Yes, I’m telling you to lie daily. . .
To an elder, spouse or friend whom you probably love and respect.
This is called “therapeutic fibbing“. It is a communication technique that doesn’t feel good at first, and it doesn’t feel good for a while. This technique does not always feel right EVEN AFTER we learn that half-truths, omissions, and lying are all necessary parts of validating and redirecting someone with dementia.
Therapeutic fibbing is used to avoid fights, agitation, and stepping into highly sensitive subjects when communicating with someone plagued by Alzheimer’s or dementia. It saves you and the one you are caring for stress, time, and general unpleasantness. It increases quality time, and cognition by skipping over upset that can cause communication breakdown.
When should therapeutic fibbing be used?
- Only when you have to
- When truth and rationalizing does not work
- When telling the whole truth creates anxiety, resistance to care, agitation, argument, or a fight
- When what you are trying to communicate is causing stress levels to go up
- When you desperately try and fail to frame the truth in a way that the dementia won’t mangle and throw back into your face.
INT. LIVING ROOM – NIGHT 10:15 PM
YOU and your MOM sit, not so quietly, watching the nightly news.
Mom is shifting in her seat, she abruptly stands up, teeters on her feet, ignores her walker and heads for the front door.
Wringing her hands she tells you, “It’s dark already! I’ve got to get home to my kids, it’s a school night.”
You are up, trailing her with the walker in hand. You try to redirect, “Mom, come sit down, don’t you want to finish watching the news?”
She takes her walker, looks you dead in the eyes and insists, “No. Are you kidding? What time is it? I’ve got to get home to my kids.” She starts to try to open the locked door.
“Mom,” you say, calmly fibbing, “the kids are with grandma. We have the night off, let’s just relax here on the couch and enjoy our time.” You skillfully offer her an alternate course of action for her evening. Still, she suspiciously shoots you a sideways glance asking, “Are you sure?”
“Of course I’m sure,” you say with confidence, “let’s relax and pick the kids up in the morning. Want some ice cream?” You deftly add yet another redirection, and it’s starting to work, Mom is visibly more relaxed. She asks, “What kind of ice cream?
Telling Mom that you ARE her kid, and that she is in YOUR home doesn’t validate her reality. By telling the truth you are essentially pointing out her disorientation, rubbing her disease in her face.
Why Therapeutic Fibbing is Better Than Telling the Truth
Dementia, being the tricky beast that it is, denies the sufferer awareness of its hold and effect on them. Mom’s reality, in that moment, might be that she is a 40-year-old woman with serious responsibilities. Yanking that reality out from under her feet is unpleasant, jarring, and in her mind, effecting her children’s safety – of course she is going to fight! So, don’t tell the truth!
How Does Therapeutic Fibbing Make You Feel?
At first, therapeutic fibbing probably does not feel good. It feels like lying, because it is lying, but you also just side-stepped a more stressful situation, a potential fight, rattling the front door.
It is likely that this scene will repeat that evening, and maybe for several evenings. Now that you know that it is okay to lie, the intensity and frequency of scenes like this will diminish, along with the fighting that correcting Mom can bring.
More lying, less confrontation = more time for ice cream.
INTERIOR – ASSISTED LIVING COMMUNITY – DAY
MOM is fed up. “I am so sick of this place, all my things are missing. I think someone is stealing around here.”
You’ve heard this before and dread what is about to happen, except this time you try playing along and you validate mom’s complaint, “Oh no! What are you missing?”
“Well!” she says, looking around, “my clothes.. my good sweater.” She is talking about the sweater she is wearing, you cringe inside, “Mom, you are wearing your good sweater.”
“Not this one! Dammit, they are all stealing from me.” She raises her voice. You think fast, match your mom’s intensity, validate! “You know what? I think you are RIGHT!” Then, you lie, “I think it should be investigated! I’m going to report this right of way!”
Mom grabs your hand, her voice lowers a bit. “Yes it should be reported. Thank you.”
Early in this example, you tried reality, this is a good idea. Telling Mom that she was wearing the sweater she was looking for didn’t work – Mom got more angry, the truth made things worse.
In early and middle stage Alzheimer’s, giving the truth due diligence is a good idea. You must be gentle, test the messaging. Why? Because, I’ve seen the overuse of therapeutic fibbing backfire.
Teaming up with Mom, validating her, showing concern and matching her level of irritation over what she thinks is going on, makes Mom feel heard, looked after, and safe. In this case, you may even want to call a trusted caregiver over to help you and Mom keep an eye out for the missing items – they will play along perfectly if they know anything about dementia care.
How Does Therapeutic Fibbing Backfire?
Yes, therapeutic fibbing can backfire. Gently trying and retrying out the truth, or a half truth is a good idea, and respectful. It gives the dementia sufferer a chance to process the actual situation.
When we get lazy, and use therapeutic fibbing too much (especially in early stages), the dementia sufferer may catch on. I’ve seen people develop a deep distrust for caregivers who aren’t creative enough, or who use the same fib for every situation. This repetition may slip past the dementia beast and become apparent to the person behind it. Essentially, the repetitive fibbing makes it into your relative’s long-term memory and awareness. So, be creative, and respectful.
Like all communication efforts, it is a good idea to gently include the person in their own care. Always try the truth first, but when we know the truth will not work, when the dementia beast gets in the way, we have to try to trick that beast with some fancy communication techniques like therapeutic fibbing.