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Validation Therapy for Alzheimer's Patients

What is the Validation Method?

Not to devalue the importance of groundbreaking discoveries in Alzheimer’s research, understanding how an Alzheimer’s vaccine works doesn’t necessarily help you cope with the day-to-day challenges of caregiving. How can you communicate with your care recipient when they’re not even in the same year as you?

A report from the World Alzheimer's Congress presented information on the revival of the “validation method”, developed over 20 years ago to help caregivers understand and communicate with their loved ones.

People with Alzheimer's exhibit abnormal, sometimes incomprehensible, behavior. For example, they may think they are living in a different time or place or they may continuously repeat a physical gesture. Many people - including professionals - feel that caregivers should handle this behavior by stopping it, ignoring it or correcting it.

According to validation method developer Naomi Feil, MSW, ACSW, this unconventional behavior, while illogical, is an attempt by the Alzheimer’s sufferer to communicate and express their needs. The aim of the validation method is to understand and empathize with the needs the person is trying to express.

Rita Altman, RN, of Country Meadows Retirement Communities in PA, explains:

“All human beings have three basic needs: to express themselves, to be loved or feel secure and the need to be productive or useful. People with Alzheimer’s Disease often must look to unconventional means to express and fulfill these needs. A man who constantly pounds his fists into his hand may have been a successful carpenter earlier in life. Validation helps us understand that he is reliving that work behavior and finding a purpose.”

In her article “Communicating with the Confused Elderly Patient,” Feil gives further examples of the how the validation method works to help communication between patient and caregiver. The following material is an except from this article:

The following scenario, based on actual case experience, depicts a less effective way of responding to disorientation.

Mrs. K: “Doctor, I have to go home now to feed my children.”

Physician: “Mrs. K, you can’t go home. Your children are not there. You are 96 years old. Your children are grown and live far away.”

Mrs. K.: “Oh, Doctor I know all that. That’s why I have to get out of here, right now. I have to feed them. They’re coming home for lunch, and the door is locked. Get me out of here!”

The following response may be more appropriate, because it focuses instead on the objective here and now and avoids asking why - a concept that disoriented older people may not wish or be able to deal with.

Mrs. K.: “Doctor, I have to go home now to feed my children.”

Physician: “What will you feed them?”

Mrs. K.: “Oh, Doctor, I am a good mother.” (The patient here confuses present and past time.) “They love tuna. Do you think that’s good for them?”

Physician: “It has a lot of protein. Is that what you fed your children? Do your grandchildren eat tuna?”

Mrs. K.: “They love it. I brought them all up right!” ( The patient now moves between past fantasy and present reality. When her need to be a good mother is expressed, she can place herself in present time.)

Express the emotional need of the person aloud, thereby affirming the person’s right to feel and to express feelings. Example:

Mrs. K.: “Doctor, I have to feed my children.”

Physician: “You must have been a good mother. You must miss your children.”

Mrs. K.: “You know it. I always cared for them. Whatever they wanted, I gave them. You guessed it. But I get along all right now without them.”

The validation method - when performed appropriately- has proven to be successful in both improving the well-being of the patient as well as reducing stress in both the patient and caregiver. In addition, professional care facilities using this method have shown decreased rates of staff turnover.

Sources

• “What is Validation?” from the Validation Training Institute Inc. http://www.vfvalidation.org/whatis.html

• “Communicating with the Confused Elderly Patient” from the Validation Training Institute http://www.vfvalidation.org/article1.html

• “Basic Concepts of Validation” http://www.healthpropress.com/CATALOG/in-depth/ValTrain.html

Related Articles

• Using Validation Therapy to Manage Difficult Behaviors by Jan Allen, CSW, MSE

• 101 Things to Do With a Person With Alzheimer’s Disease from the Columbia, Missouri Chapter of the Alzheimer's Association

• Crafts and Activities for People With Dementia by Jan Allen, CSW, MSE

• Management of Agitation Behavior by Richard O'Boyle

Recommended Reading

• The Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer’s-Type Dementia, Naomi Feil

• Therapeutic Caregiving: A Practical Guide for Caregivers of Persons With Alzheimer’s and Other Dementia Causing Diseases, Barbara Bridges

• The Complete Guide to Alzheimer’s Proofing Your Home, Mark L. Warner

• The Alzheimer’s Caregiver: Dealing With the Realities of Dementia, Harriet Hodgson

• Interventions for Alzheimer’s Disease: A Caregiver’s Complete Reference, Ruth M. Tappen (Special Order)