Table 2.

Examples for the Category Recognition and Acceptance of Loss and Change.

Exploration of Losses	Classification of Changes as Part of Dementia	Addressing Unrealistic Hopes and Cognitive Restructuring	Identification of Painful Emotions	Psychoeducation on Loss as a Unique Aspect of Dementia Caregiving
T: And now you are confronted with [the symptoms of dementia] directly, right? [ … ] With your husband changing, the isolation, and that your own life is not how you imagined it, right? C: Yes … we had this wonderful apartment by the beach in Mallorca and we had all these plans. [ … ] They will never come true now, right?	T: Because of this disease, he has changed so much; he is not the man you married, the man he used to be, anymore. In reality, you have already had to say goodbye to your husband, even though he is still alive. [ … ] C: Exactly! Now you’ve said the right thing. And I have not said goodbye yet. I have said goodbye to many things and it will go on, this goodbye.	T: Is it possible that behind the thought “The weather could have caused the forgetfulness,” there is hope that he might get better again? C: Yes! Don’t you think so? [ … ] T: I can understand this hope and, in fact, many spouses find it very difficult to accept the progressive nature of the disease. That’s something you don’t want and you always hope that it doesn’t progress further. And I can imagine that behind your thought that the weather could have caused his decline, there is hope that he’ll get better when the weather changes? C: Yes. It’s so hot at the moment and he doesn’t remember so many things. He hardly recognizes his son, he asks me ten times a day “Who is that?”. You don’t think that’s already…? T: It is possible. Maybe it’s the natural cause of the disease. [ … ] C: I’m glad you told me. I really hoped, if the weather got cooler, he would get better …	T: How do you feel when you realize there is something you always used to do [together] and all of a sudden it is not possible anymore? C: Well, I feel the loss and that makes me sad.	T: There is a difference between someone who has a partner, but that partner is not capable of being a real partner anymore, and someone who does not have a partner at all and who can get used to the situation. You are married, you have a partner. But still he cannot offer you what a healthy man could offer. C: Yes. T: And that is sad, that is what is sad about dementia. Sometimes, it is easier to accept it when somebody dies, but this disease is so difficult to bear because the person is still here but also gone.

Abbreviations: T, therapist; C, caregiver.