In Praise Of The “Therapeutic Fiblet”

Shhhh!

by Joan Blumenfeld, MS, LPC

We all agree that lying is awful. It’s rotten and reprehensible. People lie to escape punishment for doing something they know is wrong or for manipulating others to their own advantage. But a therapeutic fiblet — now that’s another matter altogether! A therapeutic fiblet is kissing cousin to a white lie and delivers a partial truth, something to guide another person in a direction that is deemed to be good for them, even when they would prefer to be left alone.

At first, the very concept of a “therapeutic fiblet” really went against my grain. But over time I’ve learned that it can be quite a useful tool, especially when working with people who have dementia, and when the full, unvarnished truth would only escalate their agitation and resistance.

Case in point:

My 86-year-old client, Charles, was frankly unmanageable. He was diagnosed with frontal lobe dementia, a brain disease which seriously affected his behavior, his memory and his judgment. He was combative and impulsive. He refused his medications. He wandered the neighborhood terrifying children and getting lost with regularity. Emma, his wife of 60 years, was truly afraid of him, and his children were beside themselves with worry about their parents.

Their daughter, Alice, thought it would be a good idea to move her parents into her home, where she could help on a daily basis and keep watch over them.

It was a very noble effort, but, instead of improving things, it was a disaster for everyone. Both parents were totally upended by the move. Charles had nothing to do. Everything was unfamiliar: the street, the house, the neighbors and the neighborhood. He was at high risk to either get hit by a car during his wanderings or hurt someone else in his confused and angry state.

Emma also had nothing to do. She was no longer in charge of running her own household. She had no friends to visit. She did not know the neighborhood. She could not go to her church or talk to her minister. Everything was unfamiliar to her, too.

In addition, the routines of Alice’s family were severely disrupted. It was almost impossible for Alice to get to work on time. Feeding, planning and caring for her parents stretched her patience and her budget to the limit. No one was happy. Chaos ensued on all fronts. That’s when I was called in to help sort out and solve the multitude of problems.

First, I arranged for Emma and Charles to connect with a local geriatric physician to address their pre-existing medical conditions and to treat Emma’s depression. Then I boldly suggested they consider an assisted-living facility with a dementia unit, which would contain Charles and provide services and support for Emma as well.

The entire family was strongly resistant to the idea of assisted living. Emma felt she was abandoning her husband and not fulfilling her marital oath, the part about “until death us do part.” Alice and her siblings thought they were betraying their parents by relinquishing their filial obligation to take care of them. And Charles simply wanted to go home and be left to his own devices.

In spite of their reservations, the family agreed to visit the two facilities I recommended. They were favorably impressed with the lovely appearance of both places as well as the excellent skills of their friendly staffs. The entire family was beginning to see the advantages of Charles and Emma’s moving into an assisted-living facility.

He would be safe and contained. She could visit him every day. Both would benefit from appropriate activities, social interactions, good nutrition and medication monitoring. Charles and Emma would be safe and comfortable, while much of the burden of caring for them would be lifted from Alice’s shoulders.

Now here’s where the “therapeutic fiblet” comes in. Charles would most certainly refuse to make the move. The “fiblet” was to tell him that his doctor wanted him to stay in the assisted-living facility for a few weeks to get him settled on proper medications, which was, of course, only partly true. Charles was more likely to accept the authority of his doctor’s recommendation than suggestions from either his children or me.

However, the real plan behind the move was to make it a permanent living arrangement. It was expected that Charles and Emma would both adapt to their new environment within a few months and, because of his dementia, Charles would most likely forget that he was told the arrangement was temporary.

The reason for the ploy was to get Charles and Emma to try out the assisted-living facility for at least a few weeks, and hopefully even longer, during which time we hoped they might get used to the idea and even enjoy the benefits enough to stay on without a fight.

Unfortunately, this care plan never had a chance to be implemented. Charles accidently overheard a tearful family discussion about his future. When he learned that this was to be a permanent move, he absolutely refused to go! He raged for days and demanded that he be taken home at once! Neither Emma nor his children had the stomach to coerce him any further. So home they went, taking with them all the original problems which were certain to become more severe as time went by.

Pearl of wisdom: As much as it goes against the grain for most of us, sometimes the half-truth of a “therapeutic fiblet” can save the day and result in a safer, better quality of life for the mentally compromised older adult.

Joan Blumenfeld, MS, LPC, is a Geriatric Care Manager practicing in Fairfield County, CT. For information, visit joanblumenfeld.com. © Joan Blumenfeld 2013.



One Response to “In Praise Of The “Therapeutic Fiblet””

  1. Karen Welzel says:

    We moved mother to an ALF two weeks ago, after a week in the hospital and three weeks in rehab. She was not too bad with her dementia prior to the hospitalization, but after being moved three times, and the trauma of the hospital, she has gotten considerably worse. We originally believed she could have her little dog with her at the ALF, but that was before. We moved him in with her, but she has been obsessing about taking the dog outside of the secure facility to walk…to the point that she hangs out in the lobby, hoping someone will mistake her for a visitor instead of a resident. It almost happened!
    Additionally, she has been taking her well prepared, “people” food back to her room to give to the dog. He was sick last year because she overfed him table food, instead of dog food.
    The facility has now determined that the dog is a health and escape risk for mom and they want him to go away. Mother is totally focused on her dog, and taking him away will be VERY hard on her. Not really sure how to go about this…do we take the dog “to the vet, because he’s sick”…and he doesn’t come back? We know she will grieve, but will she eventually forget about it? Should we consider a mild anti-anxiety med, as she is very anxious most of the time. Need some advice here!

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