenomena, inc luding the human experience, in the way these phenomena appear in t h e i r f u l l e s t breadth and depth (Omery). The concern of the phenomenological researcher is to understand both the cognit ive and the subject ive perspective of the subject who has the experience, and the ef fect that perspective has on the l i v e d experience or behaviour of that subject (Morris , 1977). In th i s regard, the researcher's task is to l e t the 30 experience, as i t ex is ts for the subjects , unfold in an unbiased way through the subjects ' own descr ipt ions (Ornery, 1983). To ensure that the experience is being invest igated as i t t r u l y appears to , or as i t i s t r u l y experienced by, the subject , the researcher holds no preconceived expectations or categories of the experience (Ornery). In a d d i t i o n , in order to f u l l y understand the experience of the subject , the researcher, pr ior to c o l l e c t i n g data, brackets or suspends any preconceptions of the experience (Riemen, 1986), inc luding previous knowledge, biases , and prejudices . It i s in th i s manner that the researcher comes to f u l l y understand the experience of each subject (Riemen). The study begins with par t i c ipant s e l e c t i o n . So that they are able to speak to the phenomenon being invest igated , subjects are selected on the basis of the i r experience with the phenomenon being studied (Anderson, 1985). They are "experts" in the area under inves t igat ion (Anderson). In order to f u l l y understand the depth and breadth of the experiences of the subjects , and in accordance with the phenomenological research method (Ornery, 1983), the sample s ize i s smal l . A convenience sample of subjects who meet the c r i t e r i a and want to p a r t i c i p a t e is i n i t i a l l y sought (Morse, 1986) and interviewed. Subsequent to the i n i t i a l interviews, t h e o r e t i c a l sampling is used, whereby the continued se lec t ion and interviewing of subjects is re lated to the f indings that emerge in the course of the study (Sandelowski, 1986). The number of interviews conducted depends on the depth of information obtained and on the researcher's understanding of the information. Addi t iona l interviews are conducted in order to c l a r i f y data, to explore areas that seem more pertinent to the subjects , and to va l idate concepts from an e a r l i e r interview (Anderson, 1985). Sampling and data c o l l e c t i o n cease when each subject has described her experience and no further c l a r i f i c a t i o n is needed (Riemen, 1986). Using G i o r g i ' s method (Omery, 1983) data are gathered through taped interviews which involve one to three , hour-long sessions over a period of three to four months. In order to ensure that the experience, as i t ex is ts for the subjects , unfolds in an unbiased way, the researcher does not offer any he lp fu l c l a r i f i c a t i o n s during the interviews (Omery). The researcher analyzes the data using G i o r g i ' s (1975) method of data a n a l y s i s . In order to get a sense of the whole, the researcher f i r s t reads through each subject ' s ent ire descr ip t ion of the experience. Then the researcher rereads each subject 's ent ire descr ip t ion and i d e n t i f i e s the natural "meaning uni ts" , as expressed by the subject , which sequent ia l ly make up the whole experience for that subject . Having completed th i s step, the researcher then s tates , in as simple a statement as poss ib le , the theme that dominates each natural meaning u n i t . Having i d e n t i f i e d the themes, the researcher interrogates the themes, and the raw data from which the themes were taken, in terms of the s p e c i f i c research quest ion. For example, the researcher asks, "What does th i s statement t e l l me about the experiences of th i s m i d - l i f e daughter as a caregiver to her mother?". Once the themes have been thus enumerated, the researcher attempts to integrate and synthesize the e s s e n t i a l , non-redundant themes into a descr ip t ive s tructure of the meaning of the experience. The issues of in terna l and external v a l i d i t y , and r e l i a b i l i t y , are dealt with somewhat d i f f e r e n t l y in the q u a l i t a t i v e approach than they are in the quant i tat ive approach. C r e d i b i l i t y , rather than in terna l v a l i d i t y in the quant i tat ive sense, is the c r i t e r i o n against which the truth value of q u a l i t a t i v e research is evaluated (Guba & L i n c o l n , 1981). A q u a l i t a t i v e study is credib le when the ind iv idua l s having the experience immediately recognize i t from the descr ip t ion as the ir own, and when, on being confronted with i t , other ind iv idua l s can recognize the ac tua l experience after having read about i t in a study (Sandelowski, 1986). F i t t i n g n e s s , rather than external v a l i d i t y in the quant i tat ive sense, is the c r i t e r i o n against which the a p p l i a b i l i t y of q u a l i t a t i v e research is evaluated (Guba & L i n c o l n , 1981). F i t t ingness means that the f indings can "f i t" into contexts outside the study s i t u a t i o n , and the audience views the f indings as meaningful and appl icable in terras of t h e i r own experiences (Guba & L i n c o l n ) . A u d i t a b i l i t y , rather than r e l i a b i l i t y in the quant i tat ive sense, i s the c r i t e r i o n against which the consistency of q u a l i t a t i v e research is evaluated. A study is auditable when another researcher can c l e a r l y follow the "decision t r a i l " used by the researcher in the study (Sandelowski, 1986). The next sect ion contains a descr ip t ion of the implementation process. Se lect ion of Par t i c ipants So that they were able to speak to the phenomenon, subjects were selected on the basis of t h e i r experience with the phenomenon being s tudied . The convenience sample was comprised of seven subjects who met or , in some cases, almost met the c r i t e r i a and wished to par t i c ipa te in the study. Se lect ion C r i t e r i a The c r i t e r i a for se l ec t ing the subjects included the fo l lowing: 1. each woman was 40 years of age or o lder , in order to represent the m i d - l i f e group of women; 2. each woman l i ved in the greater Vancouver area, for reasons of a c c e s s i b i l i t y ; 3. each woman spoke E n g l i s h , in order to f a c i l i t a t e communication; 4. each woman was married, because more female caregivers are married than s ingle (Arber, Evandrou, G i l b e r t , & Dale, 1986); 5. each woman had c h i l d r e n who l i ved at home or away from home, in order to r e f l e c t the woman's middle generation pos i t i on (Brody, 1979); 6. each woman was employed on a part-t ime or f u l l - t i m e bas i s , 34 because the majority of middle-aged women are employed and 75% of them are employed f u l l time (Brody, 1981); 7. each woman was enculturated into Canadian soc ie ty , in order to decrease the chance of c u l t u r a l factors a f f ec t ing the study; 8. each woman was a primary caregiver to her mother and had been for at least one year, in order to ensure that the daughter could e f f e c t i v e l y speak to the caregiv ing experience, and 9. each woman was geographical ly located such that d a i l y personal contact with her mother was poss ib le . The c r i t e r i a for the mothers was as fol lows: 1. each mother l i v e d on her own, as th i s c r i t e r i o n was congruent with Ory's (1985) s t a t i s t i c s , and 2. each mother was not in the acute phase of an i l l n e s s , in order to ensure the descr ip t ion of the careg iver ' s "normal" experiences only. Subject Recruitment The subjects were recru i t ed through a daughters-of-aging-parents program which was conducted by C l a r i s s a Green, a professor at the Un ivers i ty of B r i t i s h Columbia School of Nursing. The program was he ld , and s t i l l i s , at the Women's Resource Centre in Vancouver, B r i t i s h Columbia. Subjects were selected from past and present par t i c ipants of the program who had Indicated the ir wi l l ingness to par t i c ipa te in research studies r e l a t i n g to t h e i r ro le as careg ivers . The potent ia l 35 subjects had given the i r permission to Professor Green to make the i r names and addresses ava i lab le to researchers in the Univers i ty of B r i t i s h Columbia School of Nursing. Po tent ia l subjects were approached through a Letter of I n i t i a l Contact (see Appendix A ) . The researcher contacted, by phone, each subject who responded to the l e t t e r . Six of the subjects were obtained in th i s manner. A seventh subject heard of the study, through a mutual fr iend of the researcher, and submitted her name, through that mutual f r i e n d , to the researcher. The researcher sent th i s po tent ia l subject a Letter of I n i t i a l Contact, and when the potent ia l subject responded to the l e t t e r , the researcher contacted the subject by phone. The researcher arranged with each subject , a mutually convenient time and place to conduct an interview. Five of the i n i t i a l interviews were conducted in subjects ' homes, one subject was interviewed in Professor Green's o f f i c e , and the seventh subject was interviewed in the researcher's place of residence. During these i n i t i a l meetings, the researcher explained the purpose of the study and the consent to each subject , and answered any questions. Each subject then signed a P a r t i c i p a n t Consent Form (see Appendix C) and gave i t to the researcher. The researcher gave each subject a copy of the consent form to keep. A t o t a l of seven women took part in the study. C h a r a c t e r i s t i c s of the Par t i c ipant s The seven m i d - l i f e daughters ranged in age from 42 to 69 years. A l l l i ved in the lower mainland, spoke E n g l i s h , were married and l i v i n g with the i r husbands, and had c h i l d r e n . Only three of the daughters had teenage c h i l d r e n s t i l l l i v i n g at home with them. Three of the m i d - l i f e daughters continued to be employed f u l l time. Two daughters had worked f u l l time however, one of them had recent ly taken a four-day-a-week p o s i t i o n , and the other had recent ly begun to work on a par t -time basis — 12 or more hours per week. The two remaining daughters were employed on a part-time basis - - one daughter worked an average of two hours a month; the other worked an average of two to three days a week. A l l the daughters were enculturated into Canadian soc ie ty . A l l of them were geographical ly located such that d a i l y contact with the i r mothers was poss ib le . Two of the daughters were primary caregivers to the i r mothers. One had been the primary caregiver to her mother; however, her mother had died in 1988. Two of the daughters were s i s t e r s , each of whom provided care for her mother on a equal bas i s . One daughter shared caregiv ing for her mother with the daughter's cous in . And the las t daughter shared caregiv ing with her s i s t e r who was not a p a r t i c i p a n t in th i s study. The mother of one par t i c ipant was deceased; therefore, th i s par t i c ipant spoke of her caregiving experiences in a 37 r e t r o s p e c t i v e manner. In a d d i t i o n , two of the p a r t i c i p a n t s i n the study were s i s t e r s . Thus, there were f i v e mothers r e f e r r e d to i n the study. Of the f i v e mothers, one of them l i v e d i n a p r i v a t e l y rented d w e l l i n g , one l i v e d i n a p r i v a t e l y owned d w e l l i n g , one l i v e d i n an intermediate care f a c i l i t y -- having progressed from a p r i v a t e l y owned r e s i d e n c e , to a p r i v a t e l y rented apartment, to her daughter's house, and then to an intermediate care f a c i l i t y — and two of the mothers rented apartments i n group-sponsored s e n i o r s ' complexes which provided in-house r e c r e a t i o n a l programs. None of the f i v e mothers was i n an acute phase of an i l l n e s s . The age range of the mothers was 79 to 96 y e a r s . Data C o l l e c t i o n and A n a l y s i s Data c o l l e c t i o n and a n a l y s i s are d i s c u s s e d s e p a r a t e l y ; however, as poi n t e d out by Anderson (1985), these two processes ran c o n c u r r e n t l y throughout the study. The re s e a r c h e r analyzed the data throughout the c o l l e c t i o n phase, and the r e s u l t s of the a n a l y s i s provided d i r e c t i o n f o r the ongoing data c o l l e c t i o n p r o c e s s . Data C o l l e c t i o n The r e s e a r c h e r i n t e r v i e w e d f i v e of the daughters twice. Because of a f a u l t y tape, the l a s t h a l f of the i n i t i a l Interview with the s i x t h daughter was l o s t and the resear c h e r interviewed t h i s daughter a g a i n . The r e s e a r c h e r interviewed the seventh daughter once. The i n t e r v i e w s were somewhat s t r u c t u r e d and l a s t e d from 38 one to two hours each. At the beginning of each i n i t i a l interview, the researcher acquired some demographic data by asking the daughter about her family of o r i g i n and about her family of procreat ion , inc luding the number of r e l a t i v e s she had, the i r ages, the i r sex, where they l i v e d , e tc . Subsequent to t h i s , the researcher used open-ended tr igger questions (see Appendix B) during the i n i t i a l and second interviews. The researcher did not ask a l l of the daughters a l l of the t r igger questions, because once a daughter began speaking, the researcher followed her t r a i n of thought by asking her questions l i k e , "Can you t e l l me more about that?", "Can you give me an example of that?", "What do you mean by that?", "How did you deal with that?", "How did that make you fee l?", e tc . In th i s manner, the researcher followed the language and the log ic of a daughter's thought, and asked further questions in order to c l a r i f y the meaning of a p a r t i c u l a r response ( G i l l i g a n , 1982). Therefore, each daughter was t r u l y a coresearcher because she helped to d i r e c t the data c o l l e c t i o n . The researcher used another tr igger question to open a new topic only i f the previous topic had been saturated by a daughter. Following a f i r s t interview, the researcher transcribed the tapes and summarized from each daughter's t r a n s c r i p t those areas needing c l a r i f i c a t i o n , further exp lorat ion , or v a l i d a t i o n . The researcher then used these summaries to guide the second interviews. During the second interviews, s ix of the daughters addressed a l l areas requ ir ing c l a r i f i c a t i o n , exp lorat ion , and v a l i d a t i o n . The researcher accomplished th i s c l a r i f i c a t i o n , exp lorat ion , and v a l i d a t i o n with the seventh daughter in only one interview. Therefore, the researcher did not need to conduct any further interviews or r e c r u i t any new subjects . Data Analys is The researcher analyzed the data according to G i o r g i ' s (1975) method of data a n a l y s i s . The researcher read each daughter's ent ire d e s c r i p t i o n of the experience, and then reread each descr ip t ion while , at the same time, ident i fy ing the natural meaning units which made up the experience for each daughter. The researcher then s tated, in a word or a simple phrase, the theme that dominated each natural meaning u n i t . The researcher went through a l l the t r a n s c r i p t s twice more to ensure that a l l themes had been i d e n t i f i e d . The researcher then gave a category to each theme and under each theme indicated the code number of each daughter who had discussed that theme and on which page of her t r a n s c r i p t she had discussed that theme. In th i s manner, the researcher was able to ident i fy which themes were dominant or common to a l l daughters. The researcher then interrogated the common themes and the raw data by asking, "What does th i s statement t e l l me about the experiences of th i s m i d - l i f e daughter as a caregiver to her mother?". By so doing, the researcher was able to group some of the common themes together under a h i g h e r - l e v e l theme category, and leave the r e s t of the common themes st a n d i n g on t h e i r own. T h i s l e f t a d e s c r i p t i v e s t r u c t u r e of the meaning of the experience. The d e s c r i p t i v e s t r u c t u r e was at the gen e r a l l e v e l , meaning that the s t r u c t u r e centered on those aspects of the m i d - l i f e daughter's c a r i n g experience t h a t were u n i v e r s a l a c r o s s a l l daughters. The d e s c r i p t i v e s t r u c t u r e helped to d e s c r i b e how t h i s group of women p e r c e i v e d t h e i r experiences as m i d - l i f e daughters who were c a r e g i v e r s to t h e i r mothers. The r e s u l t s of the data a n a l y s i s are contained i n chapter f o u r . L E t h i c s and Human Rights The r e s e a r c h e r p r o t e c t e d the e t h i c a l and human r i g h t s of the p a r t i c i p a n t s i n the f o l l o w i n g manner: 1. The members of the U n i v e r s i t y of B r i t i s h Columbia Be h a v i o u r a l Sciences Screening Committee f o r Research and Other Studies I n v o l v i n g Human Subjects gave t h e i r w r i t t e n approval to c a r r y out t h i s study. 2. Each p o t e n t i a l p a r t i c i p a n t r e c e i v e d a copy of the L e t t e r of I n i t i a l Contact (see Appendix A) i n the m a i l . 3. The researc h e r e x p l a i n e d the study and the consent form to each p o t e n t i a l p a r t i c i p a n t . 4. Wr i t t e n consents In r e l a t i o n to p a r t i c i p a t i o n , taped i n t e r v i e w s , f i e l d notes, and c o n f i d e n t i a l i t y were requested from each p a r t i c i p a n t (see Appendix C). 5. Each p a r t i c i p a n t r e c e i v e d a copy of the consent form to 4 1 keep. 6. The r e s e a r c h e r t o l d each p a r t i c i p a n t t h a t the p a r t i c i p a n t c o u l d r e f u s e t o answer any q u e s t i o n / s . 7. The t a p e s were e r a s e d once t h e y had been t r a n s c r i b e d . 8. The name-code sheet was d e s t r o y e d i m m e d i a t e l y a f t e r the t h e s i s was completed. 9 . The coded t r a n s c r i p t s w i l l be kept f o r two y e a r s f o r use i n s c h o l a r l y p u b l i c a t i o n s , a f t e r which time the t r a n s c r i p t s w i l l be d e s t r o y e d . Summary T h i s c h a p t e r c o n t a i n e d an o v e r v i e w of the p h e n o m e n o l o g i c a l r e s e a r c h method, f o l l o w e d by a d e s c r i p t i o n of the i m p l e m e n t a t i o n of t h i s method. The r e s u l t s of the a n a l y s i s of the d a t a a r e p r e s e n t e d i n c h a p t e r f o u r . CHAPTER 4 RESEARCH FINDINGS Introduction The purpose of thi s chapter i s to report the research findings of t h i s study. The daughters in thi s study described what they experienced as caregivers to the i r mothers. From their description a number o£ common themes emerged, The researcher integrated these common themes into a developmental framework -- a process that takes place along a continuum --and e n t i t l e d t h i s continuum "the continuum of care". This continuum is both linear and f l u i d ; therefore, there is the potential for a daughter to v a s c i l l a t e back and forth along the continuum. There are three points and two t r a n s i t i o n phases along the continuum of care. The researcher has named the points "the outer-centered point", "the inner-centered point", and "the ethic-of-care point". The st a r t i n g point on the continuum i s the outer-centered point. There is a t r a n s i t i o n phase between the outer- and the inner-centered points, and between the inner-centered point and the ethic-of-care point. The order of the points and phases represents progressive movement and development along the continuum of care. At the st a r t i n g point -- the outer-centered point — on the continuum the daughters are outer-centered, meaning that they are c l o s e l y connected or fused with their mothers, and thei r attention i s primarily on their mothers. Their outer-43 centeredness i s evident i n t h e i r e x t e n s i v e knowledge of t h e i r mothers and t h e i r mothers' needs, and i n t h e i r deference and responsiveness to t h e i r mothers' needs. As the daughters enter the t r a n s i t i o n phase between the oute r - c e n t e r e d and the in n e r - c e n t e r e d p o i n t s along the continuum of care, they become cognizant of the inner c o n f l i c t and t u r m o i l which they are e x p e r i e n c i n g because of t h e i r r e l a t i o n s h i p s with t h e i r mothers. T h i s inner c o n f l i c t and t u r m o i l takes the form of worry, anger, s t r e s s , disappointment, d e p r e s s i o n , and emotional p a i n . Because of t h e i r inner c o n f l i c t and t u r m o i l the daughters become concerned with t h e i r own s u r v i v a l i n the c a r e g i v i n g r e l a t i o n s h i p s . R e a l i z i n g t h a t they and t h e i r mothers are d i f f e r e n t , they begin to c r i t i c i z e t h e i r mothers and to rese n t t h e i r r e l a t i o n s h i p s with t h e i r mothers. They a l s o begin to use t h e i r inner c o n f l i c t and t u r m o i l to c r e a t e d i s t a n c e between themselves and t h e i r mothers. At some p o i n t d u r i n g the t r a n s i t i o n phase, each daughter reaches her upper l i m i t — her t h r e s h o l d -- of inner c o n f l i c t and t u r m o i l that she i s able to t o l e r a t e . T h i s t h r e s h o l d i s presumably a d i f f e r e n t degree of inner c o n f l i c t f o r each daughter. A daughter's r e a l i z a t i o n of her i n d i v i d u a l t h r e s h o l d i s a p i v o t a l or t u r n i n g p o i n t which r e s u l t s i n her gr e a t e r concern f o r her own needs than f o r those of her mother. The r e a l i z a t i o n of her t h r e s h o l d r e s u l t s i n a daughter's p r o g r e s s i o n to the second p o i n t along the continuum of care — the inner-centered point — where her a t tent ion is p r i m a r i l y on herse l f . As they near the inner-centered point along the continuum, the daughters become increas ing ly inner-centered. While at the inner-centered point , they begin to compare the ir present-day experiences with the ir mothers to the i r fantasies of what they thought the i r mothers, and t h e i r re la t ionsh ips with the i r mothers, would be l i k e at th i s stage in the ir l i v e s . Coming to terms with the fact that t h e i r fantasies are not, in fac t , the r e a l i t y , the daughters begin to grieve for t h e i r fantas ies . Through the process of comparing and contrast ing the ir fantasies and r e a l i t y , the daughters also begin to i d e n t i f y the i r own needs in the caregiv ing r e l a t i o n s h i p s , a process which is c r i t i c a l to the i r further progression along the continuum of care. Having r e a l i z e d the i r own needs the daughters move into the second t r a n s i t i o n phase, wherein they begin to act on the ir newly i d e n t i f i e d needs. Rea l i z ing that they cannot be knowledge-rich and act ion-poor , they begin to make contextual caregiv ing decis ions - - decis ions which consider not only t h e i r mothers' needs, but also the ir own needs, and the needs of any family members who may be affected by t h e i r dec i s ions . Because they are making contextual dec i s ions , the daughters must, necessar i ly , set some l i m i t s on the i r caregiv ing a c t i v i t i e s . This l i m i t - s e t t i n g process generates further inner c o n f l i c t which forces the daughters to question 45 the r i g h t f u l n e s s of i n c l u d i n g t h e i r own needs i n t h e i r c i r c l e s of c a r e . I f she can e f f e c t i v e l y d e a l w i t h her i n n e r c o n f l i c t a daughter moves toward the t h i r d p o i n t a l o n g the continuum --the e t h i c - o f - c a r e p o i n t -- where she f i n d s a b a l a n c e . Here the d a u g h t e r s a r e f i r m e r i n t h e i r commitment t o make c o n t e x t u a l d e c i s i o n s . They c o n t i n u e t o s e t r e a l i s t i c l i m i t s on t h e i r c a r e g i v i n g a c t i v i t i e s , and t h e y are b e t t e r a b l e t o work t h r o u g h t h e i r i n n e r c o n f l i c t i n a r e a l i s t i c manner. One dominant theme encompasses the continuum of c a r e , a theme which the r e s e a r c h e r has e n t i t l e d "the l o g i c a l p r o c e s s of w o r k i n g towards h e a l t h y d i f f e r e n t i a t i o n from mother". T h i s theme i n c o r p o r a t e s the s t r a t e g i e s which the d a u g h t e r s use t o move towards h e a l t h y d i f f e r e n t i a t i o n from t h e i r mothers. To f a c i l i t a t e the r e a d e r ' s f u l l u n d e r s t a n d i n g of t h i s d e v e l o p m e n t a l framework, the r e s e a r c h e r has d e s c r i b e d , i n d e t a i l , each of the components of t h i s d e v e l o p m e n t a l framwork (see F i g u r e 1 , o v e r l e a f ) . How the C a r e g i v i n g R e l a t i o n s h i p B e g i n s P r i o r t o a d d r e s s i n g the continuum of c a r e d i r e c t l y , i t i s of i n t e r e s t t o e x p l o r e what t r i g g e r e d the onset of the c a r e g i v i n g r e l a t i o n s h i p s between these d a u g h t e r s and t h e i r mothers. The s h i f t i n a mother-daughter r e l a t i o n s h i p was d e f i n i t i v e enough t o be i d e n t i f i e d , and o f t e n , but not a l w a y s , i n v o l v e d a c r i s i s . As i s e v i d e n t i n the f o l l o w i n g q u o t e s , t h i s 3" CD I I I I t - 1 H H 0 M O CD CD SB SB 09 SB 09 3 H- I-* 4 H* SB 3 O 3 c+Oq H* JD H- H- 3 H B 3 0 ° N O H- O O o"3 ? 3 o O 0 ° SO rt- CD H 4 01 H O ra 3 0 ° SB ct o B O 0) c+ 3 So 3 3" 09 4 3 0) - 0 ° 4 tn ro 3 CD ct O O 3 P< CD 4 ro 3* 0 n> 09 ct so So B ct O ^ P. O 3 4 ci" O o so 3 4 0 P 13 4 3* IV CD CD CD CD CD »-b CD CO 4 O P CD P*d M 4 CO o 4 ts CD 3 H- p CD oq p. 09 09 co B O Ct Ct O to he B 4 o B ct o So 31 ct 3 tD 3" p. 4 CD 4 ra m CO -> o ct CD h3 4 O I H- O 3 CD ct 3 ct CD 4 CD P. Transition Phase -inner c o n f l i c t , emotional turmoil, and distancing - h i t t i n g the wall i i p, 4 CD 3 ct 09 CO p . H- H- 3 ro M> 3 H-B <<: 09 N o tn H* H-ct CD 3 «> 3 3" SO OP O Ocj CD H> 4 4 ct B B 3" << B «< SO VJ 3 3 »-b p. CD Mj CB W CD SO 3 ro M> p. 3 ct CD •-*> ra ct so I-1 CD So ro >-•> 4 ra H-CD H- CD 3 CD ra ct tn H* SB ct t-* o 3 4 o B 3 o ct 3-CD 4 <! 