What is the validation approach to dementia?

According to the Validation Training Institute, this approach is a communication method that acknowledges and accepts the reality of a person with dementia. It is based on the belief that even seemingly irrational behavior has a purpose and emotional root, making the validation approach to dementia a powerful tool for caregivers.

Quick Summary

The validation approach to dementia is a person-centered communication method focused on acknowledging and respecting the feelings and perceived reality of a person with memory loss, rather than trying to correct them. It helps reduce anxiety and agitation while improving connection and dignity.

Key Points

• Empathy is Key: The validation approach prioritizes empathetic listening and understanding the emotions behind a person's words and behaviors, rather than correcting factual inaccuracies.

• Join Their Reality: Instead of forcing a person with dementia to accept your reality, you enter their world to reduce their anxiety and build trust.

• Avoid Arguing: Arguing over facts is counterproductive and can increase agitation. The focus is on the emotional message being conveyed.

• Increases Dignity: By acknowledging and accepting a person's perspective, validation restores their sense of self-worth and dignity.

• Reduces Stress for All: This method lowers stress and frustration for both the person with dementia and their caregivers, leading to more positive interactions.

• Uses Non-Verbal Cues: Techniques include matching emotional tone, using appropriate touch, and maintaining eye contact to establish a connection.

• Based on Unresolved Issues: The theory suggests that many disoriented behaviors are attempts to resolve past conflicts or unmet needs.

• Offers Practical Techniques: The approach includes specific strategies like asking open-ended questions and reminiscing to engage with the person respectfully.

Understanding the Validation Approach

Developed by social worker Naomi Feil, the validation approach is a philosophy and set of techniques for communicating with older adults who are disoriented. Rather than attempting to force a person with dementia back into our reality, the core principle is to step into their reality. This empathetic method recognizes that behind confusing or seemingly illogical behavior lies a legitimate emotional need or an unresolved life issue.

By focusing on the emotions driving the behavior, caregivers can build trust, reduce a person's anxiety and frustration, and foster a deeper, more meaningful connection. This is in stark contrast to older methods like "reality orientation," which often caused distress by repeatedly correcting the individual and highlighting their cognitive deficits.

The Core Principles of Validation

The Validation Training Institute outlines several foundational principles that guide this therapeutic method:

• Empathy and Listening: Active, empathetic listening builds trust and rapport. This involves paying attention not just to the words, but also to nonverbal cues like tone of voice, body language, and facial expressions.
• Acceptance: The caregiver accepts the person with dementia as they are, without judgment. There is no attempt to change their behavior or perception of reality.
• Underlying Meaning: Every behavior has a reason. Validation seeks to uncover the unmet need or unresolved life issue that the person is trying to express.
• Acknowledged Feelings: When painful feelings are acknowledged and validated by a trusted listener, their intensity diminishes. Ignoring or suppressing these feelings can cause them to grow stronger.
• Respect and Dignity: The person with dementia is treated with respect and dignity, honoring their personal history and life experiences.

Practical Validation Techniques

Caregivers can use several techniques to apply the validation approach effectively:

• Use a respectful tone of voice: A calm, low-pitched voice conveys respect and helps to de-escalate tension.
• Establish eye contact: Making genuine eye contact lets the person know they are valued and heard.
• Mirror their emotions: Reflecting the emotion you perceive—for example, saying, “You seem upset”—shows that you are attuned to their feelings.
• Ask open-ended questions: Instead of asking "why," which can be cognitively challenging, ask who, what, when, or where. This encourages them to share more.
• Rephrase their words: Paraphrasing what they said shows you were listening and can help clarify their meaning.
• Use appropriate touch: A gentle, reassuring touch on the arm can provide comfort and connection, if the person is receptive to it.
• Use ambiguity: If the person's meaning is unclear, use vague pronouns like "them" or "it" to engage without confronting.

Validation Therapy vs. Reality Orientation

It's helpful to compare validation with the outdated "reality orientation" approach to understand why the former is so much more compassionate and effective. The differences are significant:

Feature	Validation Therapy	Reality Orientation
Core Philosophy	Enters the person's reality to understand emotional needs.	Forces the person back into objective reality, correcting their perceptions.
Focus	Emotional state, underlying feelings, and unmet needs.	Factual content, time, date, and place.
Goal	Reduce anxiety, restore dignity, and improve communication.	Improve cognitive function and reduce confusion (often unsuccessfully).
Outcome	Builds trust and rapport; reduces agitation and negative behaviors.	Can cause increased agitation, frustration, and withdrawal.
Techniques	Empathetic listening, mirroring, open-ended questions.	Repetitive prompting of facts, correcting false information.

