Validation Therapy and Dementia: Pros and Cons

Dementia is a decline in memory and/or intellectual functioning severe enough to interfere with social or occupational functioning. Dementia is not a disease itself, but group of symptoms. It is characterized as a progressive decline in cognitive function due to damage or disease (such as Alzheimer’s) in the brain. Areas particularly affected include: memory, attention, judgment, language and problem solving.

Dementia is condition in which a person loses the ability to think, remember, learn, make decisions and solve problems. Symptoms may also include personality changes and emotional problems. Personality does not change with age in the absence of mental disease.

There are many causes of dementia, including Alzheimer’s disease, brain cancer, and brain injury. Some Parkinson’s patients experience dementia at later stages of disease progression

Enter Validation Therapy

The idea behind validation therapy is to “validate” or accept the values, beliefs and “reality” of the person suffering from dementia. The key is to “agree” with them, but to also use conversation to get them to do something else without them realizing they are actually being redirected. So, if an 87 year old woman says that she needs a phone to call her grandmother, validation therapy says, “OK.” Here is an example for a caregiver working with someone with dementia in an adult day care:

Older adult: “I have to find my car keys.”
Caregiver: “Your car keys…” ( Don’t mention he doesn’t have a car and he hasn’t driven for years)
Older adult: “Yes, I need to go home – lot’s of work to do!”
Caregiver: “You are busy today?” (Don’t mention he is at adult day care and isn’t going home for hours)
Older adult: “Hell, yes! I’m busy every day.”
Caregiver: “You like being busy?” (Trying to find a topic of conversation that they might accept discussing)
Older adult: “Are your kidding? I didn’t say I LIKED it. I just have to work  like the rest of the world.” (He’s getting a little frustrated, but seems to have forgotten about the keys.)
Caregiver: “I know about work. I do some of that myself. In fact, I’m getting ready to fix some lunch for us. Care to join me?”
Older adult: “Lunch, huh? What are you having?”

Why Validation Therapy Works: The Pros

The number one reason why validation therapy works well is because it is not confrontational. Never is a person belittled, yelled at, or told “no.” Remember dementia is a group of symptoms, not a disease. It is easy to misdiagnose. For example, people suffering from UTIs (urinary tract infections) are said to demonstrate characteristics of dementia if the infection goes undetected.

Criticisms of Validation Therapy: The Cons

The biggest criticism of validation therapy is that it promotes lying. These lies weigh heavy on the consciouses of caregivers and family members. For example, validation therapy says that a family member should just accept their aging parent calling them someone else’s name, not correct them. When family stories are switched around, the family is suppose to just listen to the stories as they are told. While there seems to be significant emotional harm to caregivers and family members, very little harm is done to the person with dementia; but isn’t it the well-being of the person with dementia that is most important.

Photo credit: jam343

About the Author: Ryan Malone is the founder of Inside Elder Care and author of the By Families, For Families Guide to Assisted Living. He regularly speaks and advises families about how to improve their aging loved one’s quality of life. Ryan is also the president of SmartBug Media, a content marketing agency that helps companies increase leads, customers and influence. You can read more from Ryan on the SmartBug Media blog or follow him on Twitter.

  • Ellen Besso

    Ryan: You're coming out with a lot of fascinating stuff these days! I guess I've been using validation therapy all along with my mother, who as you know, has Alzheimers Disease. To me it's a no brainer. It only diminishes & frustrates the person to correct them all the time (my aunt used to do that with her mother-in-law, my maternal grandmother; ironically and sadly, the aunt developed Alzheimers in later years!).

    Another interest, & pet peeve of mine, is the way many people react to the idea of Alzheimers as if the person is gone – that's not true – I've learned over the past 12 years that most of my mother's personality remains intact, even now when when she is non-verbal for the most part.

    “The Myth of Alzheimers” by Peter J. Whitehouse, MD, speaks to this. The author believes in playing to & using the strengths of the person with dementia & believes the label Alzheimers is a crippling one.

