Therapeutic Lying. Is This Really a Thing?

July 14, 2023

Spent a few weeks this month bringing laughter tools to a gorgeous senior community in New York City, Coterie Hudson Yards, after reading about it in a profile on the director Paul Shrader in The New Yorker. They don’t pay me to say nice things here, but the luxury and care their residents experience is first rate.

New Yorkers being who they are, in and around the laughter we also engaged in some very real and meaningful conversations with family members about caring for loved ones in cognitive decline.

When I run these workshops, I use an acronym that includes the letter “H” for Honesty. It’s easy to understand why honesty is important in making people laugh, how many times have you heard a comic say something and laughed thinking, “that’s so true!”? Surely there are other techniques in play like the element of surprise, escalation, rule of three’s, etc. But at its core, we often laugh at a joke or story because some key aspect of it rings true. It’s not complicated, the truth is funny.

It’s also key in communicating with people in cognitive decline. It’s a little known fact that as people’s minds become more disconnected, they become very sensitive to non-verbal communication like energy and tone of voice. Although they might not be able to articulate, they can often feel when someone is lying to them. For example, to keep saying, “You’re fine. Everything’s fine. It’s nice out today. Everything is fine,” dialogue I often overheard by the most well-intentioned of visitors at my mother’s place, can cause them to withdraw further because it is simply not acknowledging the truth, because even in the best of circumstances, even at a 5 star community, they are not always fine. To deny this is to deny their experience.

On the other hand, and this is a big hand, there is no value in brutal honesty, for example  re-wounding someone with knowledge of a death they won’t remember and they no longer have the intellect to process. This is why I always present the letter H with the caveats of empathy and compassion and another key comedian took, “knowing your audience.” Which brought us to the real lesson of the day, therapeutic lying. I remember one of my mother’s care managers authorizing this early on and I couldn’t believe it was a thing, medically sanctioned dishonesty. But it is, and it is the kindest way to communicate with people who have enough to deal with just remembering how to use a fork.

As the social worker in the room pointed out in response to the question, “How do you start lying to someone when you’ve had forty or fifty years of integrity in your marriage?” You have to think about what is best for your loved one. Telling people harsh truths of death or relocation is unkind to a person who will a) likely forget and need to be retold, and b) no longer have the capability of processing the loss.