18 Jun The Power of Humble Deferral™
In our work at Dementia Together with families and professionals caring for people living with the disability of dementia, we discuss the importance of choosing to be kind instead of right. However, kindness in dementia care is not always enough if our goal is to promote lifelong well-being. At Dementia Together, we teach the UK-originated, evidence-based, family-driven SPECAL® (pronounced “speckle”) method to help people in care companion roles promote well-being for those experiencing dementia and for themselves. One of the general principles of SPECAL®, as with other relationship-based models, is to avoid contradiction.
Well-meaning care partners who don’t have a SPECAL® understanding of how harmful contradictions can be for someone experiencing dementia, will often indignantly insist, “well, I’m not going to LIE my loved one.” Common sense approaches to dementia care require the use of condescending, patronizing terms that imply deception, such as “therapeutic fibbing,” “white lies,” or “fiblets” in attempts to explain how to avoid contraction. In contrast, by understanding the disability of dementia through a SPECAL® lens, care partners realize that the concern they have related to deception is completely unnecessary. The SPECAL® framework allows understanding of the disability of dementia which helps SPECAL®-informed care partners realize that avoiding contradiction actually shows respect and fosters dignity. The concept of deception indeed becomes irrelevant.
The SPECAL® Method uses the SPECAL® Photograph Album analogy to offer a powerful framework for understanding and managing dementia without the need to understand medical terminology or pathophysiology. SPECAL® strategies work even in the presence of other dementia symptoms often not considered “memory related.” The SPECAL® Photograph Album analogy enables visualization of memory as a photograph album, with each experience stored as a photograph containing both facts and associated feelings. For someone with dementia, the album continues to store photographs of every single experience as usual, but with one crucial difference: facts are randomly, intermittently, and increasingly failing to store, while feelings continue to store the same way as usual. We call feelings-only photographs “blanks,” meaning blank in facts. For the purposes of managing the condition, this simple understanding informs how to effectively accommodate for the disability of dementia. SPECAL® empowers care partners to see the potentially traumatic impact incontrovertible contradiction has on a person who is no longer reliably storing facts while continuing to store feelings the same way as usual.
Care partners who don’t know SPECAL® may feel conflict which can only be framed in common sense terms of deception and leads to self-righteous, prideful refusal to share anything but the actual factual details with their loved one with dementia. This approach leaves the person experiencing dementia with feelings of frustration or worry, often without the facts to help them understand why. This common sense communication as usual, continuing to do what they’ve always done, ultimately makes life harder on care partners and their loved ones, falsely assuming that the anxiety or agitation that results is “just the way it is with dementia.”
At Dementia Together, we know it doesn’t have to be that way. When we choose kindness, humility, compassion, and courage to do it differently, it makes all the difference. Building on the SPECAL® framework, Dementia Together has coined the term, “humble deferral™” to capture what accommodation for the disability of dementia looks like. Humble deferral, what we also refer to as “compassionate deferral™,” raises the dignity of the person we are deferring to. Humble deferral promotes the inherent worth of another. Humble deferral reflects the moral imperative care partners have to avoid disturbing the sense the expert with dementia is making when recent facts increasingly fail to store.
Humble deferral and compassionate deferral reflect a respectful approach for interacting with people living with dementia. Humble deferral acknowledges that the person with dementia is the expert in their own experience. By discerning how facts are not reliably storing, while feelings store as usual for the expert with dementia, and by considering which old facts the experts might be referencing to help them make sense of what is happening today, care partners can communicate more effectively.
When we defer to the person experiencing dementia, we positively work with that person’s natural coping strategies and prioritize their well-being over the traditional common sense approach that is not useful when recent facts are not storing reliably.
With every interaction involving someone with a “blanking album,” we (the people without blanks in our album) simply need to ask ourselves, For whose benefit? Whose album am I considering with this response? What response do I need to give so that I don’t disturb the sense the person with dementia is making based on the new facts that are failing to store and old facts the person is choosing to match to in order to provide context to explain the feelings they are currently experiencing? Listening to the expert means we discern when and how the person with dementia is using their album and respond in ways that don’t trip them up.
Feelings store for everyone. When we use SPECAL® sense instead of common sense, we help the person use their own history and experience to make sense of what they are feeling at the moment. Our moral imperative is to promote well-being. We do this by NOT disturbing the sense the people with dementia are making for themselves–humbly deferring to what they feel makes sense so they can cope with what’s happening around them. Visualizing the “album” of a person with dementia enables authentic reframing from deception to discernment which leads any compassionate human to humble deferral. Humble deferral (or, the equally accurate term, compassionate deferral) is THE most respectful approach for maintaining dignity and well-being for the person living with dementia.
For more information on practical strategies to practice humble deferral, SPECAL® classes, workshops, support groups, and consultations are offered at Dementia Together at no charge for family care partners.
Shared with gratitude to the Contented Dementia Trust in England who recognizes Dementia Together as the North American Center of Excellence for the SPECAL® Method.
