The Whitworths of Arizona, bringing science to you in everyday language.

Friday, May 24, 2019

Thera-Fibs 2: Not Just One Kind

Last week's blog was an introduction to therapeutic fibbing (thera-fibbing), a technique useful when a loved one's thinking errors make reasoning impossible. If you haven't read it, go back and do it now. This week's blog is has more about the multiple kinds of "thera-fibs."
Remember Katie's resistance to lying to her husband? She's not alone.

I see the value of thera-fibs, but when I try to use one, I feel awful. Usually, it isn't successful. -- Katie

Katie's discomfort is too obvious and that is what Fred reacts to, not what she says. One way for Katie to overcome this resistance is to think of thera-fibbing as improv acting. That is she would respond from Fred's reality, not her own. If Katie can view herself as play-acting in Fred's "drama," and not lying, she will probably be able to use thera-fibs with less discomfort. For more about using improv with dementia, start with our 10/24/17 blog.

It used to be that I could tell Fred that his little men weren't real and he'd believe me. But now I can't. What he sees is real to him and that's that. -- Katie

Going along. Improv works well for going along with Fred's hallucination. Hallucinations are difficult for LBD care partners because this symptom can show up prior before thinking errors. Katie had become used offering her own reality to Fred and having it accepted. And then it wasn't. His dementia had progressed and taken away his ability to accept any view but his own. As it often does, it took Katie a while to catch on, But now that she has, she can just go along, nod, and even ask a question or two to show interest. She can also enter his reality and use play-acting to move his "drama" to something more comfortable for him.

Avoiding or shading the truth. Improv can work with this too. The main thing to remember here is that emotions are more important than words. The goal is always to decrease the stressful ones and increase the positive emotions. For example, if Fred is resisting going for his usual walk because the neighbor's dog triggers fears from his past, Katie can reassure him that she will protect him. She might even carry a stick "for chasing the dog off." She doesn't try to tell him that the dog is not dangerous. She simply speaks to the fears.

A white lie. Sometimes lying seems the only answer. Fred's mother died years ago, but every once in a while he asks about her or wants to telephone her. Katie has learned not to tell him his mother is gone because this causes Fred to grieve her loss all over again. Instead, she says she is on a trip, or doing something where she can't phone. "Wait a day or so to call," she tells him. And then she suggests something that they can do, like calling their son. This distracts Fred and he forgets about his first concern. Katie has also learned to avoid making promises she can't keep. For example, she didn't tell Fred his mom would be back in a day or so. He likely wouldn't remember, but if he did, she'd have to come up with another lie!

Tricks. These are setups so that the person living with dementia gets something they resist but need, such as a nap, medicine or a doctor's visit. The trick might be fairly simple, such as putting medicine in applesauce so that Fred will eat it. Or it can be more complicated like combining an ice-cream run with an "impromptu" (but actually well-planned) stop-off at the doctor's office first.

Withholding the truth. Katie and Fred were used to sharing everything. When his mother died, they grieved together. When their son won a trip to Hawaii, they celebrated together. Those days are over. Now, issues that aren't in Fred's "here and now" simply make him anxious. Katie has learned to edit them from her conversations with him. She didn't tell him when a friend passed away or when another one had a new grandchild.

Like the care Katie and Fred once took to be truthful with each other, the sharing of such sorrows and celebrations was a valuable part of their relationship. Thus, these omissions are painful to Katie. She grieves their loss even though she knows that using thera-fibbing in its various forms makes Fred's life, and therefore hers, happier and less stressful.

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.

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