09 - — — — 3 3 •Cl CD O 4 H- I 3 O Ct CD 3 ct CD 4 CD P. O O 3 •-3 M 2 CJ c s o o t> ts w Transition Phase -action on needs -inner c o n f l i c t generated by action on needs M el-s' »Tl H-O O H- I 3 O ct •-•> I O CD 4 CD 47 s h i f t served to fuse or connect the daughters more c l o s e l y to their mothers. For the purposes.of quoting the daughters and the researcher, the daughters are referred to as coresearchers, and the l e t t e r s C. and R. indicate coresearcher and researcher respectively. Some of the caregiving relationships began with a c r i s i s . R. When did you f i r s t " f e e l responsible" as you said? Can you put a finger on i t ? . . . C. Perhaps when my dad was sick and was hospitalized .... i t started...an awareness .... Then... when my dad d i e d . . . i t was r e a l l y apparent. And, another daughter stated: C. She [mother] had an emergency admittance into hospital one time...[because] she just hadn't looked after herself....I just f e l t that something should be done about i t . Some mother-daughter relationships s h i f t e d out of fairness. The daughters did not want their s i b l i n g s , who had already cared for other e l d e r l y r e l a t i v e s u n t i l their deaths, to have to assume the caregiving role again. C. I didn't want my brother to go through a l l that [caregiving] again. It was a horrible time [for him]....So, I said, "Well, come and l i v e with us, Mom". That's when i t [the caregiving relationship] started. Thus, i t appears that some c r i s i s event or decision brought the daughters closer to their mothers and i n i t i a t e d t h e i r a r r i v a l at the outer-centered point on the continuum of care. The Outer-Centered Point on. the Continuum of Care Three sub-themes of the caregiving experience are present at the outer-centered point on the continuum of care. The 4 8 researcher e n t i t l e d these sub-themes "knowing mother and her needs"; "responding to mother's needs", and "deferring to mother's needs". The fol lowing is a descr ip t ion of each of these sub-themes, followed by examples of data to support them. Knowing Mother and Her Needs One of the dominant sub-themes at th i s point in the continuum is "knowing mother and her needs". The daughters' outer-centered or ienta t ion at th i s point on the continuum was evident in the extensive knowledge of the ir mothers and the ir mothers' needs that the daughters f e l t was important to the i r caregiv ing r e l a t i o n s h i p s . Everything that the daughters d id for the i r mothers was explained in terms of the i r mothers; therefore , i t appeared that the ir intimate and extensive knowledge of the ir mothers provided the daughters with d i r e c t i o n regarding the types of caregiv ing a c t i v i t i e s required by the i r mothers. The knowledge that the daughters had appeared to focus on the ir mother's l ikes and dis l ikes> the ir a b i l i t i e s and i n a b i l i t i e s , the ir usual behaviours, the ir c h a r a c t e r i s t i c s , the ir needs, and the i r values . F i n a l l y , the daughters were also knowledgeable about what types of supports and at t i tudes e f f e c t i v e l y served to meet the ir mothers' needs. The fol lowing quotes r e f l e c t the extent of the daughters' intimate knowledge of t h e i r mothers. This daughter, whose mother was deceased, demonstrated 49 her extensive knowledge of her mother by descr ib ing her mother's c h a r a c t e r i s t i c s , usual behaviours, l i k e s , needs, and i n a b i l i t i e s . C. My mother was a strong woman....She never approved of anybody's r e l a t i o n s h i p . . . . She l i k e d to be waited upon. . . .She was always poking in and t e l l i n g you what to d o . . . . S h e was alone in the w o r I d . . . . S h e . . . h a d a t e r r i b l e job making f r i e n d s . . . . S h e was absolute ly t e r r i b l e to people ; . . . [She] never talked about f ee l ings . Another daughter's extensive knowledge was evident in her descr ip t ion of her mother's i n a b i l i t i e s , needs, and values . C. She is not able to love people or to reach out and be l o v e d . . . She's very independent. . . She presents a very tough image to the world. Yet another daughter's knowledge came through in her descr ip t ion of her mother's c h a r a c t e r i s t i c s , values , usual behaviours, i n a b i l i t i e s , and l i k e s . C. She [mother] i s n ' t a nurturing person and she i s n ' t a good communicator . . . . She's a high achiever . . . . She must be independent . . . . She's a very c r i t i c a l person. . .She gets quite t i ed up i f she's around people and she has to t a l k . . . . S h e doesn't l i k e to be around old people. Another daughter demonstrated her intimate knowledge of what types of supports and at t i tudes e f f e c t i v e l y met her mother's needs. C. But i t i s amazing how good she [mother] feels when she is understood by not just the family but by other people. And f i n a l l y , in the fol lowing quote, t h i s same daughter demonstrated her knowledge of her mother's c h a r a c t e r i s t i c p r i d e . C. She doesn't want me to ta lk about her to anybody . . . . [She ' s ] very proud that way. in summary, while at the outer-centered point on the continuum of care, the daughters demonstrated the ir extensive and intimate knowledge of the ir mothers and the i r mothers' needs. The daughters' knowledge appeared to focus on the ir mothers' a b i l i t i e s and i n a b i l i t i e s , c h a r a c t e r i s t i c s , usual behaviours, needs, values , l i k e s and d i s l i k e s , and on what supports and at t i tudes met the i r mothers' needs. Their knowledge appeared to provide the daughters with d i r e c t i o n regarding the types of caregiv ing a c t i v i t i e s the i r mothers required . Responding to Mother's Needs Another dominant sub-theme re lated to the outer-centered point on the continuum of care is e n t i t l e d "a daughter's responsiveness to her mother's needs". Although the daughters c a r r i e d out a v a r i e t y of caregiv ing a c t i v i t i e s for the i r mothers, i t was apparent that not a l l the daughters d id the same things for the ir mothers. On a regular bas i s , the daughters provided various types of care for the ir mothers. These caregiv ing a c t i v i t i e s appeared to f a l l into eight categories: (1) tending to mother's l ega l a f f a i r s , inc luding having power of attorney for her; (2) tending to mother's f i n a n c i a l a f f a i r s , inc luding g iv ing her money, doing her income tax, paying her b i l l s , and looking af ter her banking; (3) maintaining mother's s o c i a l and family network, inc luding chauffeuring her to s o c i a l a c t i v i t i e s , taking her to see her f r i ends , having her and her 51 fr iends over for lunch, having her over for dinners , holding family get togethers on holidays and spec ia l occasions and ensuring that she was present, helping her with her general correspondence, sharing mail with her; (4) maintaining mother's household and her q u a l i t y of l i f e , inc luding vacuuming, shopping for her grocer ies , paying for her grocer ies , bringing her cooked food, bringing her flowers, taking her shopping and out for meals, doing errands for her, supplying her with jams and j e l l i e s from the pantry, and dusting and t i d y i n g her place; (5) organizing mother's a c t i v i t i e s , inc luding taking her to appointments, and a s s i s t i n g her with her d i a r y and her calendar; (6) providing mother with emotional support, including providing her with comfort care, encouragement, and reassurance, keeping her happy, and l i s t e n i n g to her worries and complaints; (7) maintaining mother's image, inc luding washing and se t t ing her h a i r , doing her darning, mending, laundry, and dryc leaning , and (8) communicating with mother, inc luding v i s i t i n g and phoning her. One daughter, notable for her extensive involvement in her mother's l i f e , responded to her mother's needs by using her own money to furnish a room in her basement for her mother and, again using her own money, caring for her mother for f ive years . The same daughter also organized her mother's move into a group-sponsored seniors ' complex. Pr ior to her mother's move 52 th is daughter signed that she was responsible for her mother, inc luding the rent , i f her mother did not pay i t . The daughter also ensured that the apartment was c lean . She stocked the f r i d g e , f i l l e d the place with flowers, put up p i c tures , and fixed the t e l e v i s i o n . Then she took her mother there to show her the p lace . Another daughter and her nuclear family f u l l y g u t t e d and redecorated the apartment which her mother had purchased after s e l l i n g her own p r i v a t e home. This daughter's responsiveness to her mother's needs was a lso very evident in the fol lowing quote. C. She [mother] had quite a very serious o p e r a t i o n . . . she almost d ied , thanks to incompetence on the part o£ her phys i c ian . . . .We [my family and I] were l i v i n g 500 miles away.. .and we came down and t r i e d to do something about i t and ran into constant f r u s t r a t i o n . [So] I f i n a l l y sa id to her [mother], "Okay, you've got two weeks and i f you're not better you're coming home with us and I ' l l get our doctor to look after you" . . . .She did come to l i v e with us for about three weeks. On two occasions, the mother of another daughter became i l l . This daughter was also very responsive to her mother's needs. On the occasion of her mother's f i r s t i l l n e s s the daughter took a week off work to be with her mother. On the second occasion the daughter cut her sk i weekend short to f l y to another c i t y to be with her mother while she was i l l . This same daughter gave a v i v i d descr ip t ion of her responsiveness to her mother's needs. C. We [my husband and I] have said to her [mother]. . ."Our place is your p l a c e . . . y o u are welcome here any time you want. If you ever want to come down or are 53 f ee l ing lone ly , just phone us and w e ' l l come and pick you up." And further: C. I spend a lo t of mental energy on her [mother] and I spend time almost every weekend. . . . I'm t r y i n g to second guess what would make her happy. I think about her r e g u l a r l y I ta lk to her a l l the t i m e . . . . I • 1 1 • k i d h e r . . . . W e go to restaurants where she l i k e s the food. . . .When she has dinner at our p l a c e . . . I give her a care parcel to take h o m e . . . . I f I do some baking I always make sure she's got that and I give her apples from the t r e e . . . . I pick flowers for her out of the g a r d e n . . . . I bought her a toaster oven . . . so she c a n . . . h e a t i t [the le f tovers] up that way. Another daughter, who had been her mother's primary caregiver for the past 18 years , explained how she helped her mother with her Christmas correspondence. This daughter also showed great ins ight in to , and responsiveness to , her mother's needs. C. It is d i f f i c u l t for her [mother] to keep people s t r a i g h t . . . W e always have to go over i t [her mai l ing l i s t ] very s lowly. She has a l l her cards from las t year. I've got them a l l in order so she can see what the person said to her las t y e a r . . . . I know she gets a lo t of pleasure in th inking that she can help with her cards th i s year because she couldn't l a s t year. In summary, i t is evident from the f ind ings , that when the daughters were at the outer-centered point on the continuum of care , they were very responsive to the i r mothers' needs. The daughters c a r r i e d out a number of diverse a c t i v i t i e s for the i r mothers, and they did so with amazing frequency and for varying durat ions . Deferring to Mother's Needs Another dominant sub-theme at the outer-centered point on 54 the continuum of care is the daughters' deference to the ir mothers' needs, sometimes to the point of s a c r i f i c i n g the i r own needs. The daughters, by deferr ing to t h e i r mothers' needs, gave up the ir own personal time, t h e i r pr ivacy , the i r peace of mind, the ir freedom, and the ir personal plans . Their deference was v i s i b l e in the fol lowing quotes. One daughter, whose mother l i ved with her from March u n t i l midsummer, was quite c lear about the cost of her deference. C. It [having mother with us] necessar i ly infr inged on our [my husband's and my] pr ivacy of course. Some daughters s i l e n t l y put up with t h e i r mothers' behaviour even though they found the i r mothers' behaviour d i s t a s t e f u l . In th i s manner these daughters gave up t h e i r peace of mind. C. There are a l l kinds of things I 'd l i k e to say to her [my mother], but I don't want to do that , because she doesn't want to hear them. And, another daughter stated: C. I get kind of upset about the [mother's] c o m p l a i n t s . . . . I just s tar t gett ing r e a l l y uptight and i t ' s just not pleasant. I fee l quite negative and I s t a r t to fee l a b i t angry. R. What do you do about that when you fee l uptight? C. B a s i c a l l y I fee l I'm there to l e t her [mother] talk about i t . . . . I think that sometimes helps [her] . I d o n ' t . . . d o anything other than g r i t my teeth . For some daughters, t h e i r deference to t h e i r mothers' needs interfered with the i r freedom and t h e i r plans.: C. I don't always fee l free to just go and do my own th ing , or stay home and do my own th ing , which I enjoy. 55 And c. My husband and I can't go away...on an extended t r i p . . . s o we're...not e x a c t l y p u t t i n g In time... but...doing a l l we can without t a k i n g h o l i d a y s . Summary While they were a t the out e r - c e n t e r e d p o i n t on the continuum of care, the daughters' a t t e n t i o n was p r i m a r i l y on t h e i r mothers. T h e i r outer o r i e n t a t i o n was e v i d e n t i n t h e i r e x t e n s i v e and in t i m a t e knowledge of t h e i r mothers and t h e i r mothers' needs, i n t h e i r responsiveness to t h e i r mothers' needs, and i n t h e i r deference to t h e i r mothers' needs. The daughters, by assuming t h i s o u t e r - o r i e n t e d posture, v o l u n t a r i l y s a c r i f i c e d t h e i r own needs to those of t h e i r mothers, and thus c r e a t e d a d i s p a r i t y . I t appeared that the daughters f e l t t h a t i t was accept a b l e f o r them to put t h e i r own needs a s i d e i n t h i s manner as long as t h e i r mothers d i d not experience any hurt, and were happier. The T r a n s i t i o n Phase Between the Outer-Centered and the Inner-Centered P o i n t s on the Continuum of Care The t r a n s i t i o n phase between the out e r - c e n t e r e d and the in n e r - c e n t e r e d p o i n t s on the continuum of care was a p e r i o d of c o v e r t , inner c o n f l i c t and t u r m o i l f o r the daughters. During t h i s t r a n s i t i o n phase some daughters reached t h e i r upper l i m i t s , or t h e i r t h r e s h o l d s , of inner c o n f l i c t and t u r m o i l that they could stand. The daughters used t h i s i n t e r n a l c o n f l i c t to put d i s t a n c e between themselves and t h e i r mothers. I t appears t h a t each daughter had a unique upper l i m i t or 56 threshold of c o n f l i c t . If she reached her upper l i m i t she "hit the wall" and moved on to the second point on the continuum of care . The dominant sub-themes in th i s t r a n s i t i o n phase are e n t i t l e d "inner c o n f l i c t , emotional turmoi l , and dis tancing" and "h i t t ing the wal l" . Inner C o n f l i c t , Emotional Turmoi l , and Distancing The issues generating th i s inner c o n f l i c t and turmoil in the daughters appeared to centre around the daughters' i n a b i l i t y to accept the caregiv ing r o l e , the i r perception that they were gett ing l i t t l e out of the i r re la t ionsh ips with the i r mothers, and the i r perception that the ir values were d i f f eren t than those of the i r mothers. Because of these issues , the daughters experienced a v a r i e t y of emotions, for varying durations of time. At various times, sometimes on a d a i l y bas i s , the daughters reported fee l ing accept ing, angry, annoyed, anxious, awful, bothered, calm, concerned, confused, defensive, depressed, devoid of love , disappointed, d i s turbed , embarrassed, exasperated, exhausted, fr ightened, f r u s t r a t e d , fur ious , great , g u i l t y , heavy, h o r r i f i e d , hurt , impatient, i r r i t a t e d , m o r t i f i e d , overwhelmed, pissed of f , pleasant, pressed for time, enraged, r e s e n t f u l , repulsed, sad, sandwiched, ashamed, sorry , spread too t h i n , s tressed, trapped, worried, upt ight , and upset. The daughters, in becoming cognizant of the fact that they and the i r mothers were d i f f e r e n t , and in r e a l i z i n g that 57 the ir s u r v i v a l hinged on the i r a b i l i t y to increase the distance between themselves and the i r mothers, began to use the ir inner c o n f l i c t and turmoil to create more and more distance between themselves and the i r mothers. For some daughters, worry and fear were part of the ir inner c o n f l i c t and emotional t u r m o i l . C. When she [mother] was in the sen iors ' complex, my husband worried about her having to move in here with us a g a i n . . . . That was his greatest fear . And that was my fear and worry too, because I knew she expected me to care for her. As i s evidenced by the fol lowing quotes, the i r growing resentment of the ir mother and the ir caregiv ing r e s p o n s i b i l i t i e s fueled t h e i r inner c o n f l i c t and turmoi l . C. And i t [the chauffeuring] got to be every day, sometimes twice a day, and i t was very d i s r u p t i v e . . . . I had to , you know, juggle my l i f e . And C. I f e l t t h a t . . . i f she [mother] sa id she had any aches or pains , that she d i d n ' t r e a l l y have them. She was saying i t to get my at tent ion from my husband. I am sure she did th i s but I can't prove i t . And, another daughter stated: C. She [mother] respects him [my cousin] and she doesn't respect my opinions . She thinks that I don't know what I am ta lk ing about. So i f I suggest something she just ignores i t . But i f he [my cousin] suggests i t then she w i l l do i t . And, f i n a l l y , yet another daughter s tated: C. Sometimes I fee l spread too t h i n . . . . T o o many expectations from family , per iod . Some daughters experienced inner c o n f l i c t because they perceived that they were gett ing l i t t l e out of t h e i r 58 re la t ionsh ips with the i r mothers. C. There's not much in i t [our re la t ionsh ip ] for me. I think there's a lo t in i t for my mother . . . .My mother has no idea of what I do with my l i f e . And another daughter stated:, C. She [mother] never asks about me. I never share anything about my own family with her. She's not in teres ted . She doesn't l i k e my c h i l d r e n . And yet another daughter experienced inner c o n f l i c t because of the u n i d i r e c t i o n a l nature of the r e l a t i o n s h i p . C. I t ' s [my mother's and my conversat ion's] a monologue with me d e f l e c t i n g . And sometimes I just want to stand up and scream. R. So how does that make you feel? C. A w f u l . . . . I just s i t t h e r e . . . a n d do a l l th i s act ive l i s t e n i n g . But ins ide I'm g e t t i n g . . . pissed o f f . . . a n g r y . And C. Even i f I pop in [to see mother] for lunch, I now bring my lunch. I even bring the lunch. Like i t ' s a real t r i a l for her to get lunch. For some daughters, the i r in terna l c o n f l i c t was fed by t h e i r anger, hurt , depression, and disappointment. C. I just t r y to work on two leve ls with her [mother]. I j u s t , sort of, l i v e with her as though everything was fine and she l ikes i t that way - - she prefers i t that way . . . .The other l e v e l is just that constant anger. And, another daughter s tated: C. I f ee l angry and hurt and exasperated b e c a u s e . . . . I'm t r y i n g to do things that make her [mother] happy . . . .And when...she suddenly puts you down for something, you fee l l i k e dumping her out on the sidewalk and l e t t i n g her take the bus home. And, yet another daughter s tated: C. I f ind i t r e a l l y a depressing t i m e . . . [ I ' v e ] got a lo t of anger . . .d isappointment . . .whatever you would expect. 59 Part o£ the ir Inner c o n f l i c t was the s tress the daughters f e l t In the i r re la t ionsh ips with the ir mothers. C. When I'm with her [mother] i t is s t r e s s f u l , because I f ind I'm a lways . . . on the d e f e n s i v e . . . . E v e n when I hear myself say i t I th ink , "Why do I do i t ? " Part of the i r inner c o n f l i c t arose from the worry and disappointment they experienced. C. I'm worried about becoming l i k e her [mother] I am a worrier but I don't want i t to get l i k e i t is with her, where she doesn't e n j o y . . . a n y t h i n g . Some of the i r inner c o n f l i c t was fueled by i r r i t a t i o n with t h e i r mother's i n a b i l i t i e s . C. I t ' s the l i t t l e things that she [mother] can't make decis ions a b o u t . . . . T h a t is i r r i t a t i n g . Some of the ir inner c o n f l i c t was fueled by anger at t h e i r mothers' i n a b i l i t i e s . C. Sometimes I get r e a l l y kind of pissed off with her [mother's] dependency and her world gett ing narrower and narrower as mine tends to be going further and get t ing f u l l e r and f u l l e r . And, some of the i r inner c o n f l i c t was fueled by the i r mothers' d i f f eren t values . C. One t ime . . . she [mother] s a i d . . . . H e [your father 3 should have taught me so much more." And I j u s t . . . s a i d [to her ] , "That's your r e s p o n s i b i l i t y , not h i s . . . . Y o u should have taken that on." Some daughters' inner c o n f l i c t was fed by t h e i r anger, which appeared to ar i se from a c o n f l i c t in values . C. My mother phoned our daughter one day and s a i d , "You should get r i d of your boyfriend because he is much too o ld" . I mean, we [my husband and I] would never say that . Some of the ir inner c o n f l i c t was fueled by shame 60 and horror at the ir mothers' behaviour. C. She [mother] to ld him [my young nephew] that he d i d n ' t have the brains to understand something. And that just blows my mind . . . .She said i t . . . i n such a malicious w a y . . . . I was . . . so ashamed of her . . . . That's such a destruct ive way to ta lk to p e o p l e . . . . I'm just h o r r i f i e d . Their inner c o n f l i c t was also fed by the i r uncertainty about the i r caregiv ing r o l e . C. I don't know what's expected of me anymore. . . .And I've said [to mother], "I fee l l i k e I'm supposed to resolve your problems and I can't" . And she s a i d , "Oh, but I don't want you to resolve my problems." And I s a i d , "What do you want me to do then?" And she s a i d , "I just want you to l i s t e n . " And I s a i d , "Well, f ine , I ' l l just l i s t e n . " But I get sucked into i t a l l . . . . I tend to get a l l trapped into i t a l l . I wallow in i t . I f ight i t . . . I t ' s very p a i n f u l , very p a i n f u l . Because of the ir inner c o n f l i c t and emotional turmoi l , the daughters began to put more and more distance between themselves and the ir mothers. C. I t ' s not so easy to give loving care to somebody who, i f they d i d n ' t happen to be a parent, you wouldn't bother to cross the road to see t h e m . . . . I am t r y i n g to be. . .more of a caregiver to her although I am having a hard time with i t [ careg iv ing] , because I am at the stage in my development where I am. . .angry at h e r . . . . A t th i s moment i t makes i t very d i f f i c u l t . I have to fake i t r ight now. In summary, the issues generating the daughters' inner c o n f l i c t and turmoil appeared to centre around the ir i n a b i l i t y to accept the caregiv ing r o l e , the i r perception that they were gett ing l i t t l e out of the i r re la t ionsh ips with the i r mothers, and t h e i r perception that t h e i r values were d i f f e r e n t from those of the ir mothers. These issues generated a var i e ty of emotions in the daughters, and the daughters used th i s inner 61 c o n f l i c t to put distance between themselves and the i r mothers. H i t t i n g the Wall At some point during the t r a n s i t i o n phase, some daughters reached the i r upper l i m i t s of inner c o n f l i c t and turmoi l . For each daughter who did r e a l i z e her upper l i m i t of c o n f l i c t - - the point at which she h i t the wall and could stand no more — her r e a l i z a t i o n was a p i v o t a l point for her. Her r e a l i z a t i o n was a p i v o t a l point because at th i s point she broke her cycle of s a c r i f i c i n g her own needs, a cycle which had been, or had p o t e n t i a l l y been, unhealthy for her, and she began to progress along the continuum of care — to come c loser to f inding her own sense of s e l f . It appeared that a daughter could not progress from the outer-centered point to the inner-centered point on the continuum of care unless she f i r s t r e a l i z e d her upper l i m i t of c o n f l i c t and h i t the w a l l . The same issues that generated the daughters' inner c o n f l i c t in the f i r s t p lace , a lso caused the daughters to r e a l i z e the i r upper l i m i t s of c o n f l i c t . Some daughters r e a l i z e d the ir upper l i m i t s of c o n f l i c t because the ir values, for example, about the way to treat others, were not congruent with those of t h e i r mothers. C. Then she [mother] . . . s tar ted t e l l i n g people off at the dinner t a b l e . . . She was p a r t i c u l a r l y y e l l i n g at me about d i f f eren t things and I thought, "Who needs th i s?" Some daughters reached the i r upper l i m i t s of c o n f l i c t because of the ir anger and the i r perception that the ir mothers were not putt ing enough into the r e l a t i o n s h i p s . C. I purposely d id not offer her a lo t of indulgence . . . because I thought, " T h a t 1 s . . . not what she would do for me". And I . . . t o o k a serves -her -r ight kind of a t t i t u d e . Almost v i n d i c t i v e , not n i c e . . . b u t that ' s just the way I wanted to do i t . . . . I was at that stage. . .where I was t e r r i b l y , t e r r i b l y angry, and I just thought, "To h e l l with her. who cares". Summary The t r a n s i t i o n phase between the outer- and the inner-centered points on the continuum of care was a period of covert , inner c o n f l i c t and emotional turmoil for the daughters. The issues generating th i s inner c o n f l i c t and turmoil in the daughters appeared to centre around the ir d i f f i c u l t y in accepting the caregiv ing r o l e , the i r perception that they were gett ing l i t t l e out of the i r re la t ionsh ips with the i r mothers, and t h e i r perception that t h e i r values were d i f f e r e n t than those of the i r mothers. During th i s t r a n s i t i o n phase the daughters experienced a v a r i e t y of emotions, from a v a r i e t