The CBT Dive

Parenting an ageing parent: Offering care with renewed boundaries

• Rahim Thawer, MSW • Season 2 • Episode 6

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Our guest this episode is a medical worker named Ale who joins psychotherapist and host Rahim Thawer to discuss his complicated relationship with his mom and the difficult feelings that arise when she calls asking him for money. In a departure from our usual episode, Rahim pivots from using a thought record to using a problem solving worksheet to better address the logistics of Ale’s situation. 

The conversation revolves around two main objectives: providing stability for Ale's mother and developing an adult relationship with her. The possible solutions discussed include Ale's mother moving to Canada, her finding a job back home, and seeing each other in person. However, there are challenges and limitations to each solution. Ale realises that he needs to shift his perspective on stability and take a more active role in coordinating the immigration process. The conversation ends on a realistic note, acknowledging the hard truths and the need for Ale to manage his expectations and frustrations.


ABOUT THE CBT DIVE PODCAST
The CBT Dive is a video podcast that brings therapy skills to the real world. Each episode welcomes a new guest who wants to explore a challenging situation using the most common cognitive behavioural therapy tool: the thought record.

ABOUT HOST
Rahim Thawer is a queer, racialized social worker and psychotherapist based in Toronto. He's created The CBT Dive podcast to support folks who want to learn how to use a thought record and to demystify what therapy can look like.

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SPEAKER_00:

Welcome to the CBT Dive. This is the podcast that demystifies cognitive behavioral therapy. I'm psychotherapist and host Rahim Thawar. In each episode, I walk a guest through applying CBT skills to real-world situations. Hello, Hale. Welcome to the CBT Dive. How are you today? I'm doing great. How are you? I'm doing good. I'm doing good. Ale initially came to Canada to learn English at age 16. Then he went straight into university, began doing a program in criminology, but didn't enjoy it as much as he thought he would, but also couldn't afford it. The international fees are quite high. He saved money and eventually did a program as a med tech assistant and then worked in healthcare settings and is now in a community-based health center. And of course, Ali and I have met just through healthcare work here in Toronto. Before this recording, we were talking about situations that bring up difficult feelings. And you had identified that it's often with your mom, right? She's somebody who's, I guess, been a big part of your life. And as you've gotten older, you have a strong reaction whenever she calls. So tell me a little bit about you and your relationship with your mom. Yeah, so I think, like, we get along great. And, like, growing up, because my dad used to be, he used to be, like, 28 years her senior. So to our... When I was in high school, then my mom was like his primary caregiver. Even though I offered to stay, my dad didn't want me to see him deteriorate. And then after my dad died and then she sent me here, she's like, oh, I want you to go there, have a better life and blah, blah, blah. I just feel like there's a confusion of roles. Okay. So that's good context. So thank you for that. So now we're thinking about you... in a typical day here in Toronto and you get a call from your mom and your immediate thought is that your mom is calling and she's going to ask for money. When I get a voice note on WhatsApp, that's when I know, especially when she sends it like five minutes after we talk or like the next day. Ah, okay. Tell me, what are the feelings that come up for you when this happens? I hear that there's anger there. That's one of the things you had mentioned. What's another feeling that comes up? Like confusion, I guess. Like I get very conflicted, confused. I imagine there is, because it's a pattern, there's frustration? Yes. I feel like unheard, no matter what I say. Yeah. What I give is never enough. There's always something more. And, like, it's just that not understanding that I have a life here. Like, I don't live to give her money, you know? Right. Right. Do you feel sadness? I feel like at the beginning I did feel sad for the situation. But now, not really. I feel like the other feelings are stronger. Okay. Okay. Is there a small part of you that's, when you get the voice note, that you're like curious or hopeful that it'll be something else? Very little, but yes. Okay. All right. This is a good list of feelings, I would say. I'm going to ask you to rate these feelings on a scale of 1 to 10. 10 means that they're the most intense. So this is when you get the voice note. Where is your... experience of anger on a scale of 10? I think frustration will be 10. Okay. And angry would be 9. How would you rate unheard? 8. 8, okay. Yeah. And then confusion, 7. And then misunderstood, 6.

SPEAKER_01:

Okay.

SPEAKER_00:

Sadness will be like 3.

UNKNOWN:

Okay.

SPEAKER_00:

And then hopeful one. Yeah. Curious two. Okay. The next column is about behavior, right? And I'm wondering, what do you do when you receive this voice note? I've done it all. Like, if I get, like, two voice notes in the same week, I will delete it. Or, like, I will just start listening and then... If I start feeling my chest tightening up, then I just stop listening. The tightening of the chest, that's like a strong physical reaction, huh?

