|Truth or Lies - The Great Reality Divide|
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When you care for a person with dementia you are bound to experience situations that present challenges due to the resulting clash of your two different realities.
How do you respond when:
George tells you that his toy dog is sick?
Great confusion and uncertainty exists over when or whether to tell the truth or a white lie. I would like to explain and clarify here why neither of these approaches is desirable.
In the everyday care of people with dementia, two distinct response techniques are often used:
Telling the Truth as "it is", or
Inventing a white lie.
Telling the truth as "it is"
If you tend to use this approach, it may be grounded in strong ethical beliefs and a conviction to always tell the truth.
When you are suddenly faced with one of the above situations, naturally you will tell the person what you experience as the truth about their reality. You will most likely have empathy for the person when you respond:
George, you don't need to worry. Your dog is not sick. It is only a toy and therefore cannot feel any pain or discomfort.
If you've ever used responses like these in a similar situation, most likely you found that telling the truth did not elicit a positive result. On the contrary, it may well have broken the person's spirit. Try thinking back to a similar situation and be really honest with yourself. What was the person's reaction? Was it sadness, irritation, anger or aggression? Did the person call you a liar?
The clash of realities
The reason telling the truth does not work in these situations is due to the clash between your two realities. What you perceive as the truth does not match the perception of truth by the other person. This resulting clash may create tension.
You may have been taught that it is OK to tell a small white lie to the person who can't remember. At first glance, white lies can seem like a simple solution to difficult and challenging situations. You may have even had a positive experience in stopping certain behaviour - at least for a while. Sometimes too, the telling of a white lie can be seen as the most caring approach to ease the person's pain.
Of course, you will show empathy and warmth in your voice when you respond:
George, what if you give the dog to me and I will take it to the vet for you?
However, if you've ever used a response like this one, most likely you will have experienced that though the white lie may stop the behaviour momentarily, the same behaviour almost always returns, sometimes even stronger and more persistently. The white lie may leave the person feeling manipulated, confused or angry.
Why white lies don't work
White lies only deal with the face value of a situation, not with the underlying needs and feelings. More often, they can leave the person feeling that we don't care and only want them out of our hair. This approach destroys the trust that you have built between you. A white lie cannot create a long-term solution because it does not meet the underlying universal emotional need.
The challenge is to find a way in which the two contradicting realities can co-exist in respectful harmony. And there is a way!
The 5 Universal Emotional Needs
People with dementia are usually very well cared for physically, however, their emotional needs are often overlooked. Meeting these needs is the key to preventing suffering and to providing truly enriching experiences.
The 5 most common emotional needs for all of us, regardless of age, are:
1. to feel needed and useful
2. to have the opportunity to care
3. to have our self-esteem boosted
4. to love and be loved
5. to express emotions freely
Our emotional needs don't disappear just because we grow old or have dementia. The only thing that changes, especially for people with dementia, is the opportunity to have these needs fulfilled in a meaningful way. And you'll be amazed how often the challenging behaviours you come across are linked to these needs. In fact, many of the behaviours we think of as symptoms of dementia can actually be traced back to unmet emotional needs.
What's really going on?
When these emotional needs are not met, the person does not just give up. Instead, the person with dementia has an incredible way of compensating for what is missing. In his or her imagination, the person recreates a time when these needs were being fulfilled and then bring these memories to life.
These memories fall into 4 categories:
~ significant people or animals
~ significant places
~ significant situations
~ significant objects.
When George says that his toy dog is sick, it is absolutely real for him. In his younger days, he started an animal refuge, which is now a highly regarded facility. In his imagination, George recreates memories of his dogs.
The key questions here are:
What is the Unfulfilled Emotional Need the recreated memory is compensating for?
is the person attempting to communicate?
Bringing it all together
George no longer feels he has a role, an identity or meaning in his life. Recreating memories of the Animal Refuge boosts his self-esteem and restores his feelings of being needed, useful, able to care, and of giving and receiving love.
Introduce pets to George's everyday life and ask him to help look after them. Ensure he receives only the support needed, so he can experience success. Hang bird feeders and place bird baths that he can fill and clean. These are daily jobs that need love, care and attention.
Now, when George says his toy dog is sick, you can respond genuinely and sincerely, ‘George, your care and concern for the dog are absolutely wonderful. I know of no-one else who cares so much. We've been looking for someone who could help us look after our cat (or birds or whatever you have). Could I ask you to help? Would that be okay?'
By tuning in to the person's unmet emotional needs and finding creative ways to help fulfil them, you will both experience something truly wonderful. Once you meet the person's needs, the previous difficult behaviour will disappear. People with dementia always prefer to have their needs fulfilled in this reality rather than resort to their memories. The challenge is to enable them to do so.
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