Therapeutic Fibbing With Dementia: What It Is, When It Helps, and the Guilt That Comes With It

The first time I told Sharon something that was not true, I was standing in the car park outside her memory care facility with my phone pressed to my ear, and she was asking when her mother was coming to visit. Sharon's mother died decades ago. There was nothing I could say that was both honest and kind. I chose kind. I said her mother had called earlier and was doing well, and that we would talk soon. Sharon said, "Oh good, I have been thinking about her." The call ended. She sounded settled.

I got into my car and sat there for a few minutes feeling like I had done something wrong. I had lied to my mother. It had worked perfectly, and I felt terrible about it. It took me a long time to understand that the guilt was not evidence that I had made the wrong choice. It was evidence that I was taking the choice seriously, which is what people who love someone do.

What therapeutic fibbing actually is

Therapeutic fibbing is not lying in the way most of us understand lying. It is not deceiving someone for your own benefit. It is not withholding something they have the right to know. It is telling a kind untruth to a person whose brain can no longer process or integrate the factual version of reality, because the factual version will cause distress without providing any lasting understanding.

The clinical grounding for therapeutic fibbing comes from validation therapy, a framework developed by Naomi Feil in the 1960s and refined over several decades of work with people living with dementia. The central principle of validation therapy is that a person with dementia exists in their own emotional reality, and that the most helpful thing a caregiver can do is enter that reality with them rather than drag them out of it. The 11 principles of validation therapy make this explicit at every level: the goal is not to orient the person to our reality. The goal is to validate the feelings they are experiencing in theirs.

The Alzheimer Society of Canada's communication guidelines for dementia families are built on the same foundation. Correcting a person with dementia, the guidelines note, is rarely helpful and frequently harmful. The correction lands as an argument they cannot win, about a reality they cannot access, from someone they trust. The distress it produces is real. The benefit is not. A kind redirection that meets the emotional truth of what the person is experiencing, even if it does not match factual reality, is a more compassionate and more effective response.

This is not a workaround or a compromise. It is the clinically recommended approach for communication in moderate to advanced dementia, endorsed by memory care specialists, dementia nursing associations, and caregiving organisations across Canada, the UK, and Australia. Therapeutic fibbing is what the evidence says to do. The guilt many caregivers feel about using it is a cultural artefact, a holdover from a value system that was built for people whose brains can hold and integrate honest information. In dementia, that system no longer applies.

The guilt, and why it is a sign of love

Most caregivers who start using therapeutic fibbing do not arrive at it through research. They arrive at it through trial and error, and then they feel guilty about it. They know, on some level, that it is working. They also feel like they are betraying something. The relationship they had with their parent was built on honesty. Saying things that are not true, even kind things, feels like a violation of that relationship.

I want to name this feeling directly, because it is almost universal among the caregivers I talk to and it is almost never talked about in clinical settings. The guilt about not answering dementia calls is one version of this. The guilt about therapeutic fibbing is another version of the same thing. Both come from the same place: a person who loves someone with dementia and is trying to act with integrity while navigating a situation that does not have an integrity-preserving exit.

Here is what I have come to believe, and what I would say to any caregiver sitting in a car park feeling the way I felt that afternoon. The guilt is not telling you that you did something wrong. The guilt is telling you that you still care about the relationship, that you are paying attention to the moral weight of the choices you are making, and that you have not given up on treating your loved one as someone whose experience matters. A person who felt nothing after telling a therapeutic fib would be more worrying than the person who felt guilty. The guilt is the love.

The question to ask yourself is not "was that honest?" The honest answer is no, and that is okay. The question to ask is "did that serve my loved one's wellbeing?" In almost every case where therapeutic fibbing is used well, the answer is yes. The person is less distressed. The call ends on a warmer note. The anxiety that drove the conversation is resolved rather than escalated. The relationship is preserved rather than damaged. These are the outcomes the approach is designed to produce, and when it produces them, it has done exactly what it was supposed to do.

What therapeutic responses look like in practice

The hardest part of therapeutic fibbing is not deciding whether to use it. Most caregivers make that decision in the middle of a call, under pressure, with no time to deliberate. The hardest part is knowing what to actually say, in the moment, for the specific question being asked. Let me walk through the ones that come up most often in Sharon's calls and in the calls families describe to me.

"Where are you?" is one of the most common. Sharon asks this when she is anxious and cannot locate me in her mental map of where I should be. The honest answer is that I am at home in a different city, which is too much information to hold and which often increases rather than decreases the anxiety. The therapeutic response is something immediate and grounding: "I am close by and I am thinking about you. You are safe." The question underneath the question is not a request for coordinates. It is a request for reassurance that she is not alone. That is what the response addresses.

