Therapeutic Fibbing: Why Experts Recommend Lying to Someone with Dementia

therapeutic fibbing

Stepping into someone’s reality isn’t the same as lying

Honesty is not always the best policy when it comes to someone with Alzheimer’s or dementia.

That’s because their brain may experience a different version of reality. Dementia damages the brain and causes progressive decline in the ability to understand and process information. 

That’s why forcing someone to abandon their version of reality and join our “real world” can cause confusion, pain, anxiety, fear, and anger.

So, dementia care experts often recommend a technique called therapeutic fibbing. It helps you step into their current reality and spare them unnecessary upset and distress.

This technique takes some getting used to because going along with your older adult’s new reality can feel like you’re lying to them. But using white lies to validate their feelings and reassure them is certainly not the same as lying for a malicious reason.

We explain why always telling the truth could be cruel, how therapeutic fibbing helps you join their reality, and share two real-life examples of how to use therapeutic fibs to provide comfort and reassurance.




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Telling the truth could be cruel

Most of us are taught from a young age that any kind of lying is horrible and dishonest, especially lying to family and anyone we care about and respect.

So when we hear about using therapeutic fibbing to lie to someone with dementia, it seems cruel and wrong.

But always sticking to the truth, especially about an emotional subject or something trivial, is more likely to cause your older adult pain, confusion, and distress.

Dementia prevents people from properly processing and retaining information. Plus, having short-term memory issues mean they’ll probably soon forget the conversation, so it will come up again.

Telling the truth each time forces them to experience fresh distress over and over again. Is it necessary to cause them so much distress, especially when the truth you tell them is likely to be misunderstood or quickly forgotten?

 

Therapeutic fibbing helps you step into their reality

An effective way to step into your older adult’s reality is to use therapeutic fibbing. It means agreeing or saying things that are not true to avoid causing someone distress and to make them feel safe and comforted.

In many ways, this technique is similar to telling a friend that you love the thoughtful gift they gave you, even if you don’t actually like it. Telling the absolute truth in that case doesn’t change the situation and would only hurt your friend’s feelings.

Here are two examples that illustrate the difference between being completely truthful and using therapeutic fibbing. While your specific situations will be different, the same principles of gently going along with their reality and finding a distraction will apply.

Example 1
Being completely truthful
Your mom: School is over. My mommy is coming to pick me up now. I need to go outside to wait for her!

You: You’re 89 years old. You haven’t been to school in decades. And don’t you remember that your mom died 25 years ago? You don’t need to go outside because she’s not coming to pick you up.

Your mom: What? What do you mean my mom is dead? No! She can’t be dead!! I saw her this morning! She told me she would pick me up!!! I need to go outside to wait!! (She’s crying, agitated, and screaming.)

Using therapeutic fibbing
Your mom: School is over. My mommy is coming to pick me up now. I need to go outside to wait for her!

You: Oh yes, it’s almost time to go. Your mom asked me to give you a snack first so you won’t get hungry on the way home. Let’s have some juice and crackers while we wait.

Your mom: Ok, I’ll have a snack.

You: Use this distraction as an opportunity to occupy her with the snack and a fun activity until she lets go of or forgets about the idea of her mother picking her up.




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Example 2
Being completely truthful
Your spouse: I need to go to work now. I’m already late.

You: What do you mean? You don’t have a job. You retired 20 years ago. And remember, you have Alzheimer’s now. Stop trying to go out.

Your spouse: Why would you say that!? You’re lying and trying to keep me prisoner! Why are you trying to stop me! I’m leaving, get out of my way! (They’re angry, agitated, and banging things around.)

Using therapeutic fibbing
Your spouse: I need to go to work now. I’m already late.

You (option 1): That’s right, I almost forgot. Well we can’t have you going off without a good breakfast. Don’t worry, you have plenty of time, I forgot to change the clock after the time change. Give them a meal if it’s the right timing or a snack if it’s not. While they eat, have a pleasant chat about a topic they enjoy to distract them from the idea of going to work. Or, when they’re distracted enough from eating, talk about an enjoyable activity you’ll do together when they finish eating to set up the next transition.

You (option 2): That’s right, I almost forgot. Let’s get your jacket, it’s a bit chilly today, and make sure your lunch is packed. Here, I’ll help. Gently lead them to get their jacket and find a pleasant distraction along the way: look out the window and start talking about the birds, stop in front of  a partially completed fun activity like a puzzle, stop for a drink of water, etc. When they’re engaged in something else and become distracted, they’re likely to let go of the idea of going to work.

