Couples and Dementia
Published in Blog by TR on 3 February 2026
Andrew Balfour is a Clinical Psychologist, an adult psychoanalytic psychotherapist and couple psychotherapist. He is CEO of Tavistock Relationships and author of the book, Life and Death: Our Relationship with Ageing, Dementia and other Fates of Time. In this article he explores what happens to couples when one of the partners becomes ill with a deteriorating condition such as dementia.
Studies conducted around the world evidence that more than 70% of people with dementia are looked after by a family member, mostly their partner. The importance of accompaniment – in particular, between the partners in couples living with dementia - and yet the profound challenge of sustaining this – are central to our understanding of dementia care.
Research shows us that looking after a partner with dementia presents huge challenges to the mental and physical health of the carer partner. How they fare, and the quality of the relationship they are able to maintain, has profound consequences in terms of the trajectory of the illness. This includes rates of decline, mortality rates and the likelihood of the person with dementia moving to residential care.
A significant factor in terms of the experience and trajectory of the illness for the couple living with dementia, is the ability, including that of the partner with dementia, to be in touch with loss. Their capacity to mourn is crucial to their staying in some emotional contact with themselves and with each other. And whilst emotional contact is very hard to sustain, the dementia research literature finds it to be a crucial factor in quality of life and health-related outcomes.
What is it about emotional contact that makes it so important? Dementia research indicates that it is – but doesn’t explain why. Psychoanalytic approaches have a lot to offer here. As language capacities diminish in dementia and opportunities for intimacy and mutual understanding become constrained or lost, attachment relationships undergo profound changes, and the familiar social world becomes destabilised.
Reflecting on attachment needs in dementia care requires drawing on key insights from developmental research, which highlight the critical importance of reciprocal emotional exchange, and underscore the importance of the caregiver’s role in maintaining the emotional well-being of their partner with dementia. Indeed, both developmental research and psychoanalytic studies show us that, in good enough circumstances, our closest relationships can be the crucible of emotional growth throughout our lives.
At the different developmental stages we traverse, what is crucial is the sense of connection that comes from emotional contact with another mind that can understand and give words to our experience; or find other articulations or connections that go beyond words. This highlights the fundamental human need for emotional connection with another mind, supporting secure attachment through the experience of psychological containment. In the context of the attachment insecurity that dementia brings, the caregiver’s capacity for containment – their sensitivity, and ability to remain attuned to their partner’s experience, and to convey that understanding, become vitally important.
In our Tavistock Relationships study, which developed a psychoanalytically informed intervention for couples living with dementia, many participants with dementia were able to articulate their feelings about the importance of their relationship with their partner. It was striking how powerfully they conveyed their partner's unique capacity to help contain their disturbing feelings and states of mind, manage symptoms of dementia (such as hallucinations), and provide vital reassurance during times of high anxiety.
One woman described her husband’s ability to help her with disturbing and frightening states of mind and the importance of being with someone felt to have the capacity to take in her fears:
“I was having hallucinations – my husband was able to put my mind at ease. They were awful – but he would rescue me – bring me back … I could hear him coming up the stairs and I wasn’t afraid because I could hear it was him. If it hadn’t been for him telling me that I was seeing things I would have been terrified – I have feelings or sensations or dreams that are genuinely frightening … he is the one person who can calm me down … he is the only one who wanted to understand.
Carer partners were often acutely aware of their role as a containing presence for their partner with dementia and described their sensitivity to this need:
“Because if I said to him look it’s alright, calm down, just hold my hand, it’s alright, he would calm down, he would let things be done, you know in a way that, if I wasn’t around, he wouldn’t.”
This approach has aimed to "translate" key psychoanalytic and attachment concepts into a pragmatic intervention that draws upon tools developed in work with parents and children. This approach emphasises the importance of observation and incorporates video as central to our approach to fostering emotional contact between partners, for example videoing them while they are engaged together in everyday activities. The activities are then watched back with the couple. This element of the intervention served as a means of helping the individuals to gain a fresh vantage point to see themselves and their couple-hood in action.
Read more on this topic in Andrew’s book, Life and Death: Our Relationship with Ageing, Dementia and other Fates of Time, which is available from Amazon:
Find out more about Tavistock Relationships Living Together with Dementia Service:
