Becoming a caregiver, or requiring a caregiver, is another transition that may come gradually or suddenly in midlife and beyond. But when it happens, we’re instantly uprooted and transplanted into foreign territory. Our former aptitudes and strengths may no longer matter; our former vulnerabilities, once hidden, may roar to the surface. But given the new longevity of our population, at some time we will either give or receive care. As Ram Dass put it, we all transition from asking, “How can I help?” to “How can you help me?”

This major life shift triggers many unconscious shadow issues, or habitual difficult patterns: for caregivers, resentment of the lack of freedom, impatience with the other’s demanding needs, betrayal about the loss of a dream. As one woman put it, “When my husband got sick, we lost our future.” As a client said, “When my brother was diagnosed, my life became about nothing but him. I can’t cope.” As a friend said, “Did I stay healthy just to take care of him?” And a husband told me, “I adore her, but I’m not built for this kind of patience.”

Our default shadow characters, and their coping strategies, may take over. It can help to do shadow-work by naming them, quieting the mind, and observing them, rather than automatically allowing them to take charge. The Savior will try to cure the loved one. The Victim will feel helpless, overwhelmed, confused, and alone. The Researcher will obsess with googling possibilities. The Denier will turn away, unable to see what is.

For those receiving care, this shift may trigger a dark night in the liminal zone, a loss of identity, purpose, and meaning—and an uncertain end. As a cancer patient told me, “Don’t ask how I’m feeling. I am not a cancer patient. That’s not who I am.”

In addition, it may bring up denial, or the Fighter, or the Rebel, or the Obedient Patient. Beneath the roles, the shame of dependency, the loss of agency, and the fear of death linger. As one man told me, “I was so competent. Now I can’t even drive.” A wife told me, “I never had to depend on him for anything. Now I feel trapped and ashamed.”

For both caregivers and receivers of care, shadow-work can move toward conscious caregiving, crossing the threshold from an outer orientation of role—the helper and the patient—to an inner orientation of two souls on a healing journey.

Caregiving can become a portal to self-knowledge through shadow awareness. And it can become a messenger of mortality awareness.

For example, my colleague Anna told me that, for a full year, she attended to a friend with cancer, taking her to doctors, buying food, and listening to her struggles. When that woman went into remission, Anna was exhausted and resentful. “She never really appreciated all that I did. She didn’t thank me in any meaningful way.”

Anna’s early childhood injury, feeling unseen and unacknowledged by her parents, had been triggered during her long year of caregiving. In her shadow, she was striving mightily to be seen and appreciated by her friend in a way that she had not been by her family. And she had been unknowingly over-giving, neglecting her own self-care, and, most importantly, expecting something in return—to be acknowledged and valued.

When Anna reflected on her own responsibility for her reactions, she saw that her ego had a secret agenda: She admitted that a part of her—her shadow character that she the Savior—wanted credit for her friend’s remission. When her friend complied with Anna’s recommendations, they got along. But when her friend made different choices, Anna’s ego was offended.

As she examined the hidden motives in her shadow, she could feel more accountable for her reactions, and her heart opened again to her friend. She learned how to serve differently, to move in and out of the caregiving more fluidly, without identifying with it. And she learned to see her friend as a soul undergoing an ordeal, rather than another person she could fix.

When a person is caring for a spouse, it’s likely that the shadow will erupt at some point. When my client Paula was caring for her husband Jim, and it became clear that his undiagnosed illness was becoming chronic, she began to feel trapped. “Three months is enough,” she said. “It’s looking more like three years of cooking, cleaning, chores, and driving to doctor’s offices. What about me?” she asked.

Paula needed to talk about her accumulating feelings as the situation worsened, or they would be stuffed into the shadow. She felt that she couldn’t burden Jim with them, so she brought them to me. I explained how important it is for caregivers to have a safe place for their own self-care, sometimes just to vent, sometimes to explore shadow-work. Once she could reorient and focus on herself, Paula expressed difficult feelings.

“Who am I, now that my freedom is gone? Now that my future is gone? Jim was my rock, my refuge. Now, as he deteriorates, I’m lost and disoriented.”

Paula felt growing resentment and concern that, if this was her life from now on, she would become bitter and depressed. “The other day I felt so frustrated that he couldn’t help with anything that I lost it. I yelled and stormed out. Now, I’m so ashamed. He doesn’t deserve that.”

We explored how she could identify the anger and resentment before it boiled up to the surface: Her skin felt hot, and her throat closed. Her body felt like it would explode. She named this shadow Resentment and learned how to slow down this reaction with deep breathing and telling Jim that she needed a break before the anger erupted. Then she would go for a walk and release the energy from her body.

Paula also felt helpless and useless. As we traced these feelings back to her childhood, she recalled how helpless she felt in the face of her father’s alcoholism. This had shaped the Helper role that she took in the family, which was now reemerging and triggering intense early-childhood feelings.

“I had to be there for my mother’s needs with Dad. But who was there for mine? Gosh, here I am again, helping others and feeling invisible and unappreciated.”

For most of us, the re-creation of early dynamics in our adult circumstances can add emotional charge to our current responsibilities. Paula came to realize that the Helper part of her was not what her husband needed. She was not trying to fix him or to earn love. Paula saw that the Helper emerged when she couldn’t tolerate her own feelings, so she tried heroically to fix things. She wanted to be a successful Doer, as she had been in her midlife years.

But Jim mostly needed her loving presence, not her heroic doing. He didn’t need advice or solutions. He didn’t need to be cheered up. And she mostly needed to give love. So, their deeper needs, beneath the roles, actually fit.

Paula decided to hire a professional for two days a week to fill the role of caregiver. In this way, she could set limits on her own doing, focus on her own creative projects, and begin to orient from role to soul in her marriage. Someone in different circumstances might join a caregiver support group, find a friend or relative who can provide relief care, or seek help from a local social services agency.

This self-care allowed Paula’s higher emotions to emerge in her caregiving: compassion, empathy, generosity, patience, and nonjudgmental awareness. Rather than contracting into her narrow new role, she began to expand out of liminal space and find space in her new reality. She found patience with Jim’s slower pace and eventually understood that patience was now her spiritual practice. She opened to it, breath by breath.

This kind of caregiving from the inside out can become part of our sacred service or karma yoga, a path to greater unity. It can lift us out of habitual roles and labels, such as husband, wife, patient, helper, father, mother, son, or daughter, which can limit our capacities for giving due to shadow issues. And it can move us into the realm of soul. When we encounter one another behind these masks, in moments of profound joining, our feelings of separateness dissolve. Now, as our ego barriers fall away, we often can intuit the other person’s needs.

Adapted from The Inner Work of Age: Shifting from Role to Soul