"When are you coming?" arrives when the dementia separation anxiety is at its loudest. The honest answer is that I do not know exactly, or that I am coming on Thursday, which she will not remember by Thursday and which gives her something to fixate on in the interim. The therapeutic response is warm and present-tense rather than future-tense: "I am thinking about our visit right now. What have you been doing today?" Redirecting to the present moment, to something concrete and immediately accessible, is usually more effective than naming a date that will not anchor.

"I want to go home." This one is particularly hard because there is no good factual response. She is often already home, or in a memory care facility that is her home now. The home she is reaching for is a feeling, not a place. It is the feeling of being safe and familiar and in the right place, which is exactly what dementia has taken from her. The therapeutic response is to enter that feeling rather than correct its premise: "Tell me about your home. What does it look like?" or "You are somewhere safe right now. Tell me what you can see from the window." Sometimes she will settle immediately. Sometimes it takes a few exchanges. The goal is not to convince her of anything. It is to be present with her in the longing until it eases.

"Is Mum there?" or "I need to speak to Dad." When a parent with dementia asks for their own long-deceased parents, it is one of the most disorienting moments for a caregiver. Correcting it, telling them their parents are dead, causes acute grief that the person cannot integrate and will experience again the next time they ask. The therapeutic response is to acknowledge the wish without confirming or denying: "You are thinking about her. She would be so proud of you." Or, if the person is distressed enough that they need more, something like: "She is not here right now, but you are safe. Let's talk about what you love about her." The feeling behind the question is a need for comfort and familiarity. That need can be met without a painful conversation about mortality that leaves only distress.

In all of these cases, the technique is the same. Hear the emotional content of the question. Respond to that emotional content with warmth. Redirect gently toward something present, concrete, and positive. Do not engage with the factual debate, because the factual debate will be lost and the loss will be painful. The goal is not to be right. The goal is for the call to end with your loved one feeling safer than they felt when they dialled.

Where therapeutic fibbing reaches its limits

Therapeutic fibbing is a tool. Like all tools, it works well in the hands of someone who is rested, present, and emotionally regulated. It works less well, and sometimes fails entirely, when the caregiver has been answering the same calls for the ninth time today, including twice before 7am, including once during a meeting they stepped out of, including once while managing their own children's dinner.

The technique depends on the person delivering it arriving at each call with enough warmth to execute it. Warmth is not infinite. It is a resource that gets depleted by exhaustion, by repetition, by grief, and by the particular kind of stress that comes from loving someone whose illness is progressive and irreversible. A caregiver who has answered fifteen calls in a day and gets the sixteenth is not less loving than they were for the first one. They are less resourced. And when the resource runs out, the therapeutic fib comes out wrong. The voice is flat. The words are right but the warmth is gone. The person with dementia, whose emotional radar is often still sharp even as other faculties fail, notices.

This is where the call volume question intersects with the therapeutic fibbing question. The question is not just whether therapeutic fibbing is the right approach. It almost always is, in moderate to advanced dementia. The question is whether the caregiver has the structural support to deliver it consistently, at any hour, across a call volume that can reach ten, twenty, or thirty calls a day.

For most families, the honest answer is that they do not. They want to. They are committed to it. They understand why it matters. And they are also human beings with jobs and children and sleep requirements and their own emotional lives, none of which are compatible with being emotionally available on demand, twenty-four hours a day, for a person whose brain cannot remember that they just called.

This is the gap that KindredMind was built to fill. The companion answers calls in the caregiver's own voice, drawing on a knowledge base built around the caller's life. It applies the same principles as therapeutic fibbing, warm, present, non-correcting, emotionally responsive, without the caregiver needing to be on the other end of every call. The calls that Sharon used to make ten times before lunch now reach something that sounds like me, responds like me, and knows what she cares about. She settles. The call ends well. And I am still resourced enough, when we do talk, to be genuinely present rather than depleted.

The therapeutic fibbing approach does not stop being the right approach when call volume gets high. It just becomes impossible to deliver it consistently without support. The tool still fits the job. The caregiver just needs something that can hold the tool when they cannot.

Kirstin Thomas

Co-founder of KindredMind. Daughter of Sharon, who has mixed dementia. Kirstin built KindredMind with co-founder Patrick Armstrong after years of learning, often the hard way, how to meet her mother in the reality her brain was living in rather than the one that was factually accurate.