| Setting therapy goals | ‘Priorisation by the patient was difficult, because he was very uncritical.’ ‘The carer wants immediately to talk about problem solving. I again and again had to suggest the procedure [of systematic shared goal setting].’
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| Educating patient in new skills | ‘Patient needs much guidance. Concentration and endurance [are] very limited. Assistance for simple tasks [is needed].’ ‘Activities agreed on could not be carried out twice due to apathy and depressive mood.’ ‘In addition, patient had dyspraxia, which made training difficult.’ ‘[There was a] lack of training due to the negative attitude of the carer.’ ‘It is difficult for the patient to accept the disease. Therefore a high degree of convincing is needed in each session.’
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| Adapting physical or social environment | ‘The carer is the house owner and refuses any adaptation.’ ‘[Adapting physical environment] does not succeed because the carer is ostensibly open for intervention, but in reflective talks reluctant and negative.’ ‘An adaptation [of the physical environment] seems not reasonable to the patient, although [it is] necessary.’ ‘[Adapting physical environment] is possible only step by step, because the patient reacts on it with reluctance.’ ‘The patient lives rather reclusively, wishes no changes [in the social environment].’ ‘The patient is very anxious and avoiding [change]’. ‘The son strongly adheres to old patterns of interaction’. ‘The family dynamic is very fixed. Both daughters seem to have difficulty in just letting the mother [patient] simply do … Changes take place, but very slowly. [It is] questionable, whether there will be work on the goals after the intervention is finished.’ ‘In the community, there is no day care and no care centre for people with dementia.’
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| Training of carer's competence | ‘The son [is] often not or only temporary present at the sessions.’ ‘[The carer is] many a time overstrained and tries to give away [the responsibility] to the therapist.’ ‘It is difficult for the carer to get used to something new. He quickly falls back into old patterns [of behaviour] without being aware of it.’ ‘[The carer] seems to be very overstrained and burdened by the disease. He needs additional professional support, for example, from a psychologist’. ‘The carer has need for support, but refuses any offer of support for himself.’ ‘The carer mostly sees only his own problems. He cannot or only very rarely empathises with the patient. Offers of support are refused.’ ‘There are difficulties in the interaction between the family and the patient. The patient plays off the caring family members against each other.’
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