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Person oriented reality (to lie or not to lie?)

In Ian’s four stage approach to meeting someone’s needs, the last of these is avoiding confrontation by use of a ‘therapeutic lie’. It can be difficult to determine when (if ever) it is appropriate to lie to someone living with dementia, as it may not feel like the right thing to do.

Ian has also produced some guidelines on this, which we have included in the link below.

Ian makes a distinction between a good lie and a bad lie.

A good therapeutic lie would be one which is oriented to a person’s reality - it matches their life story, interpretation of the situation, and is intended to reduce their anxiety or fear. For example, in Step 3.5, Ian described a situation when a woman who was ‘time-shifted’ worried about picking up her children at the school gates. Because of the emotion involved, she was not easily distracted from this concern. Advising her that her sister will be picking up the children today was appropriate to her history, and reduced her distress.

A bad lie might shift a person’s attention, for example by telling them they need to go to their room because their daughter will arrive soon, but this would create a new expectation that could add to distress later on. A bad lie would also be one which doesn’t match the person’s life story, such as saying a person’s (deceased) husband is playing golf at the moment, if this was not something he did.

We asked all of our experts and the carers involved in the course what they thought about going along with a person’s erroneous beliefs. Their responses were really varied and included the following strategies:

  • doing what is needed to avoid confrontation
  • telling a person what you understand is the reality
  • distracting or changing the subject
  • deflecting towards a related topic to avoid directly contradicting
  • seeking outside help
  • keeping upsetting things from the person
  • telling a therapeutic lie if it reduces distress or avoids danger

By thinking about the four stage approach, we can decide which course of action is most likely to avoid confrontation, reassure the person and meet their needs. Telling a ‘good therapeutic lie’ might be one of the solutions you find works in certain circumstances.

What is your view?

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This article is from the free online course:

Dementia Care: Staying Connected and Living Well

Newcastle University

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