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.

Ben Boland

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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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  1. Is not what you described as telling Betty that you would let her know if you saw her husband, knowing that you won’t see him, lying to her? I don’t agree that because a caregiver “lies”to a resident, with the intent of giving them peace in the moment, is one of many alternatives to help relieve their distress,is the same as being a person with a lack of integrity (charting a shower as given when it wasn’t) or dishinesty in general.

  2. Interesting article – thanks for that.

    Lying is such an intrinsic part of our culture, yet I think we sometimes couch it in moral terms so that we propose the idea that ‘it is always wrong to lie’.

    Of course it is not always wrong. We lie to children about Santa Clause and a range of other mythical beings, without blinking an eye.

    If my wife (I use it as an example) says ‘how do you like this $200 dress, I am obliged to say ‘it looks great on you’ even though it makes her look like a bag of spuds.

    If Fred runs into the room, covered in blood and hides under the table – to be later followed by a stranger holding an axe asking ‘where’s Fred’, I don’t say ‘under the table’.

    I’m not sure where I am going with this by the way….. also I think Mr Boland is still lying when he says, above,

    “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’.”

    What he is doing here is lying by failing to tell her what she wants to know. Lying through omission rather than commission. Passive lying if you will.

    If I know my residents well, then I tell them anything that makes them happy. I am not diminished by it. I don’t like the term ‘therapeutic lying’ by the way. And I should not slip into non-therapeutic lying. I ought to know the difference.

    But none of what I have said ought to be taken as criticism. I enjoyed the thoughtful article.

    Thanks again.

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