Article

Dementia
Perceptions of a cognitive 2017, Vol. 16(4) 513–522
! The Author(s) 2015
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people living with cognitive DOI: 10.1177/1471301215609738

journals.sagepub.com/home/dem

impairment and their

caregivers: A qualitative
interview study
Isabelle Moebs
Dunedin Public Hospital, Southern District Health Board, New Zealand

Susan Gee
Princess Margaret Hospital, Canterbury District Health Board, New Zealand

Motohide Miyahara
Movement Development Clinic, School of Physical Education, Sport and Exercise Sciences,
University of Otago, New Zealand

Helen Paton
Dunedin Public Hospital, Southern District Health Board, New Zealand

Matthew Croucher
Princess Margaret Hospital, Canterbury District Health Board, New Zealand

Abstract
Cognitive rehabilitation has been developed to improve quality of life, activities of daily living and
mood for people with cognitive impairment, but the voice of people with cognitive impairment
has been underrepresented. This study aimed to understand the experience of people living with
cognitive impairment, as well as their caregivers who took part in a cognitive rehabilitation
intervention programme. Twelve individuals with cognitive impairment and 15 caregivers
participated in individual qualitative interviews. The interview data were analysed in three
steps: 1) familiarisation of the transcripts; 2) identification of themes; 3) re-interpretation,
refinement and integration of themes with methodological auditors. Both participants living
with cognitive impairment and caregivers valued the comfortable environment with friendly,

Corresponding author:
Isabelle Moebs, Dunedin Public Hospital, Southern District Health Board, New Zealand, Great King Street,
Dunedin, 9016, New Zealand.
Email: isabelle.moebs@gmail.com
514 Dementia 16(4)

caring and supportive group leaders who taught practical tips and strategies. The participants
living with cognitive impairment enjoyed socialising with like others. Caregivers benefited from
learning about memory problems and sharing their challenges with other caregivers. The
participants living with cognitive impairment emphasised the benefits of relational and practical
aspects, whereas the caregivers valued the informational and emotional support. In conclusion,
both participants living with cognitive impairment and caregivers found the cognitive rehabilitation
group useful.

Keywords
cognitive rehabilitation, group, dementia, cognitive impairment, family caregivers, qualitative
research

Introduction
Memory and other cognitive difficulties can impact on abilities and confidence, precipitating
anxiety, depression, and withdrawal. These changes can also cause frustration and strain for
caregivers (Bahar-Fuchs, Clare, & Woods, 2013). To sustain quality of life, early
intervention and support for people with dementia is an internationally emphasised
priority (World Health Organization and Alzheimer’s Disease International, 2015). One
such intervention is cognitive rehabilitation designed to cope and live well with cognitive
impairment. The purpose of cognitive rehabilitation is ‘‘to enable clients or patients, and
their families, to live with, manage, by-pass, reduce or come to terms with cognitive deficits
precipitated by injury to the brain’’ (Wilson, 1989, p. 117).
Cognitive rehabilitation involves the identification of achievable and relevant individual
goals and ways to address these (Clare et al., 2013). Participants are taught restorative
techniques to build on residual abilities to help learning, such as errorless learning (Clare
& Jones, 2008), spaced retrieval (Dröes, van der Roest, van Meirlo, & Meiland, 2011) and
verbal labelling (Miyahara, 2003). There is an emphasis on compensatory approaches by
using strategies and aids. The programme may also include psychoeducation and supportive
discussion related to the needs of participants (Bahar-Fuchs et al., 2013), including families
(Tardif & Simard, 2011). Traditionally cognitive rehabilitation has been offered individually,
allowing each person living with cognitive impairment to receive full attention and
individualised treatment from a therapist. In contrast, group cognitive rehabilitation is
more time-efficient for therapists, and provides participants with time and place for
socialising, sharing experiences and learning from each other.
The benefits of cognitive rehabilitation for older people with mild dementia and mild
cognitive impairment have been examined only by quantitative studies which demonstrated a
positive benefit on cognitive functioning (Clare et al., 2010; Greenaway, Duncan, & Smith,
2012; Kurz, Pohl, Ramsenthaler, & Sorg, 2009) and psychological well-being (Kurz et al.,
2009, 2012). To our knowledge no previous qualitative research has explored participants’
perceptions of cognitive rehabilitation groups for this population. A qualitative
approach may help us gain a nuanced understanding of experience, perceived benefits and
limitations of cognitive rehabilitation by looking inside ‘‘the black box’’ (das Nair &
Lincoln, 2013).
Moebs et al. 515