y of sources and for unknown durations of time. The daughters, becoming cognizant of the fact that they and the i r mothers were d i f f e r e n t , and r e a l i z i n g that t h e i r s u r v i v a l hinged on the ir a b i l i t y to put some distance between themselves and the ir mothers, began to use t h e i r in terna l c o n f l i c t and emotional turmoi l to create more distance between themselves and the i r mothers. The Inner-Centered Point on the Continuum of Care Daughters who r e a l i z e d the ir upper l i m i t s of in terna l c o n f l i c t , and who began to reconceptualize t h e i r caregiving r e s p o n s i b i l i t i e s , gradual ly arr ived at the inner-centered 63 p o i n t along the continuum of care, where they f u r t h e r d i s t a n c e d themselves from t h e i r mothers. On a r r i v i n g at t h i s p o i n t they began to attend to t h e i r own needs as w e l l as to those of t h e i r mothers; however, again, i n order to s u r v i v e , the daughters gave higher p r i o r i t y to t h e i r own needs, and they were l e s s open to e x p e r i e n c i n g t h e i r mothers' needs as t h e i r own. While at the i n n e r - c e n t e r e d p o i n t on the continuum of c a re, the daughters became cognizant of the f a n t a s i e s they had about what they thought t h e i r mothers, and t h e i r r e l a t i o n s h i p s with t h e i r mothers, would be l i k e at t h i s time i n t h e i r l i v e s . Concurrent to becoming aware of t h e i r f a n t a s i e s , the daughters began to come to terms with the f a c t t h a t they would never r e a l i z e these hopes and dreams; hence, they began to g r i e v e and to accept the i m p o s s i b i l i t y of t h e i r f a n t a s i e s . By r e c o g n i z i n g and g r i e v i n g f o r t h e i r f a n t a s i e s , the daughters, e i t h e r i n t e n t i o n a l l y or not, i n i t i a t e d an important process of i d e n t i f y i n g t h e i r own needs. The three sub-themes at the i n n e r - c e n t e r e d p o i n t on the continuum of care are " r e c o g n i z i n g my f a n t a s i e s " , " g r i e v i n g f o r my f a n t a s i e s " , and " i d e n t i f y i n g my own needs". Recognizing My F a n t a s i e s By coming to terms with what they l i k e d and d i d not l i k e about t h e i r mothers and about t h e i r r e l a t i o n s h i p s , the daughters s l o w l y r e v e a l e d t h e i r f a n t a s i e s about what they thought t h e i r mothers and t h e i r r e l a t i o n s h i p s would be l i k e at 6 4 th i s time in the ir l i v e s . This daughter, in descr ib ing her fantasy of her mother and of the i r r e l a t i o n s h i p , included many of the requi s i t e s of her fantas ies , such as f r i endsh ip , in formal i ty , having a perspect ive , and being interes ted , a c t i v e , and understanding. C. It would be great to have a fr iend who's got a perspect ive . . .who brings something to the c o n v e r s a t i o n . . . . I w o u l d . . . l i k e to be able to pick up the phone and not go through the l i t a n y and formal i ty of, "How was your d a y ? " . . . . I would l i k e to pop in [on her ] . I would 1 i k e . . . somebody who. . . [has] some kind of u n d e r s t a n d i n g . . . . ! would love to have a mother who was act ive in whatever way she defined i t , rather than dependent and threatened by everything that ' s out there. I mean, that ' s my fantasy. . . .someone not p h y s i c a l l y d i f f e r e n t , not younger, but someone who might be interested in the w o r l d . . . . i n what my s i s t e r and I do and what our kids do. Not in th i s kind of c l i n g . . . y o u know, "There, there, y o u ' l l be a l r i g h t " . The components of another daughter's fantasy included love, f r i endsh ip , pro tec t ion , and recogni t ion as a d i s t i n c t being. C. I would l i k e i t i f she had loved me, and I don't think she d o e s . . . . I would l i k e her to have been a fr iend in the sense of being interested in what I was d o i n g . . . . I would l i k e to have thought that she was there to protect me at times when I needed to be protected, and she never was. I guess I would have l i k e d her to think of me as a human being and she never has. She thinks of me as an extension of herse l f , one that was not p a r t i c u l a r l y welcome, I gather. Another daughter described her requ i s i t e s of her fantasy mother and the i r r e l a t i o n s h i p together. C. I guess I expect more of an interes t in what I am d o i n g . . . . Just to have her as a f r i e n d . . . . I ' d l i k e i t [our re la t ionsh ip ] to be more r e l a x e d . . . and not fee l expected to , or f ee l that I have to , take on her p r o b l e m s . . . . I just don't want i t to bug m e . . . . I ' d l i k e her to be happy and relaxed and not worry about everything and r e a l l y want to do th ings . . . .maybe I'd 6 5 hoped that ' s what our re la t i onsh ip would be l i k e . Another daughter volunteered de ta i l ed c r i t e r i a , for example, f r i endsh ip , shar ing , good communication, e t c . , when she discussed her fantasy r e l a t i o n s h i p with her mother. C. I keep wishing she [mother] was more ref ined and sort of l a i d back and easy going and comfortable to be with, but she c e r t a i n l y i s n ' t that way. So I think of a mother the way she i s n ' t a c t u a l l y . . . . I would love to have her the way my daughters and I have a r e l a t i o n s h i p , which i s t o t a l l y a d u l t . . . . W e are just f r i e n d s . . . . I t r e a l l y is a mutual admiration s o c i e t y . . . . I t ' s just very pos i t ive . . . . [ W e are] r e a l l y , 1 r e a l l y close and have good communication. We share things and there are no b a r r i e r s . . . . N o n e of us i s judgemental against the o t h e r . . . . I think i t ' s just a t e r r i f i c ro le to have with your c h i l d r e n and I would have loved to have had that with my mother. And, further: C. She [my husband's mother] r e a l l y was what my pic ture of [what a] mother w a s . . . . a dear l i t t l e s o u l . . . a de l ight to be a r o u n d . . . c o u l d n ' t help you enough. . . fr i e n d l y . . . f u n . . . i n t e r e s t e d . . . c a r ing . . .warm. . . and c r i t i c i s m d i d n ' t even enter into her vocabular ly . T o t a l l y d i f f eren t from my mother. The processes of comparing and contrast ing f a c i l i t a t e d another daughter's r e a l i z i n g her fantasy of a mother who was car ing and shared her f ee l ings . C. One of my good f r i e n d ' s mothers, I f e l t , had more q u a l i t i e s of mothering than my own mother. She was a very gentle , car ing person who shared some of her fee l ings on o c c a s i o n s . . . t h a t sort of touched me. . . that my own mother did not. I don't fee l that my mother shared her fee l ings with me when I was growing u p . . . . P r o b a b l y I would have f e l t a l o t c loser to her had she done t h i s . Another daughter's fantasy mother l i s t ened as the daughter shared her f ee l ings , focused on the daughter, and gave the daughter encouragement. 66 C. Just the fee l ing that I could say I was worried about something, or I was concerned about the k ids , or something bothered me about such and such, or a n y t h i n g . . . that would concern me personal ly — that she could be focused on me and not on h e r s e l f . . . a n d not fee l sorry for me, but to fee l with me and be encouraging. I guess that ' s the part that I wish would be d i f f e r e n t . And another daughter described her fantasy r e l a t i o n s h i p as an act ive one. C. I s t i l l have th i s mythology . . .br ing ing back the r e l a t i o n s h i p that I had with her as a c h i l d . Which I am no longer sure ever ex i s ted . Like maybe i t was a l l a myth. I don't know anymore . . . . I was ra i sed during the war and I have great memories of rac ing down to meet her as she l e f t the school with her l i g h t pink s u i t and looking a b i t l i k e Betty Grable . I mean, I love those images. And C. I have th i s f a n t a s y . . . o f going off to movies together [with mother] and having brunch together and doing a l l of that . Part of th i s same daughter's fantasy was a mother who was interested in her work. C. She [my mother] doesn't have any idea of what I do [at w o r k ] . . . . I t ' s kind of d i sappoint ing . In summary, the i n i t i a l port ion of the daughters' work, while they were at the inner-centered point on the continuum of care , involved t h e i r becoming cognizant of the fantasies they had about the ir mothers, and about t h e i r re la t ionsh ips with t h e i r mothers, at th i s time in the ir l i v e s . Griev ing For My Fantasies When the daughters r e a l i z e d that the i r hopes and dreams would never come to f r u i t i o n , they began to grieve and to accept the i m p o s s i b i l i t y of the i r fantas ies . 67 One daughter discussed her feelings of loss while, at the same time, questioning whether or not her expectations of her mother were r e a l i s t i c . R. So your rela t i o n s h i p i s d i f f e r e n t than what you expected. Is i t safe to say that you fe e l a...loss... because i t is not what you expected? C. Oh, a tremendous loss. But then, on the other hand.... maybe the loss is the loss of a fantasy and maybe that's t o t a l l y unattainable from year one.... Someone should have told me..."What you are thinking of does not occur". But I didn't know. Another daughter mourned for the mother she never had. C. I've never had a mother, r e a l l y , in that sense of an older person... that I could go t o . . . i f I was unhappy or lonely or anything.... And I guess I mourn that loss. Later, t h i s same daughter began to accept the loss of her fantasy and to plan ongoing forward movement along the continuum of care. C. What I now know i s , yes, that did happen [how mother mothered me]. Yes, i t was awful and I sure wish i t hadn't happened, and I sure wish she'd been a d i f f e r e n t person.... But that isn't what happened, and so...we have to go from there. And that's what I'm trying to do. Another daughter spoke of her grie f over the loss of her fantasy. C. I guess there i s a sense of grieving for that old relationship and wanting i t to be the same again, but knowing that i t won't be. And C. I guess I sense a loss in not f e e l i n g that she is as involved with me as I would l i k e her to be. And th i s same daughter also experienced loss because of the role reversal she and her mother had experienced. C. I had r e l i e d on her [mother] for advice or r e l i e f for 68 looking after the kids when they were growing u p . . . a n d now I see that my s i s t e r and I are her source of support. So i t ' s mainly us g iv ing to her, I guess. R. And does that a l l re la te back to your comment that i t was . . . a loss that you f e l t because of the ro le change? C. Yes. Expecting things to be d i f f eren t in her fantasy, she also grieved over her mother's lack of dec i s ion making and coping s k i l l s . C. I guess because you.expected maybe something d i f f erent when you were together. I d i d n ' t see her i n a b i l i t y to make decis ions and cope on her own. Yet another daughter mourned her mother's i n a b i l i t y to communicate. C. None of them [her grandchildren] l i k e to be near her [mother] which is r e a l l y sad, because I think she r e a l l y wants i t , but she just doesn't have communication s k i l l s . This same daughter mourned the fact that she could f ind very l i t t l e about her mother worth salvaging and apprec ia t ing . C. What a sad l i t t l e creature she [mother] i s . . . . S h e has said in the p a s t . . . " I wonder what people w i l l say about me when I die?" And I've thought, "Don't ask because you're se t t ing yourse l f u p " . . . . I can't think of anything good [to say about her ] . She must mean well but there's nothing about her that says she does. Yet another daughter mourned because she perceived that aging-induced changes in her mother prevented her mother from l i v i n g up to her fantasy. C. I think I am f inding i t [my r e l a t i o n s h i p with my mother] kind of depressing. I've gone through, I th ink, a f a i r b i t of depression, because I've r e a l i z e d that my mom is aging very q u i c k l y . . . . a n d just accepting that whole part of her. This same daughter also grieved over her perception that her mother, by los ing her w i l l to l i v e , lacked the desire to 69 r e a l i z e the daughter's fantasy. C. She [mother] has not a whole lo t of w i l l to l i v e . . . . S h e says "I wish I could die". L o t s . . . . R. So how does that make you feel? C. Very sad. Very sad, because . . . . I f ind that very hard to u n d e r s t a n d . . . . R. Is i t f a i r to say that she could reach out to other people and make herse l f happier i f she wanted to , but that i t makes you sad because she doesn't do that? C. That's r i g h t . That's exact ly what I f e e l . In summary, when the daughters r e a l i z e d that they would never experience the i r fantasies — the ir hopes and dreams — they began to grieve and to accept the i m p o s s i b i l i t y of the i r fantas ies . Ident i fy ing My Needs The process of comparing and contrast ing the i r fantasies to r e a l i t y ass i s ted the daughters to ident i fy t h e i r own needs. In i d e n t i f y i n g the i r own needs the daughters put further distance between themselves and the ir mothers. Not every daughter focused on exact ly the same needs; however, the major needs that various daughters focused on were the need to maintain the i r own health and, thus, to survive; the need to enjoy the i r l i v e s ; the need to prevent d e t e r i o r a t i o n of the i r relationships with t h e i r mothers; the need to maintain the i r l eve ls of self-esteem; the need to address the i r own problems, rather than those of the i r mothers, and the need to avoid taking on r e s p o n s i b i l i t i e s . Some daughters focused on the need to maintain the i r health and to surv ive . C. You don't have to make yoursel f s i c k . There's a woman up the r o a d . . . . S h e had her mother l i v i n g with her for 70 26 y e a r s . . . . and the daughter had a heart attack because of i t [because of her caregiving r e s p o n s i b i l i t i e s ] . So you can make yoursel f s i c k . And I don't think that is necessary and I don't think i t ' s r i g h t . Other daughters recognized the ir need to address the ir l eve l s of self-esteem. By meeting th i s need they thought they would also que l l the i r need to destroy the ir mothers and the ir r e l a t i o n s h i p s . C. I have to get to a point where I fee l good enough about . . . the kind of person that I am, that I don't have to say things that would hurt her [my mother ] . . . . de s t roy her. Some daughters emphasized the ir need to l i v e the i r own l i v e s . C. I t ' s your l i f e . . . . I f ee l that each of us is here to l i v e our own l i f e and not to l i v e for someone e l se . Others inferred that they were recognizing the i r own need to avoid taking on r e s p o n s i b i l i t i e s . C. Sometimes I fee l responsible for her [my mother's] happiness . . . I'm t r y i n g to get out of that f e e l i n g . And C. I guess I fee l that I should be doing something about i t [my mother's worrying] . And I'm just t r y i n g to back off and t e l l myself that these are her issues and she has to deal with them. Some daughters recognized the ir need to be inner-centered in order to learn how to handle s p e c i f i c problems they were having with the ir mothers' behaviour. C. I now r e a l i z e t h a t . . . i t ' s me that has the problem. I've got to learn how to handle i t [my problem with her d r i n k i n g ] . Summary While at the inner-centered point on the continuum of care, the daughters focused on themselves, i n i t i a l l y they recognized t h e i r fantasies of the ir mothers, and of the i r re la t ionsh ips with the ir mothers, at th i s time in the i r l i v e s . Rea l i z ing that the ir fantasies were not, in fac t , the r e a l i t y , and that they would never r e a l i z e the ir fantas ies , the daughters grieved for the i r fantas ies . Ul t imate ly the two processes of recognizing t h e i r fantasies and gr iev ing over t h e i r loss ass i s ted the daughters to i d e n t i f y t h e i r own needs. The outcome of these processes was a daughter's a b i l i t y to a r t i c u l a t e her own needs and a c lear sense of s e l f . The T r a n s i t i o n Phase Between the Inner-Centered and the E t h i c - o f - C a r e Points on the Continuum of Care Having i d e n t i f i e d the i r own needs, the daughters entered the t r a n s i t i o n phase between the inner-centered point and the e th ic -o f - care point on the continuum of care . While in th i s t r a n s i t i o n phase the daughters, knowing they could not be knowledge-rich and act ion-poor , began to take further ac t ion on the i r needs. They became more firm in the i r commitment to include the i r own needs in the i r care dec i s ions . Thus, the i r care decis ions became t r u l y contextual in nature. The daughters had to include t h e i r needs in the i r decision-making processes in order to continue the i r progression along the continuum of care . We already witnessed some daughters act ing on the i r needs while they were at the inner-centered point on the continuum. During th i s t r a n s i t i o n phase, the daughters continued to make 72 contextual dec i s ions , by drawing the l ine and se t t ing l i m i t s on the i r caregiv ing a c t i v i t i e s . However, because they were inc luding the i r own needs in the ir caregiv ing dec i s ions , the daughters again experienced inner c o n f l i c t and turmoi l , in the forms of worry, g u i l t , and fee l ing s e l f i s h and/or c r u e l . The two sub-themes in th i s t r a n s i t i o n phase are e n t i t l e d "action on needs" and "inner c o n f l i c t generated by act ion on needs". Act ion on Needs The r e a l i z a t i o n by the daughters that they were change agents led to a welcome fee l ing of contro l in the i r r e l a t i o n s h i p s . C. She [mother] is cons i s t ent ly the same. I'm the one that i s n ' t . Rea l i z ing that they were change agents, the daughters made c r i t i c a l choices about act ions to meet the i r needs. Their act ions involved changing the i r phone behaviours, a l t e r i n g routines to meet the ir own schedules bet ter , s taying away from the i r mothers, s e l f - t a l k i n g , a l t e r i n g the i r communication patterns , suggesting to the i r mothers the use of a l ternate resources, being r e a l i s t i c about the caregiv ing a c t i v i t i e s they could take on, and gaining contro l of the i r emotional reac t ions . By fol lowing through with these ac t ions , the daughters were able to r e t a i n more contro l over the i r re la t ionsh ips with t h e i r mothers. Some daughters acted on the ir needs by changing the ir phone behaviours. 73 c . I d i d n ' t phone mom every day. I d i d n ' t want to be i n v o l v e d t h a t much, because then she would expect i t and ask why I hadn't phoned Then I f e l t t h a t I became stronger i n myself, because I would then choose whether I went to see her or phoned her, and i f she complained... I would j u s t laugh i t o f f . . . . S o I f e l t t h a t I was being more detached than I was before and i t was e a s i e r . Note, i n the previous quote, that the daughter mentioned her growing s t r e n g t h , her growing detachment from her mother, and her growing c o n t r o l over the r e l a t i o n s h i p . Rather than being s o l e l y o u t e r - c e n t e r e d , or s o l e l y i n n e r - c e n t e r e d , the daughter was c o n s i d e r i n g both her mother's needs and her own. Some daughters acted on t h e i r needs by a l t e r i n g r o u t i n e s to meet t h e i r own schedules b e t t e r . C. She [my mother] comes over i f I ask her f o r dinner on an i n v i t a t i o n . R. How f r e q u e n t l y would t h a t be? C. Not more than once a month. I'm t r y i n g not to get i n t o some r o u t i n e t h a t ' s going to hang me up and j u s t add s t r e s s i n my l i f e , so I t r y to do i t when I f e e l that I want to do i t . Some daughters took a c t i o n on t h e i r needs by s t a y i n g away from t h e i r mothers. One daughter s t a t e d : C. I f I f e e l t h a t I've had enough of i t [the r e l a t i o n s h i p ] , I ' l l phone her [mom] out of c o u r t e s y and I ' l l say, "I'm s o r r y I can't see you, but I ' l l give you a shout tomorrow a f t e r n o o n and maybe w e ' l l see what we can do." And then I'd leave i t . And another daughter s t a t e d : C. I used to go over [to my mother's] even when I was t i r e d and that was d i s a s t r o u s . So I decided when I'm f e e l i n g too t i r e d from work I'm not going to go over, and I ' l l j u s t phone her, and t h a t seems to be a b e t t e r way to handle i t . And, yet another daughter s t a t e d : C. [Sometimes]...! j u s t back r i g h t o f f away from 74 h e r . . . . L i k e the las t few weeks I've d e l i b e r a t e l y made an e f for t to stay away for my own...peace of mind, so I don't have to fee l on the defensive. Some daughters acted on t h e i r own needs by s e l f - t a l k i n g . Their use of s e l f - t a l k enabled them to remain less involved in the i r re la t ionsh ips with t h e i r mothers. C. I'm learning to l e t them [mother's complaints] go in one ear and out the other. R. How do you l e t them go i n one ear and out the o t h e r ? C. Wel l , yeah! Hah! I think i t ' s easier sa id than done, but again, i t ' s part of t r y i n g to not take on the r e s p o n s i b i l i t y for the issues and in my head th ink ing , "Okay, that ' s her problem and she has to sort i t out. I can l i s t e n to what she has to say, but I can't do i t [solve i t for h e r ] . . . . S h e has to f ind other resources and she has them." For some daughters, taking act ion meant a l t e r i n g the i r communication patterns . C. I t r y not to give her [my mother] advice - - I just sort of say "um-hmmm" and t r y not to rack my brain to do something about something that ' s gone wrong. . . .So I'm t r y i n g to back off taking on the r e s p o n s i b i l i t y and to offer advice and suggestions. And another daughter stated: C. We [my mother and I] s i t and ta lk and i t ' s never about thoughts and feel ings and inner communicat ion. . . . It [ ta lk ing about thoughts and fee l ings] has been put down and kind of c r i t i c i z e d [by mother]. So I'm not going to put i t [my thoughts and fee l ings] out on the table to have i t walked across any more. Some daughters acted on the ir needs by suggesting to the ir mothers the use of a l ternate resources. C. Sometimes I w i l l say [to my mother] that I can't come today because I have these things that I have to d o . . . . B u t I '11 . . . suggest that I ' l l c a l l a lady that I know [who l i ve s ] in the [same] apartments, and have her do i t [get the item for my mother]. Some daughters acted on the ir own needs by being 75 r e a l i s t i c about what caregiv ing a c t i v i t i e s they could take on. c . I have to consciously work a t . . . d o i n g what I can do and not doing a whole lo t of extra things and then resenting i t . For some of the daughters, act ing on t h e i r own needs involved gaining contro l of the i r emotional react ions . C. Trying not to get overwhelmed by her [mother's] worrying or the s t re s s . Just t ry ing to maintain calm - -a more object ive — a t t i t u d e , than to f ee l responsible for a l l those worries . In summary, while in the t r a n s i t i o n phase from the inner-centered point to the e th ic -o f - care point , the daughters continued to ident i fy t h e i r own needs, and began to take act ion to meet the ir needs. Their caregiv ing decis ions were contextual in nature because they considered both the i r mothers' needs and t h e i r own. Inner C o n f l i c t Generated by Action on Needs During the t r a n s i t i o n phase, the daughters who made contextual decis ions by inc luding the i r own needs in the decision-making process, r e a l i z e d some inner c o n f l i c t . Their inner c o n f l i c t appeared to ar i se from three sources. F i r s t , the i r inner c o n f l i c t arose from t h e i r r e a l i z a t i o n that the i r continued deference to t h e i r mothers' needs was not congruent with the i r true intent ions to meet the i r own needs as well as those of the i r mothers. Secondly, t h e i r inner c o n f l i c t arose from the i r continuing to fee l torn between what they "should" do and what they "wanted" to do - -between how they perceived that others viewed the i r act ion on the ir own needs — a s s e l f i s h - - and how they viewed the ir 76 a c t i o n -- as s e l f - a s s e r t i v e . F i n a l l y , t h e i r inner c o n f l i c t a l s o arose from t h e i r r e a l i z a t i o n t h a t being s e l f - a s s e r t i v e meant t h a t they had to accept r e s p o n s i b i l i t y f o r the consequences of t h e i r d e c i s i o n s . The inner c o n f l i c t t h a t the daughters experienced from these three sources sometimes l e f t them f e e l i n g worried, g u i l t y , s e l f i s h , c o l d - h e a r t e d , and/or c r u e l . Some daughters experienced inner c o n f l i c t because of t h e i r d e c i s i o n s to l e t go of problems t h a t they had no c o n t r o l over. C. So I never t a l k about i t [mother's d r i n k i n g ] with her anymore. And I guess i t i s n ' t as d i f f i c u l t anymore, but I hope I'm not the one to f i n d h e r . . . i f she's d r i n k i n g and has a bad a c c i d e n t . But I r e a l i z e t h a t ' s a p o s s i b i l i t y . R. So you worry about her? C. Oh yes. Some daughters experienced inner c o n f l i c t because of t h e i r d e c i s i o n s to t r y to s t a y u n i n v o l v e d . R. Am I c o r r e c t i n assuming t h a t your s t r a t e g y . . . i s to t r y to s t a y uninvolved, to t r y not to f i n d a l l the answers [to your mother's problems?]