Book Review: Loving Someone Who Has Dementia by Pauline Boss

Loving Someone Who Has Dementia by Pauline Boss (2011) is subtitled “How to Find Hope While Coping with Stress and Grief”, and it delivers just that. Written by a renowned researcher and therapist, this book offers both heartfelt validation and practical guidance for those supporting someone with dementia. Whether you’re a caregiver, friend, or professional, Boss helps us understand the emotional toll of ambiguous loss- and how to live with it.

I chose this book both from personal interest and because of its relevance to my counselling work. I was looking for language that could capture the emotional complexity of caring for someone who is still physically present but no longer quite the same. These relationships often bring a deep sense of disconnection, shifting in ways that are hard to articulate, and are marked by ongoing change and uncertainty.

The purpose of this book is to be a guide providing proven strategies for managing ongoing stress and grief.

Ambiguous Loss

The first concept I grasped from reading the book was that dementia creates ambiguous loss. Boss defines ambiguous loss as a grief without clear resolution - where the person you love is both here and not here. This uncertainty creates deep chronic stress. I often hear clients describe this disorienting duality. Boss offers language and strategies that support acceptance, not detachment.

She defines the loss as “unclear; it has no resolution, no closure”. Articulating its’ unique and devastating nature being “physical or psychological, but in either case, a family member’s status as absent or present remains hazy.”  I have heard over and over carers describe the duality of their loved one’s simultaneous absence and presence. The confusion this creates - making sense is incredibly challenging. 

Her guidance is for carers to adjust their goals rather than to psychologically end the relationship, to try and shift their thinking so that it fits with the drastically changed relationship, accepting the ambiguity.  Through case studies, she compassionately describes how transformation supports the relationship for carer and the loved one.

The importance of a psychological family

Boss describes the modern American culture, common across many Western countries, where there can be an absence of nearby or supportive relatives. She encourages carers to create a “psychological family” - a chosen network of supportive friends, neighbours, or fellow caregivers. This being an expansion of the carer’s family, that they choose, who can be physically close and mentally and spiritually supportive.  This family extension provides the human connections which prevent loneliness and stave off the ill-effects that presents.

She dedicates a chapter to this, prompting reflection on who is emotionally present in your life. As a therapist, I often help clients explore how to strengthen or reimagine their support networks. I found this framing both practical and empowering.

The Good-Enough Relationship

Boss reminds us that no human relationship offers total presence. With dementia, this reality is amplified.  She guides that a carer can manage the debilitating impact of living with the incongruence of the absence and presence of a loved one with dementia by changing their thinking. 

She reframes the idea of a “good-enough” relationship - one that meets emotional needs without unrealistic expectations. Letting go of perfection isn’t giving up; it’s an act of compassion.

We live in a society where self-sufficiency is assumed and valued, and many aging people feel they should stay independent for as long as possible at a cost to themselves. We are all interdependent on others, and interdependent relationships are not necessarily unhealthy.

This chapter clearly articulates the need to share caring, using your psychological family to help maintain equilibrium and the need to evaluate when “good enough” stops being exactly that. 

In counselling clients have a reflective space to explore their changing relationship with their loved one and consider their options for maintaining a relationship that is “good enough”.

Recommendation

This book is accessible, wise, and deeply compassionate. Despite its age it does not feel dated. It can be read cover to cover or dipped into when support is needed. I recommend it to fellow therapists, carers, and anyone affected by dementia - directly or indirectly.

Loving Someone Who Has Dementia by Pauline Boss, PhD

As a self-help guide the reader will quickly resonate with the carer struggles that are comprehensively covered and be presented with thinking that can make a radical difference to the stress they carry with them.

Boss offers more than coping strategies; she helps us see how meaning and hope can still flourish, even through loss.