The brain damage experienced by dementia and Alzheimer’s patients causes a progressive decline in their ability to understand and process information – creating in essence a different version of reality in which they live. Forcing them to abandon their version of reality to join the “real world” can cause them tremendous pain, confusion, fear, anxiety, and anger.
That’s why many caregivers have begun moving away from reorientating Alzheimer’s patients to reality, and instead are adopting a technique called “therapeutic fibbing.” Recognizing that honesty isn’t always the best policy with those living in an alternate reality, they rationalize that stepping into their pretend world isn’t the same as lying. Using white lies to validate their feelings, reassure them, and spare them unnecessary distress is not the same as malicious lying. It’s more comparable to telling a friend that you love her gift even if you’re not a big fan; in that case, there’s no need to tell her the full truth if your main goal is to preserve the friendship.
Initially it may be difficult for caregivers to begin using therapeutic fibbing, especially when they’ve been taught all their lives to be completely honest. This may be especially true for adult children taking care of a parent who taught them years earlier to live ethically. But insisting on only communicating the cold, hard truth can be downright cruel, especially in emotional or trivial matters. Considering that most Alzheimer’s or dementia patients suffer from short-term memory loss, many will forget your conversation soon after you have it, which means the topic will come up over and over again. Each time they will have to relive the distressing emotion, making your life as a caregiver more stressful and causing them to become agitated.
Therapeutic fibbing simply means agreeing or saying things that aren’t true to avoid causing someone unnecessary distress, and to make them feel safe or comforted. For example, an 80-year-old Alzheimer’s patient may tell you that her mommy is coming to pick her up from school. If you tell her the truth (that her mother has been dead for years and that she’s been out of school for decades), she’ll likely relive the devastation of learning that her mother has died and also feel humiliated at being so disoriented. It’s far kinder to step into her new reality and play along. You could suggest that she has a snack while she waits for her mother, and then try to distract her with another topic or project so she forgets about looking for her.
If a patient gets upset at the thought of going to the doctor, you could instead suggest you both go out to lunch, and then “coincidentally” stop by the doctor’s office on your way home. If a spouse tells you he’s late for work, you could help him get his coat on and then distract him by suggesting you take a walk and enjoy the beautiful day before he gets into his car.
In each of these situations, the goal is to keep the patient from feeling even more disoriented and confused than they already are. Try putting yourself in their shoes; it must be extremely frightening to no longer recognize familiar surroundings, or the faces and names of loved ones. If in their mind they have reverted back to childhood, think how terrifying it would be to learn that your mother or father has died. Protecting them from harsh realities can be the kindest thing you can do. Rather than being deceptive, therapeutic fibbing can give them the feeling of being safe and comfortable.
However, not all situations require therapeutic fibbing. Other creative communication techniques can sometimes be used. Often there is no need for a response at all. If someone insists it is June when it is really January, there is no real harm in letting them believe that’s the case. In other instances, gentle reorienting may be the correct approach. For example, if an individual asks where they are, what the date is, or who you are, it is appropriate for you to answer with the truth. You can also use the method of distraction by reminiscing, taking them for a walk, or telling a story to take their mind off a particular topic.
When using a creative communication style, the important thing to remember is the reason why you’re doing so. Besides helping to reduce your stress level as a caregiver by reducing negative emotions, you are also providing the individual with the gifts of support and reassurance. If done with love and respect, therapeutic fibbing can help to maintain a higher quality of life and spare additional distress.