Gary's Guidance: Denial, Denial, and More Denial

April 2012

Gary’s Guidance

Denial, Denial and More Denial

It is quite likely that you have encountered someone who insists that something did not happen, or what you viewed to be a problem simply did not exist in the mind of the other person.  They simply did not see something the same way as you did.  Their version is different.  Caregivers and family members of the elderly are often in a position of seeing changes in a person’s condition and identifying that a problem exists.  The problem actually is real, but the person with the problem does not believe there to be a problem.  An older adult may minimize the concern, resist, and even fend off accepting help.  They may be in denial.  Why denial?  Because normal adults use denial mainly as a defense mechanism against something they perceive, or possibly find threatening like having to make changes.  It is possible to avoid a great deal of anxiety through denying the possibility of an immediate presence of danger; but of course the denial is apt to leave the denier, or yet another person, exposed to potential or actual harm.

An older adult with dementia may lack insight and judgment, be forgetful, and make things up.  Dementia can be confused with denial, and dementia and denial can co-exist in such a way as to blend together.  Denial is usually rigid and no budging the person from the position they defend.  This is hard to deal with from a caregiver’s or family member’s perspective as in being stakeholders in the well being of an older adult.  Getting a person to face the facts and agree that a problem exists, and that something else must be done to address the situation often results in a sense of futility.

What can be done?  Here are a few things:

  1. First acknowledge the other person’s (the one denying) perspective.  Counter with having a “what if” discussion to a hypothetical problem and then offer a solution.  This may need to be repeated at different intervals of time.  Hopefully, at last, the person comes to agree and cooperation is gained.
  2. Work towards compromise (this can be done when health and safety are not in immediate jeopardy).  Easing into solutions by gaining a few inches at a time can add up to several feet over time.  This helps with giving one a sense of control and say in the outcome.
  3. Record information in a notebook, take pictures, and even use audio/visual mediums as a means to help one view reality from a different context outside of them later.
  4. Avoid becoming angry or showing frustration.  It will result in contributing to hurt feelings, confusion, fear, and isolation.

Gary Kozick, LCSW

(215) 510-8901