When and How to Use Therapeutic Fibbing with a Dementia Patient
Elizabeth Morey
Picture it:
It's a cold mid-winter day, and you're hanging out with your elderly grandmother at her house, trying not to make it seem like you're there to take care of her. Grandma has been having trouble remembering a lot of things, and it's important to the family that someone be at home with her every day to make sure she doesn't get into trouble.
Your grandmother wanders into another room and comes back a few minutes later grumbling about not being able to find her favorite dress. You ask what she needs it for, and she says her boyfriend is taking her out to a drive-in movie tonight.
You know your grandmother doesn't have a boyfriend and that drive-in movies aren't even open this time of year. Your first instinct is to tell her that's not true and insist that she doesn't need to be upset that she can't find the dress. But you know doing so would be futile, and something about it also seems a tiny bit cruel.
So instead, you suggest that she take a shower and freshen up for the evening while you look for the dress. It may seem like you're only putting off her distress for a short time, but it's likely that by the time she's done with the shower, she won't remember that she was going to go out with her boyfriend in the first place. In the meantime, you can pick out a couple of pretty clothing options that fit the weather and her age a little better.
What is the benefit of this method? Not only have you avoided making your grandma feel inferior or sad because she doesn't remember correctly, you've also convinced her to engage in an activity that is good for her physical and mental well-being. You've taken away her distress and replaced it with something more productive without causing any added upset. And you've even managed to use her imaginary date night as a motivator to convince her to shower, a task that some people with dementia actively try to avoid.
This technique is called therapeutic fibbing. Therapeutic fibbing creates a safe space for people with dementia where they don't feel like idiots and don't feel like they have to lie and pretend to remember things they don't. They can continue to live in the past, where some of their best memories and the people they love are, while still being loved and cared for just as though they were still sharing our mental reality full-time.
The bottom line is that we're often tempted to try to drag a person with Alzheimer's or another form of dementia back to reality when they go astray, but it's not always the "right" way to care for a person with memory issues. Disrupting the reality they think they know can cause them to become anxious, agitated, and distressed.
It's normal and natural for us to feel this way; dealing with someone who doesn't have a firm grip on our reality can be uncomfortable and difficult, and the realization that they're slipping away from us can be a painful one. We always want to "fix" the problem, and it seems like we should be able to fix this one with a straightforward explanation that Grandma is 82 and doesn't have a boyfriend and it's the middle of winter. It's hard to accept that it's not as simple as just reminding Grandma of those facts.
"Therapeutic fibbing is all about meeting that person in their reality, because no matter how hard you try, you cannot change a person’s dementia or Alzheimer’s disease," says Mary Kay Mahoney, a gerontologist at Bella Villaggio Senior Living whose mother suffered from a memory disorder. "So what do you do? What is the most loving thing to do?"
Mahoney continues with an anecdote from her own experience: "My own mother said to me, 'I can’t afford my care. Will [the memory care facility] kick me out?'”
Mahoney replied, “‘Mom, you’ve taken care of me my entire life; now it’s my turn to take care of you.’ I saw the relief come over her face. She asked me this many times, and it was the right thing to say because each time I saw relief.”
So when do you use therapeutic fibbing? You can use it as a response anytime someone you're caring for says something that just doesn't make sense. If your instinct is to correct what they're saying or doing, maybe try to more gently redirect with a therapeutic fib. You can use therapeutic fibbing to avoid having an argument with someone, as a distraction tool, or as a way to hold a conversation with someone you might ordinarily have a hard time conversing with. Treat it like improv; say "yes" to their reality and go along with it in whatever way you can.
In short:
- Don't correct someone with dementia when you can fib.
- Don't argue with them when you can fib.
- Don't remind them about people who have died or events they may not remember; instead, ask what they do remember about their pasts
Do your best to let the person with dementia lead and just enjoy the ride. You never know what fun places their memories will take you. After all, many people with dementia struggle to remember what they ate for lunch (which is boring anyway), but they remember events from several decades ago like it was yesterday.
Take it easy on yourself when therapeutic fibbing doesn't always go exactly the way you expected it to. Being in charge of someone else's well-being, especially when it's someone you can't fully reason with and understand, is difficult and unpredictable. Just do your best.
Providing care for someone with Alzheimer's disease or another form of dementia is a difficult task no matter how you slice it. Therapeutic fibbing, when practiced with care, can help make that task easier and help the person you're caring for feel safe, loved, and whole.
