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Self-Care: Self-Care for Older Mothers With Difficult Adult Children
By Judith R. Smith, PhD, LCSW
Social Work Today
Vol. 22 No. 2 P. 6

“I’m at a crossroads. I cannot keep leaving myself out. But do you just throw them away?” Faith asked me. I met Faith as part of my research study on mothering in later life. The project was designed to learn how women older than 60 were affected by their adult children’s problems. With statistics indicating that large numbers of older adult abuse incidents go unreported, I wanted to learn from mothers how they made sense of their adult children’s problematic behaviors toward them.

Data showed that Faith had gone to an older adult legal services center in New York City to learn how she could legally evict her adult daughter, who was 51, and her grandson, who was 18. Faith’s doctor, who had told her that her blood pressure was dangerously high, recommended that she reduce the stress in her life.

She had opened the doors to her one-bedroom apartment to her daughter and grandson two years ago. Both the daughter and her son have mental health challenges. Faith described the strain of living with them in such a small space and the many arguments that occurred on a regular basis. As I interviewed Faith, it was clear that although she realized her health was suffering, she would not evict her daughter and grandson before she believed they were able to “stand on their own two feet.” Faith believed they would become homeless and would not be able to survive.

Another research subject, Alana, told me, “It’s her or me. I have to move away, but she won’t survive without me. I’m trapped in this relationship. I don’t feel able to give her up.”

And Rebecca shared, “I love him too much, [but] I don’t have the strength to put him out, even though I know he will kill me there.”

Faith’s, Alana’s, and Rebecca’s stories inform my gerontological academic research and are now part of a book for older mothers titled Difficult: Mothering Challenging Adult Children Through Conflict and Change. These women’s stories illustrate how a social worker’s attempts to encourage self-care will feel impossible for older women who have become the default caregivers for their adult children with mental illness or substance use disorder—or both. None had expected their later years to be framed by once again being a “parent.” Yet for all the many similarities, there are also unique circumstances in each child’s life. That’s what began my search for a term to describe these circumstances, and ultimately led to “difficult adult child,” which acknowledges not only the challenges faced by the grown children but also the hardships passed along to the mothers who cared for them.

Being a “Good Mother”
If “difficult”—one that blames, not just identifies—seems harsh, consider its definition: when something is hard to do or carry out; hard to deal with, manage, or overcome; and hard to understand. Mothering adult children is hard to do. Tolerating the tensions in a relationship with a struggling adult child is extremely difficult to manage. And understanding the problems that might have caused the child’s situation are hard, and knowing how to intervene can feel impossible.

Many clinicians feel frustrated when working with older clients who, on the one hand, seek services to protect themselves from their adult children, but on the other are unwilling to take the necessary safety precautions. The detailed case stories that I have collected illuminate how aging, mothering, older adult abuse, adult children’s mental illness, substance abuse, and unemployment overlap, and how they can determine the trajectory of a woman’s later years.

It’s hardly a discovery that mothers sacrifice their own needs for the sake of their children. What is news is how this sacrifice continues to affect the lives of older mothers. All the women I spoke with had allowed their adult children to move back in with them when they were unable to support themselves due to their mental health or substance use disorders. Regardless of their adult child’s problems, they displayed a commitment to do everything possible to protect their adult child while putting aside their own needs. In other words, to be a “good mother.”

Women are used to putting their own needs on the back burner. They attend to infants, young children, and teenagers, all the while telling themselves that there will be time enough for themselves when their kids are grown. But what happens when a beloved child turns out to have mental health concerns, substance abuse disorder, or financial or employment issues?

Caring for, living with, or worrying about a family member—whether that’s a troubled adult child, a frail older parent, or both—can result in a woman ignoring her own needs. Carving out the time for her to look after herself is difficult. Being able to do something pleasurable or just go to a doctor may feel unimportant or even impossible at times. That was certainly true for the women I interviewed, all of whom felt torn between their own needs and those of their adult children. Each of them told me in one way or another, “If not me, who?” This question reflects how the mothers of difficult adult children feel personally responsible for their adult child’s safety and well-being. Like Faith, many told me that they could not prioritize their own needs over the needs of their vulnerable adult children.

Steps Toward Change
These days, self-care is a popular term, often used by people who want to sell body lotions and bath products, yoga mats, and weighted blankets. It can be off-putting to hear it used so often in marketing promotions and social media campaigns—#selfcare! But the fact is, self-care is essential to everyone, especially those who are looking after the needs of others. At its most basic level, the notion of self-care is contained in the words themselves: care for the self.

Mental health professionals who help women living in demanding situations, including those living with a difficult or even abusive adult child, urge us to understand that this is not an all-or-nothing choice. There are no models for transforming mothering in later life with difficult grown children, but there is value in adapting the Stages of Change model, which has demonstratable results in helping people change many kinds of behaviors. Also known as the Transtheoretical Model, it was introduced in the late 1970s by Prochaska and DiClemente, psychologists who were studying ways to help people quit smoking.1

My work and latest book help clients learn how to use this model to assess what they want to change and how ready they are to implement these changes.2,3 Learning from effective older adult abuse intervention programs, I offer detailed resources and lived examples of how mothers can obtain legal and counseling support to help them make these difficult decisions.4,5

Being the mother of a difficult adult child is stressful. Being a social worker with clients who are mothers of difficult adult children is also stressful. Listening to the women’s deep ambivalence about prioritizing their own needs over their adult children can be a place to start.

— Judith R. Smith, PhD, LCSW, is a senior clinical social worker, therapist, researcher, and professor at Fordham University who is a leader in gerontological research, focusing on women’s experiences as they age. Her book Difficult: Mothering Challenging Adult Children Through Conflict and Change was just released by Rowman & Littlefield. Her website is difficultmothering.com.


1. Prochaska JO, Norcross JC, DiClemente CC. Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. New York, NY: William Morrow; 1994.

2. Smith JR. Mothering in later life: older mothers and their challenging adult children [published online January 25, 2021]. Ageing Soc. doi: 10.1017/S0144686X20001798.

3. Smith JR. Difficult: Mothering Challenging Adult Children Through Conflict and Change. Lanham, MD: Rowman & Littlefield; 2022.

4. Rizzo VM, Burnes D, Chalfy A. A systematic evaluation of a multidisciplinary social work–lawyer elder mistreatment intervention model. J Elder Abuse Negl. 2015;27(1):1-18.

5. Sirey JA, Halkett A, Chambers S, et al. PROTECT: a pilot program to integrate mental health treatment into elder abuse services for older women. J Elder Abuse Negl. 2015;27(4-5):438-453.