Method
Cognitive rehabilitation group
The ‘‘Coping with Forgetfulness Group’’ is a weekly nine-week group cognitive
rehabilitation programme for individuals with memory problems and their caregivers.
This group was implemented by a clinical psychologist (HP) and an old age psychiatrist
(IM) in 2011, and since then four consecutive groups have been held every year. To attend
the group, the individuals with memory problems need to have a diagnosis of mild cognitive
impairment, mild dementia or cognitive impairment secondary to an insult to the brain. In
addition, they must have a support person who could also attend.
Each group consists of six dyads of people living with cognitive impairment and
caregivers. The group is led by the clinical psychologist, a clinical psychology intern, an
occupational therapist and an Alzheimer Society community support officer as summarized
in Table 1. To foster community integration, the group is held outside the hospital in bright
and spacious Dunedin’s Community House.

Research participants
Twenty-one dyads of people living with cognitive impairment and caregivers who attended
the Coping with Forgetfulness Group programme from April 2012 until June 2013 were

Table 1. Coping with Forgetfulness Group schedule.

Time (a.m.)

10:00–11:30 Mixed group activity

10:00–10:30 Informal conversation over tea and coffee
Serenity prayer and short relaxation exercise
10:30–11:30 Core educational workshop sessiona
11:30–12:00 Separate group activity

Patient subgroup Caregiver subgroup

11:30–12:00 Cognitive exercises Discussionb

a
Workshop covers formal education about memory and adjustment to change, helpful
strategies to assist memory, problem solving and goal setting exercises, reminiscence
exercises and planning for the future.
b
Discussion over issues and problems encountered in daily life.

Table 2. Characteristics of participants.

Patients Caregivers

Number of subgroup 12 (9 men, 3 women) 15 (13 women and 2 men)

Number of diagnosis
Mild cognitive impairment 7
Early Alzheimer’s dementia 5
Age, mean  SD (year) 77.64  5.12 68.26  12.33
516 Dementia 16(4)

invited to take part in individual interviews. Twenty-seven participants (see Table 2

for detail) signed the informed consent form which had been approved by the Ministry of
Health Lower South Regional Ethics Committee. All participants were New Zealand
European or from Great Britain.

Interview procedures
All interviews were individually conducted by the first author (IM) either in a hospital room
or at the interviewee’s own home. In semi-structured interviews the interviewer encouraged
the participants to talk about their general impression of the group, the perceived benefits,
and anything they had found difficult. Each interview was audiotaped and then transcribed
by a typist with pseudonyms.
The transcribed scripts were subjected to a thematic qualitative analysis based on the
framework approach (Pope, Zieberland, & Mays, 2000). The analysis started with
familiarisation of the transcripts in order to identify key ideas and recurrent themes. The
first author highlighted themes and then created a thematic matrix. Further mapping and re-
interpretation were conducted to refine the thematic matrix. Particular emphasis was placed
on including negative or divergent views. Other members of the research team (MC, SG,
MM) served as methodological auditors to examine the credibility of conceptual
interpretation of the interview data (Lincoln & Guba, 1985). Themes were analysed for
the participants with memory impairment and caregivers separately, and then the
emergent themes were contrasted, compared and integrated into three main themes. Two
of the three main themes had some subthemes.

