Table 1

Statements by therapists stating main performance problems within the therapeutic subprocesses

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].’

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.’

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.’

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.’