“This is probably the last few chapters of her life. And I made it worse. I lied to her and I betrayed her and I don’t know if I can forgive myself.”

 

This is what a caregiver shared with me in therapy. She lamented over whether or not she made the right decision. Wondering, “Could my mom have lived in her home longer? Could we have found a different solution? Will my mom ever forgive me? Will I ever forgive myself”

 

She knew the answer to these questions were complicated and probably unanswerable. The circumstances vary.

 

The decision may be behind them. The healing is not.

 

 

In this article, I walk through what therapy can actually look like for everyone this decision has impacted — the caregiver drowning in guilt, the family fractured by conflict, and the person with dementia who may sense that something happened even when they can’t say what.

 

Family Dynamics and How Therapy Can Help

 

Relocation decisions have a way of activating long standing family dynamics — old roles, old rivalries, unresolved grievances. I’ve seen siblings who hadn’t spoken in years end up in conflict about whether to “trick” a parent into memory care, with one side seeing it as pragmatic love and the other as a betrayal.

 

These dynamics rarely appear out of nowhere. They are usually the reactivation of something older — roles, rivalries, and relational patterns that were already present long before dementia entered the picture. Knowing what to look for helps you name it early when working with a family.

 

Common patterns to recognize

• Conflicts between “safety at all costs” and “autonomy at all costs” positions, often mapped onto different siblings — each convinced the other doesn’t understand what love requires here
• Perceptions that the family “ganged up” on the older adult, especially when some family members were excluded from the early conversations and the decision felt like a fait accompli
• Cultural and generational differences in expectations about filial duty, institutionalization, and what it means to tell the truth to a parent

 

Family consultation, therapy, and care-planning sessions

When families are in conflict about a move — or about how it happened — the instinct is often to focus on the logistics. Who made the call. Whether the facility is right. What to tell mom next time she asks to go home. These are important, but to start, a focus on values can help to create a foundation.

 

When family members can articulate what they actually believe about safety, autonomy, and care — and hear each other doing the same — the practical decisions become easier to navigate.

•       Clarify values: safety, autonomy, cultural expectations, spiritual beliefs about truth and duty
•       Facilitate a shared understanding of the older adult’s risks, prognosis, and decision-making capacity
•       Help the family agree on communication strategies — what will be said, by whom, and how

Individual therapy for caregivers

The caregiver who made the call — who signed the paperwork, who drove to that parking lot — is often holding something the rest of the family is not. Relief and guilt at the same time. Love and grief at the same time. A decision they would make again, and a decision they cannot stop second-guessing.

Caregiver therapy is where we give that its due weight — not to resolve it quickly, but to sit with it honestly and help the person find their footing again.

• Process guilt, grief, and anger without minimizing or bypassing the moral weight of the decision — the guilt is real and it deserves clinical attention, not reassurance
• Support moral deliberation: What does it mean to be a good son, daughter, or partner in this situation? What does accountability look like when there are no clean options?
• Develop strategies for managing ambiguous loss: the person is physically present but psychologically changed, and the relationship has shifted in ways that may never be fully resolved

 

A note on guilt and forgiveness

Some caregivers arrive in therapy wanting absolution. Others are convinced they don’t deserve it. Both positions can become stuck — and both can keep the person from doing the actual work of repair.

 

The most useful clinical frame is usually not “Was it right or wrong?” but “What’s needed now —  for your loved one, for yourself,  the relationship — how do you restore a sense of moral integrity now?” Guilt that moves toward accountability and presence is healing. Guilt that circles and self-punishes without changing anything is not. Part of our job is helping caregivers tell the difference.

 

 

Therapy with the person who was deceived

This is the work most clinicians don’t talk about — and it may be the most delicate of all.

 

People move to memory care with vastly different levels of cognitive ability and self-awareness. Some arrive with enough insight to know that something happened, that the story they were told didn’t quite add up. Others have little or no conscious recall of the move at all. And many are somewhere in between — aware enough to feel that something is wrong, but unable to locate or articulate what it is.

 

This matters clinically because therapy with this population cannot be static. As dementia progresses, so does the person’s capacity to process new information, retain what was discussed in a previous session, and regulate the emotional distress that therapeutic content can stir up— impulse control is harder, distress escalates more quickly and de-escalates more slowly, and the window for productive therapeutic work in any given session narrows.

 

The intervention has to meet the person where they are right now, not where they were at intake.

 

With that in mind, the clinical approach needs to be reassessed regularly — not just the content of sessions, but the format, the pacing, the goals, and the degree to which you are working directly with the person versus working through family and staff on their behalf.