Results
Theme 1: ‘‘I felt quite comfortable’’
Most individuals with cognitive impairment and caregivers described the Coping with
Forgetfulness Group as an enjoyable and comfortable experience. There were some people
with memory problems who felt hesitant at the outset: one person with cognitive impairment
said, ‘‘I did not really want to go at the start, but I thought I had better.’’ Then their initial
reservations were overcome quickly: ‘‘after the first session, everybody opened up.’’
The group leaders were regarded as ‘‘friendly’’, ‘‘helpful’’, ‘‘caring’’, ‘‘good at what they
did’’ by the participants. The venue was ‘‘pleasant’’ and ‘‘comfortable’’, and the community
venue was more ‘‘normal’’ and ‘‘less clinical’’ than a hospital setting. The initial informal
social time was highlighted as helping people to feel relaxed: [it] ‘‘started with tea and cake
which was nice and relaxing’’. The experiences of serenity prayer differed among
participants. Most participants living with cognitive impairment and caregivers
appreciated it as ritual, relaxation, and a help to focus, but some participants with
cognitive impairment and caregivers thought it was ‘‘a waste of time’’ and inappropriate
because of its religious overtones.

Theme 2: ‘‘Sharing and being with others’’

For the participants with cognitive impairment being part of a group of similar people
was a positive aspect of the group. With similar others they did not have to feel
embarrassed or frustrated when they could not remember. They could talk to each other
Moebs et al. 517

easily: ‘‘everybody else had the same troubles, something we could share, recognize the
problems, makes it a lot easier to cope, felt more at ease’’.
According to the caregivers, the participants with memory problems enjoyed new people
and socialising. The caregivers described how the persons with memory problems benefited
from the group: ‘‘she enjoyed it; enjoyed talking to people; see her chatting away quite
happily; something I have not seen in years because normally she just sits at home’’.
For the caregivers the benefit of being with others with similar experiences was also a
strong theme: ‘‘It is helpful to know that other people have got similar problems. I take
comfort from that. I think that nothing is more difficult to bear than a feeling of aloneness.’’

Subtheme 1: Sharing reminiscence. Caregivers valued the insights and bonding which resulted
from the reminiscence activity: ‘‘that was great because we did more connecting as couples
and the others had a story; seeing them as young, vital people expanded their personality’’. It
was also an enjoyable and successful social experience for the participants living with
cognitive impairment as memories of the past were better preserved: ‘‘For a lot of my
past I am still very clear and I do enjoy talking with other people about the past’’ except
one participant with cognitive impairment who ‘‘didn’t find that tremendously helpful
because everybody has different memories’’.

Subtheme 2: Caregivers’ discussions as mutual support. All the caregivers valued the discussions
with the other caregivers and the group leaders in a separate room: ‘‘. . . being able to put out
there how you really feel and hearing from others the way they coped, getting little bits of
things and being able to laugh about things that happened with those that really understand.
Carers are living it, get much more from that’’. They could talk about their feelings – worry,
anxiety, irritation, fear, frustration, stress, anger, sadness, loss – ‘‘without upsetting
anybody’’. Caregivers learned from and were affirmed by listening to each other.

Subtheme 3: ‘‘Sharing and being with others’’. Three caregivers commented on the benefit for the
men with cognitive impairment to be among other men: ‘‘I thought that was very good
because the men came out of their shell a bit better.’’ One of the caregivers’ groups consisted
of only women. The benefit of being with only women was noted by those in this group:
‘‘The ladies were able to discuss. I don’t think it would have been quite so easy, had it been
mixed.’’
Most of the caregivers were wives, husbands, or partners of the person with cognitive
impairment, but there was a grown-up child of the person with cognitive impairment in each
of the four groups. These relatively younger caregivers wished that there had been someone
younger in the group who they had ‘‘had more in common with’’. Some of the leaders (intern
students) were occasionally referred to as ‘‘the little girl’’ and ‘‘the young guy’’. One
caregiver said, ‘‘the young person giving all the information is a bit difficult . . .
[Information] comes across better from a woman in her 40 s or 50 s.’’

