A woman points towards a pile of clothes on a chair.
“Please get that cat out of my room.”
You see a cardigan. She sees an animal that does not belong there.
Your first instinct may be to correct her: “That is not a cat. It is only your clothing.” But instead of reassuring her, the correction makes her more frightened. She feels that nobody believes her—and the cat is still there.
This is where therapeutic fibbing in dementia care enters a difficult space between honesty and compassion. It means choosing not to correct someone, or occasionally using a small and carefully considered untruth, when the literal truth is likely to cause distress without providing any meaningful benefit.
It is not about making fun of someone, controlling them or treating them like a child. Done appropriately, it can be a skilled attempt to protect their emotional safety and dignity.
Why correction can make things worse
Dementia can affect memory, perception, reasoning and a person’s sense of time. What appears obviously untrue to you may feel completely real to them.
Correcting the person may therefore feel less like helpful information and more like confrontation.
Imagine being frightened by an animal in your room while the person you trust insists that nothing is there. You might feel ignored, unsafe or even suspicious of them.
The Alzheimer’s Society explains that there is no single correct response to every difficult question or mistaken belief. The person’s best interests, emotional wellbeing and individual circumstances should guide the response.
The aim is not to win an argument about reality. It is to understand what the person needs at that moment.
Therapeutic fibbing is not the first or only option
The term can be misleading because many helpful responses do not require an actual lie.
Often, a carer can acknowledge the emotion without confirming or denying the belief:
- “That sounds frightening.”
- “I can see that you are worried.”
- “You are safe. I am staying with you.”
- “Let us check it together.”
- “What would help you feel more comfortable?”
This is sometimes called validation. You respond to the feeling underneath the words rather than debating the facts.
A useful order is:
- Check for immediate risk.
- Listen and identify the emotion.
- Offer calm reassurance.
- Gently explain or orient the person if that helps.
- Change the environment or redirect their attention.
- Consider a small therapeutic fib only if correction is causing distress and the response is safe, proportionate and in their best interests.
The least deceptive response that works is usually the best place to begin.
Example one: the “cat” on the chair
A resident sees a dark bundle of clothing and believes it is a cat. She is anxious and refuses to sit down.
A confrontational response might be:
“There is no cat. You are imagining it.”
That response focuses on proving her wrong.
A more compassionate response could be:
“I can see that the cat is worrying you. You are safe. I will move it away.”
The carer calmly removes the clothing, switches on another light and says:
“It has gone now. Would you like to come and have a cup of tea with me?”
The carer has stepped into the resident’s reality just far enough to resolve the fear. The objective is not to develop a story about the cat. It is to help her feel safe.
The carer should also consider why the mistake happened. Poor lighting, shadows, tiredness, reduced vision or a patterned garment may have contributed.
Dementia UK describes this kind of experience as a possible misperception: the brain receives information from something that is present but interprets it as something else.
Moving the garment, improving the lighting and checking the person’s glasses may reduce the chance of it happening again.
Example two: the talking Zimmer frame
A man looks towards his Zimmer frame and says:
“It is talking to me. It says I must not get up.”
Laughing, dismissing him or immediately taking the frame away could increase his fear. Arguing that walking frames cannot speak may not change what he is experiencing.
The carer might begin with:
“It sounds as though that has made you feel unsure. Let us check the frame together. I will stay beside you.”
If he remains focused on the voice, the carer might gently enter his frame of reference:
“All right, let us tell the frame that we are taking a safe walk together.”
The carer can then check the equipment, follow the person’s mobility plan and offer an arm or appropriate support.
This is not permission to trick the person into walking. If he does not consent, appears unwell or cannot mobilise safely, the carer should stop and seek appropriate support.
A talking frame may indicate an auditory hallucination or another change in perception. It should be recorded and reported, especially if it is new, recurring or distressing.
When might therapeutic fibbing be appropriate?
A limited therapeutic fib may be considered when:
- The belief is not placing anyone in danger
- Telling the literal truth repeatedly causes fresh distress
- The person cannot retain or process the explanation
- Validation and redirection have not been enough
- The response protects comfort rather than staff convenience
- It is consistent with the person’s care plan and known preferences
- The smallest possible departure from the truth is used
For example, repeatedly telling someone that their parent died many years ago may force them to experience the grief as if hearing the news for the first time.
The Alzheimer’s Society advises carers to consider the distress caused by repeatedly delivering painful information. A response such as “Do you miss your mum?” may meet the person’s emotional need without providing another painful correction.
When should it not be used?
Therapeutic fibbing should never become a convenient way to control someone.
Do not use it to:
- Obtain consent for care or treatment
- Hide medication inappropriately
- Conceal mistakes, neglect or abuse
- Influence financial or legal decisions
- Stop someone raising a genuine concern
- Override a person’s choices simply because they are inconvenient
- Persuade someone to do something unsafe
- Avoid investigating pain, illness or distress
A person’s claim should not automatically be dismissed because they have dementia. If they say someone has hurt them, taken their belongings or treated them badly, listen carefully and follow safeguarding procedures.
Dementia UK warns that apparently false claims can sometimes be true and should be checked before they are treated as a delusion.
Do not assume every experience is “just dementia”
Seeing a cat instead of clothing may be a visual misperception. Hearing a Zimmer frame speak may be a hallucination. A sudden change could also be related to:
- Infection or delirium
- Pain or constipation
- Dehydration
- Hunger or lack of sleep
- Changes in medication
- Reduced sight or hearing
- Poor lighting, reflections or shadows
- An unfamiliar or overstimulating environment
The NHS advises seeking medical help for hallucinations. Seek urgent help if the person suddenly becomes confused, the hallucinations rapidly worsen, they become severely agitated or there is a risk of harm.
Regular or distressing hallucinations should also be discussed with the person’s GP. A medication review, eye test, hearing test or assessment for an underlying illness may be needed.
Record what happened without judgement
Good documentation helps the care team recognise patterns and respond consistently.
Record:
- What the person said they saw, heard or believed
- The time and location
- What was happening immediately beforehand
- Whether they appeared frightened, calm or distressed
- Possible triggers such as noise, shadows or tiredness
- What you said and did
- Whether the response helped
- Who you informed
Write objectively. Avoid labels such as “attention-seeking,” “difficult” or “making things up.”
The experience was real to the person, even when others could not see or hear it.
Agree on a consistent approach
A response that reassures one person may upset another. Learn from the individual rather than relying on a single script.
Families, carers and professionals should discuss:
- How the person prefers to be reassured
- Whether gentle orientation helps or increases distress
- Familiar topics that provide comfort
- Effective distraction techniques
- Known triggers
- Words or approaches to avoid
- When medical advice should be sought
Include helpful approaches in the care plan so the person does not receive a different response from every member of staff.
Compassion without humiliation
Therapeutic fibbing must never become a joke shared between carers. Do not wink, laugh or make exaggerated claims about the person’s reality.
Speak with the same respect you would want if something felt frighteningly real to you.
The most important shift is this: good dementia communication is not always about correcting the facts. Sometimes it is about recognising the emotion, reducing fear and helping the person feel safe again.
Choosing compassion over correction is not weakness. When it is careful, proportionate and person-centred, it can be a skilled act of care.
This article provides general dementia-care information and does not replace an individual care plan, workplace procedure or advice from a qualified healthcare professional.
