The Sandwich Generation Caregivers: A Therapist’s Perspective

“I feel like I’m drowning in everyone else’s needs,” a 35-year-old client told me, her voice tight with exhaustion. “By the end of the day, there’s nothing left of me, not even enough to breathe.”

In my work as a psychotherapist in Colorado, I often sit across from individuals who feel pulled in too many directions at once. They enter their session carrying invisible burdens: the weight of raising children, supporting aging parents, maintaining a career, and trying to remember who they are beyond all those roles. These are the people caught in the "caregiver sandwich”—a term that refers to those who are simultaneously caring for their children while also supporting aging parents. It’s a population growing rapidly, and it comes with a unique kind of emotional and psychological pressure.

What is the sandwich generation?

The sandwich generation refers to individuals who are caring for both their aging parents and their children. As a millennial therapist, I see many of my peers stepping into this role earlier than they ever imagined. With parents living longer and children needing support for longer periods (especially with the rise of mental health awareness), the demands on caregivers can feel endless. And because these responsibilities so often fall on women, there’s a silent pressure to juggle it all flawlessly, to nurture, manage, and hold it together without ever letting it show. But behind closed doors, many caregivers are quietly unraveling.

The emotional toll of the caregiver sandwich

The clients I meet in this stage of life often share feelings of guilt, resentment, and burnout. Millennial caregivers usually juggle full-time jobs while providing care to parents and children (Arnone, 2024). They feel guilty for wanting alone time or dreading another call from their parents. They resent their siblings who don’t step up, or their partners who don’t fully understand the weight they carry. And they are exhausted. Bone-deep tired. The kind of tiredness that sleep can’t fix.

One client, a woman in her late 30s, described it like this: "I wake up and immediately start mentally budgeting my time and energy. Who gets what today? My son has therapy. My mom needs groceries. I need to prepare for a work meeting. And somewhere in there, I'm supposed to engage in self-care."

In fact, there’s a strong correlation between caregiving and an increase in mental distress, particularly with higher levels of depression and anxiety (Park, 2021). For many, every day is a balancing act between being present for children who need emotional nurturing and parents who need increasing physical and medical care. In the process, the caregivers' needs are constantly pushed to the bottom of the list, causing increased mental distress.

The mental and physical  health impact of the caregiver sandwich

From a clinical perspective, I see the ripple effects of this stress manifest in a variety of ways. Clients in the caregiver sandwich can suffer from chronic anxiety and symptoms of depression. As well as relationship strain and health issues due to neglecting their wellbeing. It’s not uncommon for someone to come in with physical complaints that are actually stress-related: headaches, fatigue, insomnia, and digestive issues.

In therapy, we explore the stories they've internalized about what it means to be ‘a good daughter,’ ‘a strong mom,’ or ‘the reliable one.’ Often, these roles are rooted in generational patterns or cultural expectations that have gone unquestioned. Therapy provides space to unpack those beliefs and redefine what caregiving can look like in a way that includes the caregiver’s wellbeing, not just their sacrifices.

The role of boundaries when you’re in a caregiver sandwich

Boundaries are the cornerstone of sustainable caregiving. But setting them can be incredibly difficult, especially when guilt is involved. Clients often worry that saying no to a parent or taking a night off from helping their teen means they are failing. We work together to challenge that narrative.

I like to remind my clients that boundaries are not walls – they’re bridges that help relationships stay healthy. You can love someone deeply and still say, "I can’t do that right now." Part of the work involves helping caregivers recognize that burnout doesn’t just affect them, but also impacts everyone they care for. A depleted caregiver can't show up fully for anyone.

The power of support systems

Another coping skill I encourage clients to do is to build or strengthen their support network. That might mean reaching out to siblings to divide caregiving responsibilities, hiring respite care when possible, or joining caregiver support groups. Sometimes, support can be as simple as having one friend who will validate your feelings without judgment.

Support groups, in particular, can play a powerful role in caregiver well-being. One study found that caregivers often suffer from unmet needs related to diet, exercise, and leisure, paired with a persistent feeling of guilt. Support groups help caregivers express repressed emotions, leading to a sense of relief and emotional protection. The exchange of stories and experiences within these groups validates caregivers’ challenges and fosters a shared sense of purpose. It can also empower caregivers to feel more autonomous in their role.

These groups often provide valuable information about community resources, coping strategies, and problem-solving techniques. When led by professionals, they offer opportunities to build new behavioral skills, recognize internal and external barriers, and engage in practical problem-solving. Just as importantly, they help reduce isolation and loneliness by expanding one’s social network and reinforcing that no one has to do this alone.

I also help clients grieve the realities they didn’t choose. Perhaps they expected to enjoy midlife freedom, only to find themselves knee-deep in caretaking. Perhaps they had hoped for more equitable family dynamics, which never materialized. Naming and honoring those losses is a vital part of the grieving process.

Identity beyond being stuck in a caregiver sandwich

One of the most common themes I hear in therapy is a sense of lost identity. Caregivers often say things like, "I don’t know who I am anymore outside of all the things I do for everyone else." That loss of self is profound, and it’s a slow erosion that many don’t notice until they feel empty.

Therapy becomes a space to reconnect with who they are at their core. I ask questions like, "What brings you joy outside of caregiving? What did you love before your life became about others’ needs?" Sometimes it's a creative outlet, a fitness routine, or a long-forgotten dream. These small yet sacred acts of self-expression can serve as the foundation for reclaiming a sense of self.

Are certain groups more at risk?

Caregiving is never one-size-fits-all. For some communities, the emotional, cultural, and logistical weight of caregiving is significantly heavier. Cleary et al. (2024) highlight that 27% of Millennial caregivers (born between 1981 and 1996) identify as Hispanic/Latinx, making them the largest ethnic minority within this caregiving generation. US. Latinx Millennial caregivers are expected to juggle cultural values, family expectations, and career demands. Many find themselves pulled in competing directions. Systemic barriers and healthcare disparities further intensify their challenges. 

Yet, Latinx Millennial caregivers remain an understudied group in the U.S. For many, caregiving is deeply interwoven with cultural identity, family loyalty, and generational responsibility. These layers can heighten the emotional toll and add complexity to their role. When paired with structural inequities, such as language barriers and insufficient mental health support, the caregiving experience can become especially stressful.

Statistics highlight the weight of these overlapping demands: 34% of Latinx Millennial caregivers are high-hour caregivers, providing over 20 hours of care per week. Compared to 29% of African American/Black caregivers and 20% of White caregivers (NAC & AARP, 2020). They’re also more likely to work outside the home and log longer work hours, intensifying the strain. With limited time for self-care, these overlapping stressors leave Latinx Millennial caregivers particularly vulnerable to burnout and emotional fatigue.

In my own practice, I’ve witnessed this firsthand: clients doing their best to honor deeply rooted cultural values while silently carrying the weight of work, caregiving, and emotional exhaustion. Many speak of the guilt they feel when they can’t do it all, the fear of letting their family down, and the isolation that comes from feeling like no one understands the load they carry. Their resilience is powerful, but the pressure is relentless and often invisible to those around them.

Final thoughts on the sandwich generation

Being part of the sandwich generation and being in a caregiver sandwich is not a phase that ends quickly. For many, it stretches over the ears. But within it, there can be moments of connection, growth, and healing – especially when caregivers feel seen, supported, and empowered. If you find yourself in the middle of this sandwich, know that you are not alone. Therapy can offer a place to process, plan, and rediscover who you are beneath all the roles you play.