 

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By DailyCaring Editorial Team
Image: Angels Senior Home Solutions


81 Comments

  • Reply July 29, 2019

    Arlyn Adderson

    My mother is arguing with someone that only she see . How can I help her?

  • Reply July 28, 2019

    Carole Klingler

    I prefer Naomi Feil’s Validation Methods that teach us not to lie but to validate a feeling. In example #1, instead of lying, you would say something like, “what will your mommy do when you come home.” Allowing the person to respond and building on it. If the answer is, “she always gives me a hug and then I get a cookie and milk.” You can respond by saying, “she sounds like a very good mommy, was she a good cook? The goal is to be encouraging her to talk more about her feelings of missing her mommy. The theory is that deep down she knows her mother isn’t alive, but at this moment she has an unmet human need that needs validating.

    • Reply July 28, 2019

      DailyCaring

      That’s a wonderful example and a fantastic technique. Thanks for sharing!

      It’s helpful for caregivers to have many tools they can use to suit the situation they’re in. In cases where the person with dementia is extremely stubborn or confrontational, it may be necessary to tell a fib to resolve the issue.

    • Reply August 9, 2019

      Kathleen Watson

      I too am a Naomi Feil fan!!! I agree with what you suggested, and it’s a great response.

  • Reply July 25, 2019

    Anonymous

    There is no correct or good way to lie, I would be very upset if I were lied to more so then being told the truth . If u can’t be honest then be nothing.maybe u should be lied to , then u would have someplace to speak from . A lie can cancel everything. Having dementia is not being brainless it’s having less brain. How can u say Lying is a good way not to disappoint or to handle an old person, how do u think they got so old and for what purpose? There is so much more to understand and lying is not the way !
    Being dishonest in any form is bad for everyone and anyone.
    U condone it , u say it’s ok to be dishonest to someone who is old.
    For those of u who agree with this, I hope to never come across u. U r dispecable! U can pass along the direspect , blame it on someone else, but God knows who u r !

    • Reply July 25, 2019

      DailyCaring

      Someone with dementia who has significant damage to their brain is not the same as a person with full cognitive capabilities. Therapeutic fibbing can be a tough concept to understand if you haven’t taken care of someone with dementia who repeatedly asks the same questions and where truthful answers make them very upset.

      If that happened multiple times a day, every day, it’s likely that you’d soon be looking for alternative responses that don’t cause them pain and distress. There isn’t one solution that works for every person in every situation, but it helps to have multiple tools to experiment with.

      • Reply August 12, 2019

        Anonymous

        Therapeutic fibbing is a very helpful tool. I would love to be able to just tell them the truth and have them work through the grief, but that is not the case. You would have to tell them over and over and over and each time would be like it was the first time. Very sad. When I simply say, ” I just spoke to your mom and she said she would be here tomorrow.” I get a smile, happiness, and we are able to move on with the day.

        • Reply August 12, 2019

          DailyCaring

          That’s a kind, lovely response that helps someone feel heard and comforted 💜 Thanks for sharing!

    • Reply August 9, 2019

      Carey

      You have interpreted this the wrong way. Have you ever worked with or been around someone with dimentia? You do briefly have to step in to their world and then figure out what triggers are there to lead them out of the confusion that are wrapped in. If someone confronts them with honesty, then many of those with dimentia will quickly get agitated, angry, irritated. In a flash this can happen. And the next steps are crucial b/c they could hurt themselves in the process. No one is saying to simply lie to them. Take a deep breath and think this through. They are showing you how to “gently bring them back to a safe point’ of discussion and in to reality. Your anger sounds a bit more like you have been hurt by someone in your past with lies. And for that I am sorry. But not everyone out there is trying to hurt someone or abuse someone. You are a very special person and do not deserve the disrespect you’ve been given. But, you alone, are responsible for the amount of joy you take in, or give away. Don’t give it away. And possibly take your passion and put it in to caring for someone that just may need that passion. Take care.