. C • Y Q s • » • • R. Because you know t h a t you don't have any c o n t r o l over some of these s i t u a t i o n s ? C. Yes. I t sounds so c r u e l d o e s n ' t . i t . And yet another daughter s t a t e d : C. I tend to t h i n k of myself as being a c o l d - h e a r t e d monster. F i n a l l y , two other daughters s t a t e d : C. I guess t h a t sounds s e l f i s h . Summary While they were i n the t r a n s i t i o n phase between the inner-centered point and the e t h i c - o £ - c a r e point on the continuum of care, the daughters included t h e i r own needs, as well as those of the ir mothers, in the i r care dec i s ions . However, the i r inc lus ion of the i r own needs in t h e i r c i r c l e s of care generated some inner c o n f l i c t and emotional turmoil in them. This c o n f l i c t appeared to ar i se from three sources — from t h e i r r e a l i z a t i o n that the i r continuing deference to t h e i r mothers' needs was incongruent with t h e i r intent to meet the i r own needs as well as the ir mothers', from the i r being torn between how others viewed the i r act ions and how they viewed the ir ac t ions , and, f i n a l l y , from the i r r e a l i z a t i o n that being s e l f - a s s e r t i v e meant that they must a lso accept r e s p o n s i b i l i t y for the consequences of the ir ac t ions . The E t h i c - o f - C a r e Point on the Continuum of Care Having begun the ongoing process of ac t ing on the i r own needs, the daughters, i f they were able to e f f e c t i v e l y deal with the i r inner c o n f l i c t and turmoi l , began to move further along the continuum of care to a point c a l l e d the e th ic of care . While at th i s point on the continuum, the daughters further integrated t h e i r own needs, the i r mothers' needs, and t h e i r f ami l i e s ' needs into the ir contextual decision-making processes. They sought the caregiv ing so lut ions that were most inc lus ive of everyone's needs, inc luding the i r own. In order to make contextual decis ions and to be s e l f -assert ive the daughters had to set further l i m i t s on the ir 78 caregiving activities; therefore, while at this point on the contiuuum, they often continued to experience inner conflict and turmoil with their decisions. However, because they realized that contextual decisions are, by their very nature, accompanied by some inner conflict, the daughters were better able to work through their internal conflict in a logical and rational, as opposed to an emotional, manner. At this point on the continuum, it was evident that although the daughters had differentiated from their mothers, they s t i l l continued to be connected to and interdependent with their mothers. Through their actions highly differentiated daughters demonstrated their realization that they had their own lives to live, and that their mothers' problems belonged to their mothers. In addition, through their actions highly differentiated daughters demonstrated many logical abilities, including an ability to make contextual caregiving decisions; an ability to set limits on their caregiving activities; an ability to accept responsibility for the outcomes of their care decisions; an ability to be sensitive to situations or decisions which might pose threats to their own needs, and an ability to be logically reflective about their relationships with their mothers. Highly differentiated daughters recognized that they had their own lives to live. C. I think there is a basic idea that perhaps we need to look after our parents when they are older, up to a point. But I also have the philosophy that you have to live your life and you can't let other people be a 79 b a r n a c l e . There ' s a happy balance, i s n ' t t h e r e . H i g h l y d i f f e r e n t i a t e d daughters were ab l e to make contextual decisions. C. So out of a l l this [having experienced a l l of this] I've decided, and my husband too, that we wi l l never l ive with our children, even i f they ask us t o . . . . I have seen what i t can do to people. And, another daughter stated the following. R. Can you t e l l me a l i t t l e more about how that [your mother's moving in] wouldn't be good for you? C. Because i t would be a control i ssue. . . She would want to take charge of the home.. . .And.. .I wouldn't succumb to the control. So i t would be a fr ic t ion and I don't want that. It's much better to be as friendly as we can and have her l ive in the seniors' complex I'm not prepared to have her [my mother] in my home because I real ly don't think that would be a positive move for me.. .certainly for my husband and I together. Their high level of differentiation was evident in their a b i l i t y to set l imits on their caregiving responsibi l i t ies and to l ive with the outcomes of their decisions. C. Sometimes she [mother] says to.me In our house, "That's my room". And I say, "That's not your room, that's the den". And she ' l l say, "But that's where I'm going". And I ' l l say, "That's not where you're going. You've got your room up at the seniors' complex two minutes from here". And then she ' l l say, "Yes, but later, that's where I'm going". And I ' l l say, "No, i t isn't Mom....Look, when you deteriorate you're going into the moderate care [ fac i l i ty ]" . And we laugh about i t , and she ' l l say, "Oh, you always say that". And I ' l l say, "Well, that's r ight , because then you're in the same environment". I don't try to s e l l her on i t , I just say i t and leave i t . While making their contextual decisions these differentiated daughters demonstrated their recognition of their mothers needs, and also of their own needs to set l i m i t s . 80 C. I f e e l v ery c l e a r t h a t she [mother] w i l l never l i v e with us. I say t h a t v e r y f i r m l y r i g h t now. When the time comes f o r her to be moved i n t o a moderate care I'm sure i t w i l l be d i f f i c u l t , but I have every i n t e n t i o n of being f i r m . I have no i n t e n t i o n of t h i n k i n g and r e n e g o t i a t i n g t h a t a t a l l . . . . I r e a l i z e most of her f r i e n d s have probably died...[and t h a t ] she doesn't a c q u i r e new f r i e n d s e a s i l y . And she doesn't have good communication with any f a m i l y members, so she's r e a l l y cut h e r s e l f o f f . And I don't t h i n k she's happy with i t [the f a c t t h a t she's cut h e r s e l f o f f ] , but she doesn't know what to do about i t . R. But you s t i l l see t h a t [her i n a b i l i t y to communicate]...as her problem? C. Yes, I see t h a t as her problem. Yeah, I do. Because they were h i g h l y d i f f e r e n t i a t e d , they were able to s t a y s e n s i t i v e to s i t u a t i o n s or d e c i s i o n s which might pose t h r e a t s to t h e i r own needs. C. And we [my mother, daughter, and I] had such a n i c e h o l i d a y together t h i s year, and she [mother] wants to go everywhere we go now, and t h a t ' s kind of dangerous, too. H i g h l y d i f f e r e n t i a t e d daughters were b e t t e r able to be l o g i c a l l y r e f l e c t i v e about t h e i r r e l a t i o n s h i p s with t h e i r mothers. I t i s e v i d e n t i n the f o l l o w i n g quote, t h a t t h i s h i g h l y d i f f e r e n t i a t e d daughter was d e s c r i b i n g her p r o g r e s s i o n a l o n g the continuum of care from the o u t e r - c e n t e r e d p o i n t to the i n n e r - c e n t e r e d p o i n t . Note her i n i t i a l o u t e r - c e n t e r e d o r i e n t a t i o n towards her mother, followed by her inner c o n f l i c t and her need to d i s t a n c e h e r s e l f from her mother. Then she reached her upper l i m i t of c o n f l i c t and progressed to the i n n e r - c e n t e r e d p o i n t on the continuum, where she began to i d e n t i f y her own needs. R. Did you always see i t [your mother's i n a b i l i t y to communicate] t h a t way tas her problem] or d i d you evolve i n t o s e e i n g i t t h a t way? 81 C. I think I evolved Into It. Because I remember a few years ago when I would take her shopping every Saturday. . . . I gave her lots o£ l i cence . . . to t e l l me what to do and where to go . . . .But that kind of broke. It started breaking when she started with these remarks. They [her remarks] became more frequent. And she started with her real self-assertion business, and I thought, "Well, no". And I started leaving i t — l ike that's her l i f e . . . . I just realized she was starting to take the role of my mother in a real control area. I didn't l ike that. I didn't l ike her questioning my judgement a l l the time and making me just i fy everything I d id . It appears that a daughter who was highly differentiated from her mother while her mother was a l ive , was able to continue, after the death of her mother, to accept responsibil i ty for the outcomes of her caregiving decisions and to retain her peace of mind. This daughter, whose mother was deceased, stated the following about the caregiving decisions she had made while her mother was a l ive . C. I think they [my decisions] were a l l fine. It was what was meant to be. I'm a great believer in that, you know, and that you have to follow your heart. . .you have to follow your insides to do what you need to do . . . .So everything that we did was a l l for a reason to learn from the experience. And I t h i n k . . . I feel that i t doesn't matter what the experience i s . We draw experiences to us because we need them. And i t ' s not the experience but i t ' s the way that you handle i t . R. I l ike the way you said that. C. And so, maybe I didn't handle i t very well a l l the time^ but i t was the best I knew at that time. And I suppose that she [mother], too, struggled [in dealing with the relationship] because she couldn't express herself, you see. So i t was a lr ight . This daughter perceived that the caregiving experience was a positive challenge for growth and learning. As a highly differentiated daughter, she recognized that she and her mother were separate entities with different needs, a b i l i t i e s , < 82 levels of knowledge, and available resources. By her f inal remarks, "So, i t was alright", this daughter appeared to posit that the only requisite of the caregiving experience was that a daughter and her mother recognize that they are separate and unique ent i t ies , and be the best they can be as they l ive the caregiving challenge together. Summary While at the ethic-of-care point on the continuum of care/ the daughters sought the caregiving solutions that were most inclusive of everyone's needs, including their own. Because they were including their own needs, and were making contextual decisions, they had to, at times, set further l imits on their caregiving ac t iv i t i e s . Therefore, they often continued to experience inner confl ict and turmoil with their decisions; however, they were better able to work through their confl ict log ica l ly and rat ional ly . While at the ethic-of-care point on the continuum the daughters demonstrated, through their actions, both their high level of differentiation >from, and their ongoing connectedness to, their mothers. By their actions the daughters demonstrated their real ization that they had their own lives to l ive , and their real ization that their mothers' problems belonged to their mothers. In addition, through their actions they demonstrated various logical a b i l i t i e s , including an a b i l i t y to make contextual caregiving decisions, an a b i l i t y to set l imits on their caregiving ac t iv i t i e s , an a b i l i t y to 83 accept r e s p o n s i b i l i t y for the outcomes of the i r dec i s ions , an a b i l i t y to be sens i t ive to s i tua t ions or decis ions which might pose threats to the i r own needs, and an a b i l i t y to l o g i c a l l y r e f l e c t on the i r re la t ionsh ips with t h e i r mothers. The L o g i c a l Process of Moving Towards Healthy D i f f e r e n t i a t i o n From Mother Another dominant theme in the f indings of th i s study is e n t i t l e d "the l o g i c a l process of moving towards healthy d i f f e r e n t i a t i o n from mother". The daughters used four s t r a t e g i c processes in order to work through t h e i r connectedness with the i r mothers, and to become d i f f e r e n t i a t e d from t h e i r mothers. The four s t ra teg i c processes, e n t i t l e d "gaining-control over my emotions", "managing chal lenging s i tuat ions" , " l eg i t imiz ing mother's behaviour", and "learning about and understanding.mother and se l f" , are sub-themes of t h i s dominant theme. Gaining Control Over My Emotions The daughters used a v a r i e t y of techniques, resources, systems, and out lets in order to gain contro l over the emotions that they experienced in the i r re la t ionsh ips with t h e i r mothers. Techniques They Used to Gain Control Over Their Emotions The techniques they used included using humor, not th inking about the i r caregiv ing r e l a t i o n s h i p s , avoiding the ir mothers, g r i t t i n g t h e i r teeth , s e l f - t a l k i n g , confronting the i r mothers, making the i r mothers f e e l bet ter , In terna l i z ing the i r 84 emotions, and using self-abusive behaviours. It is also important to note that some daughters did not use any techniques and they did not gain control of their emotions. Some daughters used humor in order to gain control of their emotions. C. She [mother] went to v i s i t this man...every day, and she took him...mince p ies . . . .And again my husband would say, "I'm paying for the mince pies", you know. It was real ly quite funny. R. So you used some humor? C. Oh yes....We do have a sense of humor, a t e r r i f i c one, a warped one....we could see the funny side of a l l th is . Some daughters gained control of their emotions by not thinking about their relationships. C. What I do is I don't think about i t [my relationship with my mother]. I just don't, think about i t . Some daughters gained control of their emotions by avoiding their mothers. C. Sometimes I don't deal with i t [my r e l a t i o n s h i p ] . . . . If I'm having a part icularly bad time with i t I just don't phone her [mother]. And another daughter stated the following. C. I see her [my mother] every weekend. I'm glad that there are weeks between the weekends because -I find i t quite stressful actually. But . . . I 've rejuvenated myself and I have another energy surge by the next weekend and we [my mother and I] go at i t again. Some daughters gritted their teeth when their -mothers' complaints made them feel uptight. R. What do you do about that when you feel uptight? C. I usually just try and carry on. A few times I'm a bit short with her. . .and she probably senses my impatience. . . . ! don't know that I do anything other than gr i t my teeth a b i t . 85 For other daughters, the use of se l f - talk enabled them to gain control of their emotions. One daughter used self- talk to gain control prior to entering her mother's place. C. I think, "Okay, everything's going to be fine. I ' l l be positive and I won't lose my temper and be Impatient." Just, sort of se l f - ta lk , I guess, before I get in the door. Another daughter, through her use of se l f - ta lk , ultimately avoided feeling responsible for remedying her mother's upsets. G. It's part of trying to not take on the responsibi l i ty for the issues, and in my head thinking, "Okay, that•s her problem and she has to sort i t out. I can l i s ten to what she has to say, but I can't do i t [remedy the situation for her] . . . .She has to find other resources and she has them". Some daughters used confrontation in order to gain control of their emotions. C. I said [to my mother], "That real ly annoyed me, your doing that". And, this same daughter also stated: C. [When] she [mother] suddenly puts you down for something....sometimes I say to her, "I just don't believe that you would make comments l ike that." Some daughters gained control of their emotions by trying to make their mothers feel better. C. Mother has been feeling very lonesome.... R. So how does that impact on you then? C. Wel l . . . that sort of makes me feel that I should be trying to help her with t h a t . . . . R. So how do you deal with that? C. O h . . . . 1 try to -make mother feel better because that makes me feel better. Some daughters internalized their emotions, and their emotions emerged as physical symptoms. 86 C. Awful.. ..1 always feel that I should resolve whatever the [mother's] problem i s , but I'm not . . . I can't. So I . . .do a l l this active l i s ten ing . . . .But inside I'm getting. . .pissed off. I get angry. . . .And [I] have that sense of responsibi l i ty, but there's no way I'm responsible. I can't take that [her problems] on. But I sti11 feel 11 [the responslbi1ity]. R. And how do you feel It then? C. I...wear a mouth guard at night and I cry in my sleep. And I feel constant ly . . .upt ight . . . l ike I physically get uptight. So I internalize i t physically. Other daughters gained control of their emotions through the use of self-abusive behaviours. C. I do a lot o f . . . self-abusive things, l ike smoking. Other daughters did not gain control of their emotions. C. I just tend to slosh through. I don't deal with- i t [my feelings] well at a l l . Resources Used to Gain Control Over Their Emotions These daughters also used a variety of resources In-order to gain control of their emotions. Their resources Included their fa i th , talking to significant others, joining groups, and seeing psychologists. Some daughters used their faith in order to gain control of their emotions. C. I would be churned up before I got there [to mother's place]. . .So I would pray.. .and send nice thoughts. And another daughter stated: C Part of my way o£ dealing with i t . . . i s . . . m y faith in God.. . .That i s . . . v e r y important to me . . . . . I can say i t [how I feel 1 as i t i s . I don't have to pretend. Some daughters gained control of their emotions by talking with their significant others, Including their immediate family members, their in-laws, and- their friends. 87 C. When t h i n g s . . . s p i l l over 11ve always got my husband....I try to talk with my family members, a l l of whom are close enough that they understand who I am and how I feel . And another daughter stated: C. Talking about things with my sister helps to let off a l i t t l e steam, and some of the f r u s t r a t i o n . . . . It c lar i f i e s things a b i t . And, another daughter stated: C. I talk to my husband who is a very wi l l ing l istener, because he thinks my mother Is extremely cruel to me and he uses those words. Another daughter gained control of her feelings by talking to her s ister- in-law. C. She's very supportive to me....And she often has given me some very, very good suggestions even though they are very simple. Yet other daughters gained control of their emotions by talking to their friends. C. I also have two other friends...who I find i t very easy to say what I feel to. Some daughters sought professional help in order to gain . control of their emotions. C. I...went this morning. . . t o . . . [a] psychologist... .and had my f i r s t private session with her. And I wi l l continue to do that. And another daughter stated: C. I have gone to a therapist but I found that wasn't that -helpful. Systems Used to Gain Control Over Their Emotions The daughters also used various mutual support systems to gain control of their emotions. C. I talk to the other members of my group....we are a l l 88 in the same leaky boat together and i t ' s been very reinforcing. Some daughters maintained ongoing support relationships with others in order to gain control of their emotions. C. She's [mother's] a very c r i t i c a l person...... .My youngest s ister and I talk a lot about this [mother's cr i t i c i sm] . In fact we keep in very close contact. Outlets Used to Gain Control Over Their Emotions F ina l ly , some daughters used various outlets in order to gain control of their emotions.. C. Sometimes I'm unhappy. Sometimes It [the relationship] gets the better of me and I would l ike to break something. And, another daughter stated: C. Sometimes...I'11 just go into a room by myself and I ' l l just let i t a l l out. Like I'11 be angry. I'11 say a few things that come out of my head and ye l l them out. Another daughter stated: C. I do a lot of walking on the beach... .1 find walking on the beach for me is probably the best therapy ever. From the findings i t appears that some daughters' strategies for gaining control of their emotions were limited by their knowledge of their mothers' needs and a b i l i t i e s . C. Nobody has said to her imother]> "Do you realize what your effect on other people i s . Do you realize how much you offend them?"....I'm certainly reluctant to do that because I don•t know what k ind of a water f a l l that's going to s t a r t . . . . I ' m real ly not sure that she could deal with that. Summary As part of their logical process of differentiating from their mothers, the daughters used a variety of techniques, resources, systems, and out-lets in order to gain control of t h e i r emotions. Their choices of methods to use in order to gain control were sometimes limited by their knowledge of their mothers' needs and a b i l i t i e s . Managing Challenging Situations As part of their ongoing d i f f e r e n t i a t i o n process the daughters also used various techniques and resources in order to manage challenging s1-tuations that arose during the1r caregiving a c t i v i t i e s . It was apparent that sometimes some daughters were unsuccessful at managing challenging s i t u a t i o n s . Techniques for Managing Challenging Situations The techniques that these daughters used were numerous, and Included humoring, avoiding, s e l f - t a l k i n g , ensuring, s e l f -asserting, having the answers ready, confronting, and proactively exploring. Some daughters used humor in order to manage challenging s i t u a t i o n s . C. I would make a joke of it....That was the only way I could handle things - make a joke....That livened i t . Another technique some of the daughters used to manage challenging situations was avoidance. C. I had to deal with i t i f she was nasty about Imyl sending her there (to the seniors' complex]. And she was [nasty], but I managed to never stay long to know. And, another daughter stated: C. If I phone her and she's drunk....1 don't stay on the phone, I just get off the phone. I say [to her], " I ' l l talk to you tomorrow." 90 Some daughters used self- talk in order to decide how or, in this case, how not, to manage a challenging situation. G . I ' m just mortified by her [my mother * s] remarks...And I try to rationalize i t . . . t o just i fy where she's coming from. And part of me says [about mother)....."It should be communicated to you in a very clear way that the way you are communicating -is not acceptable to most people." . . . The other part of me thinks, "Because she's the sort of person she Is...how would she ever handle that [someone t e l l ing her that]?". Some daughters used the technique of ensuring in order to manage challenging situations. When discussing her worry over her mother's tendencies to walk too fast and not use her cane, one daughter stated: C. She tends to hurry (when she walks] and that's when she can f a l l . And she doesn't really-use her cane and I think she should do t h a t . . . . [ S o l i f I pick her up to come over to my house, or we go out shopping, I make sure she has her cane. Other daughters used the technique of self-assertion in order to manage challenging situations. C. I can be working in the garden and then l i e down for a few minutes.. . .[But] she [mother] feels everyone should be- working f lat out.morning, noon, and night, and she'11 t e l l me that . . . .And usual ly . . . I '11 just say [to her], "Look, i f you want to go and work in the garden feel free. I'm resting". And this same daughter also stated: C. [Mother would say that] we don't do things the way she does them... .And I say (back to her], ''Yes, that's r ight , I know I don't. But we [my family and I] l ike i t [done] this way". Another technique that some daughters used to manage challenging situations, was the technique of having the answers ready. C. You always have to have the answers ready because 91 she's (mother's] challenging and critiques the things you do. Another technique that some daughters used to manage challenging situations was confrontation. C. She would make rules and regulations. And i f I didn't agree with them I would s i t down with her. . . . (And] I'd say (to her], " I . . . r e a l l y don't want that." And, this same daughter also stated: C. I used to share things with her (my mother 1. . . .And I would hear i t back . . . in a real ly convolutedway.. . . and i t rea l ly upset me. So . . . I said to her (mother], " I . . . . t o l d you that in confidence. . . ! trusted you with that and you've broken that trust . So . . . I'm not going to share that kind of information with you any more.. . .I'm.. .disappointed". And another stated: C. One time...she (my mother] said, "I rea l ly don't think he (your father] gave me a clear break. He should have taught me so much more." A n d . . . I . . . s a i d , "That's your responsibi l i ty , not his ." And she said, "Well, he knows so much and he's always so much more intel l igent than I ever was."And I ended up yel l ing at her and saying, "You should have taken that on." And, this same daughter stated: C. My mother apologies for being a l ive , ; . . . It ' s almost l ike saying, "Excuse me for being alive". R. Do you ever talk to her about that or not? C. Yeah . . . . I ' ve . . . s a id (to her], "I cannot take the l i tany any more. I feel that you have something to o f f e r . . . . " . Some daughters managed challenging situations by proactively exploring the situation with the individuals involved in i t . C. My mother singled him (one of my children's cousins] out as the favorite grandchild.... .and did special things for him that she never did for anybody else. And I talked to my daughters about i t when they were in their teens. . . so It wasn't a problem. 92 Resources Used to Manage Challenging Situations As well as techniques, these daughters also used family resources in order to manage challenging situations. C. We, as a family, actually got together and I . . . s a i d , "We can't do that anymore [let- mother play us off against each other]". . . .So we've a l l stopped doing that (playing each other o f f ] . Unsuccessful. Attempts atMa naginq Challenging Situations Sometimes the daughters did not know how to manage challenging situations. C. (Her apartment] desperately needs cleaning, but I don't suggest it . . .because she would just get angry. . . .That bothers me at the moment — I don't know how to handle that. At other times, the daughters tried to use techniques and/or resources to manage challenging situation and they were not successful. C. My sister and I have. . . tr ied to talk to the doctor about her [mother's] depression but he's not the slightest bit interes ted . . . . I f she says [to him], "I'm depressed", he says [to her], "There, there". And I think, "Oh give me a break". So It's kind of dead ended. Another daughter t r i ed , through confrontation, to ascertain her mother's expectations of her. About her attempt to manage this challenging situation this daughter stated: C . I get sucked into i t a l l . . . . 