We've been taught that honesty is the foundation of trust. But what happens when telling the truth repeatedly causes someone distress they cannot fully understand or resolve?
For families caring for someone with Alzheimer's disease or another form of dementia, this is more than a philosophical question. A loved one may insist they need to leave for work, pick up a family member, or return to a home they no longer recognize. Explaining the facts may seem like the responsible response, yet those explanations can sometimes increase confusion, frustration, or anxiety.
The challenge is that dementia changes more than memory. It can affect how someone interprets information, processes explanations, and makes sense of the world around them. A person may be unable to retain a factual correction while continuing to experience the emotion that prompted the concern.
This creates a difficult question for caregivers: When does insisting on the truth stop being helpful, and what responsibility do we have to respond differently?
One approach is known as therapeutic storytelling, a dementia care communication technique that uses a carefully considered, sometimes fictional explanation to help someone move through a distressing moment. Its purpose is not to deceive for convenience, but to provide reassurance when conventional explanations are no longer effective.
Alzheimer's disease and other forms of dementia can affect memory, reasoning, attention, and the ability to process new information. Someone may experience a familiar sound or routine as evidence that something important is about to happen, even when their interpretation does not reflect current circumstances.
Repeatedly correcting that misunderstanding may not help. The person may be unable to retain the explanation, while the emotion driving their concern remains.
Research and clinical guidance on person-centered dementia care emphasize understanding emotional needs, reducing unnecessary confrontation, and adapting communication to the individual's abilities. Yet therapeutic storytelling remains more ethically contested than approaches such as validation or gentle redirection.
The challenge is deciding how to balance honesty with the responsibility to prevent avoidable distress.
At TheKey, we supported a client who lived close to an airport. Every evening around five, the sound of airplanes reminded him of his daughter, and he would insist that he needed to pick her up.
The airport was part of his environment. The planes could not be removed, and the familiar sounds repeatedly triggered the same concern. When caregivers explained that his daughter was not arriving, he became increasingly upset. He believed they were misleading him and insisted that he needed to leave.
His caregiver tried a different approach. Rather than repeatedly correcting him, she offered an explanation connected to the situation he understood: flights from Chicago had been grounded, so his daughter would not be arriving that evening. She then gently shifted the conversation toward getting ready and revisiting the situation the following day.
When he wanted to speak with someone from the airline, the team coordinated a consistent response.
This was therapeutic storytelling in practice. The caregiver used a fictional explanation to address an immediate emotional need and help the client move away from a distressing situation.
The example illustrates why this technique can be appealing, but also why it requires careful judgment. The explanation was intentionally untrue, and its use should not be treated as a routine substitute for honest communication.
Although these approaches can overlap, they are not interchangeable. Redirection gently guides someone's attention toward another conversation, activity, or experience, often without introducing false information. Validation acknowledges the person's emotions and perspective, even when their understanding of events differs from reality. Therapeutic storytelling goes further by offering a fictional explanation intended to reduce distress.
In the airport example, validation might begin by acknowledging how important the client's daughter is to him. Redirection might involve discussing family memories or transitioning to a familiar evening routine. Therapeutic storytelling introduces the explanation about the delayed flight.
Understanding these differences helps caregivers choose an approach appropriate to the person and situation, rather than relying on the same response for every difficult moment.
Therapeutic storytelling should not be the first response to every misunderstanding. Families and professional caregivers should first consider whether reassurance, validation, environmental adjustments, or gentle redirection could address the person's needs without introducing false information.
When those approaches are unsuccessful and distress is significant, a carefully considered therapeutic story may sometimes be appropriate within an individualized care plan.
The response should serve the person's well-being rather than the caregiver's convenience. It should never be used to conceal neglect, avoid necessary medical attention, obtain consent, or manipulate important financial or personal decisions. Caregivers should also consider whether a fictional explanation could create new confusion, undermine trust, or require increasingly elaborate stories.
There is no universal script. What reassures one person may upset another, and an approach that works today may not work tomorrow.
At TheKey, our approach to dementia care begins with understanding the individual beyond their diagnosis. Personal history, relationships, routines, and preferences all influence how someone experiences daily life.
Through our science-informed Balanced Care Method®, caregivers support six dimensions of well-being: Move More, Nourish & Hydrate, Connect with Others, Engage with Joy & Purpose, Flex Your Mind, and Sleep Well.
These principles help shape meaningful daily experiences, including familiar activities and routines that may reduce confusion and support emotional comfort. Therapeutic storytelling, when considered, belongs within this broader person-centered approach. It is not a replacement for appropriate supervision, medical evaluation, or the person's right to participate in decisions to the extent they are able.
Dementia care often requires decisions that cannot be reduced to simple rules. Honesty matters, but so do emotional safety, dignity, trust, and the experience of the person receiving care. Therapeutic storytelling reminds us that good caregiving requires more than knowing what to say. It requires understanding why someone is distressed, considering the consequences of our response, and choosing an approach that respects the person behind the diagnosis.
The goal is not to make reality more convenient for caregivers. It is to help someone feel safe, understood, and connected, even when the world around them has become difficult to interpret.
Learn more about TheKey's Dementia Care Services and how personalized home care can support individuals living with dementia and their families.