Thera-Fibs 1: A Valuable Tool

I’ve never lied to Fred and I don’t want to start now. — Katie

This is a common dilemma among care partners, especially if you and your loved one have had a long term relationship built upon honesty and trust. However, dementia changes the rules. Because LBD's thinking errors can start well before the more obvious memory, these rule changes may need to start early too.

Dementia damages a person's ability to reason, judge, compare and see other options. (3/31/2017 blog) With these gone, a person is left with concrete thinking which is:

• two-dimensional (either-or with no in-betweens)
• based on the first information received (the person's own view)
• often combined with a past emotion
• inflexible (CAN'T be changed)
• impulsive (no consideration of future consequences)
• lacks empathy (unable to put themselves in your shoes)

When Katie understands that Fred's reality is "hard wired" or inflexible, it is easier for her to accept that no amount of explanations, arguing, defending or even begging is going to change what he believes and what he acts upon. Then she can explore other ways of interacting; ways more supportive of Fred's needs than a truth he can't accept or that will cause him unnecessary distress.

Therapeutic fibbing (or thera-fibbing) is one of these methods. There's good support for this technique. When early stage dementia patients were polled, they found the technique acceptable when a) it is for the person’s own good and b) the dementia is so advanced that lie isn't recognized as such." A nursing group recommended it "when the truth would incite mental anguish, anxiety, agitation and confusion." Another group noted that unvarnished honesty can lead to distress for both care partner and loved one. Thus, thera- fibbing could helpful for Katie...and ethical--if she uses it to:

• Create safety. Ex: To stop Fred from unsafe driving.
• Enhance quality of life: Ex: To decrease the stress caused when Katie expresses a reality that is different from Fred's.
• Ensure well-being: Ex: To convince Fred to take his medication.

However, thera-fibbing is not a cure-all. It should be used in moderation and combination with other techniques, such as these:

• Change the subject – Rather than agreeing or disagreeing, Katie can bring up to a different topic as a way to get Fred to change his one-track mind to something more acceptable.
• Speak to the feeling, not the words: Identify and respond to the emotion driving Fred's behavior. If he is resisting their daily walk because of an imaginary dog that triggers old fears, Katie can empathize with Fred's fear and assure him that she'll keep him safe.
• Let it be – If Fred is peaceful and in no immediate danger, there’s no harm in letting him stay in their own reality, no matter how disconnected it may be from the present.

Next week: Thera-fibbing Pt. 2: More than One Kind

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia
Responsive Dementia Care: Fewer Behaviors Fewer Drugs
Riding A Roller Coaster with Lewy Body Dementia: A Manual for Staff

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.