This paper describes an approach to working with couples where one partner has a dementia, which is currently under development at the Tavistock Centre for Couple Relationships. This draws upon video-based methods that have been used with parents and children, as well as in psychoanalytic couple psychotherapy, to develop an intervention to assist emotional contact, communication and understanding in couples living with dementia. Our approach includes the person with dementia and their partner, focussing upon the relationship between them and using shared involvement in everyday activities as a basis for enhancing emotional contact. Evidence is reviewed of the need for such an approach, which aims to foster the resilience of the couple's relationship and strengthen their capacity to manage the emotional challenges of the situation. The importance of services holding a relational view in their delivery and the economic and humanitarian consequences of a neglect of this in dementia-care settings are also discussed.