The Validation Breakthrough Simple Techniques for Communicating with People with "Alzheimer's- Type Dementia," Second Edition By Naomi Feil, M.S.W.

Excerpted from the Chapter 2 of The Validation Breakthrough: Simple Techniques for Communicating with People with “Alzheimer’s-Type Dementia,” Second Edition by Naomi Feil.

Copyright © 2002 by Naomi Feil. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Chapter 2

WHAT IS VALIDATION?

Validation is a therapy for communicating with old-old people who are diagnosed as having Alzheimer’s disease and related dementias. It is a therapy that I developed over a period of many years. As a gerontological social worker, I worked for decades with disoriented nursing home residents. Over the years, I noticed that old-old people with Alzheimer’s type dementia tended to engage in similar kinds of behaviors. Eventually, I identified different clusters of physical and behavioral traits that distinguish different groups of disoriented old-old people. Between 1963 and 1980, I formed a set of beliefs about why old-old people behave the way they do. From this understanding of their behavior, I developed techniques for communicating with them. Validation developed directly from my experience with old-old residents of nursing homes.

Validation is based on an attitude of respect and empathy for older adults with Alzheimer’s-type dementia who are struggling to resolve unfinished business before they die. Validation suggests a way of classifying the behaviors of these disoriented old people and offers simple, practical techniques that help them restore dignity and avoid deteriorating into a vegetative state.

Validation provides disoriented old-old people with an empathetic listener, someone who does not judge them, but accepts their view of reality. As the trust between the old-old person and the validating caregiver grows, anxiety is reduced, the need for restraints lessens, and the sense of self worth is restored. Physical and social functioning improve and withdrawal to a vegetative state is prevented.

THE PRINCIPLES OF VALIDATION

Validation presupposes the following fundamental, humanistic beliefs and values.

• All people are unique and must be treated as individuals.
• All people are valuable, no matter how disoriented they are.
• There is a reason behind the behavior of disoriented old-old people.
• Behavior in old-old age is not merely a function of anatomic changes in the brain, but reflects a combination of physical, social, and psychological changes that take place over the lifespan.
• Old-old people cannot be forced to change their behaviors. Behaviors can be changed only if the person wants to change them.
• Old-old people must be accepted nonjudgmentally.
• Particular life tasks are associated with each stage of life. Failure to complete a task at the appropriate stage of life may lead to psychological problems.
• Empathy builds trust, reduces anxiety, and restores dignity.

To understand a person’s behavior, his or her physical strengths, social needs, and psychological needs must be known. Behavior cannot be judged appropriate or inappropriate unless it is viewed within the context of these needs. For example, a 13-year-old is expected to rebel. Physically, the glands are changing, making it difficult to control behavior. Teenagers swear at their parents, slam doors, and then become contrite. We know that this may be a normal psychological, social, and physiological reaction for a teenager and do not label such behavior as manic depressive. The same behavior in a 45-year-old man, who abused his colleagues and then became depressed, might be diagnosed as manic depressive. Our expectations of a 45-year-old man are different from our expectations of behavior of a 13-year-old. All behavior must be viewed within the context of what is appropriate at each stage of life.

Validation theory and practice is based on the following principles.

1. Painful feelings that are expressed, acknowledged, and validated by a trusted listener will diminish.
2. Painful feelings that are ignored or suppressed will gain strength and can become “toxic.’’
3. Early, well-established, emotional memories remain on some level into old-old age.
4. When more recent memory fails, older adults try to restore balance to their lives by retrieving earlier memories.
5. When eyesight fails, they use the mind’s eye to see. When hearing goes, they listen to sounds from the past.
6. Human beings have many levels of awareness.
7. When present reality becomes painful, some old-old survive by retreating and stimulating memories of the past.
8. Emotions felt in present time can trigger similar emotions felt in the past. A validating caregiver acknowledges the loss of eyesight, hearing, recent memory, and social controls of very old people.

A validating caregiver understands that some very old people with a blurry, present day reality can easily return to the past to retrieve familiar faces. They need to go back to mend torn relationships. The validating caregiver does not judge them as behaving inappropriately. Viewed in the context of physical, social, and psychological factors, their behavior is healing; their retrieval of the past is functional.

Validation is based on the notion that there is a reason behind all behavior. Understanding why disoriented old-old people behave the way they do and accepting the way they behave is the key to validating them. The validating caregiver accepts the physical deterioration of the person; enters that person’s world; and becomes a nurturing, trusted authority. The old-old person then feels safe, and begins to communicate, with or without words.

Disoriented old-old people respond to the genuine touching, nurturing, caring, and empathy they feel from the validating caregiver. Increased feelings of self-worth and well-being through Validation often lead to significant changes in behavior. Most importantly, older people in Resolution do not withdraw inward to a vegetative state, but continue to communicate to the maximum of their potential.