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Posted: June 01, 2006

Spousal Caregiving

Habits of Highly Effective Caregivers

Bill Andrew

Someone recently asked me, "How do I become an effective family caregiver?" After thinking about it for a bit, I realized that most family caregivers learn about caregiving the hard way -- on the job without any previous training. There are no books or training manuals on the subject that I know of, although there is much written on the various diseases that affect our spouses. 

As spousal caregivers, isn't that how you learned how to provide care for your spouse? I know that I learned the hard way -- by doing it, making mistakes, and learning from those mistakes.

As I thought about that question a bit more, I remembered a book published several years ago on the habits of highly effective people. Perhaps those same habits could be applied to family caregivers -- especially to spousal caregivers.   If a person's habits can make them more effective, why couldn't a family caregiver's habits make them more effective? Perhaps, I thought, we can learn something from such a book.

The book is entitled The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change and is authored by Dr. Stephen R. Covey. An internationally respected leadership authority, family expert, teacher and organizational consultant, Dr. Covey dedicates his life to teaching principle-centered living and leadership to individuals, families, and organizations. Holder of an MBA from Harvard and a doctorate from Brigham Young University, Dr. Covey's book was named the #1 Most Influential Business Book of the Twentieth Century. First published in 1990 this book was a ground-breaker and continues to be a business best-seller with over 15 million copies sold worldwide.

The 7 Habits of Highly Effective People presents an "inside-out" approach to effectiveness that is centered on principles and character. Inside-out means that the change starts within oneself. For many people, this approach represents a paradigm shift away from what is called the "personality ethic" and toward what is called the "character ethic." (Refer to the book for more discussion on the latter.)

Our character is a collection of our habits -- and habits have a powerful role in our respective lives. Habits consist of knowledge, skill, and desire. Knowledge allows us to know what to do, skill gives us the ability to know how to do it, and desire is the motivation to do it. (Is this starting to sound like a recipe for family and spousal caregiving?)

Dr. Covey's seven habits move us through the following stages:

  1. Dependence: the paradigm under which we are born -- relying upon others to take care of us. 
  2. Independence: the paradigm under which we can make our own decisions and take care of ourselves.
  3. Interdependence: the paradigm under which we cooperate to achieve something that can not be achieved independently.

Much of the success-literature today tends to value independence -- encouraging people to become liberated and to do their own thing. The reality is that we are interdependent -- and the independent model is not optimal for use in an interdependent environment that requires leaders and team players. (And isn't that what caregiving is all about?)

To make the choice to become interdependent, one must first be independent, since dependent people have not yet developed the character for interdependence. Therefore, the first three habits focus on self-mastery; that is, achieving the private victories required to move from dependence to independence. The first three habits are:

  • Habit #1: Be proactive.
  • Habit #2: Begin with the end in mind.
  • Habit #3: Put first things first.

The next three habits address interdependence:

  • Habit #4: Think win/win.
  • Habit #5: Seek first to understand, then to be understood.
  • Habit #6: Synergize. 

The seventh habit is one of renewal and continual improvement; that is, of building one's personal production capability. To be truly effective, one must find the proper balance between actually "producing" and improving one's "capability to produce." Thus, effectiveness is a function of both production and the capacity to produce. Finding the right trade-off is central to one's personal effectiveness. 

  • Habit #7: Sharpen the saw.

 Summary of the Seven Habits

Habit #1: Be proactive. Change starts from within. Highly effective people make the decision to improve their lives through the things that they can influence rather than by simply reacting to external forces.

Do you react to whatever your spousal caregiving role places in front of you? Or do you plan and influence what happens to you and your spouse during the day? To be an effective caregiver, you must be proactive. Proactive people use their personal resourcefulness and initiative to find solutions rather than encountering problems and waiting for other people to solve them.

Habit #2: Begin with the end in mind. Develop a principle-centered personal "mission statement." What are your goals and objectives as a spousal caregiver? Extend the mission statement into long-term goals based upon your personal principles.

What do you hope to accomplish as your spouse's personal caregiver? How do you plan on accomplishing those goals and objectives? What steps can you take, what resources are available, how much time can you devote to your caregiving activities -- these and other issues need to be addressed up front.

Habit #3: Put first things first. Spend time doing what fits into your personal mission, observing the proper balance between production (doing the job) and building production capacity (getting ready to do the job). Identify the key roles that you take on in life, and make time for each of them.

As spousal caregivers, we tend to think that we can do everything (that's production) without assistance and support (that's capacity). Often, we do not have a balance between production and capacity -- rather, an imbalance exists. After a while, we find that we can not do it all and both we and our spouses suffer. And that is where skill development, respite care, support, education, information, and knowledge come to the rescue! 

