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Therapeutic Lying  in Dementia Care

Therapeutic Lying  in Dementia Care

Have you ever lied to someone? Or even worse, have you ever caught a person you love lying to you?

How does that make you feel?

When it happens to me, I feel betrayed.

For many years, while working in the field of dementia care, I believed the lie about “Therapeutic Lying”. I believed that this was an acceptable way to help our loved ones with dementia.

What is “Therapeutic Lying”? It is a technique that I have, sad to say, used very often and taught for many years.

It is when, in order to help a person living with dementia, we don’t tell them the truth and lie to them.

The purpose is noble. The technique is frequently somewhat successfully used to mitigate and decrease “challenging behaviors” of a person living with dementia.

But a noble purpose is not always the right purpose.

Let's look at an example of “Therapeutic Lying”.

Mom says to a care partner: “I need to pick up my children.” Mom is getting anxious, pacing and is crying because she needs to get her kids. The care partner may use a “Therapeutic Lie” in order to decrease her anxiety and set her mind at ease.

Live Mom’s reality.

The care partner may say something like: “Don’t worry, Mary- the kids are playing at Johnny’s house and will be home soon.”

I used to believe this was okay, and acceptable. And I taught many students, care partners and other therapists that this was the best thing to do and say. Use a “Therapeutic Lie”.

I was wrong.

Recently, we had a Sunday School class, where our Sunday school teacher (an ordained pastor) was expounding the Westminster Shorter Catechism Questions 76-78.

And this changed my thinking about therapeutic lying.

You see, I serve a God of truth. And the devil is the father of lies. So, therefore- it is a sin to use a therapeutic lie.

Let's look at what the questions are that have changed how I work with people living with dementia. The first is: What is the ninth commandment? The ninth commandment is, Thou shalt not bear false witness against thy neighbor.

Therapeutic Lying  in Dementia Care

That seems easy. That is the obvious: “Don’t lie to someone” command. We all know, and have been taught from a young age that lying is wrong.

Yet I used to believe that it is acceptable to tell a “therapeutic lie” to help a person living with dementia.

The next question in the Westminster Shorter Catechism speaks about what is required in the ninth commandment. What OUR duty is to God and our neighbor.

And this is where I realized my sin and my error. The answer to the question is that we are REQUIRED to maintain and promote the truth between man and man, and promote and maintain our neighbors good name especially in witness bearing.

So, when I tell a “therapeutic lie” to “help” my patients or clients or parents, I am not promoting or maintaining truth between man and man and am a false witness.

When I realized that, it changed how I think and what I do. I have always believed that I strive to tell the truth, and now I realize how much I lied to myself every time I used this technique.

This has made me revisit how I work with people with dementia. I have come to realize that there is always a way to tell the truth, even with people who have dementia.

Even when they are struggling to understand their reality and, due to their brain changes, are living in a different time and reality than what we are.

We just need to find it. God will always have a way for me to tell the truth. It is just sometimes easier telling the lie, because the lie is usually obvious.

Proverbs 19: 5 states: “A false witness will not go unpunished, And he who tells lies will not escape.” and another verse from the same chapter, verse 9 states: “A false witness will not go unpunished, And he who tells lies will perish.”

And you KNOW when God is repeating himself, that he really is driving a point home to us.

Why is this important? Because, dear reader, I believe that we all can find a way to tell the truth to the people we love with dementia, we just need to learn a new strategy to not lie to them at that moment.

How do we do this? I will admit, the “therapeutic lie” strategy is easier than the “therapeutic truth telling” strategy.

But here is the best way I have found to re-frame the strategy, not tell a lie and still help my loved one with dementia.

It is a simple 2 step strategy.

Step one is to ask a question: “Where do YOU think they are?”, “What do YOU think has happened?” or “What do YOU believe is happening here?”

Re-frame the situation to ASK the person living with dementia what it is that they believe.

Step 2 in the strategy is to agree that they must be right. You just confirm their own belief, and not tell a lie to them. Or find a part that is true, and confirm the truth.

Let me give you an example of “therapeutic truth telling” when we were weaning my mother from alcoholic wine to non-alcoholic wine.

We were able to tell her that “This is your wine”, without lying because there was still wine in the mixture we were giving her to drink.

But one day, she asked if it was non-alcoholic wine, and I told her the truth. I confirmed that it was non-alcoholic wine but also that there was one bottle of wine in the box, and that we would not take that last bottle away from her.

I told the truth. And was able to fully follow what I believe, and that is that we ARE commanded to tell the truth. And I was able to maintain my mother’s inherent worth as a person created in the image of God.

Therapeutic Lying  in Dementia Care

I will forever be grateful to the pastor who challenged me to think differently about “therapeutic lying” and how I can re-frame a technique that was sinful (but appeared to work) into “therapeutic truth telling”.

Now I can still serve the God I love and not the father of lies, the devil. While supporting my parents, client or patient living with dementia.

Now I can live coram Deo, before the face of God, with a clear conscience.

I can still support a person living with dementia, mitigating their challenging behaviors and honoring their worth as a person created in the image of God.

Yes, this technique is a bit harder to learn, because if we are honest with ourselves, lying is usually easier for us all!

But I hope you will consider using the 2 step Truth Telling Technique to help your person with dementia live a meaningful life!

Because nothing feels worse than finding out someone you love lied to you. Even though they may have had good intentions, even though they may have believed that it was the right thing to do. It was wrong.

A “therapeutic lie” is just that: a lie, and not the truth. If you need more help, join me at my upcoming workshop.

Read More:

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About the author

“Think Different” Dementia’s owner, Lizette Cloete, OTR/L graduated as an Occupational Therapist from the University of Pretoria in South Africa in 1992. Lizette has almost 30 years of experience as an Occupational Therapist in a variety of settings, the latest being in the home health environment. She enjoys teaching on the topic of dementia, most recently presenting at a national conference on the topic “Dementia Made Simple”.

Disclaimer: These blogs, videos and any work done by Lizette Cloete OT, as a Member of Think Different Dementia, LLC, is given only as educational content and consulting work. This does not create an Occupational Therapist-Patient Relationship. The educational content and consulting work performed should not be considered medical treatment as an Occupational Therapist. The consulting work does not take the place of medical work normally performed by a licensed Occupational Therapist. Please consult a licensed Occupational Therapist for medical advice.

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