    Ellen Besso
    MidLife Coach, Author & Elder Care Expert
    ellenbesso.com
    “Surviving Eldercare: Where Their Needs End & Yours Begin”

  • http://www.smartbugmedia.com Ryan @ SmartBug Media

    Thanks Ellen,

    There is a lot of info that people don't cover that needs to be address. Glad you like it.

    I've not read that particular book, but I have read Alzheimer's from the Inside Out by Dr. Richard Taylor. He's a great guy and has an amazing story and outlook.

  • http://www.AHelpingHandVA.us Kevin Parks

    I share your frustration… I am so disappointed when I hear a caregiver, or any facility staff member, speak to/at/of a resident with dementia as if they're “not there”. They are absolutely there and need to be treated as such. If we claim we are truly champions for this vulnerable population, I really feel we have a responsibility to educate those entrusted to provide the front-line care for these folks. However, more important, the administrator and every member of the management team needs to take the lead on this and ensure they understand Naomi Fell's validation therapy and praise and promote it within their communities.

    In the greater Richmond, VA area, we are blessed to have wonderful, passionate folks leading our local chapter of the Alzheimer's Association, and these gals have been teaching validation therapy from day one. However, I continue to meet caregivers and managers that just don't seem to get it.

    Anyhow, thanks for your post and continued support of championing quality of life for seniors…

  • http://www.smartbugmedia.com Ryan @ SmartBug Media

    Agree, Kevin. Thanks for coming by.

  • Linda Lewis

    Ryan – This is very interesting, especially, “people suffering from UTIs (urinary tract infections) are said to demonstrate characteristics of dementia if the infection goes undetected.” My father's dementia was much worse when he had a UTI! I'm passing this info along.

  • http://www.smartbugmedia.com Ryan @ SmartBug Media

    Another crazy one is the pharmaceutical induced dementia that many seniors faced when they get into and out of the hospital. My mother almost always experienced that after she had one of her many surgeries.

  • Rcbornstein

    Validation is not promoting lying because you are not allowing the person to search 6 hours for keys or pace the hallway all day looking for their mother. Redirection is like helping someone who is drowning, in this case, in their own mind.
    In my horticulture therapy practice, I am redirecting my classes all day to keep them on track. We all redirect our employees, children, friends. It does not have to be considered lying. Validation is a wonderful tool and it works with anyone you are communicating with.

  • http://www.smartbugmedia.com Ryan @ SmartBug Media

    Great comment, and I agree with you. Redirection pops it head up in many places beside just dementia care. Unfortunately, it is consider “okay” in those environment and sometimes perceived to be a negative when utilized with seniors.

  • W0095461

    I'm a nursing student who is currently doing a paper on validation therapy VS reality orientation therapy. I found your article to contain very valuable information on the subject, and used some of your information as quotes in my paper. I hope we receive an outstanding grade!

  • http://www.smartbugmedia.com Ryan @ SmartBug Media

    Fantastic. Good luck on it!

  • http://www.stressfreecaregiving.com Anne

    I realize I am too late to assist with your paper but I have seen first hand the effects of validation vs. reality orientation therapy. I cared for an elderly woman who everyday around 5 began looking for her husband to return home. She would ask everyone who passed by her if they had seen him. The answers such as “I am sure he is on his way. What are you fixing for supper?” seemed much more humane to me than the MAKE THEM SEE THE TRUTH individual who chose to remind the lady that her husband was dead and had been. At that point the poor lady relived every emotion you would expect if she were hearing the information for the first time. She did not remember he had past away so it was new information to her. She cried for hours and wanted to know why she hadn't been told and why she had missed the funeral. She went throught the entire grief process. It was pitiful. I use validation therapy all the time and teach it to all my family caregivers. I preface it by “God forgives these humane lies”.

  • http://www.smartbugmedia.com Ryan @ SmartBug Media

    Anne – I really appreciate your response and your example. I think when more people see these real world examples, they would realize just how powerful validation therapy is. Have a great week.

