Can it ever be acceptable to tell a therapeutic untruth?
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Can it ever be acceptable to tell a therapeutic untruth?

Karen McKenzie Professor of psychology, clinical psychologist, Northumbria University, Newcastle upon Tyne

While therapeutic untruths can be used in the best interests of the person being supported, they should be monitored to avoid misuse

Research suggests that the use of ‘untruths’ is relatively common in our personal lives, but the idea of using any form of deception with people who have a learning disability can make us feel uncomfortable.

Learning Disability Practice. 27, 1, 20-21. doi: 10.7748/ldp.27.1.20.s9

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This article has been subject to external double-blind peer review and has been checked for plagiarism using automated software

Published: 08 February 2024

The use of deception is common and can come in many forms. Less explicit forms of deception might include missing out particular bits of information that might cause someone distress (a deliberate omission), avoiding a topic altogether or distracting someone when they try to discuss it. Similarly, it may involve colluding with someone or failing to challenge something that the person believes that you know is untrue.

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Telling ‘white lies’

More explicit deception might involve telling a ‘white lie’ to protect the feelings of others. This might be telling someone that you enjoyed the meal they cooked when it gave you bad indigestion, or that you liked a gift they gave you when it is not to your taste.

Then there are outright lies or using verbal or non-verbal means to trick someone into believing things that are untrue (Blum 1994). While there is no single definition of therapeutic untruths, they are understood to be types of deception designed to be used in the best interests of the person being supported, rather than the person who is telling the untruth.

While therapeutic untruths can take the same form as the types of deception outlined earlier, they would be used in situations where they would be of benefit to the person with a learning disability, for example, by reducing their distress or de-escalating situations that may otherwise result in aggression or harm (Cantone et al 2019).

While the use of therapeutic untruths is not explicitly encouraged, research suggests that social care staff, nursing staff, and nursing students all use therapeutic untruths in their day-to-day support of people with a learning disability (McKenzie et al 2020, 2021).

Observing colleagues

A study of learning disability nursing students found that all of them had observed a colleague using therapeutic untruths during their training and that 96% had used some form of therapeutic untruth on at least one occasion themselves (McKenzie et al 2020).

Similar figures were found for social care staff, with 96% of staff reporting using therapeutic untruths themselves as well as experiencing colleagues using them (McKenzie et al 2020). The type of therapeutic untruth that was used depended on the situation and the most commonly used approach by health and social care staff was ‘omission’ and the least commonly used was telling an outright lie.

Behaviours

The use of therapeutic untruths was also influenced by how effective it was seen to be as a response to behaviours that challenge and, to a lesser extent, how comfortable the person felt when using it. If the therapeutic untruth was seen as being an effective response to the behaviour, the health professional was more likely to use it (McKenzie et al 2020, 2021).

Positive, person-centred approaches that respect the individual are seen as central to providing high-quality support to people with a learning disability (Leif et al 2023). By definition, therapeutic untruths should only be used in the best interests of the person, however, as they are based on deception, there is a risk that they will be misapplied.

Despite the early efforts of researchers (for example, Watt 2008), there has been little discussion about and limited research into the use of therapeutic untruths with people who have a learning disability.

The research that does exist suggests that using therapeutic untruths in learning disability services is relatively common. This suggests that staff working in these services may benefit from more explicit guidance about therapeutic untruths and training in their use.

Guidance from the Mental Health Foundation (2016) was developed to help staff working in services for people with dementia. This recommends that staff try to be as truthful as possible with those they are supporting, unless this approach will cause unnecessary distress.

It is suggested that the use of therapeutic untruths should be part of a wider, person-centred approach based on an understanding of the person’s life and circumstances and that the same approach should be used, as much as possible, by everyone.

The use of therapeutic untruths should also be part of an evidence-based approach, where their effectiveness is evaluated and reviewed. Similar principles are applicable in learning disability services.

Nurse education

It has also been recommended that nurse education covers the use of therapeutic untruths and provides more formal ways in which their use can be debated and, if considered to be appropriate, modelled and evaluated (McKenzie et al 2020).

There is also a need to obtain the views of people with a learning disability about the use of therapeutic untruths to ensure that, if they are used, it is done in ways that would be most acceptable.

This is unlikely to be a straightforward process as research with people who have dementia suggests that what they perceived as acceptable varied according to the type of deception being used, who was carrying it out and the extent to which they knew they were being deceived (Day et al 2011).

References

  1. Blum NS (1994) Deceptive practices in managing a family member with Alzheimer’s disease. Symbolic Interaction. 17, 1, 21-36.10.1525/si.1994.17.1.21
  2. Cantone D, Attena F, Cerrone S et al (2019) Lying to patients with dementia: attitudes versus behaviours in nurses. Nursing Ethics. 26, 4, 984-992. 10.1080/13607861003587610
  3. Day AM, James IA, Meyer TD et al (2011) Do people with dementia find lies and deception in dementia care acceptable? Aging & Mental Health. 15, 7, 822-829. doi:10.1080/13607863.2011.569489
  4. Leif ES, Fox RA, Subban P et al (2023) Editorial for the special issu. Positive behaviour support: moving toward a human rights based model of support. International Journal of Developmental Disabilities. 69, 1, 1-4. 10.1080/20473869.2023.2162705
  5. McKenzie K, Armitage B, Murray GC et al (2021) The use of therapeutic untruths by staff supporting people with an intellectual disability who display behaviours that challenge. Journal of Applied Research in Intellectual Disabilities. 34, 1, 28-35. 10.1111/jar.12780
  6. McKenzie K, Taylor S, Murray GC et al (2020) The use of therapeutic untruths by learning disability nursing students. Nursing Ethics. 27, 8, 1607-1617. 10.1177/0969733020928130
  7. Mental Health Foundation (2016) What is Truth? An Inquiry About Truth and Lying in Dementia Care. http://www.mentalhealth.org.uk/explore-mental-health/publications/what-truth-inquiry-about-truth-and-lying-dementia-care (Last accessed: 5 May 2023.)
  8. Watt G (2008) The Mental Capacity Act and benevolent deception under the guise of ‘best interests’. Learning Disability Practice. 11, 3, 42-45. 10.7748/ldp2008.04.11.3.42.c6476

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