SPEAKER_01:

Yeah.

SPEAKER_00:

Yeah. I'm moving over to the next column, which is about automatic thoughts. These are things that you're thinking about in this situation. So what's going through your head? Even if it's not money, like literally she will call me... And, like, I get a sense she'll be like, oh, can you get me this, like, Michael Kers purse and send it to me? And I'm like, ah. Or she just dumps all this stuff that she's going through because... I'm the only one that listens, even though she has like four siblings. I can be her son. I can be her confidant. I can be her friend. I can just be all these things to her. Because it's just too much. Okay. I'm curious about your curiosity. Because there's a hint. There's a part of you that feels like, huh, I wonder if she's going to... Share something different. She's going to have a different pattern. So my mom's a lawyer. So over the years, she has had some like big, big war cases. I'm always hopeful that something will come through for her. Because I feel like she needs it at this stage in her life. So I'm hoping that it will be like, you know what, I won the case or they pay me, blah, blah, blah. Something like that. That she'll be self-reliant in a way. yeah okay i am going to go through these and ask you some follow-up questions and the follow-up questions are they're intended to get a little bit deeper into the automatic thoughts so i'm trying to figure out what does each of these things mean or what's the implication of them so for example my mom will ask for money right If that's true, what will the consequence of that be? So, when I first came here, I would rely on her for money. When I just started working, like, I was barely making any money for me. Yes. Yet, I was stressing out as to, like, how do I send her money? You've given me some history that suggests that you'll be in a precarious position again. Yeah. And then it's like, now, it just impacts... what I share with her. So if your mom asks for money and you were to give it to her, then what happens? There was like a couple of months that she was literally, Rahim, asking me for money every week. And I've sent like$5,000 in the span of three months. And then I was like, this is not okay. So I came up with this, like, okay, I'll send you$400 the 19th of every month. And that's it, right? So we've been doing that since last summer. But then lately, She was like, I send her the money, the 19, and on the 20th, I get a voice note. It's like, oh, can you send me an extra 100 or an extra 150? And then I talk to my cousins there. Yeah. And like what she tells me and what my cousins tell me are like two different things. Every time that she calls me that she's struggling... I will talk to my cousins and then I'm like, is she really traveling? She's like, no. Like, listen, your mom owns her apartment. She lives alone. She's like, I see her shopping. She goes to the casino. But she doesn't tell me all these things. In the past, when you were in a precarious position because you would send her more, how bad did your own precarity get? Like, did you go without food? Yeah, like there were times that all I had in the food was like Nutella and like sandwich bread, right? And then I will pay more money to get to work than I will make at work, right? I think this dovetails into the next thought you had, which is she has unrealistic expectations of me. What are her expectations of you? My life is to provide for her. So she sees you as an extension of her, like her. Yeah. You take care of her. When you try to tell her otherwise, like this is not possible or I can't do this. Why don't you ask other people for support? What does she say? She has this facade, which I just find very annoying because they're all doing the same. Because when I talk to my cousin, we're all going through the same thing. Like I told her, I'm like, find a job, like any job, like go work at a salon, you know. I mean, she was a lawyer, right? Granted, it's very difficult to find jobs if you're not connected to the government. And it's very difficult for people to have funds and money. But I told her, I'm like, if I send you this, maybe just find any job. And then she's like, after being a lawyer, how dare I be a receptionist at a hair salon? So she feels a bit demoralized. Yeah. If this dynamic were to continue, what would happen to your relationship? I don't know, because I want her to come here. Because I mean, like she's getting old. I'm not moving back home. She's alone.

SPEAKER_01:

But

SPEAKER_00:

