When I wrote about the VERA Framework last month and touched on validation, I realised that I’ve never dedicated a blog post to exploring what validation is and why it’s such an important tool in the box of support for a person with dementia.
My validation experiences
In truth, I had no idea about validation when my dad was alive. We did what felt natural as a family to support dad, but looking back this was a mixture of reality orientation and validation – two terms I’d never heard of then. To sum up what they both mean, reality orientation is where you communicate with the person describing the state of things as they actually exist – where they are, who’s alive (or dead) etc. Validation is where you work with the person’s understanding of the world, you live in their moment and enter their reality (which may not relate to current time and place), recognising and affirming their feelings, emotions, needs etc.
As we became more experienced with supporting my dad, we realised that what I know now as reality orientation served little purpose, and through dad’s love of music we connected almost identically to the way Naomi Feil (the founder of the validation method) demonstrates in her famous film with Gladys Wilson.
I only saw that film once I became immersed in the wider dementia world in the months after dad died. It struck me as the most beautiful example of communicating and connecting between a person with dementia and a person supporting them, and I’ve shared the film far and wide since. However, as Naomi Feil says in the film:
“The breakthrough doesn’t happen every time, the person will not always open their eyes and look at you. But if you keep trying and you keep centring yourself, and really look at that person and really mirror their movements, maybe not this time but the next time you come you’ll have a communication.”
So, what do you need to do to maximise your chances of ‘the breakthrough’?
Gladys and Naomi – A beautiful connection
It’s important to consider the key elements that we see in the film to understand how we might replicate the example it shows. These elements include:
- Good positioning. Naomi is largely interacting with Gladys at her level, although she isn’t sitting down and I would recommend always sitting with a person unless they are standing. It could be argued that at times Naomi is too close to Gladys – some people (myself included) would feel our personal space is being invaded – so always consider the distancing that’s right for the person.
- Eye contact between Gladys and Naomi. This is consistent and hugely important. It connects the two ladies and gives Gladys a sense of feeling safe and being able to trust Naomi.
- Meaningful body language. This is superb. Naomi uses repetitive movement instead of speech, mirroring Gladys by moving with her. You can read more about mirror movements in my blog: ‘Communication – It’s more than just words’.
- Use of touch. Like eye contact, this is another example of an unspoken but highly effective way to communicate so long as the person is happy to be touched. If the person isn’t comfortable with the type of facial contact that Naomi demonstrates, hand-to-hand or hand to arm contact may be a good compromise.
- Pace directed by Gladys. Naomi matches the intensity in her voice to Gladys’ movements, and when Gladys is quiet and peaceful, Naomi matches this, breathing as Gladys breathes. This is really empowering for the person – they are truly in control in a world that may often be trying to control them.
- Naomi’s knowledge of Gladys’ life story. Naomi’s knowledge of Gladys’ life story is crucial for this interaction to be as effective as it is. Knowing the right things to say makes a huge difference. Read my blog: ‘Life story work – The gift that keeps on giving’ for inspiration to start, or continue, life story work for a person you support.
- The music Gladys’ loves. I’ve written many times about the power of music for (most) people with dementia (‘Singing from the same hymn sheet’ documents how I connected with my dad through music). Knowing the music Gladys loves the most helps Naomi to make ‘the breakthrough’.
Important points to remember about validation
Where is the person in their mind? Remember, you’re aiming to join the person in their reality and be in their moment with them, rather than expecting the person to be in the reality you are living in. As a person’s dementia advances, they will likely go further into their own reality, which may place a person who is now in their 50’s, 60’s, 70’s, 80’s or beyond in a much earlier part of their life (childhood, teens or twenties) or in a very different environment or circumstance to that which they are in now. Embracing this difference is at the heart of validation therapy.
Lying. One of the common misconceptions about validation is that it involves lying to the person. That is the not the case. Validation is not lying and if you are using a validating approach you don’t lie.
Feelings and emotions. Key to validation is to consider the feelings, emotions and thoughts behind a person’s communication or actions and help them to find comfort or happiness within their own reality. To illustrate this, let’s look at a really emotionally charged question that’s commonly asked as a person’s dementia progresses and they have lost memories of where key people in their life are now:
“Where is my mum?”
Begin by thinking – what is the need behind asking for mum? The need for our mum is usually a cry for safety, security, comfort and/or love.
A validating approach to this question would mean responding by talking about, and asking questions about, mum. Where might mum be at the time in the day that the person thinks it is and what might she be doing? – IE: would she be cooking the dinner, at work, what was her routine? Do we know about any items or activities that relate to mum?
Recalling fond memories, and any other interactions that involve reminiscing about the person’s life with their mum in a positive way, will be supportive and allow for free expression of feelings and emotions. Clearly, the more knowledge you have about the person’s life story – and in this scenario about their mum – the more successful you are likely to be.
When validation works in response to this question, it redirects the person away from anxiety, anger or upset about where their mum is, and allows a positive interaction to develop that gives the person a warm recollection of memories and/or the opportunity to communicate with pride and passion about their mum. If you incorporate the elements of Naomi’s interaction (positioning, eye contact, touch etc), you will have the best possible chance of success.
Share your love for validation
If you love validation and you’ve used it in the past, or if you are going to try it for the first time, I’d love to hear about your experiences. Do add your comments below.
Until next time…