When my best friend went through multiple surgeries and dislocations following a botched hip replacement, she was in near-constant pain. Her husband rose to the challenge of caring for her, but it wasn’t always easy for him. Nor was it easy for my friend, who vacillated between gratitude and frustration over his care. 

“I often had to ask for help, which didn’t feel great,” my friend told me. “I felt apologetic, but I didn’t have much choice. It’s hard to give, but it’s also hard to ask.”

Our close relationships are an important part of a meaningful life. But what happens when someone we love is sick or going through a very rough time, and we are called upon to be a helper over and over again?

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Caretaking for someone can be a challenge, but it’s especially charged when their needs are frequent and long-term. A caregiver may feel obligated to help, but doing so may bring little joy or sense of meaning, making it hard to sustain. And it can be equally stressful for the receiver of care.

How can couples improve this dynamic? New research suggests that what motivates people to help is crucial—and that motivation is affected by both their interactions with the person they’re caring for and their life outside caregiving.

Why do you help?

Researchers who study motivation identify two basic types: autonomous or intrinsic motivation—when you do something because it brings you joy, satisfaction, or meaning—and controlled or extrinsic motivation—when you do something out of loyalty or because you’d feel guilty if you didn’t do it. Either way, you end up helping, but autonomous motivation feels better and leads to better outcomes. 

In studies looking at caregiving situations like my friend’s, researchers found that caregivers who had more intrinsic motivation to help their sick partners felt happier, more satisfied with their relationship, and less distressed about caregiving, and were less prone to exhaustion, than those who helped out of a sense of duty. Interestingly, the partner being cared for also seemed to benefit: They were more satisfied with their relationship and, in some cases, felt greater pain relief.

Why would the internal motivations of helpers affect their partners? Sara Kindt, one of the coauthors of these studies, says it has to do with how motivation affects the caregivers’ responsiveness toward their partner.

“Autonomously motivated partners are more open, curious, and sincerely receptive to a partners’ preferences and needs,” she says. “In contrast, a partner’s controlled helping motivation might be associated with reacting in a more restrictive, less responsive way.”

That may be well and good, but isn’t your motivation out of your control? It turns out it’s not—at least not entirely. Instead, it might be possible to nudge it in a more autonomous direction with gratitude.

In a recent study by Kindt and her colleagues, couples—where one member suffered from a painful condition called fibromyalgia and the other was a frequent caregiver—filled out daily questionnaires for two weeks. The caregivers reported on what motivated them to help their partners, whether they thought their partners were grateful, and to what degree helping kept them from fulfilling personal goals that day—like maintaining relationships with others, enjoying leisure time, working, or taking care of their own health.

Researchers found that on days when caregivers perceived more gratitude from their partners, their motivation to help was significantly more autonomous. It was less autonomous when they felt thwarted in fulfilling their goals—probably no surprise there. However, perceiving gratitude also had carryover effects, making caregivers more intrinsically motivated to help the next day, too. Conflicts with personal goals had no such carryover effects.

“Gratitude is a powerful thing,” says Kindt. “Like the title of a paper by Adam Grant suggests, ‘A little thanks goes a long way.’”

How to give and receive

What might this mean for couples going through hard times? According to Kindt, it helps show that preserving a positive relationship during caregiving is important for the well-being of both caregivers and care receivers, and that giving and receiving gratitude could be the glue that helps do that.

Still, it might be hard to feel grateful when you’re in pain or feeling down. My friend suggested that it was difficult for her when she sensed her husband was not anticipating her needs as well as he could or trying to get by doing the minimum.

“It was usually easy to say thank you, and I did tell him I was grateful,” she said. “But I didn’t feel an uncomplicated gratitude. It was more like, ‘Thank you, but I wish it was different.’”

You can’t force gratitude—otherwise, it can feel more like an expression of indebtedness, which does not result in the same benefits as authentic gratitude. And, if other people pick up on our ambivalence, it might be hard for them to accept our gratitude as real.

In these moments, perhaps it would be helpful to recognize our difficult situation and try expressive writing, which can be a good way to explore painful emotions—like disappointment, sadness, or anger—and find more compassion for ourselves and others. Doing so may open the door to more positive emotions—like gratitude.

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On the other hand, we could also say thank you anyway and hope that it will become easier over time. Much of the research on gratitude involves people being told to focus on their blessings whether or not their lives are going well—and they still become happier, healthier, and more satisfied in their relationships.

But giving thanks won’t mean much if the receiver is closed to taking it in. While gratitude is hard to feel sometimes, it can also be hard to absorb. Kindt says it’s important for people receiving thanks to recognize it and acknowledge it. Otherwise, they may miss out on a joyful, rewarding aspect of caring for another.

“Couples may benefit from expressing more gratitude, but also from learning to pay attention and to make positive attributions when spouses express gratitude to them,” she says. In this case, a positive attribution means recognizing that a partner’s thanks is an expression of their love and appreciation. 

Given the potential benefits of gratitude, it could be a good idea for couples to practice it regularly, whether or not their relationship is being tested by hardship. It might help buffer them when hard times come, which is likely to happen in any long-term relationship. 

“When my partner thanks me for small things I do, like cooking dinner, I feel that it makes the cooking activity, which I don’t always like, less of a burden,” says Kindt. “Gratitude may be even more important in relationships that are at risk or are in a difficult situation.”

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