I just cannot do everything for her. For example, the government opened this application for people from Venezuela to come as a permanent resident. Right. So I sent her the application like three months ago and I'm like, can you start working on it and do it? Nothing happened, nothing happened, nothing happened. So our last big fight, I was just like, I send you this for you to come here. At least you can come for a little bit, get used to it. And then she didn't do anything. And then I had to start doing it. And then when I request things from her, it takes her so long that now they closed the application and she couldn't apply. When I told her the application was closed, he's like, oh, do you know somebody in immigration that you can call and they can put one? I'm like, it doesn't work like that here. Like I can't bring chocolates to an immigration officer. And like... I'm hearing a kind of resentment on your end about doing this, having a caretaking role, while also leaning into the reality of maybe having a caretaking role. Do you think that eventually her care will fall on you? Yes. But the thing is, she needs to help me take care of her. And When she uses you as a support and not other people, I'm trying to figure out why do you think she does that? I don't know because it's like every time that I think I talk to her friends, I'm like, oh, your mom talks like you're doing this amazing work in Canada. So I think she has built me up. here like i think how people know me back home here is not who i am i don't know who that person she's telling everybody i don't know who that person is yeah so i think she needs to like keep up with whatever she said so it's like then she doesn't have anybody that she can say like you know what this is not working blah blah blah You did mention actually that, you know, other people say she's doing okay. And she goes, you mentioned the word casino. And I wondered if she has like difficulty with impulse control or spending too much. Yeah, always. Since I was a kid, my mom has never been a good... She doesn't know how to save, and I think that comes because my grandfather was so stingy. He was rich, but he wouldn't give you$0.20 for a chocolate unless you go to the second-hand store. And then he lived in a 12-bedroom house. So she lived a very sheltered life. So when she came out, every money she made, she would spend. And I think that was my resentment. Mm-hmm. When that happened, she's like, oh, I want to take you on a trip. And I'm like, mom, why don't you save this money for a rainy day? And then she's like, when you make this kind of money, then you can spend it however you want. She feels criticized. Yeah. So then I'm just like, I think I carry that because I'm like, we wouldn't have to be going through this at all. Yeah. And so you... you've kind of got a judgment of her, which is fair, which is that she should be more conscientious or more responsible, yeah? Well, I learned from her experiences, you know what I mean? What have you learned from her experiences? To save money? Like, I don't think... I will not want to go through what she's going through. If you are the son that can't help her, right? Let's say somehow you can't. What will that say about you? I don't think I will feel like a failure because probably if I can't support her, I'm probably struggling with other things that I can think about her. But I don't know if she would do taking different actions because I wasn't there. Okay, so that's kind of interesting because you're saying– you're kind of saying I'm curious if she will be more self-reliant if I don't help. Yeah. And that makes sense to me because I think a lot of people do worry like if there's an underlying habit, am I enabling that habit? Mm-hmm. Okay.

UNKNOWN:

Yeah.

SPEAKER_00:

