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Validation Therapy in Dementia Care

As humans, we have a need for validation. We need to feel loved and accepted. This need doesn't go away just because dementia has profoundly affected someone's perception of the world around them. In fact, their need for acceptance may be increased because their world has been shaken to the core. Validation therapy has proven successful in being able to make a difference in the lives of those living with the devastating effects of Alzheimer's and dementia.

What is Validation Therapy?

As you quietly listen to someone explaining something to you, you may utter an occasional, “Hh huh,” at the correct moments or periodically nod your head. In this exchange, these two actions let the speaker know you are respectfully and actively listening to them. Validation therapy does much the same thing but takes it a step further to overcome the communication loss caused by Alzheimer's and dementia.

Validation therapy is a method of therapeutic communication which can be used to connect with someone who has moderate to late-stage dementia. It places more emphasis on the emotional aspect of a conversation and less on the factual content, thereby imparting respect to the person, their feelings and their beliefs.

This method of communication often prevents argumentative and agitated behaviors. Validation may require you to agree with a statement that has been made, even though the statement is neither true or real, because to the person with dementia, it may actually be both true and real. Additionally, the principles of Validation Therapy attempt to help you determine the underlying cause behind the actions taken or words spoken, and, to discover how those actions or words are true for the person with dementia.

The basic principle behind validation therapy is to communicate with respect, showing that their opinions and beliefs are heard, acknowledged, valued and esteemed, rather than dismissed or marginalized. It may require you to do so even when you don't agree with or believe what has been shared. Because this technique's emphasis is on empathy and listening, it's generally comforting and calming to a person who has dementia.

How is Validation Therapy Used in Dementia Care?

The eleven Principles of Validation Therapy, created by Naomi Feil and discussed in her book, The Validation Breakthrough, define the types of actions or behaviors one should use when communicating with a person who has dementia. Application of these principles fosters validation for them and for the thoughts and feelings they may be attempting to convey.

The theoretical assumptions and bases used to conceive the principles were adopted from the work of other theorists such as Maslow, Freud, Piaget, Jung and Rogers. These theoretical assumptions which also apply to the general population can be used to support the Validation Principles Feil created.

The principles are based on the belief that dementia patients are unique and worthwhile, and that they are in the final stage of life. As such, their actions are driven by their need to take care of unfinished business, so they can face their death in peace. Validation Therapy provides the person with dementia a means of expression, either verbally or nonverbally.

It is centered around a person's needs. Rather than attempting to halt or ignore illogical or irrational behavior, alternatives are offered. The goal of Validation Therapy is to be present and accepting without having to ask why.

Validation therapy encourages us to join them in their reality rather than trying to bring them back to ours. Attempting to force them into accepting reality as we know it to be can have negative consequences. By entering their world, we're able to reduce their anxiety, and they begin to feel a sense of security as empathy is established and trust is built.

The key concepts of Validation Therapy include:

  • As older individuals struggle to find resolution for their unfinished or unresolved issues, they may express past struggles in disguised forms. This could manifest as them retreating into themselves, relying on movements rather than words or totally shutting out the world around them.
  • To help them resolve these past issues or struggles, you must actively listen to them with empathy and respect helping them to feel valued and respected, not belittled, criticized or judged.

What are Some Validation Therapy Techniques?

Some suggestions which line up with the techniques Feil outlined for communicating with a disoriented person include:

  • To prepare yourself to listen empathetically, set your own emotions and anger aside to be dealt with and acknowledged later. Concentrate fully on what they are sharing, making sure you're able to pick up on any little nuance they exhibit or share.
  • Reminisce with them, especially talking about how they were able to solve a problem. A person with dementia cannot learn new coping skills; but, remembering how they handled problems in the past may help them rediscover a way to deal with problems they currently face.
  • If the person with dementia enjoys physical contact, and would not consider you to be violating their space, use touch to establish a relationship with them. Gently stroking their cheek or hand may remind them of pleasant times from the past, such as times when their mother did the same. Remember, people who have problems with others being in their personal space will continue to have those issues, disoriented or not. Respect for their boundaries is important.
  • Maintain close eye contact. Gazing into their eyes will help them feel secure and loved.
  • Music is a great tool. Music and songs often transport us to another place and time. Think how many times a song reminds you of other people, places or events. Non-verbal people with dementia can even sing songs they once knew when they are otherwise unable to speak.
  • Do not argue with them. Arguing with a confused person is rarely productive and leads to frustration and agitation.
  • Use a clear, low (but not quiet) and loving tone. High-pitched tones and soft tones are difficult for someone with impaired hearing to understand. Plus, an overly loud voice can come across as harsh or angry; therefore, do not talk louder than necessary just because they are hard of hearing.
  • Use non-threatening, factual words. A person with dementia is not the least bit concerned in discovering why they behave the way they do. Rather than asking why something was done, focus instead on the more concrete questions of who, what, where, when and how.

As you can see, these techniques are much easier to apply when working with someone you know and even easier if you know them well. Knowing someone's history makes it easier to steer conversations in the right direction, but is by no means a guarantee that it will work every time.  Sometimes you just have to figuratively keep pitching the ball until they're able to hit it and run with it.

Who Created Validation Therapy?

Validation Therapy was developed by Naomi Feil, M.S.W., A.C.S.W. After her birth in 1932 in Munich, Germany, she and her parents moved to Cleveland, Ohio. In Cleveland, she grew up in the Montefiore Home for the Aged where her father served as administrator and her mother as head of the Social Service Department. After high school, she received her Master's degree in Social Work from Columbia University in New York and soon began working with the elderly.

Experiencing dissatisfaction with traditional treatment methods used with disoriented elderly dementia sufferers, Feil developed what we know today to be Validation Therapy. She has written two books about the techniques she uses, Validation: The Feil Method and The Validation Breakthrough.  She currently serves as Executive Director of the Validation Institute and offers Validation workshops in parts of Europe. She is also a popular speaker in North America and Europe; and, she and her husband have made numerous videos and films about aging and the Validation Method.

Summary

By bestowing empathy and respect, Validation Therapy helps a person with dementia feel supported and understood. Validation Therapy restores some of the dignity dementia has taken from them. Ideally, it also provides a sense of peace in their final stage of life. Feeling validated, respected and understood, they are less likely to exhibit the agitation and frustration often characterized by dementia sufferers. This improves their life and the lives of those around them.  Sounds like a win-win for all concerned.

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