1 • v e asked her speci f ica l ly what she might- want from me, or i f she needs things . . . .But (she said] , "Oh, no, no. You lead your own l i f e" . . . . [And] you can't get any further [with her]. Or I don't know how to get any further. So I have attempted to define i t [her expectations of me], but I tend to get a l l trapped into It a l l . I wallow in i t . I fight i t . Summary The findings suggest that as part of their process of logical ly differentiating from their mothers, the daughters used a variety of techniques and resources to manage challenging situations. It also was apparent that sometimes the daughters did not know how to manage challenging situations, and that their attempts to do so were sometimes unsuccessful. Legitimizing Mother's Behaviour Another logical process -that the daughters used in order to move toward healthy differentiation from-their mothers was the process of legitimizing why their mothers behaved as they did. The daughters legitimized their mothers• behaviour by attributing i t to history, to different generational trends and expectations, to multigenerational effects, and/or to losses that posed threats to their mothers• survival . Using History to Legitimize Mother's Behaviour Some daughters used history to legitimize their mothers' behaviour. C. See i t goes right back to her Imy mother's 1 mother being sick.. . .When my mother was 10 she had to take on all- the responsibi l i t ies of the home, 1 ike cooking. . and cleaning. . . . .She had to wait on her mother hand and foot. She [my mother's mother] was in bed nearly al1 .the latter part of her l i f e . . . [ S o l maybe she [my mother 1 expected that's what daughters should do. And the same daughter stated: C. He [my husband] s t i l l doesn't feel that she [my mother] ever related to him...When you look back, It may have been due to the fact that she was abused when she was.young...[And] that spoiled a l l her 94 relationships with men.. . . Or because she was never rea l ly happy in her marriages. Another daughter used history to legitimize her mother *s inab i l i ty to love anyone. G. My mother is not much of a caregiver. But my mother has never had care given to her, so she doesn't know how to be a careg iver . . . . She was never shown anything from her parents .My mother grew up tough. Another daughter legitimized her mother's inabi l i ty to be a nurturer and a good communicator by using history. C. For somereason that [nurturing and coaching] wasn't a pr ior i ty with h e r . . . . P a r t of i t was her upbringing. Her own father died when she was three and she real ly didn't l ike her stepfather....[because] he...curbed her development....She's a high achiever. . . . [and] she didn't real ly meet her goals, I don't think, in her own l i f e . And she's a very c r i t i c a l p e r s o n . . s h e thinks of positive things [nurturing and coaching]...as being weak....She would never show a weakness in anything. Another daughter also used history to legitimize her mother•s behaviour. C. I don't feel that my mother shared her feelings with me when I was growing up. . . .But I don't think mother was used to giving confidences either. Another daughter legitimized her mother's behaviour by relating It to her mother's marital history. C. Ever since I can remember....I've always been there for my mother, for her emotional state, because my father was a wonderful, gentle person, but he never sat down and listened. Another daughter used the history of her mother and father's codependent relationship to legitimize her mother's present-day behaviour. C. My father was alcoholic. . .what better role for her to move i n t o . . . a marriage made In heaven. Somebody (like her] with low self-esteem and low self-95 confidence...we11, you marry an alcoholic and that•s simply reinforced. And, this same daughter also stated: > C. I don't think she's Imy mother's1 ever been a very happy person. And...she's never been direct and c l e a r . . . . I don't think she's ever allowed herself to state what she wanted out of l i f e . I don't think she's ever seen that as something that she might have been able to do . . . .My mother never did that [defined her needs] for herself> and she always gave over to somebody e lse . . . .1 don't think she would ever be able to say what [she] needs to grow or to expand as a person, or what gives (her] pleasure. Using Generational Trends and Expectations to Legitimize Mother1s Behaviour Some daughters legitimized their mothers1 behaviour by attributing i t to changes in generational trends and expectations. C. Ideally she [mother] probably would l ike to be looked after by a beloved ch i ld . And I th ink . . . that our expectations are so different from [those of ] our parents•..vThey expected......that after a l l -they'd done for us we would do: this [care] for t h e m . . . . A n d i t hurts them [parents] when their children don't volunteer to take them into their homes and take care of them. But they don't realize that they are better cared for in a f a c i l i t y . Another daughter used generational trends and expectations to legitimize the behaviour of her mother and her mother's s is ters . C. A l l these women [my mother and her s i s ters ] . And none of them real ly defining theraseIves, but defining themselves in terms of their husbands. And a l l of them very bright and very talented, and having had some crack at the workforce before they got married. And [a11 of them 1 quite accomplished. -But then dropping 11 a l l once they got married, as was their "quote" . r ightful thing to do in that era. 96 Using Multigenerational Effects to Legitiraize Mother's  Behaviour Some daughters legitimized their mothers' behaviour by drawing on their knowledge of the multlgeneratlonal effects of parenting. c. She's tmother'si always been angry at her parents...And my grandmother was... very v i o l e n t . . . . A n d . . . here's my mother who's looking to me... to make that a l l better for her, and i t doesn't work, but she doesn't know what else to do. It's a real chicken and egg situation. Using Recent Losses to Legitimize Mother's Behaviour F ina l ly , some daughters legitimized their mothers' behaviour by attributing i t to recent losses that posed threats to their mothers' survival . C. Her (mother'si worrying...got more intense after he [father] died, because she realized she had to do everything on her own... .I sometimes feel that she's become very self-centered, but I understand that when you are worried about coping on your own...you're bound to become more-involved in yourself. And, this same daughter stated: C. I didn't see her [mother's] inab i l i ty to make decisions and cope on her own... .I think my dad was sort of the buffer for that. Summary Another logical process that the daughters, used to differentiate from-the the process of legitimizing their mothers' behaviour. The daughters legitimized their mothers' behaviour by attributing i t to history, to generational, trends and expectations, to multigenerational effects, and to recent losses that posed 97 threats to their mothers' survival . Learning About andUnderstanding Mother and Self Another strategic process that the daughters ut i l i zed in their log!cai process of moving towards healthy differentiation from their mothers, was the process of learning about and understanding their mothers and themselves. C. I think I'm always learning. Because of her Imy motherII went-to Alanon. And because of her I went to Clarissa Green's course. I'm open to learning anything about her. If somebody could say, "This is what you do, A, B, C . .and things are going to work out" — of course i t would never happen that way — but I would do i t . I'm prepared to do i t . . . . I think as I'm- getting older I'm learning more about my mother... learn ing her techniques...I'm always learning why we picked up things from her. The daughters used a variety of avenues in order to acquire their knowledge about their -mothers and themselves. They learned through their professional experiences. They also learned by doing genograms, reading books, attending groups, talking to others about their relationships with their mothers, talking to their mothers, taIking to health professionals, reviewing history, and taking courses. Some daughters learned by reading books. C. I started to read this book and I though, "My God, they are talking about me in this book". Some daughters learned by talking about their relationships with their .mothers, to others. •' C. I might learn some things i f you ask me the right question. Or i f you ask me a question andI have to answer i t then I learn things about myself. And that's good for me. I l ike to do that. Some daughters used their mothers as learning resources. 98 C. I sometimes s i t down with her tmy m o t h e r I real ly try to probe into her- childhood just for my own -interest.. . .Because when she's gone we've lost that part of her heritage. Some daughters acquired knowledge about their mothers and themselves through their professional experiences. R. Your professional background....has i t been a benefit (to you 1 or not? C. It helps in communicating, and getting her to t a l k . . . about how she's feeling, and being aware of what happens to people when they get older. . .and the resources that are available for them. And another daughter stated: C. since I was 30 I have counselled l o t s o f people. And I've learned through the years . . . . I 'm 69 now so that's 39 years I in my profession]. And I've read a great d e a l . . . . The k1nds of knowledge and understanding that the daughters acquired through their learning experiences was variable. Some of the topics they learned about included the following: how to express one's feelings; what impact generationally-induced attitudes and values have, on a mother-daughter relationship; how*multigenerattonal effects affect a mother-daughter relationship; how to cope and communicate in the caregiving relationship; the impact of history on a daughter *s behaviour and on a mother's behaviour; healthy approaches to challenging situations; what a daughter can r e a l i s t i c a l l y change in her relationship with her mother and what she has to let go of and, f ina l ly , the aging process. The daughters used their newly acquired knowledge and understanding in order to c lar i fy the differences and s imi lar i t ies between themselves and their mothers, and thus to 99 log ica l ly differentiate -themselves from their mothers. some daughters learned the art of expressing their feelings. This daughter, whose mother was deceased, stated: C. You have to say how you feel and' say i t nicely. And I've done that, b u t I didn't do that with her [my mother]. R. You acquired that art on your own? C . I had to. Some daughters learned about the impact of generationally induced attitudes and expectations on the mother^daughter relationship. C. I knew she [mother] expected me to care for her . . . .Her generation expected that children should and would care for them [parents]. . . . [but] I've seen what i t [having your parents l ive with you] can do to people. Some daughters learned about the impact of multigenerational effects on their relationships with their mothers. C. We did a genogram...in my group and i t ' s very obvious that . . . love has never been a part of her (mother'si l i f e . R. So how has that..-. .affected your relationship.with her now? C. At the moment i t makes i t very d i f f i c u l t . I have to fake i t . . . B u t . . . I'm hoping that I w i l l be able to work my way to a stage where I ' l l be able to say, "Yes, this is what happened. It wasn't her fault She interpreted her l i f e in the only way she could". And this same daughter also stated of multigenerational effects: R. Does your relationship with her (your mother] resemble her relationship with her mom or not? . . . C. Yes....When we did the genogram...that [resemblance] came out very s trongly . . . . that she . . . herself, was never shown anything from her parents. And, f lna l ly , this same daughter also stated: 100 C. A book that I just read. . . ta lks about parents who, rather than having chi ldren. . .do what the book ca l l s "taking hostages"...These are parents who...have never worked through their own anger at their parents for n e g l e c t . . . S o . . i l f they have a ch i ld , they say ^There. Now I have had you. Now, take care of me". And that's my mother. . . . I t 's not her f a u l t . I t just keeps going further and further down the l ine . Some daughters learned how to cope with the relationship and how to continue to relate to their mothers; C. That's one of the reasons I'm going to the group. Because.. . .I have to get to a point where I can cope with i t lour relationship] on some leve l , where I can relate to her on some level . Some daughters, by reviewinghistory, learned about, and began to understand, themselves. C. I never felt relaxed with my dad. And so we never expressed too much feeling with him, and we certainly didn't get angry around him. So, I don't think I ever learned how to express anger in a male-female relationship in a f a m i l y . . . . Some daughters strove to learn about and understand their mothers• experiences because, in doing so, they learned about themselves. C. I want to understand some of where I'm coming from, so i f she- [mother] can t e l l me some of the things that have happened to her. For example, say how she expressed anger....1*m wondering how that was handled in her f a m i l y . . . . I'd l ike to know more about her upbringing. . . .I 'm desperately trying to understand where she •• s tmy mother' s 3 coming from. Some daughters learned how to handle challenging situations. C. I've been to the drug and alcohol abuse c l i n i c , and to doctors, and Alanon, and getting information and trying to educate myse l f . . . . I real ly went around talking to her friends and our family members. And' this same daughter stated: 101 C. Earl ier o n . . . I was trying to come to terms with s i t t ing down and real ly lett ing her [mother] have i t between the eyes. And I just couldn't do i t , and I wasn't sure what she would do. . . . [ so] I thought, " I ' l l wait-and -maybe there's more I can learn". Through their learning ac t iv i t i e s , some daughters came to understand what they had control over and what they had to 1et G. [Now] I do understand I can't do anything about i t [my mother's drinking]. Some daughters learned about their and their mothers' different perceptions of aging. G. In that course I was on we talked about what old i s . . . It depends on where you are s i t t ing yourself. And I asked her [my mother] after I got off that course..."How old is old to you?" "Oh, about 102", she says. Some daughters learned about the aging process and i ts impact on their mothers' behaviour. C. What I'm learning. . . i s . . .how many doors get closed because of old age i t s e l f . A n d not the psychology and themakeup, but the physical deterioration and the loss of memory, and the anger that must cause you, and the frustrat ion. . . .Everything is d i f f i c u l t for her [my mother], and a lot of i t is a physical thing. . .and I have to be very careful that I don't judge this because sometimes I think, you know, "It [doing something] is not that hard". But for her i t [doing that thing] is very hard. Summary Another strategic process that the daughters used in order to log ica l ly move toward healthy differentiation from their mothers, was the process of learning about and understanding their mothers and themselves. The daughters learned about a variety of topics through a myriad of learning 102 experiences.They used 'their knowledge and understanding in order to c lar i fy the differences and s imi lar i t ies between themselves and their mothers,and thus to differentiate themselves from their mothers. WhatFaci l i tates the Daughters in Their Caregiving Role Some daughters did not think that anything would fac i l i ta te them in their caregiving roles. C. I just feel i t ' s a dead end . . . . I don't see anything to fac i l i ta te i t [my role in the relationship] at the moment, I real ly don't. And this same daughter stated: G. I don't see anything [that would fac i l i ta te the relationship]. I don't. I don't see anything at a l l . . . . T h a t ' s the most depressing part of i t a l l . I just see i t as just socking i n . . . j u s t remaining the same....Maybe getting worse, I don't know. But I don't see much change. However, other daughters volunteered what d id , or what would, f ac i l i t a t e them in their caregiving relationships with their mothers. Although the researcher did not incorporate these fac i l i ta tors into the continuum of care, knowledge of what did or what would fac i l i ta te the caregiving role is useful because i t gives possible clues to valuable supports and interventions. The researcher grouped the fac i l i ta tors that the daughters mentioned into four categories and entit led them as follows: fac i l i ta tors that centered around mothers; fac i l i ta tors that centered around daughters; -faci l i tators that centered around both mothers and daughters, and fac i l i ta tors that centered around others. 103 Fac111tators that Centered Around Mothers F a c i l i t a t o r s t h a t centered around mothers i n c l u d e d : a mother's being mellow; her t a k i n g c o n t r o l of her l i f e ; her being happy; her a c c e p t i n g the aging-induced changes t h a t she was e x p e r i e n c i n g ; her being a c t i v e ; her wanting to change, and the a v a i l a b i l i t y of c o n f i d e n t i a l d i s c u s s i o n s f o r aging mothers. The f o l l o w i n g quotes r e f l e c t the f a c i l i t a t o r s t h a t centered around mothers. Some daughters found t h a t t h e i r c a r e g i v i n g r e l a t i o n s h i p s were f a c i l l t a t e d 1 f t h e i r mothers had mellow a t t i t u d e s . C. She [my mother 1 was much more mellow a f t e r she...came out of h o s p i t a l . And t h a t made a d i f f e r e n c e . . . because when I went there [to my mother's p l a c e ! I d i d n ' t f e e l n e a r l y so bad. I t seemed to be a l r i g h t . Some daughters thought t h a t t h e i r c a r e g i v i n g r e l a t i o n s h i p s would be f a c i l i t a t e d i f t h e i r mothers' were happy, r e l a x e d , and a c t i v e , had more c o n t r o l over t h e i r l i v e s , and/or d i d not worry. C. I'd l i k e her (my mother! to be happy and r e l a x e d ; and not worry about e v e r y t h i n g , and r e a 1 l y want to do t h i n g s . But she doesn't.... You get the f e e l i n g t h a t she'd j u s t l i k e the day to be over with? I t h i n k she's k i n d of d e p r e s s e d I would l i k e those t h i n g s to be gone and I think t h a t would probably make our r e l a t i o n s h i p a l i t t l e more r e l a x e d — l e s s s t r e s s f u l f o r me. And another daughter s t a t e d : C. I know she should have c o n t r o l over her l i f e . ...I know she i s n ' t p a r t i c u l a r l y happy. I f she was happy, or i f she had ways of e x h i b i t i n g happiness i n s p i t e of i t [her lack of c o n t r o l over her l i f e 1, I don't think that I would be worried [about her 1... because I would accept t h a t she doesn't have the -same needs (as I do!. And, f i n a l l y , another daughter s t a t e d : 104 C. It would make i t easier for me i f my mother would be happy.. .It would be easier on me i f my mother could, become active in some way. The lives of some daughters were easier i f their mothers accepted the situations they found themselves in . C. She's quite accepting of the meals at the [seniors'] faci 1 i ty and has a positive a11itude towards the -whole set up there . . . I t makes l i f e a lot easier, because i f she were unhappy I would real ly have more concerns about her. For some daughters, their mothers' acceptance of what was happening to them fac i l i tated the daughters'role by enhancing their a b i l i t y to let go. And further, some daughters stated that their mothers• a b i l i t y to accept what was happening to them would be enhanced i f their mothers had access to confidential situations inwhich they could discuss what they were experiencing during the aging process. C. The more she accepts what is happening to her the more I feel I can let go and not feel I'm wanting her to be something that she can't -be..-. R. And how do you think she's coming to accept i t [her getting -older and more forgetful ]? . . . C. I wouldn't say any particular person has helped h e r . . . I feel real ly sad . . . . that there aren't places f o r . . . older people. . . to have an o u t l e t . . . . It is amazing how good she feels when she -is understood by not just the family but by other people. She doesn't want me to talk about her to anybody....She is very paranoid about things l ike that. R; She-would l ike a confidential situation where she could just be herself? C. Yes. Fac i l i ta tors that Centered AroundDaughters and Mothers Faci l i tators that centered around both daughters- and mothers included: opportunities for a daughter and her-mother to talk about the changes that had gone on in their 105 r e l a t i o n s h i p and t h e i r f e e l i n g s ; l e s s p e r s o n a l t o p i c s o f c o n v e r s a t i o n ; r e l a t i n g t h e p a s t t o the p r e s e n t , and open d i s c u s s i o n s about how i t f e l t t o grow o l d and* about a mother's u p b r i n g i n g . The f o l l o w i n g quotes c o n t a i n examples of fac i l i ta tors that centered around both daughters and mothers. Some d a u g h t e r s t h o u g h t t h a t a mutual e x p l o r a t i o n of t h e changes t h a t had gone on i n t h e i r r e l a t i o n s h i p s would f a c i l i t a t e t h e i r c a r e g i v i n g r e l a t i o n s h i p s . C. I suppose i f we c o u l d t a l k about t t h e ] changes t h a t had gone on t i n our r e l a t i o n s h i p ] and how we were f e e l i n g , o p e n l y and h o n e s t l y , t h a t might h e l p . . . . T h a t might change our r e l a t i o n s h i p t o a more p o s i t i v e one....Perhaps my f e e l i n g s towards her (my mother] would be a l i t t l e b i t more l i k e t h e y used t o b e — m o r e enjoyment i n the r e l a t i o n s h i p . And a n o t h e r daughter s t a t e d : C. I suppose t a l k i n g about what our r e l a t i o n s h i p i s and how we a r e g e t t i n g a l o n g . For some d a u g h t e r s , l e s s p e r s o n a l t o p i c s o f c o n v e r s a t i o n f a c i l i t a t e d t h e i r c a r e g i v i n g r e l a t i o n s h i p s . C. Sometimes i t ' s p l e a s a n t when you can-move o f f from her (my mother's] needs and t a l k about t h i n g s i n g e n e r a l and l e s s p e r s o n a l t o her (or t h e ] t h i n g s she needs. Some d a u g h t e r s found t h a t t h e p r o c e s s o f r e l a t i n g the p a s t t o the p r e s e n t f a c i l i t a t e d t h e i r c a r e g i v i n g r e l a t i o n s h i p s . R. I f t h e r e was a n y t h i n g t h a t would h e l p your r e l a t i o n s h i p w i t h your mom what would i t be?... C. T a l k i n g about her p a s t and c o n n e c t i n g i t w i t h mine. Some d a u g h t e r s t h o u g h t t h a t open d i s c u s s I o n s w i t h t h e ! r mothers about how i t f e l t t o grow o l d and about t h e i r mothers• u p b r i n g i n g would h e l p t o make t h e i r r e l a t i o n s h i p s more 106 positive. C. Probably more about how i t feels to grow old. . .and things l ike that.. . . .I-'d like to know more about her upbringing. . . l ike. . .how they handled problems.. . . Faci l i tators That-Centered Around Daughters Faci l i tators that centered around daughters included: their a b i l i t y to define their own needs; their understanding of their mothers and their mothers' backgrounds; their a b i l i t y to control their emotional reactions; their not feeling guilty; their a b i l i t y to distancethemselves from the relationships; their a b i l i t y to set r e a l i s t i c l imits on caregiving; their a b i l i t y to forgive their mothers; their faith> and talking about their caregiving relationships with others. The following quotes reflect fac i l i ta tors that centered around the daughters. Some daughters inferred that their a b i l i t y to define their own needs would fac i l i ta te their caregiving relationships. C. One of thethings that's always been rea l ly hard for me i s -to define my own personal needs . Sometimes . . . I have to rea l ly work at defining what I need for me.. . .1 've taken workshops on i t . . . . I t is real ly hard for me i to do]. Their caregiving relationships were also fac i l i tated when the daughters had an understanding of their mothers and their mothers' backgrounds. C. . . . t r y i n g to understand where she [mother] is coming from. And another daughter stated: C. And my understanding...more about her [mother's] 107 background and where she came from...that always relaxes me and makes me not feel so uptight around h e r . . . .because I want to understand some of where l-'m coming from. Some daughters thought that they could fac i l i ta te their caregiving relationships i f they could control their emotional reactions. C. Not to get angry with her [ray mother). Some daughters thought that their a b i l i t y to avoid feeling gui l ty would fac i l i ta te their relationships with their mothers. R. What i f anything would fac i l i ta te your relationship with her (your mother)...? C. I know that I shouldn't feel g u i l t y . . . . b u t I do feel g u i l t y . . . I t ' s just me. For some daughters, distancing themselves from their mothers faci l i tated their caregiving relationships. C. It 's (guilt 's] usually there a l l the time unless I'm away....