Theme 3: ‘‘How to cope, caregivers and the person’’

The group was a place where the participants gained strategies and insights to help them
cope better. Perceptions of the usefulness of some programme components varied.
Caregivers and participants valued practical tips from the group, receiving ‘‘a lot of
practical help, like the whiteboard that can help cope with your life’’. Many gave specific
518 Dementia 16(4)

examples, particularly drinking sufficient water and using memory aids, such as notebooks,
diaries and clock with date. Spaced retrieval exercise with a puppet helped participants to
realise that repetition could consolidate memory. People with more severe memory problems
recalled few memory aids and strategies.

Subtheme 1: Knowledge sessions. The caregivers felt that learning about memory was helpful
for themselves, and they particularly valued ‘‘the doctor coming in to talk’’. They found it
helpful to gain ‘‘a better understanding of the difficulties they [participants living with
cognitive impairment] are facing, the background of what causes Alzheimer[s]’’. A few
caregivers thought learning about memory ‘‘was not for the patient.’’
Four individuals with advanced memory problems remembered nothing about the
knowledge sessions. Participants with less severe cognitive impairment recalled the
sessions without any specific details: ‘‘you certainly learnt a wee bit as you went along.’’
One of them found the theoretical knowledge ‘‘a bit useless really because I am more with
the practical side.’’

Subtheme 2: Goal setting. Most of the participants with memory difficulties talked about the
goals that they had set, achieved and changed as necessary. Many goals consisted of using
memory aids, and engaging in physical and social activities. Some caregivers commented on
goal-setting: ‘‘It was something to aim for, and it was good that the goals were
personalised.’’ There were, however, other caregivers who found the goal-setting less
useful: ‘‘[participant with cognitive impairment] just think it’s silly’’; ‘‘we’ve already done
that’’; [at] ‘‘our stage of life we already have set out patterns’’.

Subtheme 3: Strategies for caregivers. The caregivers reported their gains of coping techniques
and insights often by discussing within the caregivers-only sessions. For example, one
caregiver said, ‘‘I am more careful because I didn’t understand when I shift things, it
always annoyed . . . So now I am more careful to leave things in the same place and I
have labels on icing sugar, sultanas, whatever.’’ Another caregiver benefited from
reframing a problematic behaviour: ‘‘It drives her crazy all the time going to the letterbox
and we all agreed. ‘‘Then somebody suggested,’’ Well, look at him getting a bit of exercise.
Oh, now I just think he is going for a little walk.’’ For several of the caregivers the group
affirmed: ‘‘I have to work on my own way of taking time for myself, go off for an hour and
do things.’’

Subtheme 4: Changing attitudes. Some of the people with cognitive impairment felt that the group
helped them to feel that they ‘‘could still learn’’, ‘‘practically cope better’’, and become more
‘‘understanding’’, ‘‘tolerant’’, ‘‘considerate’’ and ‘‘patient’’. The group enabled a caregiver to
gain insight that his mother was difficult not by choice: ‘‘maybe it is understanding a bit more
that mum is not being annoying to me, and so, I am a bit more tolerant.’’ Some participants with
cognitive impairment also reported caregivers’ positive attitudinal changes.

Discussion
Cognitive rehabilitation has traditionally been offered as an individual intervention. The aim
of this qualitative interview study was to illustrate the insiders’ views of the cognitive
rehabilitation intervention in a group format. The cognitive rehabilitation programme in a
Moebs et al. 519

