Book Review: Psychotherapeutic Support for Family Caregivers of People With Dementia

Dementia and family caregiving are among my most current research interests recently, and I was very happy to have the opportunity to review this amazing book written by Dr Wilz.

As a family gerontologist, discussing this issue may carry a somewhat heavy feeling in public areas, but I am willing to speak about how important it is for us to contemplate the themes of aging, dementia, caregiving, and the family system. We are currently faced with these challenges. One aspect that amazed me in this book is how the author vividly portrays what caregivers face physically, emotionally, and socially. The specific situations are detailed through narratives, providing real examples that allow us to easily imagine and empathize with the caregivers. This approach helps us support those experiencing similar feelings. At the end of each chapter, appropriate support and solutions are provided for caregivers, offering informative solutions as well.

This book comprises a total of 15 chapters, each addressing specific themes. It starts with introducing the demands, burden, and health impact of caregiving. When considering the populations affected by dementia and caregiving, it is crucial to note the global increase in dementia cases. The primary caregivers for individuals with dementia are typically females, adult children, and spouses. I believe this book will serve as a textbook for students in medical areas, social work, and any other field dealing with Alzheimer’s or dementia patients in educational programs and caregiver education classes as a guidebook.

As an introductory and start of family caregiving, Chapter 1, 2, and 3 delves and discussed into the caregiver’s role, its associated burdens, changes in social relations, and the potential for isolation from both people and employment. It is essential to highlight that caregiver often face social isolation and depression during their caregiving journey, adding further complexity to both physical and emotional challenges. In Chapter 2, the author discusses the necessity and effectiveness of psychosocial interventions, particularly focusing on family caregiving. A crucial aspect highlighted in this chapter is the intervention aimed at utilizing home-based caregiving for decision-making processes. Additionally, the author mentions Cognitive Behavioral Therapy (CBT)-based caregiving and Tele.TAnDem (teletherapy for family caregivers of people with dementia), both of which provide valuable insights for current and future caregivers of dementia patients. Author provides the helpful information for caregiving in Chapter 3. It says there should be a comprehensive guide, offering valuable information on specific issues faced by dementia patients. It covers the causes and behaviors associated with dementia, along with legal and financial considerations, illustrated with realistic examples. The chapter includes diverse situational examples, encompassing nursing caregiving, housekeeping, mobility, and support for daily life. Furthermore, the author explains how to address financial matters and manage daily driving. I believe these issues are crucial in describing the challenges that caregivers may encounter while caring for individuals with dementia.

When discussing therapy and diagnostic tools for caregiving, it is crucial to consider what and how to use them. The author has explained these concepts well and provided guidance on specific supportive materials in general. Chapters 4 to 7 of this book offer a therapeutic perspective and present tools for addressing caregiving issues. Chapter 4 outlines diagnostic tools for caregiving for people with dementia. This chapter delves into the measurement and assessment of specific caregiving situation issues. Notably, it carefully explores the use of questionnaires for the subjective assessment of behavioral problems. Chapter 5 discusses therapist attitude and relationship building. The author explores caregivers’ attitudes and validates their efforts, providing case examples. However, the chapter emphasizes caregiving as an unchangeable burden and the loss of control that family caregivers may face. Chapter 6 presents therapy topics, intervention methods, and frameworks. It introduces specific individualized interventions, outlining the process and structure of the sessions. Therapeutic homework is detailed, highlighting cognitive and behavioral tasks specifically. Chapter 7 discusses the first session and relationship building as caregivers initiate the caregiving process. When caregivers start providing care for their family members with dementia, they explore and analyze problems, developing their caregiving motivations. At the conclusion of the first session, caregivers evaluate their feelings, observe changes in emotions, assess what they did well, and anticipate challenges they may face.

