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The 3-A's of Working through Adversity

Caregiving is not done in a vacuum given that our lives are multi-faceted. Although my work primarily involves assisting family caregivers of the chronically ill, the assistance I provide does not always apply directly to the caregiving. Family caregivers more often than not have other challenging issues they are dealing with as well. These issues may or may not be a consequence of having a chronically ill family member.

Those who have attended my workshops or read my book Caregiving with Strength are aware that my perspective of dealing with adversity is through grief processing using the 3-A Approach I developed. A major assumption in using the 3-A's is that wherever there is adversity, there are situational losses - usually more than one loss.

Situation loss is the loss of a person, thing or quality resulting from alteration of a life situation including changes related to - in addition to death - illness, body image or environment --Mosby's Medical Dictionary 8th Ed, 2009

The loss of a person who dies, moves away or goes missing is more tangible than the loss of a quality such as loss of freedom, control, and power. The intangible losses are important to acknowledge and can have just as great, if not greater impact. The impact is also unique to the individual. If a young child loses her favourite toy, the impact may be as great as an adult who loses a great deal of money in the stock market. The emotional impact can be compared to those who are grieving the loss of a job or a relationship - including sadness, anger, fear, etc. The impact may manifest in certain behaviours such as social withdrawal, eating more and sleeping less. All are characteristic of grief.

The 3-A Approach involves the use of the 3-A's: Acknowledge, Assess, Assist as a self-awareness and self-monitoring tool for addressing the losses experienced. Although 'acknowledge is positioned first in sequence, it is not to be considered the first step or phase or stage of the 3-A Approach. The words can be used alone or interdependent of one another. A healthcare professional is assisting by assessing if the family member is acknowledging the losses being experienced and how the reaction to the loss is manifesting. For self-care, family caregivers can assist themselves through acknowledging their losses and assessing for themselves how the reaction to the losses is manifesting.

Acknowledgement, on its own, can bring relief similar to the relief of receiving a diagnosis for puzzling symptoms. It is not enough to generally acknowledge loss,though, but rather to be specific with what the losses are. For instance, a husband who is losing his wife to Alzheimer's is also losing what his wife represented to him such as losing her companionship, her cooking, her social directing and so on. Also, as the disease progresses, there may be more losses such as loss of freedom due to being unable to leave his wife alone. Other losses may be unrelated such as the loss of privacy and control when a daughter who gets divorced, is unable to financially manage and moves in with her 3 year old. Also, this was not how the caregiver thought his daughter's life was going to turn out , so it is a loss of the ideal. By assessing for the abstract losses, a context for the grief is acknowledged where there may have otherwise been ambiguity.

By acknowledging situational loss, assessing impact and assisting with grief processing and coping strategies, resiliency and well-being can be strengthened. By applying the other principle of the 3-A Approach, that grief is a reaction to significant situational loss, it is beneficial, relieving and a means of coming to some resolution by processing the grief reaction linked to the situational loss context.


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