Ethic dilemmas in Dementia: Therapeutic Lying (3)

Is therapeutic lying to your loved one or patient okay when the truth would be distressing to him or her? It requires the caregiver or family member to give up trying to force the person with Dementia to accept reality and surrender instead to the fact that the patient is living in another mental and emotional world. There are professionals on both sides of the problem. In general, it is best to use other techniques, such as distraction by a change of topic or meaningful activity, or try validation therapy.

Honesty and openness

Explaining why you are doing something is very important. Not only for patients, families but also colleagues.

We seem to accept lying to a child or withholding something for his/her own good. But can we just lie to an adult with Dementia? What is more important: the right to be treated as a fully-fledged adult or the positive effect of withholding expected by “us”?

Code of honor

Honesty stands for sincerity and trust. When the other person knows that you are an honest and sincere person, he can trust you. You can be appreciated as an honest person. As the word says: when you are honest, you can trust your honor. You give as it were a code of honor.

Honesty is opposed to lying. Lying is intentionally and deliberately proclaiming untruths. Someone who is lying cannot be trusted. You cannot rely on his or her words, because he or she damages the code of honor.

And if you do not tell something to someone – while you do know it and also know that it can be important for that person – are you honest? After all, you don’t tell lies, you just hold back something. As long as someone does not ask you about certain facts and you do not have to answer them, you do not tell untruths. You can say that you are honest. You might tell if you are asked, but as long as that does not happen, you will not tell. Honesty is therefore something other than openness.


The dilemmas in Dementia that arise due to conflicts with norms and values occur again and again and daily – both in the different phases of Dementia and in different places: both at home and in the nursing home.

You will always have to consider what is the right thing to do for this person in this situation right now. It is essential to identify for yourself or with your team who the people directly involved are and what values are at stake for them in the dilemma.

In other words: who finds what important in this dilemma? And what value do we consider the most important? If you make a decision for a certain direction in the dilemma and therefore choose a certain value, that will always be at the expense of one or more other values. That hurts – that’s why it’s a dilemma.

Tell or not to tell?

Moving to the nursing home is an important step and experience in the life of every person, including your loved one with Dementia. Not to tell that, even if your family member doesn’t ask for it at all, it often feels very annoying. At the same time, you do not want to panic your loved one. Certainly not if you would have to repeat it the next day.

My advice would be to try yet to broach the subject but in a very open manner. For example, say, “What would you think if you had to move to the nursing home?” Or, “Have you ever thought about moving to the nursing home?”

You can conduct an open conversation in such a way that there is much room for feelings, such as fear. Also, pay attention to your feelings of guilt that you may have because you are working on a possible move “behind the back” of your loved one. You may even be able to introduce those guilt feelings into the conversation if there is enough room for that.

If this conversation fails altogether, or if your family member panics, you can leave it at that. Then it is not worth another attempt. But then you did try and with that attempted honesty and even openness.

Have you announced the move to a nursing home with your loved one or relative? Why or why not? Share it at in a comment on our Facebook page. This is how you bring ideas to others.

Validation therapy

Validation therapy is a way to approach older adults with empathy and understanding. It is often used to comfort and reassure people who are living with Alzheimer’s disease or another kind of Dementia. For example, if someone asking where her or his mother is (and the mother passed away many years ago), validation therapy would suggest that you ask her to tell you more about her mother or ask her what she loved about her.

The basic idea 

The basic idea behind validation therapy is that people who are in the late stages of life may have unresolved issues that drive their behaviors and emotions. The way caregivers or family members respond to these behaviors and emotions can either make them worse or help resolve them.

Validation therapy is more than simply validating a person’s feelings, although that is one component of it. Validation therapy focuses on helping the person work through the emotions behind challenging behaviors. These behaviors are viewed essentially as a way to communicate those emotions, especially for people with memory loss, confusion, disorientation and other symptoms of Dementia.

Who Developed Validation Therapy?

Validation therapy was developed over time, between 1963 and 1980, by Naomi Feil. Her first book on validation was published in 1982. Feil is a social worker who grew up immersed in the care of older adults: her mother was a social worker, and her father was the administrator of a nursing home.

How to Use Validation Therapy

Imagine that your mother, who has Alzheimer’s disease, lives with you in your home and frequently calls out for her mother. According to the Validation Training Institute, people who practice validation therapy can use the following techniques in that situation:

Center Yourself

Take a deep breath and slow down. Your initial reaction may be to try to use logic when your mother, who is 92 years old, starts calling out loudly for her mother. But before you react, think — and breathe.


Ask your mother what her mom was like, and what she misses about her. Share a memory about your grandmother with your mother, and allow her to express her loneliness.

Use Extremes

Ask her if she always misses her mother, or what she misses most about her mother. This can allow her to process those feelings of grief related to losing her mother.

Match and Express the Emotion

Join with your mother in her feelings. Acknowledge the sadness of losing her mother and the special relationship they had with each other.


Rephrasing her feelings back to her can provide reassurance that you understand and feel her loss. Saying “You must miss your mother” can decrease her anxiety because she hears you expressing what she is feeling.

Use Senses

Ask questions about her mother. For example, ask about her favorite food that her mother cooked and how it smelled, or how pretty her mother looked all dressed up for church on Sunday mornings.

How Effective Is Validation Therapy?

Research is mixed when it comes to conclusions about the effectiveness of validation therapy. Different studies conducted on validation therapy have different conclusions, with some stating that it’s effective, and others determined that it’s no more helpful than a placebo. A couple of Systemic Reviews conclude there’s insufficient evidence to conclude that it’s effective — not meaning that it’s ineffective, but that there wasn’t strong enough data to show that it is clearly helpful.

While there’s not a definite conclusion on how effective validation therapy is in treating Dementia, it does appear that it may be a tool that’s worth understanding and using in some circumstances, for some people. At a minimum, it can help caregivers remember to place themselves in the other person’s situation, consider what it is that they’re feeling or experiencing, and then respond with compassion.

If you want to have a dialogue about this subject or have other questions, please contact us via our contact form or our Facebook page, Instagram or Twitter.