group format was perceived as useful and beneficial for people with cognitive impairment
and their caregivers. Both the people with cognitive impairment and the caregivers valued
the relational and practical aspects of the group, whereas the education and the emotional
supports were mainly appreciated by the caregivers. These results contribute to the existing
research on the benefits of psychosocial interventions for people with memory problems and
their caregivers by qualitatively evaluating the group cognitive rehabilitation programme.
The results of this study reinforce the importance of relational aspects of being in
psychosocial intervention groups with likeminded others (Clare & Shakespeare, 2004;
Melunsky et al., 2013). People with memory problems enjoyed the social contact because
in other social interactions, they often feel isolated, embarrassed and frustrated due to their
memory problems. The caregivers also enjoyed expressing their feelings and consulting their
difficulties in a separate group which provided a tailored support, opportunities to share
experiences, and others’ points of views (Haupt, Karger, & Jänner, 2000; Mittelman,
Brodaty, Wallen, & Burns, 2008). The caregivers only sessions at times operated as a
mutual-aid group based on the exchange of support and experiential knowledge amongst
the group members themselves. One of the helping professionals’ roles was to facilitate the
members help each other (Shulman, 2008; Steinberg, 2004). Thus, the caregivers’ need to
have discussion time for themselves was met, while the participants with cognitive
impairment were engaging in cognitive exercises away from their caregivers.
Frustration was the most predominant emotion that caregivers identified amongst
themselves and that the caregivers also identified in the persons with the memory problems.
Frustration has been listed as one of the core features of grief in caregivers (Chan, Livingston,
Jones, & Sampson, 2013). Grief implies a response to a loss. By attending the cognitive
rehabilitation programme, the participants felt empowered by memory aids and strategies
(Dixon, Hopp, Cohen, de Frias, & Bäckman, 2003), realising that memory was not
completely lost and that they could still memorise new items. Additionally the participants
gained a new perspective on the memory problems that enabled them to perceive behaviours
from a different view point. The process of the discoveries inspired the caregivers and relieved
the caregivers’ frustration and enabled them to become more tolerant of the behaviour
resulting from the memory problems. Learning and gaining a new perspective increased
competence, a sense of achievement and installed hope which enabled caregivers to
continue caring for the person with memory problems and improved their sense of well-being.
The group with likeminded others has a characteristic of universality, or the normalising
effect of meeting people with the same condition (Yalom, 1985). The people with memory
problems realised that they were not the only ones with memory problems and they could
talk freely to each other. Because their long-term memory was usually intact, they often
reminisced about the past and used it as a tool to relate with one another. Reminiscence
could improve sense of wellbeing (Brooker & Duce, 2000; Melunsky et al., 2013), which was
recognised in our groups. Interacting with likeminded people in the spacious and pleasant
room outside the hospital facilitated the group members to feel that the group meeting was a
part of civic life, thus normalised (Yalom, 1985). When group cognitive rehabilitation is
planned elsewhere in the world, the aspects of universality and normalisation should be
considered in terms of likeminded people and non-clinical venue.
The possible downside of limited individualisation in the group rather than individual
format was detected in some of the divergent views that were expressed by a minority of
participants. While many of the participants with memory impairment shared goals they had
achieved, there were reservations about the experience amongst some of the caregivers. It is
520 Dementia 16(4)

important to consider how to best tailor support for goal setting and achievement in a group
format. The group format also did not allow for tailoring of the general theoretical
education about the brain and memory. While the caregivers valued the knowledge
gained, it was sometimes seen as less useful and appropriate for the individuals with
cognitive impairment. The minority views also reinforce that it is important to consider
the needs of subgroups of participants in the group format (Melunsky et al., 2013),
including gender and younger filial carers.
A possible bias of the present study is that the results do not represent the voice of the
group members who chose not to participate in the research. These individuals might have
had less positive experiences or be less confident in communicating. While the interviewer
had not been involved in the groups, she had been involved in the clinical care of some of the
research participants and this may have created a social desirability bias. There is also an
inherent difficulty in asking people with memory problems to remember the group
experience in detail (Spector, Gardener, & Orrell, 2011). In general, the individuals with
cognitive impairment interviews were less elaborated and detailed than those of the
caregivers and four of the participants could recall very little specifically about the group.
This may have led to more generically positive narratives.
Although cognitive rehabilitation began as an individual therapy, this exploration
reinforces that a group format can offer its own advantages. The social opportunities
offered by the group were strongly valued, and the inclusion of caregivers only discussion
time was central to the perceived benefit of the experience for the caregivers. While a group
format will not suit all individuals, offering it as an option has the potential to extend a well-
received early intervention to a wider number of people.

