When it comes to caring for a loved one or client with dementia, caregivers can take several comprehensive approaches. One such approach is validation therapy, a technique firmly based on empathy.
"Validation therapy (VT) is a communication strategy for people with dementia (PD)," explains Dr. Elizabeth Landsverk, geriatrician and author of Living in the Moment: Overcoming Challenges and Finding Moments of Joy in Alzheimer's and Other Dementias . » "The main idea is to compassionately recognize and validate your emotions and perceptions regardless of reality. »
Here, Landsverk and other experts explain how validation therapy works, why it can be helpful for both caregivers and patients, and more.
"Validation therapy (VT) is a communication strategy for people with dementia. The main idea is to compassionately recognize and validate your emotions and perceptions regardless of reality.
—Dr. Elizabeth Landsverk, geriatrician and author
What is validation therapy?
Conceived in the 1980s by American gerontologist Naomi Feil, validation therapy is a kind, empathetic and, yes, validating way to communicate with loved ones and clients with advanced dementia , says licensed psychologist Michelle Feng, who specializes in psychology, geriatrics and Clinical Medicine Specialized Director of Executive Mental Health .
"Feil introduces the skills and tools caregivers can use to "enter their world" to better understand the needs of their loved ones, especially when verbal communication becomes more difficult," says Feng.
Validation therapy beliefs
According to the Validation Training Institute , a nonprofit organization that conducts training and education based on Feil's work, validation therapy practitioners believe:
1. Disoriented older adults, often diagnosed with Alzheimer's dementia , are in the final stages of their lives and are trying to resolve outstanding issues so they can die peacefully.
2. Their final battle is important and caregivers can use empathy to help them express what they want to express, whether in verbal or non-verbal communication.
3. Once they express things that have often been suppressed for years, the intensity of the feelings in turn decreases, allowing them to communicate more and retreat less into later phases of disorientation.
"It may seem counterintuitive for caregivers to acknowledge something they know isn't true, such as seeing someone they know dead," says Lucy Andrews, PhD, registered nurse and CEO of At Your Service Home Care and International Brain Protection System . "But what they really realize is that a loved one or someone they care about sees it and believes it. It's a subtle but significant difference.
Here Feil practices validation therapy with a nonverbal patient:
The principles of validation therapy.
These are, according to Andrews, the basic key techniques and practices of validation therapy, which build on Feil's work:
- Empathetic listening. Caregivers must actively listen to understand the emotional need behind the words.
- Reflect emotions. Instead of facing reality, caregivers must mirror the feelings expressed by the person with dementia.
- Nonverbal communication. Maintain eye contact, use a gentle tone and appropriate physical touch to convey understanding and empathy.
Other techniques, Landsverk said, might include "moving loved ones or patients from noisy, crowded environments to quieter, more relaxed places, playing relaxing music, and engaging in pleasant conversations."
Can families and caregivers use validation therapy?
The Validation Training Institute offers a range of courses and training (mainly online) for family members and professional caregivers, covering a variety of situations and circumstances.
However, Andrews points out that a license is not required to practice FP. "Family members can use the technique without certification," he says. "However, training is beneficial for both professionals and family members to ensure that the foundation for the effective use of validation therapy is laid." »
For caregivers who wish to provide validation therapy (particularly family caregivers without formal training), it is important to note that VT is not a one-size-fits-all solution. "Validation therapy involves adaptability," says Andrews. "Every person with dementia is unique and therefore the approach must be tailored to their specific history, preferences and emotional needs. »
Specific examples of validation therapy
Validation therapy is about "going with the flow," Feng says, adding, "Caregivers can think of it as meeting the person where they are." The goal is not to convince family members or redirect or correct patients. Rather, the goal is to make them feel understood and safe.
"Caregivers can see this as meeting the person where they are. The goal is not to redirect or correct family members or patients. Rather, the goal is to make them feel understood and safe.
—Michelle Feng, licensed psychologist specializing in psychology and geriatrics.
Below are two examples: the first from Andrews and the following from Landsverk:
Example 1: Mr. Johnson, an 82-year-old man with dementia, sometimes believes he is still a principal. At night ( when the sun goes down ) he becomes restless and feels like he has to prepare for the next day at school.
