Many families struggle to communicate effectively with their loved ones who experience issues with cognition and memory loss. For example, forms of dementia can make loved ones experience a different kind of reality, one where they perhaps live in the past when their spouse was still alive.
Trying to bring someone out of this altered state can be difficult for all involved. For starters, the family feels frustrated trying to establish time and place. The loved one with dementia meanwhile can feel confused, undignified, and hurt when they are pulled from their own reality only to realize that their beloved spouse actually passed years ago.
The end result? Everyone is frustrated and upset.
A better way to approach dementia patients is to not challenge their reality, at least according to Naomi Feil. In the 1960s, she began developing her validation theory for patients with cognitive impairment with no prior history of mental health problems. The goal was to provide empathy to people with cognitive impairment during their final stage of life. Today, many use validation therapy for dementia patients, including those with Alzheimer’s disease.
Validation is at the core of validation therapy. Validation means to communicate respect and validate the other person’s feelings, even if one doesn’t agree with what the other person is saying. Using validation acknowledges and respects dementia patients’ feelings and does not challenge their altered realities, since doing so can be upsetting and does not guarantee that such fantasies will not reoccur.
The creator of validation therapy stresses that while validation is indeed therapeutic, it in and of itself is not actually a form of therapy. In other words, “validation” as a technique cannot cure someone’s underlying conditions and it does not attempt to give the patient insight. Instead, its purpose is simply to meet patients with empathy, which subsequently provides them relief and healing.
The core of validation therapy is simple: use empathy to engage with others and do not challenge dementia patients who believe they are living in the past or another imagined scenario. This is in contrast to reality orientation, which would involve trying to get the dementia patient to enter the current time and location where their spouse is deceased.
In practice that means letting the person with dementia believe that their long-dead spouse is still alive, for example. In other words, instead of trying to provide someone with insight (telling someone their spouse is dead), family caregivers using the validation method would simply listen to their loved one. They would let the older adult continue reminiscing about the past, make eye contact, and use a loving tone to communicate.
This approach to dementia care, Feil argues, allows older people to maintain their self-worth, speak their truth, and find healing by either simply having someone else respect their feelings or even by tackling unfinished business they have from the past.
According to proponents of validating techniques, the benefits include:
Many people advocate for validation therapy, although it is not without criticisms.
For starters, some caregivers and family members feel as if validation therapy is lying to people with dementia. Proponents instead argue that this therapy doesn’t condone lying so much as it condones reducing anxiety by simply not challenging the dementia patient’s altered sense of reality.
Others argue that there is not enough evidence to conclusively say that validation therapy is the single-most effective therapy for reducing anxiety and depression in dementia patients. For example, one review concludes that there are not enough trials to draw any sort of conclusion about the efficacy of this technique.
Dementia can be stressful for all involved; fortunately, knowing how to interact with loved ones who experience cognitive impairment can not only make interacting with them easier and more enjoyable, but also helps preserve the dignity of people with dementia. According to many people, validation techniques may help families better communicate with their loved ones, helping reduce tension and anxiety for everyone in a respectful manner.