Habit #4: Think win/win. Seek agreements and relationships that are mutually beneficial. In cases where a "win/win" deal can not be achieved, accept the fact that agreeing to make "no deal" may be the best alternative. In developing an organizational culture, be sure to reward win/win behavior and avoid inadvertently rewarding win/lose behavior.

As spousal caregivers, we should always think in terms of "win/win" arrangements that benefit both you and your spouse. If your spouse argues with you, try to deflect or divert the discussion to a topic that is agreeable to both of you. If your spouse disagrees with what you are doing in your caregiver capacity, try to show them why you are doing what you are doing so that it is a benefit for them. Many times, especially with a dementia or Alzheimer's afflicted spouse, this may seem to be impossible. But believe me, it works. You see, my spouse, Carol, has late-stage Alzheimer's disease and I have found that "win/win" is the only way to go.

Habit #5: Seek first to understand, then to be understood. First seek to understand the other person, and only then try to be understood. Dr. Covey presents this habit as the most important principle of interpersonal relationships. Effective listening is not simply echoing what the other person has said through the lens of one's own personal experience. Rather, it is putting oneself into the perspective of the other person, listening empathically for both feeling and meaning.

As a spousal caregiver, you must listen with your ears and focus your attention on your spouse. However, you must also "listen" in other ways -- such as actions, words, body language, reactions, and other indicators of what your spouse is trying to convey. Your undivided attention -- often difficult to do -- is essential if you are to understand your spouse. In effect, you must "walk in another Indian's moccasins" if you are to understand what they are going through. 

The Prayer of Saint Francis of Assisi says it all: 

O Divine Master, grant that I may not so much seek
To be consoled as to console,
To be understood as to understand,
To be loved as to love;
For it is in giving that we receive;
It is in pardoning that we are pardoned;
It is in dying to self that we are born to eternal life.

Habit #6: Synergize. Through trustful communication, find ways to leverage individual differences to create a "whole" that is greater than the "sum of the parts." Through mutual trust and understanding, one often can solve conflicts and find a better solution than would have been obtained through either person's own solution.

What we are saying is that you and your spouse must work together for the benefit of each of you. Hopefully, your spouse has complete trust in you and your capacity to deliver the type of care needed. That may not be so easy if your spouse has a dementia, such as Alzheimer's disease, or one of the other dementias that result in memory and cognitive failure. Hopefully, you also have complete trust in your ability to deliver that care. The "bottom line" is that your individual roles, as well as those of other related caregivers, are all subjugated to the "whole" of quality patient care for your spouse.

Habit #7: Sharpen the saw. Take time out from production (caregiving) to build production capacity (ability to provide care) through personal renewal of the physical, mental, social/emotional, and spiritual dimensions in your life. Make sure that you maintain a balance among these dimensions.

"Sharpen the saw" may be a strange term to use -- but it does get right to the point. If the saw is not sharp, it will not cut as well as it will when it is sharp. If you, as a caregiver, do not "sharpen" your caregiving skills, you will not be as good a caregiver as you could and should be. Many national caregiver surveys have identified the following family caregiver needs:

  • Respite care.
  • Skill development.
  • Information and education.
  • Caregiver health and well-being.

What are you doing about "sharpening" your caregiver skills and capacity?

While Dr. Covey's seven habits of highly effective people are directed toward those in the work place, these same seven habits can be applied to those of us in the caregiving place. I have personally developed and applied these seven habits in the work place -- that was my job before retirement and becoming a spousal caregiver. I have also applied these same seven habits to my role as a spousal caregiver. Believe me, they work! If you have not already done so, try to develop and apply these habits in your personal spousal caregiver role. It may not be easy -- but the end result will be better care for your spouse and an easier job for you as a spousal caregiver. And isn't that worth the effort?

If you have had occasion to apply one or more of these habits in your role as a spousal caregiver and would like to share them with our readers, e-mail me at


 "How use doth breed a habit in a man!"

William Shakespeare (1564-1616)
The Two Gentlemen of Verona", Act 5, Scene 4

Bill Andrew identifies himself as a former “nutritionally-empowered Alzheimer’s caregiver” who attributes the slow-down in progression of Alzheimer’s disease in his wife, Carol – and the growth of his own personal emotional, mental, physical, and spiritual capability and strength to provide quality 24/7 care for her in their own home – to the targeted nutritional supplements they both took on a daily basis. Carol went to her Heavenly reward on June 9, 2008 – Bill continues on to advocate for family caregivers. Contact Bill with your caregiving questions and comments via email at

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© 2006 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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