Years ago, professionals once believed one of the best approaches to interacting with individuals cognitively impaired due to Alzheimer’s and other dementia-related conditions was “Reality Orientation”. This approach was widely used and involved an attempt to draw the impaired person into the here and now as a way to correct confusion and disorientation. It didn’t work so well and many times caused agitation and aggression because the focus was on reality instead of feelings and emotions, which is what validation is all about.
What is Validation Therapy?
As cognitive impairment worsens, one of the most important tools is communication with a focus on empathy and active listening. Reality isn’t as important as how the person is feeling and what they are experiencing at the moment. Regardless of their cognitive status, factual content is irrelevant and emotional well-being is key. Communicating respectfully, showing interest, and creating an environment that calms and comforts are all important aspects of validation therapy.
Who Developed Validation Therapy?
Naomi Feil, a native of Cleveland, Ohio, is credited for the development of validation therapy. She and her parents moved from Germany to Cleveland where her father was an administrator and her mother was a social worker at the Montefiore Home for the Aged. After earning degrees from Columbia University in New York, she entered the world of senior care and quickly picked up that the current methods of interacting with older adults with dementia weren’t effective or successful.
Why Validation vs. Reality?
Trying to get the confused person to enter into reality can be very stressful and lead to negative behavioral reactions. Questions like “What year is it”? or “What city do you live in”? are attempts to draw the memory impaired into their current situation, which they may or may not know. More important issues including how the individual feels, their need for food or drink, the experience of pain or discomfort and even the need to go to the bathroom are immediate needs that require validation. Is the current year more important than the individual’s fear as the sun sets and shadows appear, also known as “Sundowning”? The answer is clearly no.
How to Validate
It’s important to understand what validation is and then how to engage in it with memory impaired persons. The first and most important element of validation is to genuinely care about the person and be fully present with him or her. Then, enter into their reality, which can be very effective in reducing anxiety and agitation. When the caregiver is in their reality, trust and a sense of security may be achieved. Next, focus on emotional rather than cognitive content – in other words, their feelings are more important than their mental accuracy about time, place or objects. Throughout the validation experience, active listening is critical because it focuses on not only what is being said, but the emotions behind the words.
Tips on Validation Therapy
While emotions take precedent over thoughts, there are several tips and strategies to enhance a validating experience. The caregiver may employ the following:
- Use a lower tone of voice while speaking clearly and somewhat slower than usual
- Maintain loving and kind eye contact throughout the interaction
- Use reassuring and nonthreatening physical contact if the individual allows or desires
- Enter the world of their past and reminisce and engage in life review
- Watch old television shows or movies that they’ve enjoyed throughout their lives
- Play music that resonates with their past
- Never argue when the individual makes confused or disoriented statements
Final Thoughts on The Power of Validation for Cognitive Impairment
For some individuals with dementia or memory impairment, their current reality may not be very pleasant. They may have moved from their once beloved home and now reside in a nursing home. Their spouse or children may be deceased. Many feelings emerge from such memories; it is therefore far better to focus on feelings over thoughts or cognitive content. When interacting with someone who is confused or disoriented, validate their experience instead of bringing them into today’s reality.