[Then] I can't be there so I don't worry about i t [my caregiving responsibi l i t ies ) . I relax and enjoy myself very much, 1 ike we [my husband and I] did when we were on the-sailboat. Their being able to set rea l i s t i c l imits to avoid resentment, and their being able to forgive their mothers and not expect justice, were processes which fac i l i tated the daughters in their caregiving relationships. C. I have to consciously work at . . .doing what I can do and not doing a whole lot of extra things and then resenting i t . . . . A n d because of mom's aging. . . that is going so quickly right now...I feel that forgiveness there. I feel that I can forgive a l l that part of i t and not feel there has to be justice for me. A belief in God was helpful to some daughters. C. Part of my way of dealing with i t (my caregiving 108 re la t ionsh ip] . . . i s knowing that I have.. .ray faith in God.. . .That is also very important to me. Some daughters found that talking about their caregiving relationships with others acted as a f a c i l i t a t o r . C. I . . . l i k e to do i t (talk about my relationship] from a se l f i sh point of view because...I can use i t as a l i t t l e bit of. therapy for .myself. . . .If .you ask me a guestion and I have to answer It, then I learn things about myself and that's good for me. I l ike to do that. Facl11tators That Centered-Around Others Faci l i tators that centered around others included: someone else sharing the caregiving responsibi l i t ies; discussion with, and understanding and support from, others in similar situations; understanding from important significant others, and feeling that they could be themselves and s t i l l be accepted. The following are quotes which reflect fac i l i ta tors that centered^around others. Some daughters felt that their caregiving relationships were fac i l i tated i f others shared' the responsibi l i t ies for their mothers. c. He (my cousin] would take her (mother] out and would be able to talk to her very easi ly , much more easily than I, which was great. It (my cousin's doing that]. . . took the pressure off me. . . . I f there is just myself, then I am a l l she's [mother's] g o t . . . . I f he's there, that diffuses that responsibi l i ty . . . . [Then] i f she's unhappy i t ' s not [only] my fault anymore. Signifleant others fac i l i tated the caregiving relationships of some daughters by sharing their caregiving responsibi l i t ies . C. He's [my husband's] gone out there (to mother's place] and...she just...makes the big l i s t (of things to do], and he just goes and does i t which is wonderful for 109 me....Then I don't have to think about i t [my responsibi l i t ies for my mother]....And i f he phones her I don't c a l l her . . . .So i f someone else takes i t [the respons ib i l i ty ] . . . . 1 just go and soak in the tub or read my -book. Forget i t . And, another daughter stated: C. Our daughter and son-in- law..vi take mother home with them sometimes from family dos, and I don't have to leave [the family get-together] and take mother back [to the intermediate care f a c i l i t y ] . Other daughters thought that group discussions with individuals who were going through similar situations would fac i l i ta te their caregiving relationships with their mothers. C. I would l ike to be in a group that gets together every so often. . . [with people] that are going through similar s i tuat ions . . . .That ' s very, very he lpfu l . . . to be able to talk about i t . . . t o know that other people are going through i t . Another daughter stated: C. I find I can't lay a l l that [my feelings about my mother's and my relationship] on my family. So, that's why I think i t ' s important [to get support] outside of my family. And another daughter stated: C. I think that there Is a need for women to talk together. . . , and maybe come up with some- rea l ly concrete ideas on how you deal with i t . Other daughters fe l t that understanding from others who had lived the experience would help them in their relationships with their mothers. C. I think just understanding from other people who've experienced the same t h i n g . . . . . I t does make a difference when somebody is understanding and is going through i t . And...you could take different things from what they are going through to help yourse l f , . ..1 think that's very important. Some daughters found hearing about the experiences of 110 others helpful and supportive. C. That one-day workshop was very good.. . .That kind of bonding...that kind of support is real ly essential s t u f f . . . . I t was rea l ly helpful to hear about everybody else's experience.And the support network was real ly important. Some daughters thought that understanding from important significant others, and feeling that they could be themselves and s t i l l be accepted, would fac i l i ta te them in their caregiving relationships. C. It 's to people that you real ly respect and you real ly care for that you want the most understanding from. . . . And, this same daughter stated: C. I just want to be able to be who I am at the time. Summary Some daughters posited that there were a variety of fac i l i ta tors which did or would fac i l i ta te their caregiving relationships with their mothers. These fac i l i ta tors were of four types: those that centered around mothers, those that centered around mothers and daughters, those that centered around daughters and, f ina l ly , those that centered around others. Other daughters suggested that nothing would fac i l i ta te their caregiving role . I l l CHAPTER 5 DISCUSSION Introduction This chapter contains a discussion of the study's findings. The discussion is divided into three sections. The f i r s t section contains- an analysis of the usefulness of the feminist perspective as a conceptual framework for the study. The second section centers around the various sources of the inner confl ict which the daughters experience between the outer- and inner-centered points on the continuumof care> and the health-promoting behaviours, such as real iz ing their upper l imits of confl ict and distancing, which they use to manage this conf l ic t . The third section of the discussion focuses on a further exploration of how the logical process of working towards healthy differentiation interrelates with the daughters' progression along the continuum of care to higher levels of health. Conceptual Framework In order to conceptualize the problem, the researcher used a feminist perspective. This framework was useful because i t provided guidance for the l i terature search and i t elucidated the Importance of seeking the daughters' perspectives. This conceptual framework was also useful because the researcher took -direction from i t when overviewing the findings, when one views the findings of this study using a 112 feminist perspective, i t becomes apparent that p o l i t i c a l , economic, cu l tural , and social forces are important determinants of a mid-life daughter's caregiving experience. The responsiveness of these daughters to their mothers' needs is both ongoing and laudable; at the same time, i t is a s i lent response, one that receives l i t t l e public recognition. From a p o l i t i c a l perspective, i t makes sense for p o l i t i c a l leaders to ignore the essential role of caregiving mid-life daughters. By exercising ignorance of the unpaid work mid-life daughters do in caring for their mothers, pol i t ic ians are able to curb spending that would increase community health services for this population. However, one wonders about the implications of this p o l i t i c a l rea l i ty on the health of these women. One also wonders about the implications for societal attitudes. It seems that mid-life daughters' desire to provide e ldercare— to give of themselves to their mothers and enhance the quallty of their mothers' l ives — Is a strong thread in the moral fabric of society, one that should be recognized and supported, rather than ignored. From an economic perspective, i t is evident from these findings that mid-lifedaughters, by responding to their mothers' needs, curb public expense by keeping their mothers out of institutions. However, the work of mid-life daughters is neither rewarded nor supported - - i t is thankless, so l i tary , and voluntary In nature. F ina l ly , i t is also apparent from the study's findings 113 that the caregiving experiences of mid-life daughters are influenced by social and cultural processes and inst i tutions, such as motherhood, the family, and parental expectations. In summary, the feminist perspective was ause fu l framework for directing the researcher to seek the daughters' perspectives. It was also useful in helping the researcher to delineate p o l i t i c a l , soc ia l , cu l tura l , and economic forces that impact on the experiences of caregiving mid-life daughters. Inner confl ict and Turmoil and Health Promoting Behaviours As health professionals, nurses are naturally concerned With actual and potential health-promoting behaviours. Therefore, in the second and third portions of the discussion, i t seems appropriate to focus on findings associated with health-promoting behaviours. Accordingly, the second portion of the discussion focuses not only on the sourcesof the daughters' inner conf l ic t ; i t also focuses on the potentially health-promoting behaviours the daughters display when they realize their upper levels of inner conf l ic t , and when they effectively deal with their inner confl ict through distancing. The third portion of the discussion focuses on the daughters' a b i l i t y to move towards healthy differentiation from their mothers as potentially health-promoting behaviour. Most of the inner conf1let these daughters experienced appeared to arise from three sources —from issues 114 surrounding role transition and role reversal, from the daughters' perception that their mothers should contribute more to their mother-daughter relationships, and/or from issues surrounding intergenerational and personal differences in attitudes and values. Role Transition and Reversal as a Source of Inner Conflict One might assume that as a daughter and her mother grow older, they progress through various role transit ions. As is evident from the findings of this study, however, sometimes the f ina l outcome of the role transition process is that daughters reverse roles with mothers; that i s , daughters give up their roles as recipients of care from their mothers and accept their new roles as caregivers for their mothers. The findings of this study show that somedaughters found this arrangement less than satisfactory, and-they experienced inner conf l ic t . Bengtson (1979) explained that role transit ion, including role reversal, is an inevitable source of intergenerational conf l ic t , and is an aspect of what he considered to be the number one problem of the normal family: coping with intergenerational relations over the years. Bengtson pointed out that role transitions require considerable adaptation on the part of both generations of family members, because the changing circumstances of family members, and their changing roles, create different expectations on the part of both children and parents. 115 Some of the inner confl ict experienced by these daughters was generated by role reversal. Specif ical ly , the new expectations that were part of their new roles caused inner confl ict to some daughters. Bengtson's (1979) writing suggests that reversing roles from care-recipient to caregiver creates inner turmoil, and this inner turmoil requires adaptation. If one equates the process of adaptation with a higher level of health, one might log ica l ly posit that the behaviours associated with real izing their upper l imits of turmoil, and then effectively dealing with their turmoil, were adaptive or health-promoting behaviours for the daughters in this study, because their behaving in this manner necessitated their further progression along the continuum of care. The reasons why the expectations of their new role generated inner-conflict In some daughters may revolve around several issues — issues relating to social expectations, and issues relating to the daughters' not being given the opportunity to choose whether or not they wanted to take on the new role . Graham (1983) and Sommers (1985) alluded to these same issues. Graham stated that in our society the nurturing and protection functions are primarily ascribed to women. And Sommers posited that women are presumed to be responsible for the well-being of their family members. It seems that the daughters in this study reflected what many women have experienced the rote assumption of a new role for which they have been programmed throughout their l ives . 116 There might be many reasons why, when a daughter reverses roles with her mother, she experiences inner conf l ic t . One reason might be that a daughter may not be psychologically ready to take on the new role of caregiver for her mother, because i t interferes with her already well organized l i f e plan. Another reason might be that a daughter may not be emotionally ready to care for her mother, because she has not had time to work through the "loss" she is experiencing due to aging-induced changes in her mother. And, f ina l ly , a daughter may not feel that she is knowledge-equipped enough to take on the caregiving role. In summary, i t appears from the findings that some of the daughters' inner confl ict was generated by the fact that they had to shed their role as care recipients and become, instead, caregivers. One might logical ly assume that the behaviours associated with f i r s t recognizing and then dealing with their inner confl ict were health-promoting for the daughters, because by acting in this manner the daughters had to move forward along the continuum of care. A Daughter's Perception that Her Mother Should Contribute More  to the Relationship Another source of inner confl ict for some daughters was their perception that their mothers should contribute more to their relationships. Some daughters described their relationships with their mothers as unidirectional , rather than bidirect ional , and as monologues, rather than dialogues. 117 A daughter's expectation of a just exchange in her relationship with her mother is congruent with the writings of various authors. Authors who described the intensity of generational investment and i ts importance in the lives of most individuals include H i l l , Foote, Aldous, Carlson, and Macdonald (1970) and Shanas, Townsend, Wedderburn, Fr i s s , Milhoj, and Stehouwer (1968). Bengtson (1979)posited that one problem families face when dealing with interaction between generations is the notion of equitable exchange the notion of a just balance of giving and receiving between generations. It therefore appears understandable why daughters who perceive that their contributions are not reciprocated by their mothers might experience inner conf l ic t . However, the findings from this study appear to present an interesting twist to the notion of equitable exchange. In the previously mentioned l i terature (Bengtson, 1979), the members of one generation want to ensure that their contribution to the members of another generation is equal to that received.* From the findings of this study, i t appears that some daughters use this notion of equitable exchange, not in relation to their own contributions to the relationship, but in relation to their mothers' contributions, and that a perceived disparity between the two generates inner confl ict in the daughters. Taking direction from Bengtson (1979), H i l l et a l (1970) and Shanas et a l (1968), perhaps when a daughter thinks she may be continuously giving more to the relationship 118 than her mother, she begins to compare their respective contributions and, i f she perceives a disparity, the intensity of her own generational investment recedes. In summary, i t appears from the findings that some daughters affirmed the notion of equitable exchange in their relationships with their mothers, and when these daughters perceived a disparity in the exchange, they experienced Inner conf l ic t . In relation to inner confl ict from this source, one might, again, logical ly assume that the behaviours associated with recognizing their inner confl ict and then effectively dealing with i t were health-promoting behaviours for the daughters, because acting in this manner necessitated their further progression along the continuum of care. Intergenerational and Personal Differences in Attitudes and  Values Another majorsource of the daughters' inner confl ict was the lncongruency between their mothers* attitudes and values and their own. Some of this lncongruency arose from intergenerational and personal differences in attitudes, values, and expectations. The importance of the imprint of history (Elder, 1981) is a f a i r l y new real izat ion. Bengtson and Cutler (1976) stated that only recently has i t become clear that generational differences reflect complex configurations of time and social structure, and Elder (1981) suggested that the imprint of history is one of the most neglected facts in development. 119 The mothers and the daughters in thi s study li v e d through a complex array of s o c i a l history and l i f e experiences. However, their s o c i a l h i s t o r i e s and their l i f e experiences were very d i f f e r e n t . Marchand (1989) posited that aged parents are sometimes perceived to be individuals who grew up in the dark ages, "before Gloria Steinem"; they have d i f f e r e n t values than their children, and they don't understand the term empowerment. Useful in examining intergenerational differences is the concept of cohort e f f e c t , that i s , re a l or apparent differences between individuals born at d i f f e r e n t points in h i s t o r i c a l time (Bengtson, 1979). Because they were born in di f f e r e n t decades in time, these mothers and daughters are presently experiencing d i f f e r e n t stages in their developmental — psychological, physiological, and s o c i o l o g i c a l -- processes (Bengtson). In addition to experiencing present events d i f f e r e n t l y , a daughter and her mother also experienced past s o c i o p o l i t i c a l events d i f f e r e n t l y , because they were at di f f e r e n t stages in their l i f e span development when they encountered these h i s t o r i c a l events (Bengtson). The outcome of these d i f f e r e n t cohort experiences i s an incongruency between the values and attitudes of a daughter and her mother, and i t is thi s incongruency that i s one source of inner c o n f l i c t and turmoil in a daughter. This opinion is ref l e c t e d in Parkes' (1971) b e l i e f s that one factor that i s l i k e l y to predispose to a relationship's breakdown is a major 120 discrepancy between the assumptive worlds of the two individuals in the relationship. In order to appreciate the cohort effect seen in the women in this study, let us look, for a moment, at the soc iopol i t ica l events experienced by the birth cohorts of the mothers in this study. The mothers presumably experienced times of scarcity of resources and times of abundance. A sequential overview of the major sociopol i t ical events in their l ives -which shaped their psychosocial development might include the post-war 1920 ' s , a time of unparalleled economic growth; the economic collapse during the Depression in the 1930s; recovery through industrial mobilization during World War II , and then growing prosperity during the 1940s and 1950s. O'Reil ly (1989) stated that women of this generation never knew themselves and they had no self-esteem. Most of them existed only to take care of a family and to work. They were pretty self less; however, at the same time, many of them thought they were owed a great deal in exchange. They squashed a l l emotion --they didn't have time to worry about their own feelings or to give emotional support to others. F ina l ly , their combination of ambitions was different from ours today. The sociopol i t ical events experienced by the daughters in this study were probably quite different. A l l o£ the daughters, except one, were born after 1930. Therefore, a 121 daughter's f i r s t major soc iopol i t ica l event might have been World War II , and that at a very young age. Henceforth, their major l i f e influences included the prosperous f i f t i e s , the peace and human rights movements of the s ixt ies , the women's movement of the seventies, and the environmental movement of the 1980s. It is easy to understand how the mothers' history-induced attitudes and values could be Incongruent with those of their daughters, and how the mothers' behaviour, therefore, generates inner confl ict in their daughters. The differences in the attitudes and values between the mothers and the daughters becomes very clear when one speculates how differently a mother and a daughter would interpret, for example, the notion of women in the workforce. The mothers grew up during the depression when the hiring practice was to give preferential treatment to men so that they could support their families. These women replaced men in the workplace only when necessary, for example, during the war. when the war was over they reassumed their r ightful place in the home. Conversely, the daughters experienced the women's movement which advocated equal access to education and employment for women, and pay equity for women. And think for a moment about how differently the mothers and the daughters would relate to the notion of expressing one's needs and feelings. The mothers grew up during the depression and the war when people were rewarded for se l f - sacr i f ic ing their own needs to those of the 122 col lect ive . Survival was the name of the game. The daughters, on the other hand, grew up during the human rights movement when the collective view cleared and the value and rights of each individual came to the fore. In summary, i t appears from the findings of this study that the inner confl ict that these daughters experienced arose from three sources - - f r o m role transition and role reversal, from some daughters' perceptions of inequities in the mother-daughter relationships, and from intergenerational and personal differences in attitudes and values, related to the cohort effect. In each instance their behaviours in recognizing and then successfully dealing with their inner confl ict might be perceived as being health-promoting behaviours, because acting in this manner necessitated the daughters• further progression along the continuum of care. The Logical Process of Working Towards Healthy Differentiat ion The third portion of the discussion chapter centers on the daughters' logical process of working towards healthy differentiation from their mothers. Specif ical ly , the content of this discussion focuses on how this logical process relates to the daughters' progression along the continuum of care towards a higher level of health. Given the nature of the mother-daughter caregiving relationship that emerged in this study, i t is reasonable to conjecture that these daughters were emotionally tied to their 123 mothers. This emotional attachment was evidenced in the inner confl ict and turmoil the daughters experienced during the transition phases, and in the caregiving act iv i t ies which they performed for their mothers. However, at the same time that the daughters were emotionally tied to theirmothers, they were also mature adults, capable of logical thought; hence, this theme, entitled "the logical process of working towards healthy differentiation from mother". Given that the process of working towards differentiation i s , in part, logical and intel lectual in nature (Bowen, 1978), one might assume that this logic dovetails with, and l ike ly counterbalances, the inner confl ict and turmoil the daughters experienced during their progression along the continuum of care. It could even be said that the daughters' ongoing process of counterbalancing their emotional react ivity with logic provided the ideal context for progression along the continuum towards a higher level of health. These conjectures are supported by Bowen's (1978) belief that "differentiation of self" has to do with the way an individual handles the intermix between emotional and intel lectual functioning. He also suggested that although i t is out of awareness, emotional fusion is universal In a l l people. Based on th i s , i t would appear that the daughters used the logical processes of gaining control of their emotions, managing cha1lenging situations, legitiraizing their mothers' behaviour, and learning about and understanding their mothers 124 and themselves, In order to decrease their emotional fusion and react ivi ty and increase their level of dif ferentiat ion. Bydif ferent lat ing from their mothers, these daughters were not abandoning their mothers. Differentiating from another does-not preclude continuing connection with that individual . Mil ler and Winstead-Fry (1982) explained the differences between less differentiated and highly differentiated individuals. Less differentiated individuals are more controlled by the emotionality of individuals around them. Further, less differentiated individuals have a high level of fusion between their own emotional and intel lectual systems, with the result that their emotional systems control their intel lectual decision-making and behaviour. Thus, less differentiated individuals tend to emotionally, rather than inte l lectual ly , react to the emotions of those around them. In addition, because their intel lectual systems, which develop choices, are overwhelmed by their emotional systems, less differentiated individuals are less adaptable to changeand are less capable of planning their l ives . One might logical ly assume that they are, therefore, less healthy individuals. Conversely, continued Mil ler and Winstead-Fry (1982), highly differentiated individuals are less controlled by the emotionality of individuals about them. Highly differentiated individuals are able to use their intel lectual systems in order to override their emotional systems. Therefore, they tend to react inte l lectual ly and log ica l ly , rather than 125 emotionally, to the emotionality of those around them. Given their a b i l i t y to react in a more intel lectual manner, highly differentiated individuals are more f lexible , adaptable, and responsive to change, and they have more control over their l i fes ty les . One might logical ly assume that they are healthier than less differentiated individuals are. Thus, i t would appear that the behaviour of highly differentiated daughters, because i t is driven by their intel lects rather than by their emotions, is less controlled by the emotionality of their mothers. Further, because highly differentiated daughters are more confident of their a b i l i t y to override their emotional react ivi ty with their inte l lect , they are not afraid to face the challenge of doing so. Therefore, rather than abandoning their mothers because of their fear of becoming lost in their mothers' emotions, they are able to continue their relationships with their mothers, while s t i l l maintaining their separate identit ies . One might log ica l ly assume that the relationships of highly differentiated daughters with their mothers are healthier in nature than are the relationships of less differentiated daughters with their mothers. Because the term "differentiation" denotes a process, one might presume that these daughters became Increasingly differentiated as they progressed along the continuum. However, the question s t i l l exists: what caused the daughters' emotional fusion with - their lesser differentiation from— 126 their mothers in the f i r s t place? The l i terature contained in the i n i t i a l chapters of this study alluded to some important factors which may have contributed to the daughters' i n i t i a l emotional fusion with their mothers. Chodorow (1974) stated that feminine personality comes to define i t se l f in relation and connection to other people more than does masculine personality. Specif ical ly , mothers tend to experience their daughters as more l ike , and-continuous with, themselves. Correspondingly, g i r l s , in identifying themselves as female, experience