What do you do when Mom calls to say she’s at (long-deceased) Grandma’s and is wondering where Dad [also gone] is? What’s the communication strategy in that situation? Knowing to approach from the front is great; breaking a task into short, concise instructions is helpful– but what does any of that have to do with this situation?
I’ve recently been promoting “Communication Tips & Strategies: A Guide for Dementia Care Partners,” which is full of good stuff–but not exactly what a reader needed in the moment she described above. I created the guide because I wanted to bring you valuable tips and strategies you could start implementing right away, to start seeing positive change right away. I also didn’t want to pack it with so much stuff that you felt like you were drinking from a fire hose!
But thanks to “Lily,” I realized there’s a missing piece in the guide: situational context. Here’s the email that caught my attention (identifying details have been changed to protect privacy):
Hi, Christy…..my mother is 85 and has had dementia for 5 years now. It has always been and on many levels continues to be manageable, as I call it. She repeats questions, doesn’t know the day, but most of the time knows me.
Last week, she called me saying she was at my Grandmother’s (she’s no longer living) and was wondering where my Dad was (he’s been gone for 30 years). She has never done this before and always has remembered he had passed away. I made the mistake of telling her over the phone that he was gone (I’ll never do that again!). She was so upset and distraught. I live nearby and went to her house right away. It took me about an hour to calm her down about my father, but most of the day to get her calmed down about the house she was living in.
Two friends said I should’ve told a white lie about my dad and said he’d be home soon and distract her. Does that always work? What if she keeps asking where he was and when was he getting home?
The first thing that jumped out at me was this: “Two friends said I should’ve told a white lie about my dad and said he’d be home soon and distract her. Does that always work?” The short answer is No, that doesn’t always work.
The more nuanced answer is, Nothing works 100% of the time. An approach or intervention can work like a charm 99 times in a row, but fall flat the 100th time. That doesn’t mean the first 99 times were a failure, right? And in this case, we know one way that has a 0% success rate, which is “reality orientation,” or sharing the information that Dad died quite some time ago.
Rather than reality orientation, use “validation therapy.” The difference between the two approaches is that I’m not going to try to pull someone who’s living with dementia into “reality”–because she’s already clearly expressed that’s not the reality that’s happening for her in this moment. Instead, I’m going to validate what’s happening for her by focusing on the emotions behind the words.
The second piece (“What if she keeps asking where he was and when was he getting home?”) is about how to manage repetitive questions, because the question could be about anything. Ideally, we want to avoid setting up a situation that’s ripe for repetitive questions; those tend to happen when the person is feeling anxious. So if we avoid oversharing information or oversharing about a particular topic, we’ll typically see a dramatic decrease in anxiety manifesting as repetitive questions.
In this case, though, the barn door’s already open. So we circle back to the idea behind validation therapy, which is addressing the emotion behind the words.
Third, we want to embrace the concept of the “therapeutic fiblet,” or telling a lie for the greater good. Before I more fully explain the concept, let me speak to the folks who object to lying on principle: I get where you’re coming from, and I commend you. Meanwhile, back in dementia world, we want our focus–always–to be on bringing respect, kindness, and love, always asking ourselves, in any given situation, “What’s the kindest, most loving thing I could do in this moment?”
Using that as the framework (and recognizing that we’ve all uttered some variation of “Yes, your new hairdo looks great!” over the years–to people we care far less about, I might add), it makes sense to tell a therapeutic fiblet when necessary. We’re aiming for kindness, and we know making a person living with dementia re-live the shock and grief of losing a partner or parent isn’t kind. We also know that if reason and logic worked, dementia wouldn’t be the topic of discussion.
Figuring there’s more than one of you out there going through this or something similar, I put together a free download for you, Validation Therapy & Therapeutic Fiblets In Action: Real-life Stories & Scripts for Dementia Care Partners. It includes more scenarios, what works, what doesn’t, and why. I’m committed to creating content that makes a positive difference in your life and your loved one’s, so if you find the download helpful, I’d appreciate it if you let me know. 🙂
Christy Turner is the founder of DementiaSherpa.com (CTC Dementia Care Management) and has enjoyed the privilege of working with over 1,045 people living with dementia and their families. Follow on Facebook, Google+, Instagram, Periscope, Pinterest, Twitter, and YouTube. Content varies daily across platforms.