I believe chapters 8 to 15 serve as the highlight of this book, shedding light on the real-life experiences of caregivers in dementia caregiving. These chapters contain heart-wrenching stories and practical, hands-on support for those who need to provide caregiving. In addition, policymakers, medical professionals, and social workers should consider reviewing these stories to update current policies accordingly. Chapter 8, titled “I grew up in the countryside, and that was a given there”: Changing dysfunctional thoughts and appraisals, delves into the inherent stress and feelings of guilt associated with providing caregiving. This chapter presents helpful questions for cognitive restructuring, illustrating them with case examples in a qualitative communication-based approach. These examples vividly portray the emotional complexity that caregivers experience in their daily care for individuals with dementia. Chapter 9, titled “You are still home here!” - Dealing with challenging behavior, addresses the moments when caregivers find themselves confused about the changes in the personality of their family members with dementia. Questions such as “Who is this?” and “What am I doing for this?” arise when faced with memory and cognitive impairments. The chapter highlights the challenge for caregivers as dementia patients struggle to control their emotions and behaviors. The author emphasizes the importance of “understand, assume, and accept,” as seen on page 60. Table 4 provides detailed examples of challenging behaviors, followed by a psychoeducational guide on the next page, aiming to discover better solutions for these issues. The author showed specific case example with the qualitative narration, Chapter 10, titled “Anger is completely normal” - Stress-care and value-based activities, explores anger as a normal and common emotion experienced by caregivers when providing care for individuals with dementia. The narratives within the chapter illustrate the emotions caregivers feel, the challenges they face, and how therapists guide them to navigate less stressful situations. Chapter 11, titled “And what about me?” - Self-care and value-based activities, provides readers with insights into the caregiving situation for dementia patients at home. The chapter explores scenarios where caregivers may lack self-care or struggle with balancing activities. Case examples 28 and 29 vividly illustrate the consequences of neglecting personal needs and the impact on caregivers. Subsequent pages demonstrate how caregivers can overcome feelings of guilt associated with caregiving. This is a crucial issue for those caring for dementia patients at home, as many family caregivers are prone to experiencing negative emotions that may contribute to depression. Chapter 12, titled “For the diagnosis until death” - Dealing with change, loss, and grief, provides resources for coping with the grief, guilt, and fears experienced by caregivers. The author introduces accepting thoughts as a tool for identifying situations, illustrated with case example 37, featuring the story of “distinguishing and accepting feelings,” “grief,” and “irrational feelings of guilt.” Case example 42 highlights “helpful rituals for dealing with the experience of loss,” offering valuable insights. This is something all caregivers will face in the future, and its impact can be significant if they are not adequately informed. Chapter 13, titled “I need to do it on my own” - Support options for family caregivers of persons with dementia, explores the dynamics of caregivers seeking support from external sources. While some caregivers may resist outside assistance, believing it is their own responsibility and not wanting to burden others, the author emphasizes the importance of overcoming barriers to utilizing available support. The author suggests that caregivers, in trying to handle everything on their own, may encounter significant problems such as illness, depression, and isolation from others. It is crucial for caregivers to actively seek support, ask for assistance, and ultimately release themselves from the caregiving burden for both the patient and their well-being. The author proposes that utilizing professional services may be the best solution. Chapter 14, titled “Nursing-home placement - When the limits of home care have been reached,” introduces how caregivers can utilize institutional care, make decisions, and outlines the positive and negative aspects of using professional care facilities. Case examples 60, 61, 62, 63, and 64 effectively illustrate the process of utilizing therapeutic facilities and provide valuable insights into the considerations caregivers should have when planning, especially in cases involving violence or neglect. Chapter 15, titled “Completion of therapy,” explains the conclusion of the therapeutic approach, including the evaluation process. Caregivers can seek additional support and provide feedback to the therapist during this stage.

In reviewing the book, reflecting on dementia and family caregiving through Dr Wilz’s writing has been a rewarding experience. It has prompted me to contemplate the “what” and “how” of providing practical future caregiving in the evolving landscape of family and social systems. We live in a world that is globally aging, changing, and diverse in culture, yet we all share the common reality that “we are all getting old and will eventually pass away.” Aging doesn’t necessarily imply developing dementia, but it does entail the likelihood that someone in our family will become a caregiver. I believe that someone could be “you.”

*****If there are any questions regarding the reviewing comments, individuals can contact you, Hyunsook Kang, PhD, at Stephen F. Austin State University, School of Human Sciences, via email at kangh@sfasu.edu.