#43 Therapeutic Lying - Dos and Don'ts

Show notes: Episode #43

Therapeutic Lying - Dos and Don'ts

People resort to lying for so many different reasons. Often we lie to avoid punishment or to protect ourselves or someone else. We may also lie to maintain our privacy or to avoid embarrassment. In this episode, the focus is on therapeutic lying, particularly in dementia care.

So what exactly is a therapeutic lie?

In an aged care setting, it is a lie that is told to a person in care that is deemed to be in their best interest. Therapeutic lying can also mean agreeing with things that are not true to avoid causing someone distress to make them feel safe and comforted.

But where do we draw the line between telling the truth and telling a lie? What are the positive aspects? What are the challenges? And are there any alternative strategies?

Therapeutic lying has its critics and those who support it. There is no real guidance on the right or wrong way to go about it. We must use our clinical judgement and decide at any given moment do we lie or tell the truth? If we lie, how much do we say? Is it possible to use distraction instead? Teepa Snow, a leading educator on dementia is a big fan of distraction, and also in going along with a person’s story if they are distressed. If someone is distressed, as a carer, we don’t want to make them feel worse.

A case scenario described in the article ‘Therapeutic Lying to Assist People with Dementia in Maintaining Medication Adherence’ published in Nursing Ethics, adds some perspective on a situation where therapeutic lying may be used. The scenario is described below:

Sam, an 80 year-old man with advanced Alzheimer’s disease has recently been admitted to a long term care facility that specialises in caring for people with dementia. During the first nursing assessment, Elizabeth (Sam’s wife) tells the nursing team that Sam is often suspicious about taking medication because he usually feels well and also infrequently took medicines during his life. She explains to the charge nurse that Sam’s anti-psychotic medications are very important as they ‘determine his daily mood’. Elizabeth, as Sam’s primary advocate of care, warns the nursing team that if Sam does not receive the anti-psychotic medication, he will become extremely distressed and potentially violent. In order to successfully maintain adherence to taking his tablets, Elizabeth has told Sam for the last few years that the tablets are for his blood pressure and she strongly insists that all nursing professionals adopt her behaviour and lie therapeutically in order to promote Sam’s wellbeing.

In this situation, the staff must weigh up the pros and cons of lying versus telling the truth. Will Sam comply if they tell the truth? Does he have a right to refuse? And importantly, what is the best outcome for him and his health?

The subject raises many ethical and moral questions. Recent research shows many health practitioners think therapeutic lying can be beneficial. A study conducted by researchers at Newcastle University in the UK found that out of 112 care homes surveyed, 96% admitted to lying to patients with dementia. Further to this, 85% wanted clear guidelines in place on the issue.

There is a real opportunity here to include some training and upskilling for carers to help them identify when and if therapeutic lying is in the best interests of their clients.

The scenario involving Sam and his medication is one situation, but clients can ask you all sorts of questions that you may not be able to truthfully answer. For example, if you are asked for personal details like where you live, my policy has always been answering the question but using judgement on how much information I give, maybe saying ‘I live in the mountains’ rather than mentioning an address. It helps to have scripted responses prepared for common questions so you can answer more skilfully when put on the spot.

Another situation could be during a sundowner moment, when your client starts saying, ‘School is over now, Mum is coming to get me.’ If we tell the truth in this scenario, our client will likely become agitated and upset. An alternative is to go along with it, saying ‘Oh yes, lets’ have a snack while we wait’, using distraction as opposed to challenging and problem solving. When working with dementia patients, tackling issues front on can be very difficult and you may find yourself going around in circles.

I encourage you to reflect on your own attitude and comfort zone when it comes to therapeutic lying.

Personally, I do think there is a place for it in dementia care, however, it needs to be done skilfully, respectfully, and include some elements of distraction.

In this episode you will learn:

• What is therapeutic lying?
• Why might we use therapeutic lying in dementia care?
• What are the alternatives to therapeutic lying?
• Which situations may call for a therapeutic lie or distraction?
• Why it’s important to reflect on your own attitude and comfort zone.

Links

New Resource - Supporting Elderly Clients With a Reduced Family and Social Network (wisecare.com.au)

20 Strategies to help an older person struggling with changes in late life

Mitchell, G (2014) ‘Therapeutic lying to assist people with dementia in maintaining medication adherence’, Nursing Ethics, 21(7):844–845. doi: 10.1177/0969733014543886

Cunningham J (2005) Care staff views about telling the absolute truth to people with dementia. PhD thesis Newcastle University, Newcastle upon Tyne.