I'm trying to figure out here, what thought in this column stands out to you as being the most salient or the most prominent? I've learned a lot, but she can't seem to learn these things. Yeah, I feel like that one. Okay. I'm trying to figure out where... The feeling of being unheard fits into this, actually. Sometimes I feel like she doesn't hear what's going on in my life to care enough aside from her own stuff. And when she doesn't care about, it's not you as a human, but like your achievements or what's going on in your life. Yeah. I'm guessing that hasn't always been the case or has it? No, no. Like, before, like, when I leave that home, it's just like, you know, if I had, like, a competition, she will come, she will ask me what I'm doing, she will be interested in what's happening in my life. And what change do you think? I guess a distance. And then I think after a while, like, for example, in my role, like, she doesn't really understand what I do, so I don't really talk much about it. And, like... She doesn't make efforts to really understand what I do. So then I just stop putting efforts as well to explaining it. Yeah. Okay. I'm going to return to these thoughts here. And the one that I just added was she doesn't care about my life or my achievements. Is that one prominent? Yeah, that one that she needs to appear financially stable drives me mental. So I will say maybe more so. Okay. Now, these are three very different thoughts. And they're all quite prominent. Now, you've already given me many points. many pieces of evidence that supports this idea. So when we take a thought that's bolded here, we want to evaluate it. Now, I'm going to admit that this thought record hasn't gone in the direction I thought it would. Normally, We would use a thought record where the difficult feelings come up for you, and then we identify an unhelpful thinking pattern that resides in you, right? And then we want to evaluate any thought pattern that's unhelpful. to try to come up with an alternative way of thinking. But your thought isn't about you. If you said, I'm unable to budget, then we would say, what's the evidence for that? What's the evidence against? How do we think about it differently? But your key thought is about the other person. So you put me in a difficult position in the middle of a recording. We're going to turn this into a problem-solving... Okay, which is also a cognitive behavioral therapy tool, but it's used for when things are more factual and there isn't, it's not driven by unhelpful thinking style. So because everything you're saying and thinking is just pretty well factual in this case. So I'm going to say, I want to know here, the next column I'm going to say is objective. And then I'm going to say possible objective. solutions, and then evaluation, and outcome. Thank you for complicating my life, Ale. You're welcome. But, you know, I think we're experiencing the complexity right now of which direction to go in, even therapeutically, in the same way that I think you experience confusion with your mom. Right? That parallel is not lost on me. So, as we approach... This problem that you have to solve, what is your objective? What do you want to achieve? What is the goal here with mom? I want her to have a stable life. What does that include? That includes she has sufficient monthly income, a safe space to live, health care, and like... Something to do to occupy her time. Okay. And what is your objective in terms of your relationship with her? I think I want us to get to know each other now as opposed to how I was when I left. Okay. We've got two big objectives. One is about mom having stability. The other is about the relationship. What are... Possible solutions. So you've already mentioned some of them. Yeah, like her coming here. Yeah. If she came here, what would that look like? Where would she live? Would she live with you? Like, I think to start and then not. Okay. What are other parts of the solution? What's another solution? I think if she can find a job at home that is, like, secure, like, that's not depending on the government and who's in power and, like, all that. Yes. And you're saying even if it's not in her field? Yeah. In terms of, like, the adult relationship... Is there anything that could foster that in the present moment? To be honest, until the first one is not kind of happening, I will find it difficult to get to the other one. But one thing that could help is like if we are like in real life meeting as opposed to through the phone. And do you visit? No, no, I don't have my passport to go home. Oh, okay. So seeing each other in person... Could help. But when we get to evaluation, we'll know that that's not possible because of the passport. But is she able to come here even as a tourist? Yeah, yeah. All right. Now we're going to look at these possible solutions, right? And I want us to evaluate them. So how realistic is it and how possible is it? So her moving to Canada, what would that require? Like an implication to immigration? Mm-hmm. And is it simple because you would be her sponsor? Well, the one that they closed, I didn't have to be her sponsor. She could have been here as a permanent resident, but she lost her time. So I'm hoping that they will reopen that pathway because I don't want to be her sponsor. Uh-huh. So this works if... the non-sponsorship option reopens. Otherwise, what happens? Like, I mean, like, I think as a refugee, she could come. Okay. I don't know if she'll like it, but that she can go back home, that's the only thing that I think she will say no. Mm-hmm. And I think that's it. if she did come here, do you think, like, she'd be able to stay with you, find work, and then live on her own? Yeah, like, I think... Like, I think leading to her moving here, if she could come sporadically just to meet people, meet the Latin community, and kind of start building her own community... that will work. And does she have a desire to do that? Like, she didn't until this year, the first time that she's actually like, oh, you know what, I'm thinking about it. But before, she didn't want to come here. Ah, okay. So there's some optimism growing here.

SPEAKER_01:

Okay.

SPEAKER_00:

