What is Therapeutic Fibbing in Dementia Care?


March 31, 2023

Therapeutic Fibbing Dementia


There is a technique in dementia care called Therapeutic Fibbing in which the caregiver steps into the current reality of the person who has dementia to spare them unnecessary upset and distress. It’s used when behavior needs to be encouraged for your loved one’s wellbeing or safety and when used appropriately, can have a positive effect. 

It’s common for those with Alzheimer’s and other forms of dementia to slip into their past and become confused by their surroundings. 

Honesty isn’t always the best policy when it comes to someone with Alzheimer’s or dementia. However, this technique takes some getting used to because going along with your older adult’s new reality can feel like you’re lying to them. Using white lies to validate their feelings and reassure them is different from lying for malicious reasons. Stepping into their reality isn’t the same as lying because their brain is experiencing a different version of reality.

Telling the truth could be cruel

Most of us are taught from a young age that any kind of lying is horrible and dishonest, especially lying to family and anyone we care about and respect. But always sticking to the truth, especially about an emotional subject or something trivial, is more likely to cause the one you care for pain, confusion, and distress.

“In the beginning, I didn’t know any better than to tell the truth all the time,” says Joe Mangi of Saline, Michigan. When his wife asked about her sister, for example, he’d remind her that her sister had died.

“My wife would wept for a while, then come right back to me and ask the same question, and I did the same thing. What a terrible thing to do.

I’ve had many times when I needed to confront whether I was going to be a truthful person or a loving person because I could not always be both at the same time.

A person with dementia is in a different world. Their reality is different. Nothing we can do or say is going to bring them out of the reality they’re in. In that sense, if she felt her sister was still alive, who am I to tell her that it isn’t true?”

Is it necessary to cause them so much distress, especially when the truth you tell them is likely to be misunderstood or quickly forgotten?

When to use therapeutic fibbing for dementia care

Do some situations warrant its use more than others? Are other means to be used first? Below are some suggestions on the use of therapeutic fibbing:

  • Try a diversional tactic: try changing the subject or respond with a question to try to identify what’s causing the behavior.
    • For example: If your care recipient asks, “Where’s my daddy?” you could respond with “Well, he’s not here right now.” then ask a diversional question like, “He used to work as a telephone lineman, right?”
  • Keeping them safe: By using therapeutic fibbing as a technique for safety and wellbeing, it can help to enhance your loved one’s wellbeing and quality of life. This technique can be used when you’re trying to get the person to go to the doctor.
    • For example: If they resist doctor’s visits suggest and alternate activity like going to a favorite restaurant. You still go to the restaurant; you just leave out the doctor’s visit is first.
  • Realize exactly what you’re dealing with: As Alzheimer’s and dementia progresses, it destroys the person’s ability to store memories and to process them. The person becomes incapable of recognizing what is reality and what isn’t.
    • For example: If you try to force your loved one to try to understand something that he or she is having difficulty with, then it can cause greater confusion, discomfort, and severe agitation.
  • If it’s not broke, don’t fix it: This means if your loved one is in his or her own world and no harm will come from it, don’t worry about it.
  • Your intuition will guide you: You know the person you’re caring for. If a moment becomes uncomfortable or threatening for your loved one, your instincts are better to handle this than others who don’t know them as well as you do.
  • Mix up the methods: Use therapeutic fibbing in a combination with other methods like distraction.

Some people with advanced dementia live in a world of fear and confusion. Things, places, and faces they once knew may now be frightening and unfamiliar. Being completely honest can cause more harm than good. Employ therapeutic fibbing to help to reduce their stress, agitation, and anxiety when confronted with, for them, frightening situations.

Sources: Right at Home; AARP; Daily Caring

We hope this information is helpful to you in the important work you do as a family caregiver.
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