When it comes to caring for loved ones or caring for someone with dementia, there are a number of overall approaches caregivers can take. One such approach is validation therapy, a communication strategy that is firmly rooted in empathy and is intended for people with dementia. The main idea behind it is to show compassion and validation when recognising their emotions and perceptions, even though the reality may look different.
Here, we break down how validation therapy works, why it can be helpful for both caregivers and patients and more.
What is validation therapy?
Validation therapy involves utilising empathy and understanding as a communication strategy in the treatment of dementia, with the aim of making the individual with dementia feel acknowledged while preserving their sense of dignity. Designed by American gerontologist Naomi Feil in the 1980s, validation therapy is a gentle, empathetic and, yes, validating way to communicate with loved ones and clients with later stage dementia.
Once verbal communication becomes more difficult, loved ones caring for those with dementia can lean on the skills and tools outlined by Feil in order to better understand the needs of the individual with dementia.
The beliefs of validation therapy
According to a nonprofit organization that hosts training courses and continued education based on Feil’s work, practitioners of validation therapy believe:
1. Older disoriented adults, who are often diagnosed as having Alzheimer’s type dementia, are in the final stage of life, trying to resolve unfinished issues in order to die in peace.
2. Their final struggle is important and caregivers, using empathy, can help them express what they wish to express whether it is verbal or nonverbal communication.
3. Once they express things that have often been suppressed for years, the intensity of the feelings lessens, in turn, allowing them to communicate more and withdraw into further stages of disorientation less.
Although it may feel strange or counterintuitive for caregivers to acknowledge something they know isn’t true, such as seeing a person they know has passed away, it’s important to remember that what they’re really acknowledging is that the person with dementia sees and believes it. And this makes all the difference.
The principles of validation therapy
Here are the basic key techniques and practices of validation therapy, based on Feil’s work:
- Empathetic listening. Caregivers should actively listen in order to understand the emotional need beneath the words.
- Reflecting emotions. Instead of confronting reality, caregivers should echo the emotions the person with dementia is expressing.
- Nonverbal communication. Maintain eye contact, use a gentle tone and appropriate physical touch to convey understanding and empathy.
Another example of validation therapy may be moving the person with dementia out of crowded, noisy places to more peaceful and quiet places, playing soothing music to calm them or engaging in light-hearted conversation.
Can families and caregivers use validation in dementia care?
There is no qualification or certification required to practice VT. However, training may be beneficial for both professional staff and family members who are interested in validation therapy and dementia to ensure the effective use of the technique.
For caregivers hoping to implement validation therapy (particularly family caregivers without formal training), it’s important to keep in mind that although empathy and dementia work well together, VT isn’t one size fits all. It involves adaptability and the ability to tailor the approach to a specific history, specific preferences and emotional needs, since each individual with dementia is unique.
Specific examples of validation therapy
Validation therapy involves a lot of going with the flow and meeting the person with dementia where they are at. The focus isn’t on reorienting or correcting them, it’s on helping them feel understood, safe and secure.
Here are two examples — provided by experts in the field:
Example 1: Mr. Johnson, an 82-year-old man with dementia, sometimes believes he is still a school principal. He gets agitated in the evenings (sundowning), feeling like he needs to prepare for the next school day.
Validation therapy approach:
Respond empathetically. Instead of telling Mr. Johnson that he’s retired, his family or professional care provider might say, “You must have been very dedicated to your job as a principal. What was your favourite part about it?”
Engage in his reality/reflect his emotions. The caregiver can engage in a conversation about his experiences as a principal, helping him reminisce and feel valued.
Gentle redirection. After discussing his job as a principal, the caregiver might gently redirect him to a calming evening activity, perhaps related to his past occupation, like organising books or planning a “lesson” for the next day.
Using validation therapy in the scope of Mr. Johnson’s dementia and treatment helps calm his anxiety, makes him feel understood, recognises his past job as a principal and gives him a smooth transition into a more relaxed evening routine.
Example 2: Mrs. Jones’s husband died the previous year, yet she keeps asking where her spouse is.
Validation therapy approach:
Respond empathetically. Rather than confronting her with the facts every time, which leaves her devastated again and again, try to show compassion and play along with what she believes to be true.
Engage in her reality/gently redirect. Tell her he went fishing with his mates and then switch up the conversation by asking her about the fishing trips she took with her husband.
Note: One challenge validation therapy can present to caregivers is the feeling that they’re lying. However, the notion that validation therapy involves deception is a misconception. It’s much more about addressing and acknowledging the emotional truth of the personal with dementia.
How validation therapy can be helpful for people with dementia
Here are a few ways validation therapy can be helpful for adults with dementia, as well as their family and/or other caregivers, according to the experts.
1. It can provide comfort
Much of what caregivers say to people with dementia, especially later stage dementia, is forgotten. However, the feeling that a caregiver gives them sticks around longer. This means that although a person with dementia may not remember a caregiver, they may still react positively towards them because the caregiver left them with a good feeling and had a positive impact on them. There are plenty of tools within validation therapy that can help facilitate this feeling of comfort and connection.
2. It can help sidestep the upsetting emotions of constant reality checks
While caregivers practicing VT meet patients and loved ones where they are, reality therapy is the exact opposite — and it can be very jarring, since it only deals with the facts. For instance: it’s Wednesday 7 March, they live in a nursing home, their parents are dead, their children are adults, they no longer work, etc. People with dementia may become upset, bewildered or irritated when confronted with their reality. What’s more, it’s not uncommon for them to totally forget the explanation after a few minutes, and continue insisting that they pick up the kids from school or attend a meeting at work.
3. It helps with bonding
Through validation therapy, caregivers engage with people with dementia in their current state, which can promote bonding, according to an expert. VT diffuses aggression by acknowledging how a person with dementia feels, what they believe to be true and doesn’t try to force them to see the world differently to how they currently perceive it.
4. It can reduce anxiety and agitation
Caregivers and people with dementia communicating with each other based on a validation therapy approach can help reduce anxiety, agitation and aggression.
A good example to explain how this is works is to think about how when we witness an event, and we are certain about how we saw it unfold in a certain way. And yet, numerous other people who also witnessed the event saw the same thing happen but perceived it differently to how we did. Each individual is absolutely sure that how they perceived it is how it actually occurred. This is not unlike the way hallucinations and other brain anomalies manifest for people with dementia; they are absolutely convinced that what they see and believe is real. So for us to try and convince them otherwise can create anxiety, aggression or withdrawal.
5. Caregivers are less stressed
For the reasons listed above, caregivers are generally less stressed and providing care for the person with dementia on a daily basis becomes easier.
The bottom line
Validation therapy is a gentle way of caring for patients or loved ones with dementia, and represents a unique shift in dementia care.
When we validate the feelings and experiences of people with dementia, we can provide a sense of comfort and understanding. This improves their quality of life and leads to more positive interactions. It requires plenty of patience and empathy, but the positive impact on both people with dementia and their caregivers makes it more than worth it. Validation therapy is about more than just managing dementia; it’s about connecting with the most vulnerable of individuals, and acknowledging their reality.