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CONNECTION i ‘TORN APART’: INVOLUNTARY SEPARATION AND THE SEARCH FOR CONNECTION by WILLOW C. GLASIER A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES Master of Arts in Counselling Psychology We accept this thesis as conforming to the required standard …………………………………………………….. Mihaela Launeanu, Ph.D., Thesis Supervisor …………………………………………………….. Janelle Kwee, Psy.D., Second Reader …………………………………………………….. Nancy Sidell, Ph.D., External Examiner TRINITY WESTERN UNIVERSITY JUNE 2016 © Willow C. Glasier CONNECTION ii ABSTRACT Placing a loved one in care does not relieve informal caregivers’ physical and emotional stresses, yet the experience of caregivers during the long process of separation has not been fully explored, especially in Canada. This study sought to identify the social processes of involuntary separation for caregiving spouses. Participants were 17 spouse-caregivers (12 women and 5 men) with a mean age of 84 years who had been involuntarily separated for an average of 20 months. All participants lived in or near Medicine Hat, Alberta, and were of Western European descent. Data were comprised of 12 individual interviews and one focus group. Using Charmaz’s (2006) model of grounded theory, this study found that the basic social process of spouse-caregiver involuntary separation was connecting, which had three distinct stages: 1) Initial news and coping, 2) Adjusting to new situation, and 3) Moving forward. There were also four additional categories: 1) Adjustment to separation, 2) Significant Helping Roles, 3) Family, and 4) Social world. Movement through the three stages was influenced by individuals’ willingness to reach out for connection and by the abilities of others to extend accurate empathy and practical help. This study’s Canada-specific contributions include the polarized responses to the government’s required change in marital status to “involuntarily separated.” Additionally, weather conditions during harsh prairie winters had a negative impact on some participants’ abilities to spend time with their spouses in care. The implications of this study highlight spouse-caregivers’ needs for connection and support not only during the crisis of separation, but in the following months and years. CONNECTION iii Keywords: Grounded theory; medical separation; involuntary separation; qualitative; basic social process; older adults; connecting CONNECTION iv TABLE OF CONTENTS ABSTRACT .................................................................................................................................... ii TABLE OF CONTENTS ............................................................................................................... iv LIST OF TABLES ......................................................................................................................... ix LIST OF FIGURES ........................................................................................................................ x ACKNOWLEDGEMENTS ........................................................................................................... xi CHAPTER 1: Introduction ............................................................................................................. 1 CHAPTER 2: Literature Review .................................................................................................... 3 Key Terms ............................................................................................................................. 3 Informal Caregivers in the Existing Literature ...................................................................... 4 General caregivers. ....................................................................................................... 4 Impact of medical separation on caregivers. ................................................................ 6 Spouse caregivers. ........................................................................................................ 7 Transitioning factors of care facility admission. .......................................................... 8 Existing Theoretical Frameworks........................................................................................ 12 Bowlby’s attachment theory. ..................................................................................... 12 Erikson’s stages of psychosocial development. ......................................................... 13 Lazarus and Folkman’s stress and coping.................................................................. 15 Rationale of the Present Study ............................................................................................ 16 Research Question and Implications ................................................................................... 17 CHAPTER 3: Method ................................................................................................................... 18 Paradigm .............................................................................................................................. 18 Personal Interest .................................................................................................................. 20 CONNECTION v Research Design .................................................................................................................. 20 Timeline. .................................................................................................................... 20 Individual interviews.................................................................................................. 20 Focus group. ............................................................................................................... 21 Follow-up interviews. ................................................................................................ 21 Participants .......................................................................................................................... 22 Recruitment. ............................................................................................................... 22 Ethical considerations. ............................................................................................... 24 Potential risks and benefits. ....................................................................................... 25 Data Collection .................................................................................................................... 26 Data Analysis....................................................................................................................... 28 Initial coding. ............................................................................................................. 29 Focused coding. ......................................................................................................... 30 Process of analysis. .................................................................................................... 31 Rigour and Validation ......................................................................................................... 36 Memoing. ................................................................................................................... 37 CHAPTER 4: Results ................................................................................................................... 38 Adjustment to Separation .................................................................................................... 42 Relinquishing control. ................................................................................................ 42 The work of separating. ............................................................................................. 