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

Psychotherapeutic Support for Family Caregivers of People with Dementia: The Tele.TAnDem Manual by Gabriele Wilz (Marlena L. Itz, Translator), published in 2024 by Hogrefe Publishing is a timely, well-developed clinical resource for marriage and family counselors. The manual represents empirically grounded therapeutic guidelines for supporting the increasing number of family caregivers who attend to the physical, psychological, and relational needs of the aging population who present with dementia. Depending upon the type and severity of cognitive impairment, caregivers provide hours of assistance throughout the day. Marvin Goldfried, an eminent Cognitive Behavior Therapy researcher and author, estimated that over 50 million people worldwide suffer from dementia (Wilz, 2024, p. 1). The needs of caretakers have been neglected in terms of psychoeducation for best practices in working with impaired persons, as well as, the provision of clinically relevant resources for the challenged family members.

Chapter 3 (pp. 19–23) of the manual provides helpful information on the symptoms, diagnosis, and course of dementia. Alzheimer's disease is the most common form of dementia (∼60%–90% of cares). The content is based in part on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association). Dementia is a neurocognitive disorder with deficits in cognitive functioning: memory, thinking, orientation, perception, learning, language, judgment, and decision-making. In addition, there are changes in emotion regulation with increases in anxiety, impulsiveness, and aggression. Social behavior and motivation decline over time. Due to the effects of the disease process on the brain, impairment is progressive, moving from mild to moderate and severe stages. Life expectancy is 5–10 years following initial diagnosis. The ongoing decline in functioning and need for family care contribute to the sense of loss and despair reported by caregivers. Currently, around 69% of people suffering from dementia are cared for at home, primarily by wives, daughters, and daughters-in-law (p. 5).

Gabriele Wilz originally published in German the manual based on the Tele.TAnDem model, which was developed with colleagues in their research group (Wilz et al., 2015). The present work has been expertly translated to increase access to the model for English-speaking clinicians. The model was specifically constructed to provide a short-term intervention of seven sessions online or via telephone. Outcome research determined that the intervention was effective in reducing caregiver burden, especially lack of emotional-well-being. Participants in the research indicated that the brief intervention could be expanded to 12 50-minute sessions over six months in face-to-face, online, or telephone modalities. The benefits of the intervention included the following outcomes for caregivers.

Fewer depressive symptoms and physical complaints

The manual integrates cognitive behavior therapy (CBT) and acceptance and commitment therapy (ACT). The combination of CBT and ACT in one study (Losada et al., 2015) reduced experiential avoidance (ACT) and depression (CBT), as well as acceptance of the disease process and managing negative emotions and cognitions. A related goal was increasing leisure activities, pleasant experiences, and social support. The manual organized interventions according to the following modules (Wilz, pp. 15–16).

Overview of intervention strategies

The manual itself is well-written and organized. It is professional, yet accessible to counselors and clients. There is careful attention to the therapeutic alliance. The work appeals to the lived experiences of caregivers as evidenced by the titles of the modules.

I Grew Up in the Countryside, and That was a Given There (e.g., changing dysfunctional appraisals)

Each module or chapter is authoritative, yet compassionate. There are plenty of highlighted lists and tables in addition to meaningful case examples. The manual is especially effective in delivering therapeutic homework assignments that constitute much of the intervention between scheduled sessions. The counselor is aided by examples, questions, and psychoeducation resources. There are excellent transcripts to support case studies. The manual is organized by module and well-defined subsections from the first introduction to saying goodbye. Worksheets are provided in the published manual, as well as delivered online through download. Many of the worksheets represent the core components of CBT. Some of the resources are very practical (e.g., Problems with Visits to the Doctor). The worksheets guide the family caregiver from goal setting to considerations in choosing a nursing home when needed. Worksheets 11-2 (Suggestions for Pleasant Activities), 11-3 (Suggestions for Self-Care), and 11-4 (My Current Weekly Plan) are positive and strengths-oriented, maintaining a focus on relieving the burden on the family caregiver.

This evidence-based and clinically relevant manual translates research findings to practical application for beleaguered caregivers and their therapists. Marriage and family counselors will be well-served by the publication given projected increases in dementia and known burdens of family members who care for their declining loved ones. Having experienced a health crisis and recovery, I know the value of family support. This book sensitized me to the toll on the caregiver and their need for support, as well. I plan to use this manual in my clinical practice and to share a copy with my partner should the need arise. I believe it could be a valuable resource for graduate courses on aging, neurocognitive disorders, and medical family therapy.