Humans carry an inherent need to have their feelings recognized and validated by others. As we age, this need only grows stronger. For people living with Alzheimer’s-related dementia, this need for validation amplifies further as elderly adults try to make sense of their own confusion.
In its latest stages, Alzheimer’s can be emotionally and spiritually overwhelming. Memories from recent days fade away, while people and places from earlier years–parents, childhood friends, days spent in the schoolyard–grow in strength.
For people close to the end of their lives, it can be difficult to draw the line between memory and reality.
This is especially true when memory tends to be more appealing than reality.
For example, someone well into their eighties or nineties might suddenly call out for their mother, sister, or husband, even if their loved one passed away many years ago. In the Alzheimer’s mind, that person is still alive and well, and the expectation could be that today is just another day following a routine from a long time ago.
Validation Therapy vs Reality Therapy
When people living with Alzheimer’s slip into the past like this, caregivers have a choice to make. Do they try to ground the person in reality, using facts and questions to bring them back to present day? Or in an effort to avoid upsetting the person, do they go along with the person’s fantasy, and say that their loved one will be along in a few minutes?
Validation therapy finds a compromise between these two options. Someone practicing validation is not lying–they do not play into the fantasy, or let the person believe what they want to believe. They also minimize the risk of hurting the person with harsh truths, or of the person withdrawing completely because they are unable to face reality. Someone who practices validation therapy can empathize with the person’s emotions, validate their feelings, and open unexplored lines of communication that embrace memory without living within it.
What is validation therapy?
Validation therapy was created between 1963 and 1980 by Naomi Feil. Feil spent her childhood living in a family home for seniors, and found herself frustrated with many of the common “therapies” available for Alzheimer’s.
Namely, Feil found that the oldest adults in the latest stages of Alzheimer’s grew upset or withdrew more if they were forced to face reality in the wrong situations. Someone crying out for his or her mother might go nonverbal or sink into depression if they were told their mother was long dead, no matter how kindly a caretaker approached the subject. And still, claiming loved ones were still alive or routines were the same they had been decades ago felt an awful lot like lying.
Feil’s solution? Validation.
“Validation is a way of communicating with very old people who are diagnosed with dementia,” says Feil in an interview with the Validation Training Institute. “Validation doesn’t cure that old person, but it restores their dignity and their feelings of self-worth. It’s a way of being with them, of stepping into their world, feeling what they feel.”
Validation therapy is not about playing pretend, or committing to someone else’s fantasy. Instead, it is about acknowledging the reality of the emotions behind the confusion. According to Feil, many of the oldest adults struggle to make sense of past events, come to terms with long-distant traumas, and otherwise sort out their own sense of emotional and spiritual fulfilment at the end of their lives. Through validation therapy, Naomi Feil sought to help these people sort through their emotions and memories to find true peace, and embark on the latest stages of life with a clear psyche.
So, how does validation therapy work?
According to Naomi Feil’s book, The Validation Breakthrough, validation therapy follows ten basic principles:
- All people are unique and must be treated as individuals.
- All people are valuable, no matter how disoriented they are.
- There is a reason behind the behavior of disoriented old-old people.
- Behavior in old-old age is not merely a function of anatomic changes in the brain, but reflects a combination of physical, social and psychological changes that take place over the lifespan.
- Old-old people cannot be forced to change their behaviors. Behaviors can be changed only if the person wants to change them.
- Old-old people must be accepted non judgmentally.
- Particular life tasks are associated with each stage of life. Failure to complete a task at the appropriate stage of life may lead to psychological problems.
- When more recent memory fails, older adults try to restore balance in their lives by retrieving earlier memories. When eyesight fails, they use the mind’s eye to see. When hearing goes, they listen to sounds from the past.
- Painful feelings that are expressed, acknowledged, and Validated by a trusted listener will diminish. Painful feelings that are ignored or suppressed will gain strength.
- Empathy builds trust, reduces anxiety, and restores dignity
In practice, validation therapy allows a caregiver to enter their loved one’s reality. Instead of trying to ground the person in present day, a caregiver can find more positive interactions by developing empathy, building trust, and establishing a sense of security. This can be done by:
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- Listening actively. Show physical signs of paying attention, like nodding, making eye contact, and using simple touches.
- Asking questions that help the person discuss an unresolved issue or express their emotions. For example, if someone asks for their deceased sister to come visit, one could say, “You must be thinking about your sister a lot today. Tell me about her. What was your favorite thing to do together?”
- Acknowledging hallucinations positively, but not directly lying. For instance, if someone thinks a stranger or doctor is their husband, it may be more positive to say things along the lines of “You must really miss him,” or “What would you like to tell your husband?” instead of focusing on the husband’s absence.
While the benefits of validation therapy are subtle, they can grow in strength over time.
Research related to validation therapy is still in its infancy. While studies have been unable to draw connections between validation and improved cognition, others have shown positive effects like a decrease in agitation, more open communication, less withdrawal, and a general sense of peace for people living in the latest stages of Alzheimer’s.
For example, a study from the University of Vienna’s Department of Nursing determined that people on the receiving end of validation therapy exhibited non-verbal signs of improved communication. Namely, the impact showed itself in posture, expression, physical contact, and body language. In other words, people with late-stage Alzheimer’s were more engaged and interacted more effectively (although non-verbally) with caregivers practicing validation.
Similarly, Naomi Feil’s research shows correlations between validation therapy and a decreased need for psychotropic medications, like those used to combat depression and anxiety.
A 2004 study held in Australia showed a decrease in behavioral problems among residents in a senior living facility after the introduction of validation therapy. Interestingly, these behavioral issues returned to their baseline statistics after staff returned to more traditional reality therapies.
This goes to show that validation therapy is more effective over time, when adults can continue to feel that their emotions and needs are being heard and understood. Additionally, continued practice of validation therapy gives the elderly more opportunities to process unresolved issues in their lives, through whatever means are necessary.
Ultimately, validation therapy is about respecting a person’s emotions, delivering comfort, and helping them discover peace.
Alzheimer’s-related dementia steals many things from the elderly, including memories, cognition, and sometimes dignity. Through validation, loved ones, caretakers, and physicians alike can help older adults reach peace and a sense of clarity.
From our first moments on Earth to our last, we all carry a need to have our grievances heard, feel our emotions are understood, and find peace in the company of others. Although Alzheimer’s disease often makes it difficult to communicate with loved ones, validation therapy can help open lines of communication that we previously thought were lost.
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Despite having good information its still takes consistent effort to improve your memory
I find this is a validation for me as caregiver for my eldest brother living with dementia. I have been slowing down my mental state to a state of calm, despite having so much going on in my head bc of things needing done. However, he has Primary Progressive Aphasia, making it very difficult to determine what, exactly, is he trying to convey? I never thought I would be doing this in my lifetime.
When I started in this industry 30 years ago I watched a video with Naomi playing the part of a person with dementia and a hairdresser. It was a good example of Validation and I would be interested to find a copy of that video.
Hi Shirene – I have watched a lot of videos that Naomi is part of, but I have never seen that one. I do have a connection with her daughter, who is now the director of the Validation Training Institute. I will ask her if she knows of it and if it available anywhere.
Thank you,