themselves as l ike their mothers, thus fusing the experience of attachment with the process of identity formation (Chodorow, 1978). In contrast, mothers experience their sons as a male opposite, and boys, in defining themselves as masculine, separate their mothers from themselves, thus curtai l ing their primary love and sense of empathetic t ie (Chodorow, 1978). Chodorow (1978) stated that women do not have weaker ego boundaries than men. Because they are parented by a person of the same gender, g i r l s simply emerge with a stronger basis for empathy — a stronger basis for experiencing another's needs or feelings as their own — b u i l t into their primary definit ion of self , in a way that boys do not. Gir l s come to experience themselves as less differentiated than boys, as more continuous with and related to the external object-world, and as differently oriented to their inner object-world as well . Thus> i t appears that the female social ization process may have contributed to the daughters' being more emotionally fused with, and less differentiated from, their mothers at the outer-centered point on the continuum than they were at the ethic-of-care point on the continuum. In addition, the previous discussion of the impact of the daughters' sociopol i t ical history on their assumptive worlds highlighted some factors contributing to the daughters' i n i t i a l emotional fusion with their mothers. For example, these daughters were presumably very much affected by the social consciousness movements of the s ixties and seventies, including the peace movement, the human rights movement, and the women's movement. Bowen (1978) suggested that in the past 25 years the members of society appear to have been emotionally regressing or sl ipping into a functionally lower level of differentiation from each other. The result , Bowen posited, is that today the members of society are less autonomous; they are fused into each other and they are more emotionally dependent on each other. Therefore, i t would appear that the major sociopol i t ical events that these daughters experienced simply reaffirmed and reinforced their social ization experiences and their resultant a b i l i t y to empathize with others. The combination of soc iopol i t ica l events and social ization experiences may explain why these daughters were i n i t i a l l y less differentiated from — more emotionally fused with — their mothers and 128 became more differentiated —less emotionally fused as they progressed along the continuum. The differentiation process began for these daughters during the transition phase when they experienced' their upper limits of inner confl ict when-they hit the wall — a n d realized that they had to distance themselves from their mothers in order to survive in their relationships. The fact that these daughters were internally motivated by the confl ict to begin the differentiation process is congruent with Bowen's (1978) suggestion that differentiation is a self-motivated, self-energized effort that is undertaken for self alone. The daughters used four processes ~ learning about and understanding their mothers and themselves, legitimizing their mothers' behaviour, gaining control of their emotions, and managing challenging situations — to differentiate themselves from their mothers. But one wonders how the use of these processes assisted the daughters to differentiate from their mothers. These processes might be interconnected; in fact, they might work in concert. Several scenarios serve to i l lus trate this . For example, by learning about her mother's multigenerational history, a daughter would perhaps be better able to stop emotionally blaming her mother for her behaviour and to start , instead, to logical ly legitimize her mother's behaviour. In addition, learning about healthy approaches to challenging situations perhaps enabled a daughter to avoid the emotional turmoil she usually experienced when she was unable 129 to handle a challenging situation. Further, her finding healthy approaches to challenging situations might have helped her to maintain her levels of self-respect and self-esteem. Too, by learning about the aging process, a daughter was perhaps more able to let go of aspects of her mother's behaviour that she could not change> and to concentrate her efforts on what she could control . By learning how to deal more effectively with her emotions, a daughter may have established a greater sense of peace with herself, because she was better able to think log ica l ly , rather than emotionally. Further, a daughter, by testing her a b i l i t y to use her newly found knowledge during challenging situations, perhaps became better able to delineate her strengths and her vulnerabi l i t ies , and to identify her needs. It would seem that their use of each of these processes made the daughters more cognizant of the differences between them and their mothers, and subsequently assisted the daughters to further differentiate themselves from their mothers — t o become healthier Individuals. However, i t appears that the daughters' progression from lower to higher levels of differentiation is not a unidirectional and easy process. A daughter may get stuck along the continuum, or she may vasci l late along i t . If a daughter is unable to overcome certain constraints or impediments to her further development, she w i l l get stuck at some point along the continuum and she w i l l not continue her p r o g r e s s i o n . For example, a daughter may get stuck i£ she Is unable to both I n t e l l e c t u a l l y and e m o t i o n a l l y accept the l o s s of her f a n t a s i e s , or I f she i s unable to i d e n t i f y her own needs, or i f she i s unable to a c t on her own needs. I t appears t h a t not a l l of the daughters i n t h i s study were ab l e to i d e n t i f y t h e i r own needs, and not a l l of those who i d e n t i f i e d t h e i r needs were ready to a c t on them. Parkes (1971) s t a t e d t h a t the f e a r of p o s s i b l e f a i l u r e i n a new l i f e can r e t a r d the process of r e l i n q u i s h i n g the o l d . Taking d i r e c t i o n from Parkes, some daughters may become stuck If they, f o r example, f e a r t h e i r i n a b i l i t y to accept the consequences of a c c e p t i n g the l o s s of t h e i r f a n t a s i e s , or i f they f e a r the consequences of t h e i r c o n t e x t u a l decision-making p r o c e s s . T h e i r f e a r o b s t r u c t s t h e i r road to h e a l t h i e r e x i s t e n c e s . Some daughters may have had d i f f i c u l t y r e l i n q u i s h i n g t h e i r tendencies to d e f e r to t h e i r mothers and to e x e r c i s e , i n s t e a d , t h e i r s e l f - a s s e r t i o n . Four other authors p o s i t e d reasons f o r the d i f f i c u l t y women experience i n being s e l f -a s s e r t i v e . E l i o t (1965) a t t r i b u t e d t h i s d i f f i c u l t y t o women's s u s c e p t i b i l i t y to adverse judgements by o t h e r s . Taking d i r e c t i o n from E l i o t , perhaps some daughters became stuck because they were, f o r example, unable t o a c t on t h e i r own needs because they f e a r e d adverse judgements from o t h e r s . G l l l l g a n (1982) s t a t e d t h a t a woman l i s t e n s t o an inner d i a l o g u e which i n c l u d e s a l l v o i c e s — the v o i c e s of others and her own voice. Because we l ive by consensus, i f a woman takes an action simply for herself, by herself, there is no consensus there - - between the voices - - and her action is re lat ive ly hard for her to defend in our society (Gil l igan) . Taking direction from Gi l l i gan , some daughters may have become stuck because they were unable to publicly rationalize the inclusion of their own needs into their c irc les of care. Or they may have become stuck because their sole cr i ter ion for success - - that their caregiving decisions please everyone involved — was, unbeknownst to them, unreal is t ic . Further, Sassen (1980) suggested that a woman's inner confl ict might arise from her heightened perception of the *other side' of competitive success, that i s , the great emotional costs at which success achieved through competition is gained. Horner's (1968) findings supported Sassen's bel iefs . Horner found success anxiety to be present in women only when achievement was direct ly competitive - - when one person's success was at the expense of another's fa i lure . Taking direction from Sassen and Horner, some daughters may have become stuck along the continuum because they unreal1stically viewed the caregiving situation as a mother against daughter, win-lose proposition, rather than as a mother and daughter, win-win situation. It appears that some daughters may become stuck along the continuum of care only when they are not able to logical ly overcome their tendency to emotional react iv i ty , while stuck 132 they are emotionally fused with, and not differentiated from, their mothers. Because they are emotionally fused with their mothers, their primary goal is to control their emotional react iv i ty to their mothers and to somehow prevent the total deterioration of their relationships with their mothers. The pursuit of this goal takes up a great deal of the daughters' energy; therefore, they have l i t t l e energy to devote to caregiving ac t iv i t i e s , per se. They continue to devalue these act iv i t i es and they do only what is necessary for their mothers. They describe their caregiving relationships with their mothers as a "duty", and they participate in the caregiving relationship only because they feel obliged to their mothers. Taking direction from Gi l l lgan (1982), daughters in this stuck position would be unwilling any longer to protect their mothers at what now seemed to be their own expense. As they retreat from their caregiving responsibi l i t ies , their own s u r v i v a l — t h e ultimate self-protective stance— returns as their paramount concern (Gi l l lgan) . As well as the potential for a daughter to become stuck and remain emotionally fused with her mother, i t appears that the inner confl ict that the daughters experienced along the continuum of care generated a certain degree of f lu id i ty or shift ing — ebbing and flowing - - in their degree of differentiation from their mothers and, presumably, in their levels of health as well . 133 The vasci l lat ion in their levels of differentiation from their mothers was also perhaps positively correlated with their a b i l i t i e s to control their emotional react iv i ty and to deal with situations log ica l ly . Taking direction from Bowen (1978), as their a b i l i t y to control their emotional react ivity to their mothers increased, the daughters became more differentiated from - - l e s s emotionally fused with — t h e i r mothers. As their a b i l i t y to control their emotional react ivity decreased, the daughters became less differentiated from — more emotionally fused with - - their mothers. Bowen (1978) referred to this ebb and flow as the pseudo-sel f . He explained the difference between the sol id self and the ebbing and flowing pseudo-self. One's sol id self is made up of the c learly defined bel iefs , convictions, and l i f e principles , which one derives from one's l i f e experiences and then incorporates into self by inte l lectual ly reasoning and considering the alternatives involved in each choice. In choosing these beliefs and principles , one becomes responsible for self and for the consequences of one's decisions. Each belief and l i f e principle within the sol id self is consistent with a l l the others, and the sol id self w i l l take action on these beliefs and principles even in situations of high anxiety and duress. Conversely, Bowen (1978) explained, the pseudo-self is created by emotional pressure and i t can be modified by emotional pressure. Since the principles are acquired under pressure, they are random and inconsistent with one another. The pseudo-self is a "pretend" self — i t is acquired to conform to the environment, and i t contains discrepant and assorted principles that pretend to be in emotional harmony with a variety of social groups, institutions, businesses, p o l i t i c a l parties, and religious groups, without one's being aware that the groups are inconsistent with each other. The sol id self is more or less stable, and is indicative of a higher level of dif ferentiat ion. The pseudo-self, on the other hand, is unstable and responds to a variety of social pressures and st imuli . Because i t is emotionally dependent, the pseudo-self is negotiable in the relationship system, and is indicative of a lower level of dif ferentiat ion. Taking direction from Bowen, i t appears that a daughter who has a high level of pseudo-self — a low level of d i f f erent ia t ion— would be unable to consistently control her emotional react iv i ty; unt i l the less reactive stance was truly a part of self , she would continue to sacrif ice her principles and her needs when caring for her mother. One might also presume that she would, therefore, be less healthy. As the daughter became, more differentiated from her mother, that i s , as she became more secure in her notion of self as a dist inct entity, she would become more self-assertive and more comfortable with her decision to consider her own needs, as well as those of her mother, in her caregiving decisions. She would be at a higher level of health. Gi l l igan (1982) would suggest that the daughter begins to see that these two modes of response, that i s , response to her mother and response to herself, are not mutually exclusive; by including her own needs in her c irc le of care she is not being se l f i sh , she is merely being honest and f a i r . It would also seem that a daughter who is highly differentiated from her mother is better able to think log ica l ly and to set r e a l i s t i c l imits to her caregiving ac t iv i t i e s , l imits that are not negotiable in her relationship with her mother. This presumption is congruent with Bowen's (1978) statement that the basic self of a differentiated individual , once found, may be changed by the individual on the basis of new knowledge and experiences; however, one does not change one's basic self because of coercion or pressure, nor does one voluntarily change i t in order to gain approval or to enhance one's stand with others. However, although i t would seem that once a daughter became highly differentiated from hermother she would retain that position, her level of differentiation could continue to fluctuate for two reasons. F i r s t , the fluctuations in her level of differentiation could reflect her own and/or her mother's developmental agendas and changing health states. Their developmental agendas and changing health states would alter their relationship and catalyze some negotiations regarding who now did what. Bengtson (1979) supported the notion of family negotiation. He posited that as we grow up and grow older the relationships that we have within the family change. Further, he suggested that the negotiation of developmental agendas between the generations serves to highlight the apparent differences between the generations. Finally, he suggested that these intergenerational differences arise from normal crises which involve transformations in an individual's levels of autonomy and dependency. Taking direction from Bengtson, it would appear that a daughter's level of differentiation would fluctuate as she or her mother experienced a lif e change which necessitated their renegotiating their relationship. A second reason for a daughter's continued fluctuation in her level o£ differentiation might-be that her contextual decision-making process -- her Inclusion of both her own needs and those of her mother in her caregiving decisions --would always leave her with some degree of inner conflict, because she would no longer be self-sacrificing in order to make the best decision for her mother; instead, she would be choosing the decision that was the best and the fairest for both of them. Gilligan (1982) stated that a l l moral dilemmas entail hurt, and that the occurrence of the dilemma itself precludes nonharmful resolution to everyone involved, because there is no way of acting without consequences to self and other. E l l i s (1970) supported the notion that there is no perfect solution to human problems. He stated that it is irrational for individuals to think that there is invariably a right, 137 precise, and perfect solution to ahuman problem, and to think that i t is catastrophic i f this perfect solution is not found. The fact that these daughters were l iv ing a human experience quite simply precluded the existence of any easy answers to the caregiving situations they found themselves in . Taking direction from Gil l igan (1982) and E l l i s (1970), i t appears that the daughters' a b i l i t y to remain highly differentiated from their mothers — t o be healthier individuals — depended on their a b i l i t y to logical ly overcome the emotional react iv i ty they experienced because of their inabi l i ty to find solutions that to ta l ly prevented harm to everyone Involved in the caregiving situation, instead, they needed to accept that a l l they could do and, therefore, a l l they needed to do, was choose the decision which best — not perfectly - - met the needs of everyone involved, including their own. In order to remain highly differentiated from their mothers, the mid-1 ife daughters had to rat ional ly accept the fact that there were no moral absolutes to guide them because they were, in fact, breaking t r a i l . They were l iv ing their own l ives with their mothers. Therefore, no one else could truly speak to their -experiences, or l ive their experiences for them, because they and their mothers were unique enti t ies . And, for the same reason, no one would be qual i f ied, o r a b l e , to judge the consequences of the daughters' caregiving decisions. Individuals external to the caregiving 138 relationships could only recognize and support the daughters In their challenging positions, and trust and hope that through their decisions they would be fa ir to both their mothers and themselves; that i s , that the daughters would be able to realize personal fulfillment as separate beings, while s t i l l maintaining their v i t a l connection to and relationships with their mothers. Summary This portion of the discussion focused on the interrelationship between the daughters' process of d1fferentiating from their mothers, and the daughters' progression along the continuum of care towards higher levels of health. From the last two sections of this discussion i t would appear that the daughters' realization of their upper limits of inner confl ict during the In i t i a l transition phase, triggers their differentiation process and their progressive movement along the continuum of care. Their behavlour as they realize and then successfully deal with their inner confl ict might be perceived as being health-promoting behaviour — behaviour which is positive, mobilizing, and constructive in nature — because i f the daughters can effectively realize and then manage their upper l imits of inner confl ict they no longer need to sacrif ice their needs, and they continue to progress along the continuum. Subsequently, It appears that the daughters' further movement along the continuum of care towards higher levels of health is fueled by their continuing a b i l i t y to counterbalance their emotional react ivi ty with the logical processes of learning about and understanding their mothers and themselves, legitimizing their mothers' behaviour, gaining control of their emotions, and managing challenging situations. 140 CHAPTER 6 SUMMARY, CONCLUSIONS, AND IMPLICATIONS FOR NURSING Introduction This chapter contains a summary of the study and some conclusions about the findings of the study. In addition, this chapter suggests implications of the findings for the members of the nursing profession. The implications relate to nursing practice, nursing education, and nursing research. Summary of the Study Women, as daughters, tend to be the primary caregivers of their aged parents, and this trend is not likely to abate. As individuals age, the demands for caregiving will increase; concurrently, the complexity of the caregiving activities will also Increase. In their caregiving roles, women experience many stresses. As the demand for care, and for more and more complex caregiving activities, increases, so will the stresses experienced by women as caregivers. In addition, the number and types of stresses, and the challenge of coping with them, will only increase as more and more women enter the labour force and as l i f e , in general, becomes more complex for individuals at a l l ages. A literature search revealed few studies focussing specifically on mid-life daughters as caregivers to their mothers. Most of the studies tended to group caregivers and parents together; thus, there appears to be l i t t l e knowledge regarding the experience of mid-life daughters — of women in 141 the middle — as they provide care for their mothers. The phenomenological method proved the most effective methodology for e l i c i t i n g the experiences of the mid-life daughters. This method was also congruent with the feminist perspective —the conceptual framework - - that guided the study. The feminist perspective elucidated the importance of e l i c i t i n g not only the v is ib le caregiving experiences of the mid-life daughters, but also their internal experiences — their feelings —and the meanings they gave to their experiences. The researcher recruited subjects for the study through a daughters-of-aging-parents program which was held at the Women's Resource Centre in Vancouver, Br i t i sh Columbia. The seven women who participated in the study were a l l mid-life daughters, and their ages ranged from 42 to 69 years. The researcher conducted two intensive interviews with five of the participants in the study. Because of a faulty tape, the last half of the i n i t i a l interview with the sixth subject was lost and the researcher interviewed this participant again. The researcher Interviewed the seventh participant once. The researcher tape-recorded these interviews and subsequently transcribed the tapes. Data collection and data analysis ran concurrently throughout the study. The results of data analysis provided direction for ongoing data col lect ion. The researcher used Giorgi's (1975) phenomenological method of data analysis. The researcher identified the natural meaning units within each 142 daughter's description of her experience and the theme that dominated each natural meaning unit. The researcher then synthesized and integrated these themes into a descriptive developmental framework which the researcher entitled the continuum of care. By following the progression of these mid-l i f e daughters along the continuum the researcher gained insight into how the daughters perceived their caregiving experiences. Along the continuum of care there are three points and two transition phases. While at the outer-centered point on the continuum, the daughters' attention is on their mothers. Their outer orientation is evident in their knowledge of their mothers and their mothers' needs, and in their deference and responsiveness to their mothers' needs. A daughter moves Into the f i r s t transit ion phase as she realizes that she, alone, is being excluded from her c i rc le of care. The transition phase is a period of growing inner confl ict and turmoil. When a daughter hits the wall or realizes her upper l imit of inner confl ict and turmoil she, in order to survive, moves along to the inner-centered point on the continuum of care. While at the inner-centered point on the continuum, a daughter's attention is on herself. She becomes aware of her fantasies about what her mother and their relationship would be l ike at this point in their l ives . Realizing the imposibil ity of these hopes and dreams, the daughter then mourns for her fantasies. Concurrently, she also begins to 143 identify her own needs. Having identif ied her own needs, a daughter moves into the second transition phase. During this phase she, real iz ing that she cannot be knowledge-rich and action-poor, begins to act on her own needs by including them in her c irc le of care. She does this by setting l imits on her caregiving ac t iv i t i e s , thereby making her caregiving decisions truly contextual in nature. However, her actions generate inner confl ict and turmoil, because they are perceived by others and by herself as being sel f ish and cruel . Because she acknowledges her need to maintain her relationship with her mother and her need to ensure her own survival in the relationship, she attempts to find a way to care for both her mother and herself. Coming to terms with the fact that the integration of deference and self-assertion is possible, a daughter moves toward the ethic-of-care point along the continuum. At this point a daughter continues to make contextual decisions and to set l imits on her caregiving ac t iv i t i e s ; however, she is able to logical ly and r e a l i s t i c a l l y deal with any inner confl ict generated by her actions. A dominant theme entitled "logically working towards healthy differentiation from mother" helps provide the context for a daughter's progressive movement along the continuum of care. The four sub-themes within this dominant theme are entitled "learning about and understanding mother and self", "legitimizing mother's behaviour", "gaining control of emotions", and "managing chal lenging s i tua t ions" . A daughter uses these l o g i c a l and i n t e l l e c t u a l processes in order counterbalance the subject ive experiences - - the inner c o n f l i c t s — she experiences while progressing along the continuum of care . In th i s way she comes to see herse l f as a d i s t i n c t e n t i t y , separate from her mother yet , at the same time, interdependent with her mother. Conclusions From- the f ind lngs of t h i s study the researcher drew a number of conclusions about m i d - l i f e daughters who are caregivers to the ir mothers. 1. At the s tar t of a caregiv ing daughter-mother r e l a t i o n s h i p , a daughter is very responsive to the needs of her mother. 2. When a daughter r e a l i z e s that she i s s e l f - s a c r i f i c i n g herse l f in order to care for her mother, the daughter becomes less responsive to her mother's needs and focuses, instead, on car ing for herse l f . 3. A daughter who i s able to i d e n t i f y her own needs and then act on them is able to care for her mother and herse l f in a manner that meets both t h e i r needs. 4. A daughter experiences a number of emotions while providing care for her mother. 5. A daughter uses the l o g i c a l process of working towards healthy d i f f e r e n t i a t i o n in order to counterbalance her emotional r e a c t i v i t y . 