Jessica Novello, MS, RN, CDP
Therapeutic lying- also called a “loving lie”, “therapeutic fibbing” or “creative communication” may be recommended and/or can be beneficial to certain caregivers and persons living with dementia. Striving for honesty is important, yet there is a point where the emotional distress of re-explaining or reminding a person living with dementia about a sorrowful or traumatic event can cause emotional distress to the point of compromising safety and security. This is especially salient when the person is far progressed with memory impairment and has to relive a substantial loss (i.e. the death of a spouse, child, or sibling that they forget passed). Safety and security are the ultimate goals for dementia care and a redirection or side stepping of the truth may sometimes be the best intervention.
When the person continually forgets that the stressful event happened, they begin a cycle of grief and sadness that will restart anytime that they are reminded. This can result in mood changes and negative behaviors, especially in later stages of dementia. It is more compassionate to tell a person with advanced dementia that their loved one is at the store when you know they will forget and ask again in an hour than telling them the truth and having them process the loss of a beloved spouse multiple times in one day. In their reality- it is a new and devastating loss every time- and many people living in the advanced stages of disease believe that they are a few decades in the past when spouses, siblings, and parents were still alive. It is more therapeutic to connect with the memory and moment. An example, “Mom is not here right now, she is out. I’m thinking about her homemade apple pie right now and how delicious it is.”. This turns a negative question into a positive memory about a loved one. You do not have to directly create an elaborate lie, but it is appropriate to sidestep the truth and recount a warm memory to create a sense of safety. It also validates the feeling of loss/missing a loved one.
Sharing reassuring and supportive messaging that makes people feel safe and comfortable is the key. It can be appropriate to avoid lies in the early stages of the disease when memory and thinking are more intact and limiting direct lies that will disrupt trust. Promising ice cream and then taking the person to the doctor and never getting the treat may feel like a violation of trust for many people. Some people affected by dementia will sense lies and may already have some level paranoia. Considering that we reflexively don’t want to lie to the people that we love or care for and that some people remain very sensitive to lies makes therapeutic lying a difficult intervention. A person who tries to leave at mid-day to make their work shift may be distracted by a talk about their profession or colleagues or engagement in a meaningful related activity. If the person is expressing a concern about missing an object or a person- validate the feeling. As I have written about before, emotional memory remains and making that connection can diffuse situations where you may be redirecting behavior or omitting information to protect your loved one from danger. An example, “You have some time before your shift, can you help me to sort these washers?” Redirects the behavior instead of reminding the person that they stopped a job they loved over a decade ago and it distracts them from wandering away into an unsafe situation.
Not every redirection will work and not every memory evoked will produce the desired result. As humans engaged in personal and professional relationships, made more complicated by dementia, we need to be flexible and not discouraged by interventions that do not work perfectly. Dementia care is more about continued security and love, rather than the blatant truth or having a perfect day or interaction with every conversation. Dementia caregivers need a toolkit and the therapeutic lie may need to be added to yours at some point. If you want more support or information, there are resources available (and you are doing a great job)!
Resources and References:
Family Caregiver Alliance- Family Caregiver Alliance
Alzheimer’s Association 24/7 helpline: 24/7 Helpline: 1.800.272.3900 | Alzheimer’s Association