Understanding how to support someone living with a Dementia is not always straightforward. As memories disappear, the way a person experiences the world can shift, and what feels real to them may not match the present moment. This means we are sometimes navigating a reality that is different from our own.
This piece shares an insight into how care teams respond in those moments, focusing on something known as therapeutic lying, and why it can sometimes be the kindest approach. Through Pam’s story, we explore what it means to step into someone else’s reality to help them feel safe, understood and at ease, and why insisting on the ‘truth’ can sometimes cause unnecessary distress, rather than comfort.
Therapeutic Lies in Practice
A therapeutic lie is a thoughtful, compassionate response used to reduce anxiety and meet someone in their current reality. If a person asks for their mother, father or loved one, forgetting that they are no longer with us, correcting them may re-open grief or make the loss feel as though it is happening for the first time.
Softly reassuring them that their loved one has popped out to the shops can provide comfort and emotional safety. Alternatively, gentle redirection of the conversation, or asking if they would like to go for a walk, can help them focus on something else and reduce anxiety.
Rather than focusing on factual accuracy, therapeutic lying is about protecting someone’s emotional world. By not correcting or challenging their reality, we can reduce feelings of confusion or distress. Instead, we meet them where they are, offering reassurance and support so they can feel safe and understood.
Pam, 80 years young and living at Edenmore for just over four years, has a learning disability and lives with a Dementia. For her, comfort comes from a place that might surprise others but makes perfect sense within her world.
Reassurance, connection and touch are deeply important to Pam. She is soothed by holding hands and becomes anxious if she does not feel close to someone. When she feels overwhelmed, lying down with her favourite soft toys, especially Tony the squirrel, helps her settle.
When Pam was very young, she won Tony in a lucky dip, a story that she shares often with those around her. He has stayed with her ever since, becoming something she is deeply attached to. To Pam, Tony is not simply a soft toy, but an incredibly real and important relationship in her life.
For someone living with a Dementia, objects, people or routines may take on a strong emotional meaning, and these attachments can bring a sense of reassurance and familiarity.
Tony also plays an important role in supporting Pam’s health. If she does not feel like eating, the team will offer a little food to Tony first, which can often encourage her. If she doesn’t want to drink water, they will try pouring it into her small doll’s tea set and offer it to Tony, which can also gently prompt her to drink. These routines have been created by the team and come from their understanding of Pam’s history and what is most important to her.
When Tony’s stuffing began to come out, and his ears and arms became worn, there was a concern that losing him could cause Pam real upset. Clinical Lead Teresa, who enjoys sewing, took him home and carefully stitched new ears and arms onto him. Tony was returned safely to Pam, restored and whole, preserving not just a soft toy, but a source of comfort and continuity in her day-to-day life.
For people who may not understand how important this relationship is to Pam, it may seem like the right thing to do to tell her Tony is ‘not real’ and try to correct her perspective. But by recognising how important Tony is to Pam, and respecting that her connection to him is a very real relationship in her world, the team help her to feel safe and secure, rather than causing confusion and upsetting the way she understands and experiences things around her.
Is it Right to Lie?
There is not always a simple answer when it comes to whether telling the truth or offering a therapeutic lie is the ‘right’ thing to do. There are moments that ask us to consider what will best support someone’s wellbeing and the focus shifts from being right, to being kind.
Therapeutic lies, when used thoughtfully and responsibly, are acts of care. They allow people like Pam to feel safe, valued and emotionally held in a world that no longer behaves as it once did - recognising that, in moments of confusion, Pam’s version of the truth is the one that matters most.
Edenmore Nursing Home provides 24-hour nursing and residential care, supporting each person to continue living a life that feels meaningful and true to who they are.
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