There are more therapeutic ways to respond to a person with dementia than lying to them, writes Ben Boland.
Mavis* is crying as she walks from person to person begging them to help her get home as her twelve-year-old daughter Julia is waiting for her.
Sadly, Mavis’s distress occurs most afternoons. It was a key reason that her daughter Julia, aged 62, admitted Mavis into a secure dementia unit.
Residents, staff and families find her distress palpably painful, as does Mavis herself.
What should the staff do? A quick and easy option is to use therapeutic lying, to relieve Mavis’s anxiety. But is such an approach really therapeutic?
People often lie to people living with dementia typically for therapeutic reasons. However, I argue that lying as therapy is not appropriate because of the following:
- Often the lie is stated in a public space. Telling Mary her husband will be back later when he is dead may offer her some relief, however, it is likely there will be other residents, staff or family members present who know he is not coming back. They will simply note that staff members do not always tell the truth. This can lead to a lack of trust for future encounters. If residents and family members think that staff lie it becomes harder to address an allegation of poor care or abuse.
- Reliance on lying potentially damages the person who tells the lie. If your default position is to lie, then what happens when a non-therapeutic lie would help you? For example in fudging documentation, or saying that you have showered a resident when you haven’t.
- Therapeutic lying can become the default method to deal with a resident who is distressed. So instead of engaging with the resident people simply lie and keep moving.
- The lie is often inefficient, either because the resident recognises that it is not true or because the lie has not addressed the root cause of the distress.
Alternatives to lying
You might be wondering about the practicalities of this position and how it works with reference to the common advice to work with a person living with dementia’s reality.
I strongly affirm the value of working with a person’s reality, but I maintain that lying is counterproductive.
For example, Betty is distressed that she can’t find her husband Bill. I remember burying Bill six months ago. My stock response is to ask what Bill looks like, which may lead to a pleasant distraction for Betty. If so I simply listen as she remembers him.
If after describing him Betty is still looking for Bill, I say ‘I will keep an eye out for him and if I see him I will tell him you are looking for him’.
This two-part strategy is typically highly effective.
Yes, it involves engaging with Betty and it can take time to listen but it is much better than the alternative.
There may be a time to gently explain that Bill died but this requires both wisdom and an intimate understanding of Betty and her situation.
Perhaps two more illustrations may help to demonstrate how entering someone’s reality is both therapeutic and does not require lies.
Gladys calls me ‘Ken’. I could explain that my name is Ben, but I do not think such a response is loving. To correct her is to focus on her impairment. I do not think that whatever I am called is that important and no one likes being corrected so for her I answer to ‘Ken’.
Secondly some dementia units do not have mirrors in the bathroom. The reason is that if in your reality you are 21 and you look in the mirror and see an old man, you will be distressed.
The removal of the mirrors is not designed to lie to the residents but simply to avoid causing unnecessary distress.
As an aside when dealing with people who have a dementia diagnosis, a great question is ‘how old are you?’ The response will allow you to better relate to the person.
Highlighting or even pointing out disconnects between a person’s reality and common reality, particularly when that person is living with dementia, is potentially painful.
There are times when this disconnect must be addressed but deciding not to does not constitute lying.
As such lying is neither necessary nor an effective therapeutic strategy in the care of people living with dementia.
*All names are hypothetical.
Ben Boland is an experienced aged care chaplain.
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