 

 

The goal is not to undo the deception. It is to build enough safety in the present that the past stops feeling quite so destabilizing.

 

 

When the person does have some awareness that something happened — when the suspicion, agitation, repeated questioning, or persistent emotional unease is present — your role is not to confirm or correct the narrative. It is to meet the emotional reality underneath it.

 

• Validate the feeling without reinforcing a specific account of what happened: “It sounds like this hasn’t felt right to you. That makes sense. This has been a big change.”
• Focus on what is true and present: safety, care, the people who love them and keep showing up
• Attend to identity — help the person stay connected to who they are, not just where they are now. What did they love? What are they proud of? What still matters to them?
• Calibrate the depth and duration of each session to the person’s current capacity. If processing distress is becoming harder — if the person is more easily flooded, slower to return to baseline, or retaining less between sessions — scale back the exploratory work and shift toward stabilization, comfort, and presence.
• Do not probe for recall of the move unless the person raises it directly and persistently. Memory in dementia is not linear, and revisiting a painful moment that may not be fully retrievable rarely helps — and can retraumatize without resolution.
• Coordinate with staff so that everyone is using consistent, calm, reassuring language — especially when the person asks to go home. Therapeutic work done in session can be undermined quickly if the surrounding environment is not aligned.

Conjoint family sessions — bringing everyone together

There comes a point, when the dust has settled enough, where meeting with the family as a whole — sometimes including the older adult, if appropriate — can do something individual sessions cannot: it can allow for the family system to find a new equilibrium.

The adult child who made the decision alone can hear that her siblings are not actually judging her. The sibling who wasn’t in the room can say what he needed to say without it becoming an accusation. The older adult, if well enough to participate, can feel seen rather than discussed.

These sessions require careful preparation and clear clinical judgment about timing and who should be in the room. They are not always possible, and they are not always indicated. But when they work, they do something no individual session can replicate: they let a family grieve together what happened, and begin to move forward in the same direction.

• Assess readiness carefully — conjoint sessions can repair, but they can also rupture. Timing matters as much as content
• Set a clear frame: relitigating the decision is rarely productive; the more useful question is how the family moves forward together from here
• Create space for each person to name what they have been holding, without it becoming testimony or the assignment of blame
• Hold space for apology where appropriate — a genuine apology, offered without defensiveness and received without weaponizing, can shift something in a family that has been stuck for months
• Help the family articulate a shared commitment to the older adult going forward: how they will show up, what they will say, and how they will include the person with dementia in shared decision-making wherever possible

Psychoeducation and caregiver groups

Not every family needs or has access to individual therapy. And many of the hardest moments in this transition — the first time your father asks why he’s there, the first holiday visit, the guilt that surfaces at 2am — are not clinical crises. They are the common responses to an impossible situation, and they benefit from community as much as from clinical expertise.

 

Evidence-based dementia transition programs emphasize education about likely transitions, communication strategies, and involving caregivers and persons with dementia in planning from the beginning. Group psychoeducation can offer scripts, examples, and peer support for the kinds of difficult conversations most families have never had before (Alzheimer’s Association, 2018).

 

There is something that happens in a room full of people who all drove their loved one to that parking lot and told them a version of the same story. The isolation breaks. The shame has less room to grow. People who have been inside their own guilt for months discover that what they are living is not unique — and that others found their way through it.

 

That is not a small thing. For many caregivers, it is the beginning of the work.

 

Wrapping Up 

Families living with life altering medical problems, like dementia disorders are faced with impossible scenarios and are doing the best they can with very challenging situations.

 

The clinical work in these situations is not about absolution. It is about accompaniment. Sitting with people through some of the hardest things they will ever do, helping them stay accountable without being destroyed by it, and reminding them — when they can’t remember it themselves — that love and imperfection have always gone together.

 

 

 

Related Courses & Continuing Education

 

If this article resonated with you, join me for my upcoming course on Therapy Across the Stages of Dementia from Individual to Caregiver Family Therapy (6 CE Credits)

 

 

Related Articles

• Deception, Relocation, and Dementia Care: Is it Ok to Lie to a Person About Moving To Memory Care?
• Transfer Trauma in Older Adults: Relocation Stress, Identity Loss, and How Therapy Can Help
• Separation Anxiety in Older Adults: What Every Clinician Needs to Know
• Aging Parent Calling Too Many Times a Day? 5 Next Steps

• Do Caregivers Really Die Before Their Loved Ones? What The Science Actually Says
• Grieving Someone Who’s Still Alive: Understanding Ambiguous Loss