6. A daughter who success fu l ly counterbalances her emotions with l og i c discovers her basic s e l f and becomes an e n t i t y 145 dist inct from, yet interdependent with, her mother. Implications for Nursing It appears from the findings of this study that there are a number of implications for nursing practice, nursing education, and nursing research. The following section presents these implications. Implications for Nursing Practice A nurse can use the findings from this study in each phase of the nursing process. A nurse w i l l f i r s t need to assess a daughter• s experiences and perceptions and make a decision as to the daughter's position along the continuum of care. This decision should, of course, be validated with the daughter. Given the daughter's present position along the continuum, the nurse wi l l assess the daughter's a b i l i t y to meet the requisites of her position on the continuum of care, and continue her progression along the continuum of care. The nurse w i l l also look for constraints which are preventing the daughter from meeting the requisites of her position along the continuum. For example, while at the inner-centered point on the continuum, a daughter may be facing constraints which are preventing her from identifying her own needs. The nurse wi l l also determine the daughter's level of dif ferentiat ion. To do this the nurse w i l l assess the daughter's level of emotional react ivi ty , and her a b i l i t y to counterbalance her emotional react ivity through the use of logical processes —processes such as "gaining control of 146 emotions11 and "learning about and understanding mother and self", which help her to work towards healthy differentiation from her mother. Of great importance here, is the need for a h o l i s t i c , rather than simply a psychological assessment, since the impact of a daughter's emotional experiences might well be pervasive. In planning care, the nurse w i l l assist the daughter to identify rea l i s t i c goals which are congruent with her progression along the continuum of care, and interventions to meet these goals. The nurse and the daughter may identify interventions to overcome constraints which are preventing a daughter's further progression along the continuum of care; for example, interventions which assist a daughter to identify her own needs while at the inner-centered point on the continuum, or to deal effectively with her inner confl ict and emotional turmoil during a transition phase. From a health promotion and a systems perspective, here is an excellent opportunity for the nurse to build in healthy Interventions to deal with emotion and stress, such as exercise, healthy nutri t ion, etc . , which may be passed on to the members of the daughter's family system. In implementing the plan of care, the nurse wi l l continuously support the daughter by using techniques which fac i l i ta te the daughter's experience; for example, by explaining to a daughter why she is feeling as she does at this point in time, by reassuring the daughter of the normalcy of her feelings, by being non-judgemental of the daughter, and 147 by praising her strengths and accomplishments. In evaluating the nursing interventions, the nurse can assist the daughter to determine her a b i l i t y to include her own needs in her c irc le of care, her a b i l i t y to counterbalance any ensuing inner confl ict with logic, and her overall level of differentiation from her mother. If the daughter demonstrates any areas s t i l l needing strengthening, the nurse returns to the assessment phase in order to determine the daughter's present position along the continuum of care. Using the daughters' description of what fac i l i ta tes them in their roles as caregivers, the nurse should assess her own a b i l i t y to be a fac i l i ta tor to the daughters; for example, the nurse's a b i l i t y to be non-judgemental. In order to be successful in this endeavor, a nurse has to be able to honestly identify any values or beliefs - - any personal biases - - that might interfere with her a b i l i t y to collaborate with a daughter and ensure that she is the recipient of effective and professional nursing care. During the assessment and planning phases of the nursing process, a nurse assists a daughter to identify, and then set goals around areas which need strengthening; however, the nurse puts just as much emphasis on the daughter's strengths. In this manner, the focus of care is on secondary prevention and also on primary maintenance and promotion. In relation to health promotion, there are implications for nursing practice in secondary schools, as well . With an eye to proactive health care, the nurse might discuss the mid-148 l i f e daughter caregiving role and the differentiation process with graduating highschool students, prior to their entrance into the adult world. This would be an ideal time to address the topic with these students, because they wi l l have tentatively formed their own identities and might be receptive to hearing how one can protect one's identity, given the many challenges of adult l i f e . And f ina l ly , nurses should work in collaboration with mid-life daughters in influencing public health policy and leg is lat ion. In this regard nurses and daughters should make vis ible the daughters' complex caregiving role in the community and their needs for professional and ongoing supportive services. Implications for Nursing Education Many of the Implications for nursing practice are applicable to nursing education as well. In addition, nursing curricula need to include content and learning experiences that highlight the Importance of so l i c i t ing the perspectives of mid-life daughters and of avoiding stereotyping. In this regard, nursing students could learn communication techniques which would assist them to e l i c i t Information from daughters and to understand the daughters' perceptions correctly. Students might also learn techniques which they could use to fac i l i ta te the daughters' caregiving role , and interventions which would help daughters to overcome any constraints which were hindering their continued progression along the continuum of care. In order 149 to understand and assist the daughters in the process of differentiat ion, curriculum designers might ensure that students have a strong background in family systems theory, role theory, multigenerational dynamics, and the differences in cohorts of aging women. For referral purposes, curriculum designers might also ensure that students are knowledgeable of available community resources and supports. In order to ensure effective and non-biased care delivery, educators could provide students with learning experiences which enable them to recognize their beliefs and values and predict the Impact of their beliefs and values on their a b i l i t y to deliver care. Further, students might also learn ho l i s t i c assessment s k i l l s , and about the interplay between chronic emotional dis-ease and physical and social dysfunction. Educators might also ensure that students learn about primary and secondary interventions, so that they can take f u l l advantage of their contact with caregiving daughters by indirect ly influencing the health behaviours of the daughters' family members as well . In this regard, students should possibly have a strong background in family assessment and In group theory. In addition, i f students had strong backgrounds in teaching and learning theory they could teach the members of the daughters' families techniques to fac i l i ta te the daughters.in their caregiving role. 150 Implications for Nursing Research The findings of this study begin to elucidate the perceptions and the experiences of mid-life daughters who are caregivers to their mothers. The findings also highlight the need for more studies of this nature. Because the participants in this study were seven, white, anglo-saxon, middle-aged, middle-class women, there are limitations to this study. Additional studies are necessary in order to address these l imitations; for example, studies that focus on women from different ethnic groups, women from different socio-economic levels, women Who are less art iculate , women l iv ing outside the Vancouver and lower mainland area, and women who do not choose to access support groups. Each point and transit ion phase along the continuum of care should be focused on in a separate study. Case studies and longitudinal studies would be beneficial in c lar i fy ing , for example, the duration of time a daughter remains at each point or in each transit ion phase on the continuum of care; the effectiveness of the strategies and techniques that a daughter uses to gain control of her emotions and to manage challenging situations, and the progression of the differentiation process. Research into tools to measure one's level of differentiation would also be beneficial . Retrospective studies on the long-term effects of a daughter's previous inabi l i ty to identify her needs or to act on her needs would also be useful. 1.51 In terms of social policy, and in order to ease the burden on mid-life daughters, there should be further research done on alternatives for care, for example, substitute care. F ina l ly , proactive research is required on future cohorts because the policies they may need may be quite different than those developed for today's cohorts. Summary This chapter contained a summary of this study's findings and of the conclusions generated from the findings. In addition, this chapter also contained some of the implications of the findings and the conclusions for nursing practice, nursing education, and nursing research. 152 REFERENCES Anderson, J . (1985, O c t o b e r ) . P e r s p e c t i v e s on the h e a l t h of immigrant women: A f e m i n i s t a n a l y s i s . Advances i n  Nursing S c i e n c e . 61-76. Arber, s . , Evandrou, M., G i l b e r t , N., & Dale, A. (1986). Gender, household composition, and r e c e i p t of s e r v i c e s by  the e l d e r l y d i s a b l e d . Paper presented a t the B r i t i s h S o c i o l o g i c a l A s s o c i a t i o n Annual Conference, Loughborough, U n i v e r s i t y of Loughborough. Archbol d , P. A. (n.d.). An a n a l y s i s of p a r e n t c a r l n g by  women. Unpublished manuscript, Oregon Health Sciences U n i v e r s i t y , School of N u r s i n g . Bengtson, V. L. (1979). Research p e r s p e c t i v e s on i n t e r g e n e r a t l o n a l i n t e r a c t i o n . In P. Rogan (Ed.), Aging  parents (pp. 37-56). Los Angeles: Andrus Gerontology Centre. Bengtson, V. L. & C u t l e r , N. (1976). Generations and i n t e r g e n e r a t l o n a l r e l a t i o n s : P e r s p e c t i v e s on age groups and s o c i a l change. In R. Binstock & E. Shanas (E d s . ) , Handbook  of aging and the s o c i a l s c i e n c e s . New York: van Nostrand R e i n h o l d . Bergman, K. (1979). How to keep the f a m i l y s u p p o r t i v e . G e r i a t r i c Medicine, 9(1, P a r t B), 53-57. Bowen, M. (1982). F a m i l y therapy i n c l i n i c a l p r a c t i c e . New York: Jason Aronson. B r o c k l e h u r s t , J . C , M o r r i s , P., Andrews, K., R i c h a r d s , B., & Laycock, P. (1981)i S o c i a l e f f e c t s of s t r o k e . S o c i a l  Science and Medicine, ISA, 35-39. Brody, E. (1978). The aging f a m i l y . The Annals of the  American Academy of P o l i t i c a l and S o c i a l S c i e n c e , 438, 13-27. Brody, E. (1979). News about aging: S o c i a l , economic, and environmental i s s u e s with some thoughts about 'women i n the middle'. In Aging Research and P e r s p e c t i v e , Columbia  Journal1sm Monograph, 3, 37-45. New York: Columbia U n i v e r s i t y . Brody, E. (1981). Women i n the middle and f a m i l y h elp to o l d e r people. The G e r o n t o l o q l s t , 21.(5), 471-480. Brody, E. M., Kleban, M. H., Johnsen, P. T., Hoffman, c , & Schoonover, C. B. (1987). Work s t a t u s and parent c a r e : A 153 comparison of four groups of women. The Gerontologist, 27(2), 201-208. Brotman, H. B. (1982, July) . Every ninth American. An analysis for the chairman of the Select Committee on Aging, House of Representatives, Washington, DC: U.S. Government Printing Office. Cantor, M. (1980, November). Caring for the f r a i l elderly:  Impact on family, friends and neighbours. Paper presented at the 33rd Annual Scient i f ic Meeting, Gerontological Society of America, San Diego, CA. Cantor, M. H. (1983). Strain among caregivers: A study of experience In the United States. The Gerontologist, 12(6), 597-604. Carlson, C. E . (no date). Loss. In C. E . Carlson & B. Blackwel l (Eds . ) , Behavioural concepts and nursing  intervention (2nd ed.) (pp. 72-112). Chappell, N. L . , Strain, L . , & Blandford, A. A. (1986). Aging and health care: A social perspective. Holt, Rinehart and Winston of Canada. Chodorow, N. (1974). Family structure and feminine personality. In M. Z. Rosaldo and L . Lamphere (Eds.), Women, culture and society. Stanford: Stanford University Press. Chodorow, N. (1978). The reproduction of mothering. Berkeley, CA: University of California Press. Cohler, B. J . & Grunebaum, H. U. (1981). Mothers, grandmothers and daughters: Personality and chlldcare In three-generation families. New York: John Wiley & Sons. Coles> R. (1964). Children of c r i s i s . Boston: L i t t l e , Brown. C o r e l l i , R-. (1986, October 6). A matter of care. MacLean's, pp. 50-53. Elder, G. (1981). Social history and l i f e experience, in D. H. Eicharn, J . A. Clausen, N, Haan, & M. P. Honzik (Eds.), Present and past in middle l i f e (pp. 3-31). New York: Academic Press. E l i o t , G. (1965). The mi l l on the floss (1860). New York: New American Library. 154 E l 11s, A. (1970). Reason and emotion in psychotherapy. New York: Lyle Stuart. Erikson, E . H. (1968). Identity: Youth and c r i s i s . New York: W. W. Norton. Farkas, S. W. (1980). Impact of chronic i l lness on patient's spouse. Health and Social Work, 5_, 39-46. Feldman, H. & Feldman, M. (1975, May). The family l i f e cycle: Some suggestions for recycling the concept. Journal  of Marriage and the Family, 3_7(2), 277-293. Fengler, A. P. & Goodrich, N. (1979). Wives of elderly disabled men: The hidden patients. The Gerontologist, 19, 175-183. Finch, J . & Groves, D. (1980). Community care and the family: A case for equal opportunities? Journal of  Social Policy. 9(4), 487-511. Finch, J . & Groves, D. (1982). By women for women: Caring for the f r a i l elderly. Women's Studies International  Forum. 5(5), 427-438. Fischer, L . R. (1986). Linked l ives: Adult daughters and  their mothers. New York: Harper & Row. Funk and Wagnalls Canadian college dictionary. (1989). Toronto: Fitzhenry and Whiteside. Gee, E . M. & Kimball, M. M. (1987). Women and aging. Toronto: Butterworths. Gibson, M. J . (1981, November). Family support patterns,  policies and programs In developed nations. Paper presented at the Joint Annual Meeting of the Gerontological Society of America and the Canadian Gerontological Association, Toronto. G i l l i gan , G. (1982). In a different voice: Psychological  theory and women's development. Cambridge, MA: Harvard University Press. Giorgi , A. (1975). An application of phenomenological method in psychology. In A. Giorgi , C. Fischer, & E. Murray (Eds.), Duquesne studies in phenomenological  psychology: Vol . 2. (pp. 72-103). Pittsburgh: Duquesne University Press. 155 Goodman, c. (1986, November)..-Research on the Informal Carer: A selected l iterature review. Journal of Advanced Nursing, 11(6), 705-712. Graham, H. (1983). Caring: A labour of love. In J . Finch & D. Groves (Eds.), A labour of love: Women^  work, and caring (pp. 13-30). London: Routledge & Kegan Paul. Grunebaum, J . (1980). C l i n i c a l issues related to the  stereotyping of women as mothers. Unpublished manuscript, Cambridge, MA. Guba, E . G. & Lincoln, Y. S. (1981). Effective evaluation. San Francisco: Jossey Bass. Hees, G. (1987). Elements of the seniors' in i t ia t ives . Ottawa: Health Services and Promotion Branch. H i l l , C. J . (1984, March). Caring for an elderly relat ive . Canada's Mental Health, pp. 13-15. H i l l , R. , Foote, N . , Aldous, J . , Carlson, R. , & Macdonald, R. (1970). Family development in three generations. Cambridge, MA: Schenkmen. Horner, M. S. (1968). Sex differences in achievment,  motivation and performance in competitive and non  competi-t-l-ve situations. Ph.D. Diss . , University of Michigan, University Microfilms #6912135. Horowitz, A. (1981, November). Sons and daughters as  caregivers to older parents: Differences in role  performance and conseguences. Paper presented at the 34th Annual Meeting of the Gerontological Society. Isaacs, B. (1980). Burden of Care. New Age, pp. 23-25. Johnson, E. S. (1978). "Good" relationships between older mothers and their daughters: A causal model. The  Gerontologist, 18, 301-306. Johnson, E . S. & Bursk, B. J . (1977); Relationships between the elderly and their adult children. The Gerontologist, 17, 90-96. Johnson, E . S. & Spence, D. L . (1982, January). Adult children and their aging parents: An intervention program; Family Relatlons, 115-122. Johnson, E . S. & Williamson, J . B. (1980). Growing old: The social problems of aging. New York: Holt, Rinehart & Winston. 156 Kohlberg, L . (1958). The development of modes of thinking and  choices in years 10 to 16. Doctoral dissertation, University of Chicago. Kohlberg, L . (1981). The philosophy of moral development. San Francisco: Harper & Row. Land, H. (1978). Who cares for the family. Journal of  Social Policy. 3(7), 257-284. Lang, A. M. & Brody, E . M. (1983, February). Characteristics of middle-aged daughters and help to their elderly mothers. Journal of Marriage and the Family, 193-200. Lewis, J . & Meredith, B. (1988). Daughters who care: Daughters caring for mothers at home. London: Routledge. Lltwak, E . (1985). Helping networks of older people: From  hea l thto ins t i t ut i ona 11-za t ion. New York: Guilford Press. Low, N. (1978, May). The relationship of adult daughters to their mothers. Paper presented at the Annual Meeting Massachusetts Psychological Association^ Boston, MA. Macpherson, K. I. (1983, January).- Feminist methods: A new paradigm for nursing research. Advances in Nursing  Science, 5.(2), 17-25. Marchand, P. (1989, November). The parent trap. West, pp. 3-6. May, R. (1980). Sex and fantasy. New York: W. W. Norton. Mcintosh, M. (1978). The state and the oppression of women. In A. Kuhn & A. M. Wolpe (Eds.), Feminism and materialism (no pages). London: Routledge & Kegan. Mederer, H. (1982). The transit ion to a parent caring role by  adult children: A model of ease of role transit ion and  dif f iculty- of role performance. Unpublished doctoral dissertation, University of Minnesota. Miles, M. B. & Huberman, A. (1984). Qualitative data analysis: A sourcebook of new methods. Beverly H i l l s : Sage. M i l l e r , J-. B. (1976). Toward a new psychology of women. Boston: Beacon Press. M i l l e r , S. & Winstead-Fry, P. (1982). Family systems theory In nursing practice. Reston, VA: Reston. 157 Morris, M. (1977). An excursion Into creative sociology. New York: Columbia University Press. Morse, J . A. (1986). Quantitative and qualitative research: Issues in sampling. In P. L . Chinn (Ed.) , Nursing  research methodology: Issues and implementation (pp. 181-193). Rockville, MD: Aspen. Myerhoff, B. (1977). A symbol perfected in death: Continuity and r i t u a l in the l i f e of an elderly Jew. In B. Myerhoff & A. Simic (Eds.), L i f e ' s career — aging: Cultural . variations in growing old. Beverly H i l l s , CA: Sage. Ornery, A. (1983). Phenomenology: A method for nursing research. Advances in Nursing Science, 5.(2), 49-63. O'Rei l ly , J . (1989, September). Prairie wisdom: Plain truths from the heartland. Lear's , pp. 100, 102-3, 188. Ory, M. (1985, F a l l ) . The burden of care: A famil ial perspective. Generations, 14-17. Parker, G. (1985). With due care and attention: A review  of research on informal care; London: Family Policy Studies Centre. Parkes, C. M. (1971). Psycho-social transitions: A f ie ld for study. Social Science and Medicine, 5_, 101-115. Parliament, J . (1987, Summer). Increased l i f e expectancy, 1921-1981. Stat ist ics Canada - Canadian Social Trends. Piaget, J . (1965). The moral judgment of the chi ld (1932). New York: The Free Press. Piaget, J . (1968). Six psychological studies. New York: Viking Books. Reinharz, S. (1986). Friends or foes: Gerontological and feminist theory. Women's Studies International Forum, 9(5), 503-514. Riemen, D . J . (1986). The essential structure of a caring interaction: Doing phenomenology. In P. L . Munhall & C. J . Oiler (Eds.)/ Nursing research: A gualltative  perspective (pp. 85-108). Norwalk, CT: Appleton-Century-Crofts. Robinson, B. & Thurnher, M. (1979). Taking care of aged parents: A family cycle transit ion. The Gerontologist, 19, 586-593. 158 Robinson, B. c . (1983). validation o£ a caregiver strain index. Journal of gerontology, 38(3), 344-48. Rosenthal, G. J . (1980). Mu111ge ne r a11ona1 fam i l l e s : A  Canadian study. University of Toronto: Department of Behavioural Science. Sandelowski, M. (1986, A p r i l ) . The problem of rigor in qualitative research. . Advances in Nursing Science, 8.(3), 27-37. Sandford, J . R. A. (1975). Tolerance for debi l i ty in elderly dependents by supporters at home: Its significance for hospital practice. Br i t i sh Medical Journal, (3)/ 471-73. Sassen, G. (1980). Success anxiety in women: A construetivist interpretation of its sources and its significance. Harvard  Educational Review, 50, 13-25. Shanas, E . (1979). The family as a social support system in old age. The Ge r onto1og1st, 19, 169-174. Shanas, E . & Maddox, G. L . (1976). Aging, health and the organization of health resources. In R. Binstock & E . . Shanas (Eds.), Handbook of aging and the social sciences (no pages•)-.- New York: Von Nostrand. Shanas, E . , Townsend, P . , Wedderburn, D. , F r i i s , H . , Milhoj, P.> & Stehouwer, J . (1968). Old people in three industrial  societies. New York: Atherton. Silverstone, B. & Hyman> H. K. (1982). You and your aging  parent. New York: Pantheon. Sommers, T. (1985, F a l l ) . Caregiving: A women's issue. Generations, pp. 9-13. Sto l ler , E . P. (1983, November). Parental caregiving by adult children. Journal of Marriage and the Family, 851-857. Townsend, P. (1957). The family l i f e of old people. London: Routledge -and Kegan Paul. Van Home, R. (1986, June). A new agenda: Health and  Social Service Strategies for Ontario's Seniors. (Available from Publications Services Section, 5th Floor, 880 Bay Street. Toronto M7A 1N8). Webster's ninth new collegiate dictionary. (1987). Springfield, MA: Merriman-Webster. Wheatley, V. (August 28, 1980). R e l a t i v e s t r e s s . C o m m u n i t y  C a r e ; (324), 22-23. Woolf, V. (1929). A room of one's own. New York; H a r c o u r t # Brace and World. York, J . L. & C a l s y n , R. J . (1977). F a m i l y i n v o l v e m e n t i n n u r s i n g homes. The G e r o n t o l o g i s t . 17, 500-505. 160 APPENDICES 161 APPENDIX A LETTER OF INITIAL CONTACT September 25, 1989 Dear Mid-Life Daughter: Several months ago you volunteered to participate in some research that explores what i t is l ike to be a mid-l i f e daughter of aging parents. I am now in the process of l ining up interviews for one of these studies and am writing to see i f you are s t i l l interested in being a participant. This study, which focuses on the mid-life daughter's perspective of her relationship with her aging mother, is being developed by one of my graduate students, Ti King, who would be interviewing you. The following is a description of the c r i t e r i a for participating in this study: Each mid-life daughter w i l l : - be 40 years of age or older - speak English - l ive in the lower mainland and within 50 miles of her mother, such that frequent personal contact is possible - be married - have children - be employed on a half- to full-time basis - have integrated the cultural norms of Canadian society, and - for at least one year, have been the chi ld responsible for providing the aging mother with regular support. Each aging mother w i l l : - l ive alone, and - not be acutely i l l . Ti would, over a period of three to four months, conduct one to three taped interviews with you. She would ensure that the information you volunteered was kept s t r i c t l y confidential . 163 APPENDIX B TRIGGER QUESTIONS 1. How long have you cared for your mother? 2. Te l l me what i t is l ike to be a caregiver for your mother. 3. What, i f anything, would fac i l i ta te you in caring for your mother? 164 APPENDIX C PARTICIPANT CONSENT FORM This research project is entitled "The Experiences of Mid-Life Daughters Who are Caregivers to Their Mothers". This project has been explained to me by the researcher, Ti King, a candidate in the Masters of Science in Nursing Program at the University of Bri t i sh Columbia. I understand that the purpose of this research project is to explore the experiences of mid-life daughters who, l ike me, are married with children, are employed f u l l or part-time in the workforce, and are caregivers for their mothers. In order to explore my experiences, the researcher w i l l interview me on one or more occasions. Each interview wi l l be taped. During each interview the researcher wi l l take notes. The interviews wi l l take approximately one to three hours of my time over a period of three to four months. My time is offered voluntarily and I w i l l not be compensated for It. I understand that in order to keep my identity confidential , a l l tapes and notes wi l l be coded with a number and only the researcher w i l l ever know both my code number and my name. At a l l times, the researcher wi l l keep my code number and name in a locked place. I understand that an individual wi l l be hired to type up the tapes and that once the tapes have been transcribed, the researcher and the members of her thesis committee (Alison Rice, Carol J i l l i n g s , and Clarissa Green) w i l l have access to 165 the coded transcripts and notes. The researcher, Ti King, has told me that I may reach her at [home phone number] should I have any inquiries concerning the project and that she w i l l be glad to answer my questions. I understand that I can refuse to participate in this project, or I can withdraw from i t at any time, and that neither my refusal to participate nor my withdrawal wi l l jeopardize the a b i l i t y of the members of my family and/or me to attain necessary nursing and/or medical care should we require i t . I know that although the findings from this research project may not have direct implications for me, my participation might assist nurses to better understand the experiences of mid-life daughters in my situation. I consent to participate in this research project. Date Signature Name (please print) I have received a copy of this consent form. Signature 

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