Therapeutic Lying and Dementia Care, Part 1
On Therapeutic Lying
Therapeutic lying is a technique by which one affirms the experience and statements of a person living with dementia even though these statements may be based on delusions or confabulations.
Many people with a neurological disease experience memory lapses and may fill in these gaps in memory with incorrect content. This content may be coherent or it may not make any sense. This process is called confabulation. Confabulation in this context is distinguished from outright lying since the intent is not to deceive anyone but an attempt to recollect information. A delusion on the other hand is a belief that is not true despite evidence to the contrary. People who are deluded generally hold an incorrect belief, or a system of beliefs, very strongly. The distinction between confabulation and delusion can often be blurry in the context of neurological diseases. Researchers have suggested that there could be some overlap between the two since it may be difficult to tell between content that makes up a confabulation and a delusion. Nevertheless, we as caregivers are faced with a dilemma: How do we respond to these situations?
When a loved one with dementia recollects something incorrectly or tells a story that seems fabricated, a family member may go along with the story in order to avoid agitation and confusion. This would be considered therapeutic lying. Avoiding agitation, however, is not the sole reason for this technique. Its purpose stems from some of the fundamental values of person-centered dementia care: When caring for someone with dementia, it is important to “enter their world;” doing so validates their experiences as human beings and acknowledges these experiences as meaningful ones. This is especially important when a loved one is distressed about something even if their concern is not based on real events. Addressing your loved one’s emotional state is more important than trying to correct any false information.
If you can tell that your loved one is visibly anxious or concerned about something, acknowledge their feelings and statements, reassure them that you are willing to help, and try to redirect their attention to something that is less stressful.
Therapeutic lying will not get rid of confabulations or delusions. It is a technique that allows you to respond when other responses do not seem to suffice. This approach may allow you to simultaneously alleviate your loved one’s distress and to care for them in a holistic manner. Additionally, acknowledging their current emotional disposition as opposed to correcting them is a way to preserve an aspect of their autonomy. A central tenet of person-centered dementia care is to recognize that every individual’s life contains its own unique meaning and value. Utilizing techniques such as therapeutic lying allows you to affirm your loved one’s value in life through engaged listening and attentiveness.
If you want more information and advice, then please visit ElderCare at Home’s blog for more tips for caregivers or call us at 561-585-0400.
 Mendez, Mario F. “False reports from patients with frontotemporal dementia: Delusions or confabulations?” Behavioural Neurology 24, no. 3 (2011): 237-244.
Dementia Initiative. Dementia Care: The Quality Chasm. (2013): 18. Accessed August 1, 2016, https://www.leadingage.org/uploadedFiles/Content/Members/Nursing_Homes/Quality/DementiaCareTheQualityChasm.pdf.