Using Validation in Care Partnership
The Validation method can improve communication between care partners and persons living with dementia.
This article was written by a guest contributor, and the views, thoughts, and opinions expressed in this article belong solely to the author.
Some of you may have heard of the Validation method, others not. Perhaps you’ve heard of ‘person-centred care’. Well, Naomi Feil, the founder of the Validation method, inspired that focus-shift from housing elderly out of the way and keeping them ‘calm’ with tranquilizers, to engaging older adults and helping them connect and communicate in their final stage of life. She was the first person to say caregivers need to step into the shoes of the older person and get into their reality.
There are a few important principles that I’d like to share that I think will help you every day:
Disoriented older adults should be accepted as they are: we should not try to change them.
Simple, right? But what does that mean when your disoriented parent is blaming you for stealing her money, or when a resident is demanding that you let them ‘go home!’? Often our first reaction is to say, “No, I didn’t steal your money,” or “You live here now.” That’s reality orientation, asking the older adult to accept our reality.
Another reaction might be:
Mom: You took all my money.
Son/daughter: Oh, I’ll put it right back.
Resident: I have to go home NOW.
Caregiver: Well, they called and said they will pick you up a bit later.
These reactions are what is often called ‘therapeutic lying’, playing as-if you believe what the older adult says is true. In Validation, we never lie to a client because deep down, the other really knows the truth and lying to them breaks down trust.
"There is always a reason behind the behaviour of very old, disoriented people ... Usually, we can better understand what is going on by looking at the history of the person."
– Vicki de Klerk-Rubin
There is always a reason behind the behaviour of very old, disoriented people.
Using the above examples, let’s look at what MIGHT be the reason behind those expressions of needs. Usually, we can better understand what is going on by looking at the history of the person.
Mom was a refugee, lived through very lean times and has always been concerned about having enough money. Also, she has not been accepting of her aging process. She denies that she has memory loss, feels that she can do everything she used to do and is resentful of all the help she really needs.
So when she says, “You took all my money”, the Validation practitioner makes the connections and understands: mom is scared of being out of control, terrified of losing her money, her mind, her youth and her life. Her coping mechanism is to blame whoever is in charge – you.
The resident who wants to go home was a housewife and mother. She had three children who were the center of her life. Her husband never played a large role in her life. When the kids grew up and left home, she volunteered at the local primary school serving lunches and helped in the nursery school. She took care of her grandchildren every day so her daughter could work. When the grandchildren didn’t need her anymore, she started to isolate at home. Her memory failed, she stopped caring for herself and her husband eventually had her placed in a long-term care community.
The Validation practitioner understands that this history plays an important role in her statement, “I want to go home NOW.” Perhaps she misses her role as a mother, a caregiver. Perhaps she misses giving and receiving love from children. Perhaps she feels useless and desperately wants to feel useful. This woman’s coping mechanism is to retreat into a personal reality where she strives to fulfill her needs.
How to respond using Validation
How would a Validation practitioner respond to these two older adults? Understanding that every session is different and there is no recipe for which technique one should use, here are suggestions for validating responses:
Mom: You took all my money!
Me: All your money is gone?
Mom: Don’t be surprised – you know.
Me: What else is gone?
Mom: Well, now that you ask, I can’t find my calendar. You know, the big one where I write down everything.
Me: Wow, you must feel really lost without that calendar. And the money is so important to you.
Mom: Exactly! I do feel lost!
Me: What do you think would help?
Mom: I need to find them.
Me: Okay. Do you want me to help or are you happier on your own?
Mom: No, you can help. [Together they look at her checkbook and find the calendar under a stack of papers. Mom feels less anxious and they spend the next half hour going through her schedule of events.]
Resident: I want to go home NOW.
Me: Right NOW? What happens if you’re not there?
Resident: The children will be alone.
Me: Alone, my goodness. How many children are there?
Resident: Well, there’s Jane and Bobby and Sarah and….
Me: … And you have to take care of them?
Resident: I always take care of the children.
Me: What a good mother you were!
Resident: You know, I took care of so many children.
Me: Was that your favourite thing to do?
Resident: Oh yes.
Me: You gave so much love. What’s the most important thing to do for children?
Resident: Oh, you have to make sure they feel loved and safe. You have to always be there for them. And make sure they know they are good. Self-confidence, you know, is so important.
Me: You’ve put a lot of thought into caring for children and know so much. You should write a book!
Resident: (Laughing) Yes I should! I could write a good book! [Arm in arm, they walk to a common room as they continue to talk about what should be in the book.]
ABOUT THE AUTHOR
Vicki de Klerk-Rubin is the Executive Director of the Validation Training Institute and is a Validation Master. She lives in The Hague, Netherlands. She has a BFA from Boston University, an MBA from Fordham University and did her nursing degree at Higher Technical School of Amsterdam.
Together with her mother, Naomi Feil, she revised the books, Validation: the Feil Method and The Validation Breakthrough. She authored Validation Techniques for Dementia Care: the Family Guide to Improving Communication and a workbook titled Communicate with older adults with cognitive decline: Validation for First Responders.
Since 1989, Vicki has given Validation workshops, lectures and training programs in Austria, Belgium, China, Denmark, England, Finland, France, Great Britain, Germany, Ireland, Israel, Italy, Japan, Jordan, Luxemburg, the Netherlands, Spain, Sweden and the United States. She has also worked in nursing home facilities in Amsterdam, leading Validation groups and training staff. Vicki is proud of her contributions to the development of Validation certification levels, curricula, the VTI quality standards, guidelines and the Authorized Validation Organization (AVO) structure for offering training around the world.
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