    • Reply August 13, 2019

      Lynn

      Just wow. We all know lying is wrong, but if you spend time with somebody who has cognitive problems and you insist on total, unvarnished truth all the time, you will find yourself in a never-ending cycle of crying, anger, arguing, more crying, fear, anger, etc. My mother was adamant that she had been taken during the night to a place that looked exactly like her residence but wasnt. My brother insisted it never happened. It was as real to her as if it had happened, but he argued, she cried, was still agitated and crying the next day. All he had to say was that he’s so glad she came back and that he will talk to the director about it. Mama’s happy, no harm, no foul. So ease down off that high horse until you’ve shuffled a mile in our shoes.

  • Reply July 23, 2019

    Linda

    What about if they’re accusing you stealing from them? How do you handle that, knowing it’s not true?

  • Reply July 22, 2019

    Laird

    I have to agree with some commenters above that “fibbing” is not a constructive solution. I’ll often get questions from my mother like “Where’s my dad?” or “Where’s my Grandma?” It’s true, we need to avoid harsh, dismissive answers like “Oh, they’re long dead.” But reinforcing a delusion like that does not help, in my opinion. I find gentle deflection to be the most useful, like “Hmm, you know, I’m not sure about that right now but how about we figure it out after breakfast.” It’s still a bend in the truth, but not an outright falsehood that might raise false hopes for them, even temporarily.

    There may yet come a day when any attempt at reasoning or distraction is futile. Then perhaps the lie becomes the only option. But I would treat it as a last resort.

    • Reply July 22, 2019

      DailyCaring

      Absolutely, this is a technique that people can learn about and keep in their toolbox to use as they see fit. Because care techniques don’t always work in every situation or for every person, it’s helpful to be aware of different options to experiment with.

    • Reply August 13, 2019

      Lynn

      My mother told us that our daddy, dead 5 years, was spending the night every night. He slipped in at shift change and slipped back out before light. We just told her to please let him know we’d love to see him, too, if he could drop by. That’s the truth! (But it would be scary.)

  • Reply June 27, 2019

    stephana

    My mom is 92, has moderate dementia but can appear lucid.. yet forgets what you tell her in 10 minutes..She also has very fragile bones(5 broken bones in 7 years caused by Osteoporosis )and Mom being non-stop and OCD about cleaning was impossible to control… She overdoes and gets angry if anyone suggests she’s got fragile bones. Mom is 92 and hates us for putting her into a nursing home .She calls us constantly saying she is fine and How could you do this to me?.She curses us out and tells us she’s fine and we’re horrible children. It hurts because her stubborn behavior caused her to be far from us.She refused to move or travel(even if we suggested we go together) The phone calls make me feel horrible,guilty and sad.I can’t have a relationship when she treats us(my brother and I) so awful…we’re a loving family. I don’t know what to say to her anymore. We had to give up her apartment as she is in the nursing home ..She keeps asking about the apartment.We tried telling the truth.She threw a fit..then calmed down.We took her out for lunch-had a great day with her then the next day it’s complete hell and being disinherited. I know its the dementia talking but it’s rough.

    • Reply August 3, 2019

      DailyCaring

      So sorry this is happening, it’s certainly a tough situation when someone with dementia is angry about necessary changes to their life. Since telling the truth about her apartment is making her angry, it may help to avoid direct answers. For example, you could encourage her to reminisce about living there (ask “what did you like most about the apartment?”), or fib and say that it’s being fumigated/painted/under construction.

  • Reply May 6, 2019

    omar nuri

    My 93 years old Mom had Alzheimer while living in California in a nursing home. Whenever I went to visit her, I realized that she was saying things like : open this fridge and bring some fruit(pointing to a door in her room, there was no fridge!) or: Here is the King’s storage room! while I was smiling, I always agreed with her and played along. Some time my elder Brother and/sister who were also there, were disagreeing with my actions, and they actually told her that what she was saying was not true. I could remember the agitation in her facial features.
    After reading here that what I did was the right thing to do, made me happy that I made my Mom happy, even I had no idea what I was doing. I guess my thought was that why oppose and agitate her. Thank you for all the information.

    • Reply July 28, 2019

      DailyCaring

      It’s wonderful that you were able to go along with your mom’s reality and help her feel happy 💜💜 We’re so glad this article is helpful.

  • Reply January 15, 2019

    Francey Jesson

    https://thejessonpress.com/when-are-lies-ok/

    This is wonderfully affirming. I only wish I’d known about therapeutic fibbing from the get go. But I’ll be sharing this on all my social media platforms because I think the more you know ahead of time, the better. Others can benefit from, “what I didn’t know then.” Thank you for all that you do.

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