Confrontations: 3 Ways to Avoid Them in Caregiving

Senior man sitting with home care nurse eating breakfast
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When was the last time you found yourself in a situation where you fervently defended a position, won, and felt miserable? It could have been with a friend, partner, family member or person for whom you’re providing care. Yes, you “won” and believed that the struggle was justified according to some set of standards, rules, or notions of “justice.” But still there’s that feeling, if what I did was so right, why do I feel so miserable?

The Tibetans' understanding of this dilemma is expressed in the ancient saying, “You can throw hot coals at your enemy, but you’ll burn your hands doing it.” This proverb addresses one of the biggest problems with confrontation: the cost of winning. Think back to your last significant conflict where you “won.” Do you remember only the sweetness of the victory, or are you left with the negative consequences of crushing your adversary?

For most people who have experienced a significant conflict where they won, there is a bittersweet feeling where often the cost of winning was too high either for them or the person they defeated.

Is Confrontation Inevitable?

Situations arise in caregiving where it appears that confrontation is inevitable. A caregiver has a general idea of how caregiving should occur, but the person who is cared for has a different version. Difficulties arise when the conflict is thought of as a zero-sum game: If one person wins the other has to lose.

I had a client whose care for her husband was fraught with problems. Before his heart attack, he was at best, a disagreeable partner. At worst, an emotionally abusive spouse. Before his heart attack, when the confrontations between them became intolerable, she could always leave—something that occurred quite often.

Things changed after his heart attack. Since he was now severely disabled, leaving following a disruptive interaction was not a possibility since her husband needed constant care and there was no money to hire professional caregivers.

Even when she felt vindicated after an argument, she was miserable. And being trapped only compounded her frustration over not being in control of her life. In the comedy, Life of Brian, wanna-be Crusaders on imaginary horses face a killer rabbit. The leader yells, “Run away, run away.” Those able to move quickly live. Those that didn’t were eaten by the rabbit.

Many caregivers feel like Monty Python’s Crusaders who can’t run fast enough. Conflict for them, is often in the form of a zero-sum game where either their needs or a loved one’s needs are satisfied, but not both. Even when caregivers’ needs are met, a sense of guilt develops when they believe their loved one’s needs have been subverted to theirs. 

Choosing Between Solutions

We often find ourselves in situations where there is no “best” solution, but rather we are forced to choose between two or more painful ones. It’s the type of situation that develops with chronic or acute illnesses. It’s not as if caregivers are choosing between a Big Mac and a meal at a three-star Michelin restaurant. Instead, choices are similar to deciding to have coffee at a 7-11 or a Quick Stop when a gourmet coffee shop isn’t available.

That was the situation for a caregiver who had to choose between two methods of administering a painful drug to her loved one. Both would produce pain. So the caregiver had to decide which one was less painful, not what was the best procedure. It’s not a semantic difference, but rather a difference in​ attitude. If you search only for the “best,” you may be ignoring only what’s possible.

Decisions regarding confrontations are often made using what appears to be very rational criteria, such as, what’s honest, just, or right. These criteria are tied to expectations of how we and others “should feel.” For example, I should feel good pointing out how unappreciative my wife is, or I should feel vindicated when a relative tells me how right I was to leave my emotionally abusive husband.

Sometimes, being right, honest, or justified doesn't bring the satisfaction they thought would be present by “winning” an argument. There are times during caregiving when it’s better to back off rather than being confrontative.

Guidelines for Preventing Conflict

Often we don’t think about why we are choosing to engage in a conflict. And when we do, it’s often either just before the confrontation occurs, or during it. This haphazard approach is less than ideal. Instead of relying on spontaneity to decide on what you will do or say, it’s possible to plan in advance. Here are three guidelines you can use.

1. Decide On Goals
Often during an interpersonal “battle,” we forget to prioritize our goals. We may have a vague idea of what’s important or have a list of non-hierarchical goals. Trying to sort them out during a confrontation is difficult if not impossible since the “action” often clouds judgments.

One goal that causes a significant amount of problems is the need to be honest. I have counseled caregivers who were proud of their lifelong honesty with a loved one, who now struggle with the consequences of being honest. In the abstract, the notion that “honesty is the best policy” sounds reasonable and is the basis for trusted interactions. But is it the best policy for all situations?

What to do: As you weigh the choices you have at the beginning of a conflict, prioritize what’s important: winning, peacefulness, compassion, etc. When you use this as a guiding principle for action, your choices may become more apparent.

2. What is the Mental Cost of Confrontation?
We can exhaust ourselves in a confrontation. We often neglect the emotional price we may pay for both engaging in a conflict and winning. That was the case with a wife whose husband was in the early stages of Alzheimer’s. She insisted that her husband observe the same cleanliness standards he had before the dementia began. Her insistence on inappropriate, pre-diagnosis standards had two effects. At the end of the day, she was exhausted after monitoring her husband’s behaviors for 16 hours. The second effect was that her husband felt humiliated by realizing he could no longer function as he did before the Alzheimer’s began.

There were few celebratory benefits to her confrontative behaviors even though they resulted in her husband being “clean.” Both remained miserable until my client backed off from the goal of absolute cleanliness. By her being less demanding, her husband began to relax and was able to be more accepting of his deteriorating condition. For the wife, these new more relaxed standards enabled her to be less stressed and therefore a more attentive and better caregiver.

What to do: As you decide whether or not to be confrontative, determine the costs to both you and your loved one. “Winning,” even on an important issue, may not justify its emotional costs.

3. Which strategy will be most effective?
You’ve prioritized your goals and assessed the cost of confrontation. Now it’s time to select the most effective strategy. The husband of a client with progressive heart failure was consuming too much liquid at one time. The result was increased edema, a condition his physician warned against. When his wife asked the physician how to spread out his water consumption, the physician said she should “just do it.” Not the type of helpful advice for selecting a strategy.

To solve the problem, she took a water bottle and marked it into acceptable amounts, based on the physician’s maximum individual intake. She then used the physician’s total daily maximum to determine the number of bottles her husband could consume each day. She now had an effective strategy to limit his intake rather than relying on confrontations over his drinking.

What to do: Choosing the most effective strategy is often more complicated than the above example. In caregiving, we often have to find our way through less than successful actions. Don’t be afraid to deviate from your plan if it isn’t working.


“Winning,” is often thought of as the ultimate goal of conflict, whether that conflict involves a friendly game of ping-pong or the selection of a president. Some people even maintain that without conflict, life would be dull. While some people may structure their lives based on the importance of “coming out on top,” it’s a disastrous principle for many caregivers.

There was a time in American politics when compromise and civility were thought to be appropriate goals. Now, both are considered by many as a desertion of principles. That general belief has infected many aspects of non-political relationships, including caregiving.

The adherence of absolutist positions in caregiving is more likely to result in suffering rather than mutual comfort. So the next time you are about to enter a conflict, ask yourself: 1) what is the goal of my caregiving? 2) What will my actions emotionally cost me and the person for whom I'm caring? 3) What is the best strategy to use to accomplish my goal?

Successful caregiving is based more on the “grays of life” rather than absolute “whites” or “blacks.” By using these three steps before deciding on a confrontation, you’ll find that many of the unskillful behaviors that result from conflicts can be mitigated. 

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