Validation Therapy in Dementia Care
Validation therapy can help improve communication with those who have dementia through empathy and listening.
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Key Takeaways: Validation Therapy
- Validation therapy is an approach to communicating with someone who has dementia that focuses on empathy, listening, and trying to find the hidden need that’s influencing the person’s statement and behaviors.
- This form of therapy is all about acknowledging the individual even if what they’re saying isn’t factual. This can help the person with dementia feel respected and heard.
- You may be experiencing caregiver burnout without even realizing it. Thankfully, Validation therapy is helpful for managing caregiver stress, too.
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 proved successful in being able to improve the quality of life for individuals with Alzheimer’s and other forms of dementia by reducing anxiety and enhancing their sense of well-being.
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What Is Validation Therapy?
As you quietly listen to someone explaining something to you, you may utter an occasional, “Uh-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 that 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 reduces argumentative and agitated behaviors. Validation may require you to agree with a statement that has been made, even though the statement is neither true nor 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 to determine the underlying needs or causes 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 the late 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 can 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.
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Validation Therapy and the Benefits for Caregivers
Dr. Altman notes that “Validation therapy is beneficial for people with dementia and greatly helps their caregivers. By focusing on empathy and understanding, this approach reduces stress and frustration in caregiving. It helps caregivers handle challenging behaviors without confrontation, making their role feel more rewarding. Studies have shown that caregivers using validation therapy feel more competent and satisfied, improving their relationship with the person they care for and creating moments of connection.
Additionally, validation therapy helps prevent caregiver burnout. It encourages caregivers to validate the emotions of their loved ones, reducing the emotional strain of caregiving. This method also enhances communication, helping caregivers better understand and meet the needs of those with dementia. Training programs, like those from the Validation Training Institute, show that caregivers feel more equipped and confident using these techniques, leading to better care and improved well-being for both the caregiver and the person with dementia.
Here’s an example from my clinical work (names changed):
Alice, who has dementia, often focused on how she needed to cook for her children and grew agitated in not being able to find her pots and pans. Using validation therapy, her daughter Jane empathized with her feelings instead of correcting her that she can no longer cook independently. She acknowledged Alice’s upset and sadness about the missing cookware and redirected the conversation to fond memories of cooking, which calmed Alice down.
On other occasions, Jane initiated the cooking and asked Alice for her opinions on adding salt and other spices to include her in cooking and to give her a voice and meet her need for some control in the process. These approaches eased Alice's upset and also made Jane feel more confident and less stressed.” — Dr. Altman
What Are Some Validation Therapy Techniques?
Some suggestions that 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.
- Speak to them at eye level and 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. Nonverbal people with dementia can even sing songs they once knew when they are otherwise unable to speak.
- Do not argue with them or correct them if they are wrong. 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 have hearing loss.
- Use nonthreatening, factual words. A person with dementia is not the least bit concerned about 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 doesn’t guarantee that it will work every time. Sometimes you just have to figuratively keep pitching the ball until they can 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 older adults.
Experiencing dissatisfaction with traditional treatment methods used with disoriented elderly dementia sufferers, Feil developed what we know today as validation therapy. She has written two books about the techniques she uses, Validation: The Feil Method and The Validation Breakthrough. She most recently served as Executive Director of the Validation Institute and offers validation workshops in parts of Europe. She was also a popular speaker in North America and Europe; and, she and her husband made numerous videos and films about aging and the Validation Method. Naomi passed away in 2023 at 91 years of age.
To learn more ways you can support a loved one with dementia, watch our video below with Geropsychologist Abby Altman.
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.
To learn more ways you can support a loved one with dementia, watch our video below featuring geropsychologist Abby Altman.
