Therapeutic lying is a technique often used by caregivers to temporarily placate a person with memory loss to prevent further confusion or frustration. These “white lies” are not the best approach as they demean the elderly person, who is better served by the Validation Method, an empathetic method of communicating with seniors experiencing memory loss.
Therapeutic lying is prevalent in dementia care settings — about 96% of carers admit using white lies to reduce patients’ distress and help manage difficult behaviors. While it’s a commonly used technique, healthcare professionals note that it’s not the best approach because of the pitfalls and consequences that come with it.
What Is The Main Goal Of Therapeutic Lying?
Caregivers use this method in the best interest of the patient experiencing memory loss and confusion. For example, if they ask, “Where is my dad or mom?” when the parent has already died, carers are prompted to lie so as not to see the truth hurt the patient.
It’s not rare to see a caregiver deliberately lie to someone with dementia. As shown in a study by Nancy Blum, which involved Alzheimer’s disease patients living in family homes, various forms of deception are even used in non-professional care settings.
There are different ways to use therapeutic lying:
- Fibbing. This is used to step into the patient’s perceived reality, play along with false beliefs, and act accordingly.
- Bending of truth. In this case, the carer utters truth to some degree, often in a brief form, as a response to a patient’s inquiry. For instance, instead of saying that someone passed away, they will say that that person isn’t available at the moment.
- Omission of facts. This type of response tells the truth but not in full detail.
- Distraction. Though it isn’t technically lying, this method obscures the truth by redirecting the patient’s attention to another topic or activity.
- No response. Carers typically use this when the perceived reality of the patient is not that important (e.g., they might think that today is Sunday though it’s Monday).
Doing all this is beneficial only in the short term. It doesn’t address the underlying unmet needs and increases the risk of losing the patient’s trust. It can also be demeaning and put a level of guilt on carers.
Is Therapeutic Lying Ethical?
The use of therapeutic lying raises concerns on ethics as lying has a generally negative connotation, especially in the medical field where trust is an important factor affecting a physician-patient relationship.
Psychiatry specialist Dr. Michael Sperber even calls it “a contradiction of terms.” “Therapeutic” is meant to heal or cure, while “lying” is a false statement with deceit as its intention. However, as pointed out by Anthony Tuckett, “lying is conceptualized as therapeutic whereby the care provider intends to eliminate harm and control behavior.”
It could be why several clinicians support this technique and incorporate it into the care plan of people with dementia. This is emphasized by James IA and Caiazza C in their study.
In a research study involving English psychiatrists conducted by Culley H, Baber R, Hope A, and James I, they found that 69% of respondents lied to someone lacking capacity, knowing that it would be in the person’s best interests. Another 66% said they permitted carers to lie with their patients.
Nonetheless, psychologists must provide supervision on how to use it effectively. James et al. have developed guidelines that staff can follow when using lies with demented people.
What Is The Difference Between Therapeutic Lying, A Lie, And A Falsehood?
Therapeutic lying is when someone (e.g., a caregiver in a nursing home or memory care facility or a family member) tells white lies to a patient or a loved one in hopes of distracting someone from upsetting or frustrating truths, controlling behaviors, averting harm, and promoting wellbeing.
It’s one of the many interventions used in dementia care.
Lies, in general, are false statements that intend to deceive another person. It can be used negatively or positively — the difference lies in what the person lying wants to achieve.
On the other hand, falsehood is an umbrella term referring to the state of being untrue. There are three main types of falsehood in nature: lies (verbal statements), deceit (a wider concept than lies and something more elaborate), and simulation (pretension, e.g., applying make-up or putting on an act to conceal a part of your life).
Should You Lie To Dementia Patients?
Knowing when to use therapeutic lying can help carers avoid ethical issues.
In her study, author Maartje Schermer argued that caregivers must favor methods that don’t use lying when they want to enhance the quality of life of dementia patients. Her position is supported by the Mental Health Foundation, which recommends that among the typical techniques used when answering difficult questions raised by dementia-affected people, especially older adults, telling nothing but the truth should be the first option. Lying should be the last resort and should be done to prevent unnecessary distress.
When you’re uncertain whether to tell truths or untruths, always ask yourself: Is it in the person’s best interests? If therapeutic lying would serve that, then do so in the most compassionate way. Understand their feelings and always seek to promote their well-being.
At What Stage Of Dementia Is It Often Done?
Dementia refers to brain disorders that affect cognitive functionality; a patient’s condition progresses through the different stages of dementia.
According to Alzheimer’s Association, it’s in the middle stage (the longest stage) wherein demented individuals tend to forget events and personal history. This is when they frequently experience confusion and demonstrate personality and behavioral changes.
Therapeutic lying, among other techniques, is used to counter these symptoms.
What Is The Validation Method Of Communication?
Developed by author and social worker Naomi Feil, the validation method is an empathetic way that authenticates the feelings of dementia patients. Validation entails putting yourself in their shoes and identifying what causes them to raise difficult questions and statements.
For instance, if a patient asks about where their deceased spouse is, understand that they might only be telling it to seek comfort and assurance. Hence, as a response, you can say, “It must be hard not seeing your wife/husband. You must really miss her/him, and I can tell how much you love and care for her/him. What is she/he like?”
Why Is It A Better Approach?
Whether you’re a family member looking after a dementia-affected loved one or a member of the care staff in care homes, learning and implementing the validation approach is essential.
Though it may take more time and require more effort and compassion, it will be more helpful in the long run than therapeutic lying. It positively impacts the patient because they will feel that their emotions are valid and heard. The circumstances that follow will also make them feel more involved.
Taking the example above, asking what their spouse is like will prompt the patient to have a two-way conversation, which, in turn, can give them a sense of control and independence as opposed to cutting short the conversation by telling them their spouse is not available at the moment.
Furthermore, it takes the guilt out of carers and preserves the trust they’ve earned from their patients.