When it comes to caring for loved ones or clients with dementia there are a number of overall approaches caregivers can take. One such approach is validation therapy, a communication technique firmly rooted in empathy. It aims to acknowledge and validate the feelings and lived experiences of people with dementia with compassion, irrespective of the reality around them.
Here, we examine how validation therapy works, why it can be helpful for both caregivers and patients and more.
What is validation therapy for dementia?
Validation therapy involves using 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. The approach involves tools for caregivers and loved ones to help them understand the people with dementia in their lives and their lived reality better, particularly when it becomes harder for them to speak.
Validation therapy and dementia
Per the Validation Training Institute, a nonprofit organization that hosts training 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 less into further stages of disorientation.
While it can be hard for loved ones and professionals alike to appear to accept a belief that doesn’t line up with reality, validation therapy is a way of acknowledging what people with dementia feel and experience, making them feel understood.
Here, Feil practices validation therapy with a nonverbal patient:
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 behind 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.
Additional techniques may include moving people with dementia away from overstimulating and stressful environments to somewhere calmer or having a pleasant conversation.
Can families and caregivers use validation therapy?
The Validation Training Institute has a number of courses and training sessions (many online) for both family and professional caregivers that break down a variety of situations and circumstances. Certification is not required to practise the approach, but family members and professionals can benefit from training to help them feel confident with using it effectively.
For caregivers hoping to implement validation therapy (particularly family caregivers without formal training), it’s important to keep in mind that VT isn’t one size fits all. Adapting to the unique individual is key when caring for people with dementia, particularly when taking this approach.
A look at an example of validation therapy
Validation therapy is akin to “going with the flow” and engaging with people with dementia in their current state of mind, helping them feel connected, comfortable and understood.
Here are two examples:
Example 1: Bill, a 75-year-old man with dementia, sometimes believes he is raising his very young children. He becomes agitated in the evenings (sundowning), feeling he has to get ready for taking them to school in the morning.
Validation therapy approach:
Respond empathetically. Instead of telling Bill that his children are now grown up, his caregiver might say, “You must have been very dedicated to raising your children. What was your favorite part about it?”
Engage in his reality/reflect his emotions. The caregiver can engage in a conversation about his experiences as a father, helping him reminisce and feel valued.
Gentle redirection. After discussing his experience of parenting, the caregiver might gently redirect him to a calming evening activity, perhaps related to his past occupation, like organizing his clothes and books.
This application of validation therapy helps to soothe Bill and make him feel seen and heard. Drawing on his past experiences, it eases him into a calmer evening ahead.
Example 2: Laura keeps asking after her mother, who died when she was a child.
Validation therapy approach:
Respond empathetically. Taking a compassionate approach and not engaging directly with the hard fact of her mother’s death can avoid Laura being hurt by the dawning of an upsetting reality.
Engage in her reality/gently redirect. Tell her that her mother’s gone to visit relatives, then ask about trips she’s taken herself in the past.
Note: One challenge validation therapy can present to caregivers is feeling that they’re lying. However, experts suggest that the tools of this approach are focused more on connecting with the individual’s emotional reality as a way of making them feel understood.
How validation in dementia care can be helpful
Here are a few ways validation therapy can be helpful for adults with dementia, as well as their family and/or other caregivers.
1. It can provide comfort
People with dementia tend to forget what the people who care for them say to them, especially in later stages. But the emotions they experience during the interactions linger. Validation therapy tools can help a person with dementia access a sense of comfort around a caregiver even if they don’t know who they are.
2. It can help sidestep the upsetting emotions of constant reality checks
While caregivers practising VT meet patients and loved ones where they are, reality therapy is the exact opposite — and it can be very jarring. The latter approach focuses on concrete information. Yet arriving at an understanding that family members are dead, they are retired, and they’re being cared for in a home can be profoundly upsetting and alienating for the individual with dementia, and they may not retain the information for very long, continuing instead on their present path of perception.
3. It aids in bonding
Through validation therapy, caregivers engage with people with dementia in their current state, which can promote bonding. By acknowledging the feelings of individuals with dementia, the validation therapy approach helps facilitate positive interactions.
4. It can reduce anxiety and agitation
The positive impact validation therapy has on communication between caregivers and people with dementia can help individuals feel less anxious, aggressive and upset.
When multiple people are involved in the same situation, each of them is likely to perceive it in a different way, but hearing about others’ perceptions of that situation is unlikely to make an individual person deeply question their own understanding of what they’ve seen and heard. Similarly, people with dementia experience their hallucinations and other symptoms of the condition as reality. Trying to persuade them otherwise can make them nervous, angry or withdrawn.
5. Caregivers are less stressed
According to the Validation Training Institute, for the same reasons above, caregivers tend to experience less stress and irritation day-to-day.
The bottom line
Validation therapy is a gentle way of caring for people with dementia, and represents a unique shift in dementia care.
Taking an empathetic and patient approach and validating the emotions and perceptions of people with dementia can help improve quality of life. The benefits are significant, helping these individuals feel comfortable and connected when they are at their most vulnerable, and making a major positive contribution to the management of their condition.