Acknowledgements
We would like to thank the participants for their time and contribution, and also thank Catherine
Glenn for administrative support and transcribing the interviews.

Authors’ Note
The Coping with Forgetfulness Group is led by clinical psychologist Helen Paton as part of her work
with the Southern District Health Board. Isabelle Moebs conducted the study entitled ‘‘Perceptions of
the experience of participating in the Coping with Forgetfulness Group: Older people living with
cognitive impairment and their caregivers’ experience of a cognitive rehabilitation group’’ as part of
her advanced certificate in Psychiatry of Old Age with the Royal Australian and New Zealand College
of Psychiatrists which this report is based on.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this
article.
Moebs et al. 521

References
Bahar-Fuchs, A., Care, L., & Woods, B. (2013). Cognitive training and rehabilitation for mild to
moderate Alzheimer’s disease and vascular dementia. Cochrane Database of Systematic Reviews,
Issue 6. Art. No.: CD003260. DOI: 10.1002/14651858.CD003260.pub2
Brooker, D., & Duce, L. (2000). Wellbeing and activity in dementia: A comparison of group
reminiscence therapy, structured goal-directed group activities and unstructured time. Aging and
Mental Health, 4, 354–358.
Chan, D., Livingston, G., Jones, L., & Sampson, E. L. (2013). Grief reactions in dementia carers: A
systematic review. International Journal of Geriatric Psychiatry, 28, 1–17.
Clare, L., & Shakespeare, P. (2004). Negotiating the impact of forgetting. Dimensions of resistance in
task-orientated conversations between people with early-stage dementia and their partners.
Dementia, 3, 211–232.
Clare, L., & Jones, R. S. (2008). Errorless learning in the rehabilitation of memory impairment: A
critical review. Neuropsychological Review, 18, 1–23.
Clare, L., Linden, D. E., Woods, R. T., Whitaker, R., Evans, S. J., Parkinson, C. H., . . . Rugg, M. D.
(2010). Goal-orientated cognitive rehabilitation for people with early-stage Alzheimer disease: A
single-blind randomized controlled trial of clinical efficacy. American Journal of Geriatric
Psychiatry, 18, 928–939.
Clare, L., Bayer, A., Burns, A., Corgett, A., Jones, R., Knapp, M., . . . Whitaker, R. (2013). Goal-
oriented cognitive rehabilitation in early-stage dementia: Study protocol for a multi-centre single-
blind randomised controlled trial (GREAT). Trials, 14, 152.
das Nair, R., & Lincoln, N. B. (2013). The effectiveness of memory rehabilitation following
neurological disabilities: A qualitative inquiry of patient perspectives. Neuropsychological
Rehabilitation, 23(4), 528–545.
Dixon, R. A., Hopp, G. A., Cohen, A. L., de Frias, C. M., & Bäckman, L. (2003). Self-reported
memory compensation: Similar patterns in Alzheimer’s disease and very old adult samples. Journal
of Clinical and Experimental Neuropsychology, 25, 382–390.
Dröes, R. M., van der Roest, H. G., van Mierlo, L., & Meiland, F. J. M. (2011). Memory problems in
dementia: Adaptation and coping strategies and psychosocial treatment. Expert Reviews, 11, 1769–1782.
Greenaway, M. C., Duncan, N. L., & Smith, G. E. (2013). The memory support system for mild
cognitive impairment: Randomized trial of a cognitive rehabilitation intervention. International
Journal of Geriatric Psychiatry, 28, 402–409.
Haupt, M., Karger, A., & Jänner, M. (2000). Improvement of agitation and anxiety in demented
patients after psychoeducative group intervention with their caregivers. International Journal of
Geriatric Psychiatry, 15, 1125–1129.
Kurz, A., Pohl, C., Ramsenthaler, M., & Sorg, C. (2009). Cognitive rehabilitation in patients with mild
cognitive impairment. International Journal of Geriatric Psychiatry, 24, 163–168.
Kurz, A., Thöne-Otto, A., Cramer, B., Egert, S., Fröhlich, L., Gertz, H., . . . Werheid, K. (2012).
CORDIAL: Cognitive rehabilitation and cognitive-behavioural treatment for early dementia in
Alzheimer disease: A multicenter, randomized, controlled trial. Alzheimer Disease & Associated
Disorders, 26, 246–253.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.
Melunsky, N., Crellin, N., Dudzinski, E., Orrell, M., Wenborn, J., Poland, F., Woods, B., &
Charlesworth, G. (2013). The experience of family carers attending a joint reminiscence group
with people with dementia: A thematic analysis. Dementia. Epub ahead of print 26 December
2013. DOI: 10.1177/1471301213516332
Mittelman, M. S., Brodaty, H., Wallen, A. S., & Burns, A. (2008). A three-country randomized
controlled trial of psychosocial intervention for caregivers combined with pharmacological
treatment for patients with Alzheimer disease: Effects on caregiver depression. The American
Journal of Geriatric Psychiatry, 16, 893–904.
522 Dementia 16(4)

