Thoughts on "The Therapeutic Lie"?

A therapeutic lie refers to telling a dementia patient anything they need to hear to keep them calm and relaxed in any given situation. Not using "morals" "ethics" or "The 10 Commandments" which do not pertain to Alzheimer's and brain diseases in general. It does no earthly good to remind these elders of OUR reality, such as their parents died in 1970, 10,000x, so we make up therapeutic fibs or stories to suit the situation. It's the kindest thing we can do.

Examples:

Parent with dementia says "I want to go home". Your reply "We need to talk to the doctor about that" or "The doctor needs to sign off on that".

Parent with dementia claims that someone is stealing from them:

"I'll look into that, mom. I need to talk to the laundry person about that".

Person with dementia says you are the devil and have been a rotten child your whole life (while you are the person paying bills, talking to doctors, managing their lives).

"I'm sorry you feel that way, Dad. Tell me what I need to change".

Yes, you are entering THEIR reality.

I see therapeutic lies as something that will not cause pain, suffering, or distress to a loved one. And yes, you meet them in their reality.

When my mom first began dealing with serious memory issues I tried to "fix" it by telling her the truth which often involved bringing her into "reality." I quickly realized that this caused her a lot of mental and emotional anguish and pain and I stopped. Therapeutic fibs are now a go to and they mostly work.

I couldn't agee more with the responses so far. I made the mistake of imagining that my husband's reality was the same as it had been. Nope. Keeping him calm, feeling safe, respected and not isolated -- those are what he and others like him seem to need. His (expletive) son, 65-years-old and in a different state, talks to him every evening and gets showtimed; especially since the son only talks about how wonderful he and his kids are, so that hubby only has to say, "Yes!" or "Great!" Hence he thinks his father doesn't have dementia and has accused me of forcing him to live in an awful place (it's very nice, actually, and the help is wonderful) for some cruel stepmotherish reason of my own. He actually accused me of trying to kill him with negativity. He seems to think I'm hoping he'll die so that I can wallow in his wads of cash. He'll be lucky if there is enough cash to get him through to his death (he's 93 but very healthy). Amazing how a 65-year-old thinks the needs and state of a 93-year-old are the same as his. Meanwhile I am (according to my doc and my psychiatrist) in a state of PTSD -- horrible, crushing depression, anxiety, fatigue -- I've truly felt as though I may not live through the year.

Anyway, back to the subject: I think part of the kindness of helping a LO end the journey as peacefully as possible is to affirm his reality as much as possible. They are already frightened, confused, and feeling completely helpless. Being told "No, you're wrong, this other thing is the truth" may BE the truth but...how does it help them? Only if it helps or is absolutely necessary should you try to get them to accept something that is true when they don't want to.

My own trouble is with finding a therapeutic lie that seems might work. My wife and I have lived in a nice senior residence cottage for the last five years and yet now, nearly every day and often several times a day she asks me when we are going home. I have to wonder whether a lie such as "tomorrow" might settle her down or whether instead she will get busy packing and demanding I get her suitcase out for her; I think the latter is what would happen.

Similarly, her father has been dead for fifty years but nearly every day she asks why he has not come to see her. What do I say? If I say I don't know that seems to agitate her even more. Do I tell her I do know then again she wants me to get her suitcase out so she can pack and go see him. The truth does depress her but overall it seems to be the best alternative.

I’m an only “child” age 66 and my parents both 92 are roommates in a nursing home. Dad dx Alzheimers 2014, Mom 2019. She is worse cognitively than he. When I visit i tey to “read the room” get a feel for their moods and respond to their questions accordingly because therapeutic lie might be my best route on Monday and truth might be the best route Thurs. Mom is tougher because she drilled it into my head when her mom had Alzheimer’s that I always tell her the truth if she ever developed Alzheimers but as other people have stated why would i agitate her. The staff is very responsive and my only advice is see that your LO’s meds are doing the best possible. A slight increase in prozac has made mom much more comfortable with her thoughts.

Say whatever needs to be said to keep them calm and then don’t give it another thought.

You didn’t cause their situation. You’re doing your best and have nothing to feel badly about.

