By Sally Novak, DOM, LCSW-C, LAc — GW Center for Integrative Medicine/Lamplighter Wellness
That bone-deep caregiver exhaustion? It’s often a battle between your devoted “Manager,” grieving “Exile,” and reactive “Firefighter.” This blog post explores how Internal Family Systems (IFS) can help you understand these inner parts, find compassion for yourself, and create room to breathe amidst the challenges of caregiving.
Particular Kind of Exhaustion
There is a particular kind of exhaustion that caregivers carry that doesn’t show up on any lab panel. It is the exhaustion of being many things at once — devoted and resentful, hopeful and devastated, present and completely checked out — and believing that only some of those things are acceptable to feel.
I work with a lot of care partners. And what I notice, again and again, is not that they are falling apart. It is that they are working extraordinarily hard to hold themselves together — and that the effort of that holding is quietly costing them everything.
Internal Family Systems therapy — IFS, as it’s known clinically — offers a map for understanding why. The basic premise is this: the human mind is not a single, unified thing. It is a system of parts, each with its own history, its own logic, its own way of trying to protect us. Most of us have learned, somewhere along the way, that only certain parts of us are welcome in the room. The rest get managed, suppressed, or shoved into the basement.
Caregiving has a way of turning up the volume on all of them.
The Manager Who Never Clocks Out
Most caregivers I work with have a very active Manager part — the one running the logistics, tracking the medications, anticipating the next crisis, staying three steps ahead so nothing falls through the cracks. This part is genuinely heroic. It has kept a lot of people safe.
It is also, frequently, exhausted beyond description and terrified to stop.
Managers operate on the belief that if they let their guard down, something terrible will happen. And in dementia caregiving, that belief is not entirely irrational — the stakes are real. But the Manager often can’t distinguish between appropriate vigilance and white-knuckled chronic bracing. It just keeps going. And going. And going.
In my office, I often see the Manager part relax, just slightly, for the first time in months, when it realizes it doesn’t have to run the whole show alone.
The Exile in the Basement
Underneath the Manager is almost always an Exile: the part that is grieving. That is furious. That misses the person who used to be there — the husband who remembered their anniversary, the mother who gave advice, the partner who carried half the weight.
Exiles hold the unbearable feelings — the ones caregivers can’t afford to feel in the middle of a Tuesday, because there is dinner to make and an appointment to get to and a person who needs them. So those feelings get locked away. Contained. Protected.
The problem is that Exiles don’t stay contained forever. They surface as numbness, or irritability, or a sudden collapse in the car on the way home from the memory care facility. They are not pathological. They are unfelt grief, looking for a way out.
The Firefighter Who Disappears
And then there is the Firefighter — the part that activates when the Exile gets too close to the surface. Firefighters are impulsive, reactive, and often misunderstood. They are the part that pours a second glass of wine, or disappears into six hours of television, or picks a fight over something small, or goes completely numb and flat. Firefighters are not the enemy. They are doing triage. They are trying to protect the system from being flooded.
They just tend to use methods that create their own problems.
What Becomes Possible
IFS doesn’t ask caregivers to stop being exhausted, or to feel more gratitude, or to somehow transcend the very real difficulty of what they are living. It asks something simpler and stranger: to get curious about the parts that are running the show.
When a caregiver can notice the Manager with some warmth — of course, you’re exhausted, you’ve been doing this alone for two years — something shifts. And when the Exile gets even a few minutes of acknowledgment rather than suppression, the pressure in the system decreases. Then the Firefighter is understood as a protector rather than a villain – and the shame around its methods loosens.
This is slow work. It is not a technique so much as a way of being in relationship with yourself — which, for people who have been pouring themselves into a relationship with someone else, can feel almost revolutionary.
I think of it as learning to hold two truths at once: I love this person, and this is one of the hardest things I have ever done. Both are real, and both deserve space. And when a caregiver can finally stop spending energy managing the tension between those two things — when they don’t have to choose which one is true — something opens up. Not a solution, exactly. More like room to breathe.
Sally Novak, DOM, LCSW-C, LAc. works with individuals with cognitive decline and their care partners through the ReCODE program at the GW Center for Integrative Medicine and in her private practice in Ellicott City, MD. At GWCIM, Dr. Sally offers Integrative Psychotherapy and ReCODE program sessions, as well as weekly online support groups for individuals with memory loss and their caregivers.
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