How Caregivers Can Benefit from the Validation Approach

Validation therapy isn't just beneficial for the person with dementia; it also provides significant advantages for caregivers. Caregiving for a loved one with dementia can be emotionally and physically taxing, but this approach offers a less confrontational and more effective way to manage challenging behaviors.

1. Reduces caregiver stress and burnout: By providing a framework for compassionate communication, validation helps caregivers avoid the frustrating and pointless arguments that often occur with reality orientation.
2. Increases feelings of fulfillment: Successfully connecting with a loved one, even in their altered reality, can be deeply rewarding and fulfilling for a caregiver.
3. Improves communication skills: Learning the techniques of validation can improve a caregiver's overall communication skills, which are useful in all aspects of life.
4. Promotes patience and understanding: The philosophy encourages a shift in perspective, fostering greater patience and understanding toward the person's condition.

Example in Action

Consider a person with dementia who insists they need to go home, despite already being in their residence. Instead of saying, "You are home," a validation-trained caregiver might respond by joining their reality:

Person: "I need to go home. My mom is waiting for me."

Caregiver (Validation): "You miss your mom very much. What was it like when you used to live with her?" or "Tell me about her." This acknowledges the emotion (missing her) without contradicting the perceived reality.

This simple shift helps the person feel heard and validated, often leading to a calm, positive conversation about a meaningful past memory. Contrast this with the reality-oriented approach:

Caregiver (Reality Orientation): "You are home. Your mom passed away years ago." This confrontation can cause distress, confusion, and agitation, as the person cannot process or accept this information.

The Final Stages of Validation

Naomi Feil's model also outlines four progressive stages of dementia behavior, from Malorientation to Vegetation. The validation approach adapts its techniques to each stage. For example, during the "repetitive motion" stage, where verbal communication fades, a caregiver might use music or mirror the person's movements to create a connection. In the final stage, "vegetation," validation is still possible through gentle touch, eye contact, and music to maintain a human connection and show respect. The goal is to prevent withdrawal and help the person find peace.

For more information on the principles and practice of this method, consider consulting the Validation Training Institute.

Frequently Asked Questions

What is the difference between validation therapy and reality orientation?

Reality orientation attempts to correct and re-orient a person with dementia to the facts of their current reality, often causing frustration. Validation therapy, conversely, meets the individual in their perceived reality, focusing on the emotions behind their words to build trust and reduce anxiety.

Who developed the validation approach to dementia?

The validation approach, or Validation Method, was developed by social worker Naomi Feil between 1963 and 1980, based on her experiences working with and observing older adults in a care setting.

Can I use validation therapy with a loved one in early-stage dementia?

Yes, validation is beneficial across all stages of dementia. While reality orientation might have limited use in the very early stages for some, validation's emphasis on empathy and dignity is always appropriate and can help prevent future agitation as the disease progresses.

What are some examples of validation statements?

Instead of contradicting, a caregiver can acknowledge the emotion. For example, if a person says, "I need to find my husband," you could respond, "You must miss him very much," or "He must have been a wonderful man." This validates the feeling without arguing over the facts.

How does validation reduce challenging behaviors in dementia?

By acknowledging the emotional distress behind a challenging behavior, you can often de-escalate the situation. The person feels heard and understood, which reduces the need for agitation or withdrawal that often stems from feeling ignored or belittled.

Is the validation approach just about agreeing with everything they say?

No, it's not about blindly agreeing. It's about acknowledging the underlying feeling and experience. For example, you might say, "That sounds upsetting," rather than simply agreeing with a factual inaccuracy. It focuses on the emotional truth rather than the objective facts.

What are the benefits of using validation for caregivers?

Using validation can significantly reduce a caregiver's stress and burnout. It replaces frustrating conflicts with meaningful connections, leading to greater job satisfaction and personal fulfillment in the caregiving role.

What if the person's words are unclear or repetitive?

If words are unclear, focus on nonverbal cues like tone and body language to gauge their emotion. If the person is repetitive, you can still validate the emotion behind the repetition. For example, if they keep saying, "I need to go home," you can respond with the same empathetic validation, addressing the feelings each time.