Wishing you peace during this difficult time.

Generally when we are talking about the use of a "therapeutic lie" it is because the person has dementia (or possibly otherwise not grounded in reality)
If they are in their "reality" it is almost impossible to convince them that their reality is not true.
To start an argument with a person that has dementia is an exercise in futility.
So you use whatever tactic will work for you and for the person you are caring for.
If 89 year old mom wants to know where her husband is (he died 2 years ago) to tell her that the love of her life, the man she spent the last 70+ years with is dead is upsetting. It was upsetting a year ago and each time you tell her it will be like he just died. Why would you put someone through that? You tell her he is at the doctors, he went to the store, he is at work....
If mom wants to drive to the store. It is unsafe, no license and she can no longer drive. You tell her the car is in the shop, That your daughter borrowed it to go to the movies, your husband took it to the store,....

These are not lies intended to hurt or deceive someone in a hurtful manner they are lies that are intended to protect someone from hurt either emotionally or physically. They are intended to keep a person calm, make caregiving easier by not having to contend with an argument.
Arguments do nothing but upset both parties, add to stress, anxiety.

If you are not "comfortable" with the use of a therapeutic lie then redirecting sometimes works but not always. And redirecting sometimes seems to ignore the concerns of the person you are caring for and to me that seems worse than a therapeutic lie.

If a person is cognizant then that is a different story.

My mother with Alzheimers sometimes says to me, "You are such a good person, your mother must be proud of you." Of course I don't correct her and say that SHE is my mother. I simply say, "Yes, she is proud of me and I learned it all from her." Dementia and Alzheimers patients retain their emotions if not the facts. Mom recognizes me as someone who loves her. It doesn't matter if she remembers I'm her biological daughter or not.

Rather than contributing to the anxiety being felt by your loved one with dementia, this is when the practice of therapeutic fibbing can be used. Therapeutic fibbing is agreeing to or saying things that are not true to avoid causing someone distress and to make them feel safe and comforted. It really is the compassionate thing to do and we use it with residents at St. John’s. We will not argue with a resident about whether or not he/she recalls a certain memory as there is a strong likelihood that he/she does not remember and being reminded about an event and the lack of memory about it can cause negative feelings. We caution that “not arguing” with your loved one with dementia is not the same thing as fibbing or lying and encourages caregivers to use other techniques like redirection as a first course of action. Look for the unexpressed need, which is often the root cause of the conversation or behavior, can be helpful in determining ways to respond. For more information on this topic, check out this resource: https://dementia.stjohnsliving.org/therapeutic-fibbing-shows-care-for-your-loved-one-with-dementia-this-holiday/

As we care for and interact with any loved one we should always strive for comfort and happiness and avoid argument, stress, adding to confusion and sorrow. If that is accomplished through therapeutic lying, then it is the best option. The truth can be very painful. Someone who is forgetful shouldn’t have to endure repeated and repeated and renewed pain (that is abusive).

The person who constantly corrects or who has to win every debate or only tell the truth when it is unnecessary and it hurts others might be well read and precise, but most certainly is annoying to all.

When that person (or anyone else) chooses to argue or engage negatively in any way with anyone who is mentally impaired, it is downright cruel.

If you are with someone who sees something that is not there or thinks that he or she is in a different place than they really are or wonders when they are going to go home when they are already home or is just confused and thinks you are somebody other than who you are.. If those versions of reality held by your loved one don't hurt anyone else, why bother trying to correct it? Agree with that person's reality. That's all they have. I think it would be cruel to try to convince an already confused person that their reality is not true. You will never have peace for your loved one or yourself if you continually try to force " the truth" on someone who is past understanding what that means. My husband, now deceased, used to hallucinate and see birds flying around in his bedroom. Of course they were not there. But what I told him was that those birds were special, and therefore only he could see them. I felt good about that answer because he was content with it. And that's all you want when someone is infirm, their contentment.

I don't even consider it a lie...perception is reality .If they percieve something I don't, it is not a lie. It is the way their brain is functioning. Instead of trying to force them into accepting my perceptions, I, with a more adaptable brain, join them in theirs. That way I can understand and possibly ease distress and dangers.

