Ask Dr. Lisa: Power Struggles in Dementia

Once a month, I'll answer your questions about dementia and care-giving here in my blog. If you've got a question, feel free to submit it.

Question: Any tips for how to deal with inevitable power struggles? My partner has dementia, and was always the decisive one in the relationship and now I have had to take over that role. After years of being in that role, it seems like he has a hard time accepting me doing what he has been used to doing. Just telling him it’s time to go to the bathroom (to avoid an accident) can cause him to insist on not going and this leads to predictable problems and upsets him. I imagine those caring for their parents have similar power struggles from time to time as well. I’m having a hard time balancing his desire to be independent and caring for him in a way that acknowledges his inability to see his own limitations.

That's a great question! The power struggles are indeed inevitable, because let's face it, NONE of us like to be told what to do! And it can definitely be frustrating for you trying to walk that fine line of supporting independence while your loved one becomes more and more dependent on you.

We spend our lives becoming independent and self-sufficient, and suddenly other people think they can get all involved in the minutiae of our lives?? Nope! It compounds the situation when YOU know what the person's limitations are, but the person with dementia has lost insight into their abilities.

Figuring out the source of the power struggle is a good place to start, and in your situation you've done that, understanding he's having a hard time letting you take over certain roles. This let's you know where you need to make adjustments in how you're communicating with him.

Sometimes simply validating the source can be enough to ease the power struggle, "I know it's hard having me keep tabs on you..." Put yourself in his shoes and think about how you would feel being told whatever it is you're telling him to do. If someone were telling you that right now in your current state, what would you be feeling? What would you need to hear to feel better about listening to what they are telling you?

Help him to stay in control by avoiding phrases like "You have/need to" or "I want you to," and even asking him to help you come up with a solution to this: how does he think he could best remember? Along the way validating any frustration that this is even a thing you have to work through.

You could also try using language that makes him feel in control - "You asked me to remind you every two hours, so I'm just letting you know it's time," even if it falls under a little white lie. Or if he'd be more okay having an alarm tell him versus having you tell him, set an alarm to go off and remind him that's his bathroom alarm. Otherwise find ways to affirm his control anywhere you can, and to give him opportunities to help in decision-making or giving you advice, as is possible.

Sometimes you both need a break from the power struggle before it can resolve, so distraction and redirection are always good tools to keep on hand as well. Find a way to get their attention elsewhere, preferably to something more pleasant that can ease their frame of mind. Then once you're both calmer, try a different technique to approach the issue at hand.

Of course, in general, using a calm, gentle tone in these interactions will encourage them to mirror you and can go a long way in turning the dial down on tension. If you're finding yourself getting frustrated or upset, take a timeout, get some deep breaths, distract yourself, regroup in whatever way you can and come back at it.

When it's upsetting to you, it can also be valuable to even take a moment to ask yourself if it's also setting off a power struggle in you. Is something being triggered for you by their behavior? Is there something you need to let go of? Something you need to grieve or work through? Are you playing a role in escalating the situation? If it's something you can't figure out on your own, you might talk with a trusted friend or a counselor. Unfortunately, the complications and difficulties, scars and unhealed wounds don't go away just because dementia has come on the scene. Beyond smoothing the road in caring for your loved one, you also need and deserve support!

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