Validation of the therapeutic approach:
Respond with empathy. Instead of telling Mr. Johnson that he is retired, his family or healthcare provider could say, "You must be very dedicated to your work as a principal." What did you enjoy most about it?
Participate in your reality/reflect your feelings. The supervisor can start a conversation about their experiences as a director to help them remember them and feel valued.
Smooth forwarding. After discussing his job as principal, the counselor may gently guide him toward a relaxing evening activity, perhaps related to his previous occupation, such as organizing books or planning a "lesson" for the next day.
"The use of validation therapy in these circumstances helps to reduce Mr. Johnson's anxiety, makes him feel understood and acknowledged for his previous preoccupation, and allows him to transition smoothly into a more relaxed evening routine," explains Andrews.
Example 2: Ms. Jones's husband died last year, but she keeps asking where her partner is.
Validation of the therapeutic approach:
Respond with empathy. "Instead of confronting them with the facts every time and leaving them devastated over and over again, show compassion and dance around reality," says Landsverk.
Participate in your reality/gently redirect. Tell her you went fishing with the boys, then change the conversation by asking her about the fishing trips she took with her husband, suggests Landsverk.
Note: One of the challenges that validation therapy can present for caregivers is the feeling that they are lying. "One misconception about validation therapy is that it involves deception," says Andrews. "However, it is more about addressing the emotional truth of the person with dementia."
How validation therapy can help people with dementia
Here are some ways validation therapy can help adults with dementia, as well as their families and/or other caregivers, according to Feng, Landsverk and Andrews.
1. It can provide convenience
According to Feng, much of what caregivers say to people with dementia , especially in advanced stages of dementia, is forgotten. "However, the feeling of the caregiver leaving lasts longer," he says. "Therefore, a person with dementia may not remember their caregiver, but may respond positively to them based on how they felt around them. Many of the tools of validation therapy can help promote this sense of comfort and connection.
2. It can help avoid overwhelming emotions associated with constant reality checks.
While TV caregivers meet patients and their families where they are, reality therapy is the exact opposite and can be very powerful. "Reality therapy only deals with the facts: it is Wednesday March 7th, they are in the nursing home, their parents have died, their children are older, they are no longer working, etc." Landsverk notes. "Confronting people with disabilities with their realities can be overwhelming, confusing and irritating. Furthermore, it is not uncommon for them to completely forget the explanation after a few minutes and continue to insist that they pick up the children or attend that meeting.
3. Helps build connections
Through validation therapy, caregivers interact with people with dementia in their current state, which can promote bonding , says Landsverk. "Television is the basis for the spread of aggression, in the sense that it recognizes what a person with dementia feels and thinks and does not try to make them see the world differently than they perceive it."
4. It can reduce anxiety and restlessness.
Andrews points out that fear, anxiety and aggression can be reduced because carers and dementia sufferers have no difficulty communicating with each other.
"The thoughts at the time don't tell us what happened to you who chose to have a particular accident, such as a car accident, and that four other people in your same accident had a bigger accident than us," she explains. "We continue to be convinced that we are certain that we have seen what we have seen and that we cannot be convinced of anything else." This is how hallucinations and other brain abnormalities occur in people with dementia; They are absolutely convinced that their reality is real. Trying to convince them that this isn't the case can lead to fear, aggression, or withdrawal.
5. Caregivers are less stressed
According to the Validation Training Institute, nurses generally "feel less stressed and frustrated…and daily life becomes easier" for the reasons mentioned above.
The essential
Validation therapy is a gentle way of caring for patients or their loved ones with dementia, and Andrews notes that it represents a unique change in dementia care .
"By validating the feelings and experiences of people with dementia, caregivers can provide comfort and understanding, thereby improving their loved ones' quality of life and more positive interactions," she says, adding, "Although this requires patience and empathy, it is a positive experience with implications The impact on people with dementia and their carers is significant. This approach is not just about managing dementia, but also about connecting with people in their most vulnerable moments and affirming their vision and their reality.
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