I think most of the therapeutic fibs I've told have been "lies of ommision" or simply silence in response to a statement I consider to be untrue.

With my mom, who had terrible anxiety, I decided that we simply didn't need to tell her any story that was still "in progress"--no "X might have cancer" or "Y is having marital problems".

With my husband, who has MCI, I just don't argue with him anymore. If he wants to decide that some appliance isn't working because of an entirely unrelated issue, I keep quiet. It all works itself out in the end.

Safety is the issue.
Example
My daddy wanted his guns when he was in the facility, not bringing them. I took a picture of them and told him that thee were loaded and ready for him when he returned home. In actuality I had given them to his grandson, a gun enthusiast. Also, my daddy wanted all his money in his hand. I told him that I had it locked in a safe under the house and no one knew it was there. I took a picture of a box under the house and showed it to him. There was no way I was going to empty his account and give him all his money.
Those two "therapeutic lies" got me through nine months of ALZ in a man who was mentally not here yet I had to deal with his anxiety, fears and distress.
Yes I would do it all again and I encourage people to do it too if not both patient and caregiver will have a stressful, anxiety filled day.

In my opinion there is no other choice but to lie. If you are the caregiver for a person who lacks reason and capacity you do and say what you have to do to protect them from themselves and people who would prey on them. I took over my father’s finances when he would not let me and lied through my teeth about doing it daily to protect him and his assets. You do and say what you have to. As long as you are doing it for the right reasons you have nothing to be guilty about.

IMHO therapeutic lies are necessary for our LO’s with dementia. My MIL would become seriously anxious and violent when confronted with our “reality”. Her nieces would constantly ask her questions that were not a yes or no answer and became very frustrated with her when she couldn’t answer/respond to their questions. They would also constantly ask her “don’t you remember?”…which pissed me off to no end. They would never listen to us on how to speak with her to keep her anxiety low and keep her from becoming violent. They chose to ignore her existence at this point instead of retraining themselves to be around her. It’s sad that family won’t listen and try to understand.

You answered your own question. It's based on a person's reality.
If someone has dementia and doesn't remember anything from one minute to the next, telling them about something upsetting like someone dying or they're moving to a care facility is just cruel.

Why put a person and the people who have to take care of them through what the consequences of that upset are going to be? All that will be accomplished is the person with dementia will probably suffer a setback in whatever level of independence they may still possess.

I had a client with advanced dementia who lost her husband. We decided not to tell her and to ask everyone visiting for the funeral not to either.
Everyone complied except for one friend who saw her maybe twice a year decided she could not exercize any self-control. She came in hysterical and offering her condolences. All that did was upset my client in the moment who crapped her pants and got hysterical herself. Only she couldn't remember why.
After this upset she stopped being able to feed herself and communicate.

I'm all for the therepeutic lie. It's an act of mercy and compassion.

I happen to be a voluble, and if I do say so myself, rather gifted liar (stage training) and my only addition to some of the wholly worthy responses already here is to plead with everyone who resorts to this technique to STOP referring to this very sound type of therapy as LYING or FIBBING.

If you are doing this you have experienced the torment of interacting with someone who no longer uses reason or experience or reality testing to deal with thoughts produced by a declining brain/sensory system.

Those of us who attempt to provide comfort and solace to such victims need not define nor explain the techniques we employ, and certainly don’t need to apologize for them.

I still cherish (and tear up a little actually) when I listen a tape of my recently deceased LO calling to be sure I’d let her mother (deceased some 50 years previously) know that she’d be late coming home from work. I was my privilege EVERY TIME, to let her know I’d done what she’d asked.

That is absolutely correct! Don’t try to correct your loved one when they are making conversation. It is their truth and they believe they are living in the present. My mother has Alzheimer’s/ dementia. I have been married 3 years ( she doesn’t believe I ever got married, she doesn’t remember the zoom wedding in 2020). She constantly talks about her deceased father and brothers like they are still alive. She talks about people constantly from her past as if they were here in the present.
It is not a lie when they believe so strongly in their truth. My family and I have been dealing with this forever. You are not being kind when you try to tell them “the truth” about their deceased relatives and when you correct them.
Just let your loved one relish in the people and memories that he/ she has. They will be happier for it ❤️

AliOJ58: Many times the therapeutic lie is necessary/may be the only valid option.

