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Good Lies are Good Therapy?

There are those who have not seen any changes in their lives in the midst of this pandemic and quarantine.  They’re our older family members with Alzheimer’s disease or some other form of dementia that has robbed them of the ability to even comprehend the restrictions of this pandemic.  They have been isolated as protection against COVID, but their quarantine experiences are not the same as ours.  I bring this up because as more of us are able to be vaccinated and resume some semblance of life before the pandemic we also will likely be able once again to visit Mom or dad who have been under strict quarantine and may have some questions for us.  How you answer their questions and engage in conversations in general is necessarily going to be more about them than it will be about you and the rest of the world that has been upended.

Honesty is going to be the first casualty of the pandemic when we encounter a loved one who has Alzheimer’s or dementia, but I am not talking about lying.  At its core dementia is a progressive decline of the brain’s ability to process what has happened in “their world.”  You ought not view your initial reunions with older loved ones with dementia as a “chance to catchup.”  We have to be prepared to join their reality using a technique health care professionals call “therapeutic fibbing.”

You will need to learn to “go along” with the reality they know by first asking them about themselves, their recent experiences, and what’s going on. This may go against how we all were raised, but telling the truth may be cruel to someone who is not processing reality in the same way we are.  An example helps.  Picture you’re talking once again with your mother who asks where your Dad is.  He had told her, she recounts, that he was going to get the car and come by to pick her up for an outing. The unfortunate truth is that dad died last year, but she keeps coming back to scenarios in which he is just temporarily gone, and understandably is looking for his return.

You don’t tell her he died, because she will experience the awful loss all over again, she’ll cry hysterically and become agitated.  And since she has short term memory issues she will forget again so she will be primed for experiencing the grief anew the next time you correct her.  Instead you might say that Dad suggested he would be delayed a bit and that he had asked you to offer her a snack until he can make it back.  She agrees that a snack is a good idea and you get into another conversation.

Or, your father with dementia tells you that he is going to go get the car and take mom for a ride.  They like their Sunday afternoon drives…it does not have to even be Sunday.  So, maybe you can ask how the car is running and suggest it would be nice to have a snack with him for their ride.  While you prepare the snack perhaps look out the window and remark on the sunshine or the birds or anything.  Then start talking about the view and ask him questions.  Share the snack with him and get into a new conversation.

My clients with parents or spouses with dementia talk about their “therapeutic fibbing” as really hard at first until they can see their loved one actually brightening with the diversions.  And once they both have a brighter conversation, they both have now had a better day.  And tomorrow will be another chance to brighten both of their days…and tomorrow…and tomorrow.

Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.  She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.

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