ABSTRACT
The burden of caring for a dementing spouse is well documented. Changes in the marital relationship, such as loss of the dementing person as he or she used to be, are part of the burden. The history of the relationship and the attachment between spouses are crucial in understanding the individual burden and adaptation to changes. John Bowlby describes three kinds of insecure attachment, which tend to increase proneness to loss: (i) anxious attachment, (ii) compulsive care-giving and (iii) strenuous attempts to claim emotional self-sufficiency and independence. Insecure attachment is seen in relationships between care-givers and dementing spouses, reflecting problems of dependency and of regulating the relational dynamics of closeness and distance. Attachment behaviour is often overtly expressed by the dementing person. For spouses insecure attachment may cause reluctance to accept that changes are in conflict with their basic needs of stability and security.
The discussion in this chapter is illustrated with case material from a study of support groups for elderly persons caring for a dementing spouse. Such groups often focus on training in problem-focused coping to find better ways of doing practical work and managing everyday life. They also focus on emotion-focused coping, such as accepting the deterioration as an inevitable illness. A third kind of coping, which is relationship-focused, requires identification with the other in order to understand, and at the same time recognize one’s own separateness from the other. Training in communication may help establish empathy and balance identification and separateness.
When dealing with married couples, former and actual role distribution, tacit understandings, collusions, patterns of complementation, and attachment between spouses, are keys to understanding their losses and strivings during the dementing process. Training in care-giving skills and coping strategies may prove futile unless actual and former qualities of the relationship, and the care-giver’s own needs, are taken into consideration. 192Even when looking for ways of offering practical help that the carer can accept, understanding the relationship may be of the utmost importance. Further development of differentiated psychological intervention methods in this field is called for.