Miyahara, M. (2003). Effects on memory of verbal labeling for hand movements in persons with
Alzheimer’s disease. American Journal of Alzheimer’s Disease & Other Dementias, 18(6), 349–352.
Pope, C., Zieberland, S., & Mays, N. (2000). Qualitative research in health care: Analysing qualitative
data. British Medical Journal, 320, 114–116.
Shulman, L. (2008). The skills of helping individuals, families, groups and communities (6th ed.).
Belmont, CA: Brooks/Cole.
Spector, A., Gardener, C., & Orrell, M. (2011). The impact of cognitive stimulation therapy groups on
people with dementia: Views from participants, their carers and group facilitators. Aging and
Mental Health, 15(8), 945–949.
Steinberg, D. M. (2004). The mutual-aid approach to working with groups: Helping people to help
each other (2nd ed.). New York, NY: Haworth Press.
Tardif, S., & Simard, M. (2011). Cognitive stimulation programs in health elderly: A review.
International Journal of Alzheimer’s Disease. Article ID 378934.
Wilson, B. A. (1989). Models of cognitive rehabilitation. In R. L. Wood, & P. Eames (Eds.), Models of
brain injury rehabilitation (p. 117). London: Chapman & Hall.
World Health Organization and Alzheimer’s Disease International. (2015). Dementia: A public health
priority. Retrieved from www.who.int/mental_health/publications/dementia_report_2012/en/
Yalom, I. D. (1985). The theory and practice of group psychotherapy. New York, NY: Basic Books.

Isabelle Moebs, MD, FRANZCP, Cert POA and Psychotherapy is psychiatrist of old age in
Dunedin, New Zealand. She undertook the research on the Coping with Forgetfulness
Group as part of her advanced training certificate in Psychiatry of Old Age with the
Royal Australian and New Zealand College of Psychiatrists.

Susan Gee, MSc, PhD (Gerontology) is an academic psychologist. She is lead researcher in
the Psychiatry of Old Age Academic Unit, Canterbury District Health Board (CDHB).

Motohide Miyahara, PhD is a registered psychologist and an associate professor in

development and disability at University of Otago. He has conducted a series of studies
on apraxia with a focus on the development and age-related decline of sequential gesturing
ability. His research participants included children, young adults, older adults and people
with dementia, and his research methods range from case study research to quasi experiment
to functional magnetic resonance imaging experiment.

Helen Paton, MSc is a clinical psychologist in Dunedin, New Zealand. She has a clinical
psychology master’s degree from the University of New South Wales, Sydney, Australia and
an earlier master’s degree in neuropsychology from the University of Auckland, New
Zealand. She has developed and leads the Coping with Forgetfulness Group in Dunedin,
New Zealand.

Matthew Croucher, FRANZCP, Cert POA is a psychiatrist of Old Age and Senior Clinical
Lecturer with mixed clinical and academic roles in the University of Otago, Christchurch
and the Canterbury District Health Board. Dementia service development is one of his key
work areas.