  • http://wwwbicanart.com/ Bikmen33

    To be abel to continiue an on going conversation to give time to discover different facts and possibilities one should take his time . To eliminate the factors that may cause; dementia like symptoms;therapist’s;contradiction for believes is. number one; is unrealistic to change ., Second ;?t’s the end posible therapeutic alliance .
    ??think validation is a tecnik necessery aprouch for dementia like patiaces 

  • Patrick

    I whole heartedly dissagree with the lying comment in this article. If the caregiver is simply assuaging the person with dementia out of convenience than I could see this tactic being less-than helfpul. If a caregiver truly believes they are lying to the person than I would suggest more training and sensitivity to people with dementia and professional care. The reason why caregivers use this technique is to enter into the patient’s world and reality and is not deceitful in the least bit. Lastly, the caregiver, using your expample, could say:

    Let’s go to lunch first than we can go back to work.

    The caregiver is validating his desire to contribute to society and redirecting the individual.

    Something to think about.

  • Roné Jansen van Vuuren

    Would like to do a validation therapy course in South Africa – can you guide us to the right place – Alzheimer’s South africa North West Region

  • http://wardipedia.gunpowderclients2.co.uk/64-talking-therapies/ 68. Talking therapies |

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  • http://www.facebook.com/linda.shell.37 Linda Shell

    Volunteers of America is an authorized validation organization and believes strongly in the validation approach for re-directing elders with dementia. When an elder is asking for their mother, they know deep down that she is gone, but are longing for the feelings of being with a mother such as love, comfort, security, touch. Their requests and comments are insightful into identifying their needs and providing appropriate interventions. For more info or classes on Validation please visit voavalidation.org. We have seen outstanding results from validation in elders with dementia. Validation is of great benefit to families and professional caregivers.

  • http://www.ryanmalone.com Ryan Malone

    Linda:
    We love VOA and did an interview with your CEO a while ago. Say hi to David and the gang for us. – Ryan

  • http://www.facebook.com/lmrein1 Lisa DiMaio Rein

    I’ll never forget the lesson I learned early in my nursing career when I tried to “orient” a dementia resident. She told me she needed to get home as her mother was waiting for her. I proceeded to explain to her that she was 80, in a nursing home and mother had passed a long time ago. I’ll never forget her reaction! The emotional upset I caused her, however brief, served as a lesson to me and I still remember her 30 yrs later. I have a much better understanding and let’s be honest, hatred of dementia but I do love my residents and strive each day to make some sort of connection.

  • http://www.ryanmalone.com Ryan Malone

    Thanks for sharing Lisa

  • Lisa Douthit

    One thing that I see as problematic throughout healthcare is that the well-being of the person with dementia is more important than the caregiver. I do not agree with this. Both persons well-being is important.

  • Guest

    Thank you. We open our homes, give up our privacy, put our lives on hold to take care of our loved ones, and on top of that we are expected to absorb with a patient smile behavior that would be considered abusive in a healthy person. Must we ‘validate’ when we’re accused of stealing or worse? Doesn’t a caregiver, especially a volunteer family caregiver, have some rights as well?

  • Fergy

    I disagree with the statement that Validation encourages lying. It doesn’t and Naomi Feil who founded the method argues strongly against lying. Validation uses the conversation to take the sufferer to another branch of thought so that the care givers do not have to lie. It is very important to understand that with validation you are empowering both the sufferer and care giver

  • Rosemary Holst

    Of course caregivers have rights and I know that caregiver stress can be beyond imagining….validation therapy is designed to lower the stress of both the caregiver and the person with dementia…the example with the car keys…would you choose to have the person stress for hours over car keys that no longer have real meaning for them and thus stressing you out as well or redirecting the person which calms them and in turns calms you? When you are accused of stealing or called abusive names do not react but REDIRECT…peace for both of you…