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Tell the Truth or a Therapeutic Lie?

Tell the Truth or a Therapeutic Lie?

Stepping into someone’s reality isn’t the same as lying

Honesty is not always the best policy when it comes to someone with Alzheimer’s or dementia.

That’s because their brain may experience a different version of reality. Dementia damages the brain and causes progressive decline in the ability to understand and process information. 

That’s why forcing someone to abandon their version of reality and join our “real world” can cause confusion, pain, anxiety, fear, and anger.

So, dementia care experts often recommend a technique called therapeutic fibbing. It helps you step into their current reality and spare them unnecessary upset and distress.

This technique takes some getting used to because going along with your older adult’s new reality can feel like you’re lying to them. But using white lies to validate their feelings and reassure them is certainly not the same as lying for a malicious reason.

We explain why always telling the truth could be cruel, how therapeutic fibbing helps you join their reality, and share two real-life examples of how to use therapeutic fibs to provide comfort and reassurance. 

Telling the truth could be cruel

Most of us are taught from a young age that any kind of lying is horrible and dishonest, especially lying to family and anyone we care about and respect.

So, when we hear about using therapeutic fibbing to lie to someone with dementia, it seems cruel and wrong.

But always sticking to the truth, especially about an emotional subject or something trivial, is more likely to cause your older adult pain, confusion, and distress.

Dementia prevents people from properly processing and retaining information. Plus, having short-term memory issues mean they’ll probably soon forget the conversation, so it will come up again.

Telling the truth each time forces them to experience fresh distress repeatedly. Is it necessary to cause them so much distress, especially when the truth you tell them is likely to be misunderstood or quickly forgotten?

Therapeutic fibbing helps you step into their reality

An effective way to step into your older adult’s reality is to use therapeutic fibbing. It means agreeing or saying things that are not true to avoid causing someone distress and to make them feel safe and comforted.

In many ways, this technique is like telling a friend that you love the thoughtful gift they gave you, even if you don’t like it. Telling the absolute truth in that case doesn’t change the situation and would only hurt your friend’s feelings.

Here are two examples that illustrate the difference between being completely truthful and using therapeutic fibbing. While your specific situations will be different, the same principles of gently going along with their reality and finding a distraction will apply.

Example 1
Being completely truthful
Your mom: School is over. My mommy is coming to pick me up now. I need to go outside to wait for her!

You: You’re 89 years old. You haven’t been to school in decades. And don’t you remember that your mom died 25 years ago? You don’t need to go outside because she’s not coming to pick you up.

Your mom: What? What do you mean my mom is dead? No! She can’t be dead!! I saw her this morning! She told me she would pick me up!!! I need to go outside to wait!! (She’s crying, agitated, and screaming.)

Using therapeutic fibbing
Your mom: School is over. My mommy is coming to pick me up now. I need to go outside to wait for her!

You: Oh yes, it’s almost time to go. Your mom asked me to give you a snack first, so you won’t get hungry on the way home. Let’s have some juice and crackers while we wait.

Your mom: Ok, I’ll have a snack.

You: Use this distraction as an opportunity to occupy her with the snack and a fun activity until she lets go of or forgets about the idea of her mother picking her up.

Example 2
Being completely truthful
Your spouse: I need to go to work now. I’m already late.

You: What do you mean? You don’t have a job. You retired 20 years ago. And remember, you have Alzheimer’s now. Stop trying to go out.

Your spouse: Why would you say that!? You’re lying and trying to keep me prisoner! Why are you trying to stop me! I’m leaving, get out of my way! (They’re angry, agitated, and banging things around.)

Using therapeutic fibbing
Your spouse: I need to go to work now. I’m already late.

You (option 1): That’s right, I almost forgot. Well we can’t have you going off without a good breakfast. Don’t worry, you have plenty of time, I forgot to change the clock after the time change. Give them a meal if it’s the right timing or a snack if it’s not. While they eat, have a pleasant chat about a topic they enjoy distracting them from the idea of going to work. Or, when they’re distracted enough from eating, talk about an enjoyable activity you’ll do together when they finish eating to set up the next transition.

You (option 2): That’s right, I almost forgot. Let’s get your jacket, it’s a bit chilly today, and make sure your lunch is packed. Here, I’ll help. Gently lead them to get their jacket and find a pleasant distraction along the way: look out the window and start talking about the birds, stop in front of a partially completed fun activity like a puzzle, stop for a drink of water, etc. When they’re engaged in something else and become distracted, they’re likely to let go of the idea of going to work.

source: Daily Caring

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