44 Aftershocks – life at home. ........................................................................................ 47 Comfort in good care. ................................................................................................ 48 Advocacy and concern for care. ................................................................................. 49 CONNECTION vi Financial adjustment. ................................................................................................. 51 Involuntary separation................................................................................................ 52 Staying involved in spouse’s life. .............................................................................. 56 Faith. .......................................................................................................................... 59 Significant Helping Roles.................................................................................................... 61 Preparation and information....................................................................................... 61 Help with paperwork. ................................................................................................. 62 Moving spouse to the facility. .................................................................................... 63 Social workers. ........................................................................................................... 64 Home Care. ................................................................................................................ 65 Caregiver/Peer groups. ............................................................................................... 65 Facility care workers. ................................................................................................. 67 Administrators. ........................................................................................................... 67 Others. ........................................................................................................................ 68 Family .................................................................................................................................. 69 Connecting. ................................................................................................................ 69 Disconnecting............................................................................................................. 72 Social World ........................................................................................................................ 73 Connecting – by self. ................................................................................................. 74 Disconnecting – by self. ............................................................................................. 76 Connecting – by others. ............................................................................................. 78 Disconnecting – by others. ......................................................................................... 79 Identity. ...................................................................................................................... 83 CONNECTION vii Summary of Results ............................................................................................................ 84 CHAPTER 5: Discussion .............................................................................................................. 91 Longitudinal Component ..................................................................................................... 94 Novelty ................................................................................................................................ 95 Contributions ....................................................................................................................... 96 Generational context. ................................................................................................. 96 Canadian context. ....................................................................................................... 98 Dialogue with existing theoretical frameworks. ........................................................ 98 Contributions to counselling psychology. ................................................................ 105 Contributions for care professionals. ....................................................................... 107 Strengths and Limitations .................................................................................................. 107 Recommendations ............................................................................................................. 108 Education and preparation. ...................................................................................... 109 Supporting spouse-caregivers. ................................................................................. 110 Directions for Future Research .......................................................................................... 111 Conclusion ......................................................................................................................... 112 REFERENCES ........................................................................................................................... 113 APPENDIX A: Invitation – Telephone Follow-Up .................................................................... 121 APPENDIX B: Script – Telephone Follow-up ........................................................................... 122 APPENDIX C: Guideline for Original Interviews ..................................................................... 124 APPENDIX D: Interview Invitation Letter ................................................................................ 125 APPENDIX E: Focus Group Invitation Letter ........................................................................... 126 APPENDIX F: Focus Group Informed Consent ......................................................................... 127 CONNECTION viii APPENDIX G: New Interview Script ........................................................................................ 129 APPENDIX H: Interview and Focus Group Debriefing Document ........................................... 130 APPENDIX I: All Initial Codes .................................................................................................. 131 APPENDIX J: 28 Focused Codes (Categories) with Initial Codes ............................................ 163 APPENDIX K: 28 Code Families............................................................................................... 185 APPENDIX L: Concept Maps .................................................................................................... 186 CONNECTION ix LIST OF TABLES Table 3.1. Spouse-Caregiver Inclusion and Exclusion Criteria………………………………….22 Table 3.2. Initial Coding...……………………………………………………………………….32 Table 3.3. Focused Coding...…………………………………………………………………….33 Table 3.4. The Three Stages of Connecting Overlapped with Categories and Subcategories of Results……………………………………………………………………………………35 CONNECTION x LIST OF FIGURES Figure 3.1. The hierarchy of the core, main, and subcategories in grounded theory………….…34 Figure 3.2. The Three Stages of Core Category: Connecting……………………………………35 Figure 4.1. The Three Stages of Core Category: Connecting..………………………………… 38 Figure 5.1. The Four Categories and Subcategories that are Uniquely Present in Each Stage of Core Category: Connecting………………………………………………………............91 Figure 5.2. The three stages of connecting overlapped with Lazarus and Folkman’s (1987) problem vs. emotion-focused coping strategies………………………………………...104
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