So, the first solution, mom can move to Canada, stay with me at first, and then be on her own. When we evaluate it, like, can it work? How realistic is it? What are the different dimensions? Well, this works if the non-sponsorship option reopens. She'll say no to the refugee claim option. And this would require her to slowly build community through tourist visits, which she's somewhat open to. Okay. Now, what about find a job back home? Like, it seems like it's objectively hard. Yeah, like, it's just difficult to find a job unless you work for the government. And, like, she doesn't want to work for, like, a corrupt system and, like, contribute to that unless she opens a business, but she needs money to do that. And I don't know what business are there to be open in that country just now. Right. So she doesn't have many job options there. No, not right now. Not right now. You said, like, maybe she could get a job at a hair salon, for example. Would that give her enough money for stability? No. Okay. I mean, like, on top of what I send her, I think she'll have money to, like, do whatever else she needs. Not the... How do you call it? The utilities and, like, things like that. Now, you want us to have an adult relationship. Seeing each other in person could help. You can't go there, but she can come here. Is that right? Yeah. When might that happen? Because that's like a separate goal, it seems. I think I'm hoping this year. The only thing is like I have to pay for everything for her. Right? Where she stays, where we go, her expenses and everything. Yes. So I need to figure that out. But I'm hoping to bring her here at some point. But she needs to do stuff to get her visa to come here. Right? Is that something you can do on her behalf? Like I can do part of it, but like going to Venezuela to this office to whatever, take her picture with her thing that she needs to do? Yes. Yeah. Okay. I can see why you've been so frustrated. Right? Because I'm looking at the evaluation and And seeing each other, so for the second objective, I want us to have an adult relationship based on who we are now. Seeing each other in person could help. This seems a bit grim, to be honest. It's tentative at best. So in terms of an outcome, looking at that bottom one, I think the outcome is like I may or may not have the adult relationship I want. In terms of her not being able to save or doing something around spending, you want her to have stability. And one of your solutions is like that she could move here. And I'm trying to figure out, do you think this is viable? Do you think eventually it'll happen, but it'll just take a long time? Okay, so the idea could happen, like I'm sure of it. Okay. But it's just her, I don't think she grasped the idea of what it means to live here. And I'm not talking about... like the paperwork and all of that. You mean like the culture? Yeah, like the social aspect, the isolation, the winters, her not knowing anybody, her siblings are not here, I'm working every day of the week. I think that reality, that's what I need her to understand what that means. And that's why I want her to build her own community that's not, so she doesn't feel alone. Hmm. Okay. Realistically, do you think she's more employable in Canada than she is in Venezuela? Like, I mean, here she can freaking work at the dollar store. Like, I don't know. Like, I don't think she could do law here. But, I mean, like, she takes some courses and volunteer, like, at a law office as a paralegal. Like, or support Spanish-speaking clients to read documents over. Just things like that. Her employment... opportunities are kind of scarce in both places. Okay. Now I'm thinking for you, right? All of this, like employment opportunities are scarce in both places. I may or may not have the kind of relationship I want with her. These are like truths or hard realities. When we think about this could eventually happen, but it will take a long time for her to appreciate the gravity of the move. What does this require of you? Of me? Yeah. Like, I think just do the application, pay for the fees, tell her, spoon feed her what she needs to do, and then kind of plan ahead what's going to happen next. when she's here, so she has a reality of what will happen and how it will happen. Yes. And I think you're going to be frustrated the whole time. Yeah. Which is not, like, nobody wants that, but I'm... Yeah, like, I think... Yeah, I think what we did now, because she started an application now, so I told her save everything so we don't have to redo it. But I just think applying for immigration is just stressful no matter what. Yeah. And you've already started to work on some boundaries with her. And... I think you're starting to face the reality and the grief in a way of not being able to necessarily help her. Yeah. Like she might not have stability in the way that you imagine. Yeah. And then I think the way that I imagine is like how I grew up. And then I think the way she thinks of stability is like how it was before. So I think it's just changing... westability means now you know so we've come to the end of what was a thought record but then turned into a problem solving worksheet and it's not like a huge shift however we went from my mom can't save spending gives her happiness to to I want her to have stability. The big solution is she comes to Canada. And overall, the outcome seems to be like her options, none of them are great. There's a comprehension challenge on her part to appreciate all the steps, the process, the experience. And we come with this like, okay, I'll need to shift how I think about stability. Because stability might not mean her taking care of herself. It might mean her slowly understanding what I've been saying for a long time. Where does that leave you? How do you feel at the end of this? I don't know if you feel any better. You might not. Now? I don't know. I think it just confirms what I've been thinking. Yeah. Yeah. Yeah. It confirms what you've been thinking and it's kind of painful. Yeah. Do you think going through this process helps you reshape what you think your goal is with mom or how you're going to approach her or gives you any additional insight into where it's going, this relationship? Yeah, I think so. I think, you know, I was pretty lenient with all the things around immigration and the processes. So I think that has to change. And then now I need to- By lenient you mean you were laid back? Yeah, like I would be like, this is the application, go fill it, figure it out, send it back to me, you need to do this, this, this. I'm like, you have 20 cousins that live there, they all speak English, they can read, ask them for help. So that never happened. So I think now I have to be more of like a coordinator of everything. Yes, this is your other part-time job. You're going to have to be the coordinator. Yeah. And then just give her homework and be like, do this homework by this day. I need to grade it. And like, I think that's how I need to start doing things. And that way your frustration decreases because she's not disappointing you each time. Right. Okay. Ale, thank you for participating in this process. We left with some hard truths. I usually... hope that we leave on a more optimistic note um but this is heavy so thank you for for your time and for being here um thank you yeah you're very welcome anything else you want to say or ask about cbt before we before we end today no i think It has been great. I think you gave me some insight as to some of next step and maybe how I've been doing things that increases my frustrations. And then maybe something that I can do to decrease the frustration. Sure. So thank you. Thank you. And that's the CBT dive for today. Thank you for joining us as we demonstrate therapy skills for the real world. Please subscribe wherever you get your podcasts and follow us on social media. The CBT dive is intended for educational purposes only and not as a replacement for individual therapy. See you next time.

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Rahim Thawer, MSW

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