Perfectionism and Being Needed: Issues at the End of Life

Maybe when we think of couples seeking counseling, we think of young or even middle-aged couples, but the truth is therapists see older ones, too, or older individuals seeking help because of an issue with their spouse or partner.  Getting older and facing a serious illness and/or death is never easy, but what happens when both parties in the couple are the types who need to be needed, to rescue, but are afraid to need?

In the course of the years, I have met numerous couples where both needed to be needed, in a relationship in which both felt unappreciated and kept doing more and more while the other person was doing the same, and the relationship continued to worsen as each escalated this behavior. Imagine their surprise when a couple comes to see that they both want the same thing—to be needed and appreciated—and understand why their intense efforts to be indispensable are not working!  In this case both people need to see what is happening and address their own issues and how they impact the relationship.

But some couples do not seek help; they go on in this way, both feeling not loved enough, unappreciated, and more and more unworthy.  Both have the same system of feeling worthy, and that system does not take into account the emotional needs of the other.  Instead of coming to see that both have been wounded in the same way and doing something about it, they go through the years feeling unappreciated and often sad, lonely, and bitter—an emotional tragedy that happens all too often and doesn’t need to.  Time moves on, whether people seek help or not, and when they thrive on being needed and perfectionistic, they often do not thrive at all, and yet they still get older.

Therapists do see people in their 60s and 70s with this marital issue, though often just one half of the couple, and one common scenario is when the other partner is ill or infirm.  This is such a sad and difficult time for anyone, but how is it different for a PCS couple?  For anyone, but especially for a PCS person, becoming physically dependent on another is extremely painful.  The perfectionistic “do it all” stance that gave this person the illusion of feeling worthy is cruelly ripped away, and this person is often angry, bitter, and starting to emotionally withdraw.  The partner at first is mobilized.  “Finally, I can be needed and show my partner that he or she needs me!”  Yet, as time goes on, the acknowledgement of being very needed is not forthcoming.  The bitterness felt in earlier years continues, but now with the healthy partner doing more out of necessity, not just because they are driven emotionally. 

It is at this point that I have many times seen the caretaking spouse in therapy.  This individual comes in, dreading the death of the partner, feeling very alone and dreading being literally alone if their partner dies, and yet angry because of all the extra work and still not getting the acknowledgement of being needed that they had wanted all their previous years with their partner.  The caretaker comes in extremely anxious and depressed, and angry and frustrated, too.  At this stage, the partner or spouse is too infirm to come in.  I have seen many people in just this situation, men and women, dealing not only with impending loss and the horrible awareness of a future being alone when his or her time comes, but with these older issues, now intensified. 

While no one can deny the sadness or urgency of this situation, it is truly an opportunity to reach a deeper love than ever before, and I am one of those who believes it is never too late to learn and to grow.   In working with someone like this, the first issue to deal with is the grief, anger and terror that the partner is no longer available in the same ways and the knowledge that a deeper loss is in store.  Now that they truly are needed, in a life and death situation, they feel even more unappreciated.  Next they come to see that the partner is the same way and never got to be needed on his or her own terms; now it is too late for them ever to feel this way.  Perhaps the perfectionism that emotionally tortures both the caretaker and the ill or dying partner is a little softer when dealing with this situation, but for whatever reason, the partner who comes for help usually seems very amenable to seeing the dynamics going on. 

It is both a sad and happy moment when the person understands that what they are doing for the other is not what the person wants or needs, and never has been.  Yes, the physical needs are, but the emotional ones are not.  They realize the sick or dying person still wants to be needed, and is bitter and lonely only needing to stay alive.  It is then up to the healthier person to see and share with the ill partner how they have always been needed and still are, and to discuss their own fears and anxieties about the future. 

I can’t describe the shock on people’s faces when they realize this.  They see they can go to the end in the same way they have always been, or they can open more fully to love, sharing their own vulnerability and fear of needing with the other, and showing how both have been like that.  It is a huge task for someone with this personality, and yet people do it.  They share how much they have always needed and were afraid to let on, afraid to need for multiple reasons, and both can share this awareness.  All the trust that was never even invited in can come pouring out, with forgiveness, openness, and with both needing and appreciating the other.  Even in the midst of this hardship, there can be a coming full circle of the relationship, and a deep and equal love can be achieved, along with healing. 

No, this healing cannot bring back the years or take away the terrible circumstances.  But in the midst of all this, it does seem such a wonderful thing that even at the end of life people can heal both individually and as a couple—that a couple who has been together for many years and was unable to give each other what they wanted, can do so at the end stage, reaching the end of the cycle with a deep and mature love, with wisdom and healing.  You could call this a major blessing in life at a time when it is so badly needed, or you can say that at the end of the road the purpose—deep unselfish awareness of self and other—is achieved, almost like a whole new love.