When a 45-year-old woman called seeking an appointment for treatment of depression and anxiety, the psychotherapist assumed she would be a standard case. But during the initial visit, the client said her symptoms had a specific cause: Caring for her father with dementia and two teenage daughters while also holding down a full-time job was stressing her out. Her story gave the therapist pause. Would typical psychotherapeutic modalities help this client? Or would she need a specialized treatment focused on managing caregiving’s many challenges?
As our country ages and the number of American family caregivers continues to rise—from 43.5 million in 2014 to 63 million in 2024, according to the 2025 Caregiving in the U.S. report from AARP and the National Alliance for Caregiving—more psychotherapists are fielding calls from prospective clients in the midst of caregiving. To provide care that is appropriate, competent, and effective, those therapists usually realize that they need at least some understanding of caregiving stress. They aren’t sure, however, what ideal caregiver therapy looks like.
Although no professional organization has yet developed formal clinical guidelines in this area, decades of research on caregiver needs and potential interventions point to some general competencies for helping caregivers. As psychologists specializing in caregiver therapy for more than 30 years, we offer these key points that we make to therapists who would like to work with this population:
Psychoeducation
It is not uncommon for family caregivers like the daughter mentioned above to feel lost and overwhelmed in their caregiving journeys by the sheer amount of essential information and skills they need to master on medical procedures, managing finances and insurance paperwork, and coordinating multiple support services. Therapists should be able to provide basic guidance for navigating this confusing landscape, including psychoeducation on:
- Normal emotional reactions to being a caregiver, ranging from sadness to anger to guilt, as well as the potential negative impacts (increased stress, depression, and anxiety) and positive rewards (personal and spiritual growth, the opportunity to give back) of being a caregiver. This should also include expectable reactions—often relief, followed by guilt about having felt relieved, followed by sadness—to the care receiver’s death and the end of caregiving.
- Ideas for self-care, including time management techniques, respite, mindfulness practices, and limit-setting. Therapists can also give permission to caregivers who feel guilty about needing to take time to care for themselves.
- Care receivers’ medical conditions—such as dementia, Parkinson’s disease, heart failure, COPD, and cancer—the typical course and prognosis for that condition, and its usual treatments, treatment efficacy, and side effects.
- Navigating our complex, fragmented health systems to find the right providers and services for care receivers. This includes learning how to communicate with busy doctors to develop working partnerships with them.
Psychotherapeutic Approaches
For caregivers in acute distress, psychoeducation alone is necessary but not sufficient. In these cases, there are several types of psychotherapy that are helpful if used with adaptations and for specific purposes:
- Insight-oriented therapy: The relationship between a caregiver and care receiver can be fraught because of their pre-caregiving history. For example, if an older adult was a neglectful or abusive parent, an adult child caregiver may feel more conflicted and therefore more stressed about caring for them. By helping caregivers gain insight into those early relationships and how they are coloring their emotional reactions to the caregiving situation, therapists can help caregivers better separate past issues from current challenges to focus more readily on meeting the present needs of a now frail and vulnerable parent.
- Cognitive behavioral therapy: Under this broad category, there are several psychotherapies that can be useful for caregivers. Traditional cognitive behavioral therapy, which strives to correct irrational thoughts, can be applied to the perfectionistic tendencies of caregivers whose expectations for the care they should provide are set too high and who then experience unrealistic guilty feelings for “failing.” Problem-solving therapy can be used to teach caregivers a process for thinking through the inevitable problems that arise during caregiving, generating solutions, and then choosing and implementing the most promising one. Assertiveness training can encourage caregivers to set limits with care receivers who make too many demands or solicit assistance from family members who are contributing too little to the caregiving effort. Acceptance and commitment therapy, with its emphasis on clarifying personal values, can strengthen caregivers’ motivation for and commitment to providing care for a family member
- Family systems therapy: It is family conflict between adult siblings or a well and ill spouse that often leads frustrated and angry caregivers to seek psychotherapy. Family therapy techniques, including couples and family sessions, can reduce that conflict, create greater family cohesion and cooperation, and thereby decrease caregiving stress
- Grief therapy: Caregivers suffer many losses during caregiving. Because of the sacrifices of time and energy they make, they grieve their previous routine and, often, sense of personal freedom. They grieve the slow loss of their care receiver to a progressive condition such as dementia or Parkinson’s disease. Eventually, they grieve that family member’s death. Naming that grief in its different forms, including anticipatory grief and ambiguous loss, is often helpful for validating caregivers’ experiences and emotions. Other grief therapy techniques—for instance, recalling cherished memories, creating tender interactions with the care receiver to cherish later, and employing grief rituals—can help them better contain their sadness and make positive meanings of their months and years of caregiving.
The take-home point here is that there are many ways that traditionally trained psychotherapists can expand their knowledge and flex their skills to support caregivers. The work, focused on high-stakes life and death issues, can be highly emotional for the caregiver and therapist. In our experience, it is also deeply gratifying.