I enter my mother's world and lie constantly to keep her calm. Examples:

Q: "Why isn't anyone helping me get ready for school! I'm going to be late!" A: "You won't be late. Classes are cancelled. The water main burst so they closed campus until it's repaired."

Q: "What time are my parents coming to get me? They promised to take me home this weekend."
A: "They called to postpone until next weekend as there's a severe storm forecast."

Q: "I want to see my (dead) brother! Get him!"
A: "The combine broke so he had to rush to town for parts. Then he'll harvest until late, to beat the rain."

Harmless. And enough to satisfy her. Although I suspect my mother processes much more detail than the others I've seen with dementia. Her world is all over the timeline but she's still very articulate and can often pass for being ok, although she is late stage.

I'm in a bind right now because my mother thinks I'm helping an assassin who's trying to shoot her. Haven't visited lately because she becomes hysterical and rages at me. Had to be sedated last time. I can't seem to talk my way out of this one.

The alternative is to have the patient sedated by a Geriatric Psychiatrist: whatever it takes to complete the mission with respect and calmness. Always remember that the facility can refuse to care for a hostile or tantrum throwing person.

Also keep in mind: if your loved one is in a facility, you can be asked to leave if you are upsetting their resident. Their goal is to keep them calm and happy, if you aren’t doing that, you don’t need to be there!

Some of this information may help.

10 ways to respond when someone is experiencing dementia hallucinations

1. Determine if a response is needed 

The first step is to determine whether the hallucination is bothering your older adult. 

If it’s pleasant, you might not want to respond or call attention to it. 
Just know and accept that it’s a dementia symptom and thankfully isn’t causing distress.

If the hallucination is upsetting them or causing them to do something unsafe, then it’s time to quickly step in to provide comfort or redirect to a safe activity.

2. Stay calm and don’t argue or try to convince using logic

When someone is having a dementia hallucination, it’s important to stay calm and avoid contradicting them. 
What they’re seeing is a dementia symptom and is very real to them.
Trying to explain that it isn’t real simply won’t work because of the damage that dementia has caused in their brain. 
In fact, knowing that you don’t believe them might make them even more upset and agitated.
If they’re calm enough to explain, it may also help to understand what they’re seeing. Listen carefully and try to pick up clues to what they’re seeing. 
But keep in mind that dementia damage in the brain may affect their ability to use the correct words. For example, they could unintentionally say cabbages when they mean green cushions.
 
3. Validate their feelings and provide reassurance

Be careful not to dismiss your older adult’s experience. 
Brushing off what they’re seeing by saying something like, “Don’t be silly, there’s nothing there,” is likely to upset them.
It helps to allow them to talk about what they’re seeing. Having you take them seriously and provide reassurance increases their feeling of safety and security.
Focus on being kind and responding to their feelings rather than to the hallucination itself. 
If they’re scared, you could say “That sounds scary, I can see how upset you are.” 
Or if they’re happy, you might say, “How wonderful, I’m glad that makes you so happy.” 
Other possible responses could be, “It sounds like you’re worried,” or “I know this is scary for you.”
You don’t need to pretend that you can see or hear what they can, just be supportive and do what you can to relieve any fear or anxiety as if it was a real threat. 
For example, you could say ”I don’t hear or see anyone outside the window, but you seem worried. What can I do to help you feel safe?“

4. Check the environment and remove possible triggers

Oftentimes, dementia hallucinations can be triggered by things going on around your older adult. 
Their dementia brain can interpret sights and sounds differently, causing hallucinations.
To remove possible triggers, check their environment for background noise or visual stimulation that could cause a problem. 
For example, things like a TV or radio could make them believe that strangers are in the house, what’s happening on TV is real, or that they’re hearing voices. 
Dim lighting could make shadowy corners a source of fear. 
Reflections in shiny floors or windows when it’s dark outside and bright inside could make it seem like there are people in the house. 
Similarly, mirrors can be another source of fear or confusion.

