"I don't know what to do," a client told us last week, speaking about her mother who had been admitted to a nursing home three weeks earlier. "She keeps on saying she wants me to take her home, and I don't know what to say.I feel guilty, like I am a bad daughter."

Guilt is one of the most common, and powerful, feelings that caregivers experience.It is also one of the most difficult to deal with. This month we look at one way to handle feelings of guilt.

Guilt is a belief about something we have or have not done. When guilt is healthy, it is a signal for us to evaluate our behaviour, and can lead to changing or making amends.

In a caregiving situation, however, there is often no way to make an amend or change what you have or have not done or may do. There is little choice or if there is, the price is often extremely high. For example, the choice may be between burning out or risking your health or a parent moving into Seniors housing. Or the choice may be between eliminating risk or allowing harm to occur when a parent is unable to evaluate the risk. The lack or choice or ability to make amends leads to reviewing over and over again,. With no resolution the feeling becomes deeper, stronger, and destructive.

While you cannot always change the situation, you can change how you think about yourself and how you are relating to the situation. Feelings of guilt are stimulated by your thought process. There are techniques you can use to change your thoughts soc that you can manage and reduce the feeling of guilt. These techniques are from what is called Cognitive Behavioural Therapy (CBT).

Admittedly, changing your thoughts can be difficult. When you are under stress from strong feelings of guilt, your brain is causing your body to release hormones that flood your system. Your body responds at a physiological level before you are aware of it, taking over from, and sometimes overwhelming the rational part of your brain. CBT helps you to engage the rational part of your brain and reduce the stress response.The more you practice, the easier it will be.

Here is one of many CBT techniques that can help you:

With a sheet of paper held so that left to right is the long side, divide the paper into five columns. Label the columns : Thoughts, True, Not True/Distortions, New Thoughts, and Notes

1. Write down the thoughts you are having about the situation which are leading you to feel guilty. Include the thoughts you are having about yourself.
2. In the second column, write down what is true about those thoughts and the situation.
3. In the third column, write down what is NOT true about those thoughts, the situation, and yourself.What are the distortions in the way you are thinking? Pay attention to the things you write down.
4. In the fourth column, write down new thoughts that you can develop when you look at that third column. This does not mean that you are negating what was in the second column, it means you are developing alternative ways and true ways, to view and think about yourself and the situation.
5. In the fifth column write down what you notice happens to your feelings and thoughts after you have done this. Also, pay attention to the changes in your breathing, muscle tenseness, and other physical sensations.

You may have to go through this exercise several times and over a few weeks, but it will help you to change your thoughts and feel better about yourself. This does not mean you will never feel sad or guilty, but it will help you to put things in perspective and manage the feelings in a healthier way.

A few things to consider when writing the third column:

1. You did not cause this situation. You acted to respond to what was happening because of it.
2. Most likely, you have searched for and tried several solutions and approaches to the issues you have been confronting.
3. There are some things you cannot control, such as financial and resource limits.
4. You have other responsibilities and people in your life who deserve, need, and have a right to your attention.
5. Difficult decisions usually do not have a simple, or black and white answer.
6. The values and morals that come from your family and culture may not fit easily with the problems which confront you in the society in which we are living.

The following books are based on Cognitive Behavioural approaches to dealing with emotions and and can help you with feelings of guilt:

Mind Over Mood: Change How You Feel by Changing the Way You Think, by Dennis Greenberger and Christine Padesky.

The Feeling Good Handbook (and Workbook) by David Burns.