What are the treatment goals for a 68-year-old woman whose partner has been diagnosed with Lewy Body Dementia, factitious disorder, and functional neurological disorder, and has recently been placed in a dementia specialty residential environment?

Treatment Goals for a Caregiver of a Partner with Lewy Body Dementia in Residential Care

The primary treatment goals for this 68-year-old woman should focus on caregiver adaptation to the transition, emotional processing of the placement decision, and development of a new caregiving identity while maintaining her own health and quality of life. 1

Goals for Individual Sessions with the Woman

1. Emotional Processing and Adjustment

• Address transition-related grief and potential guilt despite being "resolute" in her decision 1
• Validate the emotional complexity of placement decisions even when logically sound 1
• Process feelings of loss related to changing relationship dynamics and daily routines
• Monitor for signs of depression, anxiety, and caregiver burnout that may persist post-placement 1

2. Caregiver Identity Transformation

• Support transition from primary hands-on caregiver to advocate/care coordinator role 1
• Develop strategies for meaningful engagement during daily visits that maintain connection without exhaustion
• Establish boundaries between caregiving responsibilities and personal life 1
• Create structure for her daily life beyond caregiving activities

3. Self-Care and Health Maintenance

• Implement regular self-care practices to prevent burnout and compassion fatigue
• Reconnect with personal interests, social relationships, and activities that may have been neglected
• Address any neglected health needs of her own 1
• Develop stress management techniques specific to new challenges of having a partner in residential care

4. Communication with Facility Staff

• Build skills for effective advocacy with residential care staff 1
• Develop strategies to communicate observations about partner's condition constructively
• Navigate potential conflicts regarding care decisions while maintaining collaborative relationships
• Utilize her organizational skills and observant nature productively in this new context

Goals for Couple Sessions (Neurorehab and Neuropalliative Care)

1. Relationship Adaptation

• Maintain meaningful connection despite cognitive decline and new living arrangement 1
• Develop communication strategies appropriate for Lewy Body Dementia symptoms 1
• Create new shared rituals and activities suitable for residential setting 1
• Process grief together regarding relationship changes when appropriate

2. Management of Lewy Body Dementia Symptoms

• Education about disease progression and symptom management specific to Lewy Body Dementia 2
• Develop strategies for managing hallucinations, fluctuations in cognition, and other symptoms 2, 3
• Adapt communication techniques as cognitive abilities change 1
• Support her understanding of medication effects and potential side effects 2

3. Advance Care Planning

• Continue discussions about future care preferences and end-of-life wishes 1
• Document preferences regarding medical interventions as disease progresses 1
• Support emotional processing of difficult decisions regarding future care 1
• Prepare for potential disease progression and changing care needs 4

4. Family System Integration

• Facilitate positive relationships with adult children and grandchildren 1
• Coordinate family involvement in care in ways that support both partners 1
• Address any family conflicts or differing opinions about care decisions
• Create opportunities for meaningful family engagement that benefits both partners

Implementation Approach

1. Initial Phase (1-3 months):

   • Focus on emotional processing of the transition
   • Establish new visiting routines and self-care practices
   • Provide education about facility care and Lewy Body Dementia progression

2. Middle Phase (3-6 months):

   • Develop new relationship patterns and communication strategies
   • Address emerging challenges with residential care
   • Strengthen self-care practices and personal identity beyond caregiving

3. Ongoing Phase (6+ months):

   • Monitor for caregiver burnout despite residential placement
   • Adjust to changes in partner's condition as disease progresses
   • Continue to balance caregiving responsibilities with personal well-being

Potential Challenges and Pitfalls

• Caregiver guilt: Despite logical decision-making, emotional guilt about placement is common and should be addressed directly 1
• Over-involvement: Risk of continuing intensive caregiving despite residential placement, leading to burnout
• Under-involvement: Withdrawing due to grief or guilt, potentially compromising advocacy role
• Staff conflicts: Difficulties transitioning from primary caregiver to collaborative role with professional staff
• Neglected self-care: Continuing to prioritize partner's needs at expense of own health and well-being

By addressing these goals systematically while remaining flexible to the specific needs of this organized, observant, and dedicated caregiver, therapy can support her adaptation to this significant life transition while maintaining her quality of life and relationship with her partner.