5. Offer simple answers and reassurances

When someone is having a dementia hallucination, don’t give long explanations about what’s happening. Trying to process what you’re saying may add to their distress.
Instead, respond in a calm, supportive way. 
You could say something like, “Don’t worry. I’m here to protect you. I’ll make sure you’re safe.”
Gently hugging them or patting their arm or shoulder may also provide the comfort and reassurance they need if they’re scared or stressed. 
Connecting with you may also be a welcome distraction from the hallucination.

6. Look for patterns - If hallucinations happen frequently, there could be a trigger that’s not obvious.   
One way to figure out what could be causing the behavior is to track activities and try to find a pattern.

Continued from below:

7. Distract and redirect

Another effective technique is to distract your older adult from their hallucination. 
Try to switch their focus to an activity they enjoy. 

You could ask them to help you with a chore that makes them feel successful, look at favorite family photos, sing their favorite song, do a fun puzzle, eat a tasty snack, or take a pleasant stroll to look at the view – even an indoor stroll would work.

Another way to distract is to direct their attention to you instead of the hallucination. 

If they’re hearing voices, try chatting with them. It’s harder to hear those voices if you’re now having a conversation with them. 

Or if they’re seeing someone or something, get to eye level and try to make eye contact with them. If they’re occupied with looking at you, it could make the hallucination less intense or even fade away.

8. Get support to help you cope - 

Caring for someone with dementia hallucinations is stressful. So it can be a big help to know that you’re not alone in dealing with issues like this. 
That’s why caregiver support groups highly recommended.
Sharing your experience and getting advice and tips from others can make life easier.

There are also many great online groups that are free and private, here are 11 that we recommend.
 
9. Talk with the doctor to find out if there are medical causes - 

You may want to speak with your older adult’s doctor to find out if there could be a medical reason behind their hallucination. 

This wouldn’t change the way you respond, but may help you find ways to to reduce or eliminate the behavior.

For example, some medical issues that can cause hallucinations include dehydration, urinary tract infections, kidney or bladder infections, head injuries from a fall, or pain. 

Or if your older adult recently started a new medication, it could be a negative side effect of the drug or an interaction with another medication. Immediately report any changes in their behavior to the doctor. 

And if your older adult is having trouble with hearing or vision, that could easily explain them hearing or seeing things that aren’t there.

10. Contact the doctor immediately if their safety or yours is at risk - 

If your older adult is severely distressed by hallucinations or if hallucinations cause them to hurt themselves or others, contact their doctor immediately to get help.

For example, they may be hitting out to try to defend themselves against a perceived attacker, run away from something that scares them, or something else dangerous. 

These types of actions can easily lead to injury to them and you.
When you speak with their doctor, describe the symptoms, how often they happen, and if they’ve changed in intensity or frequency over time. It helps if you’ve kept a log or notes that could help the doctor get a clearer picture of what’s happening.  If non-drug approaches aren’t working and there isn’t a medical condition that’s causing hallucinations, careful use of behavioral medication could improve the quality of life by reducing the intensity and frequency of hallucinations.

I hope that it doesn't come to that for me (or my husband). However, if it does, I totally agree that I should be told what will keep me calm and as contented as possible under deeply adverse circumstances. In the reality-based world I occupy today, I do not want to create additional stress and difficulty for whomever is caring for me at the time. I hope that mindset would carry over, but there is no way of knowing. Pain, loss of capacity and discomfort could turn me into a total shrew!

If a loved one has dementia and can not retain the information about a "loss" then a therapeutic lie is probably more palatable. It is no kindness to keep "breaking bad news" and allowing a person to grieve loss over and over and over.

Of course it's necessary. When a person is having delusions and hallucinations, you have to jump into their world to keep them calm and safe.

Im probably repeating since i havent read most of the responses but …

keep in mind how you would feel hearing the same sad/depressing news over and over.

of course the news would be new each time but imagine what hearing bad news constantly does to you physically and mentally.