I read a recent article from DailyCaring.com. In it, they indicated that experts recommend therapeutic fibbing in order to not distress a person living with dementia. While I agree that telling the truth, the whole truth, and nothing but the truth as the care provider sees it, is not helpful. I disagree that lying is OK. I happen to think there is actually a third option that is a better and actually more helpful. It is called going with the flow. I recommend going with their flow, until you discover which unmet need is being expressed or is present. Then working to get that need met.
I don’t believe it is necessary to make stuff up that is not true. Neither do I believe it is necessary to force an incomprehensible reality on someone whose time, place, situation, and personal awareness has been altered by an ever-changing condition. I believe it is my responsibility to go where the person is in the at moment in time, figure out what is happening for them, and what is not OK for them in that moment. I, then, work with what they share with me to guide them back to a place of greater comfort, a safe harbor. It is easy to think you can offer a quick fix. It is also easy to misunderstand or underestimate the value of the words and message they are sending if you are committed to believing that what they are saying is nonsense or simply illogical or has not basis in fact.
As we learn more and more about trauma informed dementia care, I would urge extreme caution when lying. It may be there is an old story that runs deeply and painfully in the person’s past. It may be that the current story is really about an important need that should be addressed. I believe curiosity and empathy go much further than a quick band-aid approach.
Click here to read the original article.
From this article, focusing on the first example, I would select neither option A or B, but would propose option C. Here is my response.
Set up: School is over. My mommy is coming to pick me up now. I need to go outside and wait for her.
My response: Hey Mary, so school is over and you are supposed to go outside to wait for your mom to come and get you?
The person’s answer: Yes I need to be outside so she will get me.
My response: Oh, you need to get outside so you won’t miss her. Yes, mommy’s definitely like children to be where they are supposed to be when they are supposed to be there.
The person’s answer: Yes, mommy gets mad when I am late and she has to wait.
My response: Yeah, some mommies do get mad when children are late. Tell you what, let’s go on outside and see if she is there yet.
The person’s answer: Yes, let’s go out and see.
My response: If she’s not there yet, we can check and see if you should stay out and wait or we come back in and you should wait with me in here.
The person’s answer: OK, that’s a good idea, we can do that.
My response: We can do that. Hey Mary, would you help me with something while we are going outside? (start walking outside)
The person’s answer: I can try.
My response: I trying to remember the words to this rhyme. Hey diddle, diddle the cat and the … I can’t think of the next word. (keep going with various nursery rhymes… fill in the rhythmic blank- use a sustained skill while going to a different place).
In this case, the person was fearful that their mother would be angry, if they were not outside on time. Since I do not know her history or story as she does, I would not know if there was a real trauma in her past or simply a sense of being abandoned or fear of being abandoned. I also don’t know for sure, if her brain is trying to tell her that she is tired of being inside or in one setting and is simply wanting or needing to go somewhere else. Human’s are made to move. Moving from place to place could be part of her life pattern. Why would someone with dementia not want to shift perspectives and places, if they have done it previously in their life? Why should I lie, when going outside might be a better alternative, when being willing to engage with her might be of greater value.
What is the PAC homework?
Try out the second example and see what you can come up with as an Option C. Then think about going with the flow the next time you are tempted to lie or tell the truth without compassion or curiosity.
It may take practice to get good at Option C. I happen to believe supporting people living with dementia is well worth the effort.