White Lies: When Fibbing Is... Therapeutic?

When it comes to caring for your loved ones with Alzheimer's or dementia, honesty may not always be the best policy.
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If your parents taught you anything, they probably told you don't lie -- especially not to them or family. Mine sure did. But when it comes to caring for your loved ones with Alzheimer's or dementia, honesty may not always be the best policy.

If you're caring for a family member affected by Alzheimer's or dementia, you know firsthand how hard it is coping effectively with the difficult behaviors the diseases cause. Aggression, agitation, confusion, hallucinations and suspicions are no walk in the park. These behaviors often leave patient and caregiver alike feeling upset, stressed and helpless -- and dreading future events. Sometimes, our responses to these behaviors will cause our loved one even greater agitation, especially when they're completely detached from immediate reality.

If these difficult Alzheimer's and dementia moments throw you for a loop, maybe ignore mom's advice and give fibbing a try. Therapeutic fibbing that is, which is very different from bold-faced lying. Trust me.

Therapeutic fibbing involves bending the truth to meet your family member in his or her current reality, where you can encourage behavior for his or her safety and well-being. It is different from situations where you need to tell the truth. That is, it's not appropriate to tell a therapeutic fib because "the truth will hurt." In these instances, it denies someone their full human experience. So, when a woman with dementia loses her husband, she's entitled to know. It may cause significant emotional pain, but grieving is part of the human experience. On the other hand, when therapeutic fibbing positively impacts health and well-being, it's very useful. For example, the father with dementia who insists on going to the store can be encouraged to stay in because the store is closed (even though it is open).

Now, quite understandably, therapeutic fibbing raises multiple concerns (and tons of guilt) among families who hesitate to deceive loved ones. Is mom's voice ringing through your head saying, "Don't go there"? Well, I say sometimes it's absolutely OK to go there.

While therapeutic fibbing isn't appropriate for every circumstance, when used correctly, it offers a much kinder, practical way to stop troubling behavior and reduce emotional distress. Who wouldn't do that for family?

So, permission to lie granted, how do you know when to use therapeutic fibbing? Although no concrete rules exist, here are some helpful guidelines to keep in mind:
  • Try other tactics first. Distract your loved one by changing the subject. Or, identify and respond to the emotion driving the behavior. For example, if you father refuses to go outside because he's assumed his 5-year-old self who fears the neighbor's dog, empathize with this fear. Assure him no harm will come while he's outdoors.
  • Mix it up. View therapeutic fibbing as a technique to use in combination with other methods. It's not a cure-all for every Alzheimer's and dementia-related behavior. Moderation is key.
  • Safety and well-being rule. Use therapeutic fibbing only when necessary to create safety, enhance quality of life and ensure your loved one's well-being -- to convince your dad to take his cholesterol-lowering prescriptions for example.
  • Know what you're dealing with. Alzheimer's and dementia are degenerative diseases that destroy the brain and ability to process and store memories. People in later stages of these illnesses are often cognitively incapable of recognizing reality. Trying to force them to comprehend it may only lead to greater confusion, agitation and discomfort.
  • Let it be. If your loved one is peaceful and no immediate danger will result, there's no harm in letting him or her stay in their personal reality no matter how disconnected from the present.
  • Your intuition is your guide, use it. You know your loved one best. When it comes to easing tough moments, do what feels right

Looking for more support for coping with tough Alzheimer's and dementia-linked behaviors? Check out CaregiverStress.com featuring helpful information for family caregivers. You can even take the free e-learning course Alzheimer's Disease and Other Dementias, which includes an installment on managing difficult behaviors.

Be well,

Dr. Amy

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