How to use Validation--

If you are a physician:

Example: You are an internist. You have been 90-year-old Elsa John's physician for 30 years. When you examine her, she insists that you are her husband and demands that you take her home.

Should you:

Assure your patient, gently, that you are not her husband. Remind her that he died 20 years ago. Reassure her that she lives with her daughter. Tell her that she sold her home long ago.

No. Convinced against her will, your 90 year old patient will argue with you. She will feel alone and forsaken. She has lost her capacity to classify people. You have the same manner as her husband, you are touching her body, so you have become her husband. You are a symbol of her husband. In Validation, a symbol is something or someone in present time that substitutes for someone or something from the past. She is meeting her human needs to be close to someone. He logical thinking centers are damaged, so she can no longer tell clock-time. She returns to the past. Her home symbolizes independence and well being. She has never learned to be old and alone.

Medicate her to reduce her anxiety.

No. Often, medications can lead to withdrawal. Her emotions are now stifled. She no longer says that she wants to go home. She no longer expresses herself. She stops talking and sits, staring out the window, in a daze, a living dead person.

Empathize with her need to return to the past when she felt loved and needed. Accept her physical deterioration; her loss of logical thinking and her inability to tell clock-time, her loss of social controls. Use these Validation techniques:

Center: When you are embarrassed or frustrated by the behavior of an older patient diagnosed with dementia, you cannot listen to them. You will become judgmental. Busy with your own emotions, you tune out the other person. Centering is a way of breathing that clears your emotions so that you can take in the feelings of another. Inhale through your nose and follow the breath mentally to a spot about 2" below your waist. This is your center of gravity. Mentally exhale from your Center. Repeat this breathing, inhaling through the nose, exhaling from the Center, five times.
Express her emotion, matching her emotion: e.g., "You need John (her husband). You miss him a lot. You were so close."
Use Polarity - the extreme: e.g., "What do you miss the most about him?"
Re-Phrase: e.g., "You want to be back in your own home. What would you do there?"
Reminisce: e.g., "Did you build the house with John?"

When you are a Nursing Assistant

Example: While you are giving him a shower, your 88-year-old patient, diagnosed with Alzheimer's Dementia, wants you to rub his penis. When you refuse, he masturbates. Should you:

Use behavior modification. Negative reinforcement. Remove his hand from his penis. Get him dressed. Tell him that you will not return if he continues this behavior.

No. Your patient will become hostile. Unable to control his sexual needs, with no outlet to express them, he will either withdraw or strike out.

Hide your embarrassment. Pretend it never happened. Divert him by taking him to another room and play Bingo.

No. Your patient has lost cognition, self-awareness, and social controls. When the Bingo playing is over he will continue to masturbate.

Acknowledge his need to express sexual feelings: e.g., "Mr. Jones, you really miss being close to a woman and having sex." Use these Validation techniques:

Reminiscing: e.g., "Do you remember the first time you had sex?"
The Preferred Sense: tap his visual memory, e.g., "What did she look like? Did she have blue eyes?"

These Validation techniques build trust. Without trust, Validation doesn't work. The man chuckles as he pictures the scene in his minds eye. He remembers the moment in detail. Expressing his sexual feelings, he does not need to act them out as much. An important Validation principle is when feelings are expressed and validated, they dissipate and lose their strength.

When you are an adult child

Example: Your 92-year-old mother is diagnosed with Alzheimer's Dementia. She hides her picture albums, her scrapbooks, and her wedding ring, and then she accuses you of throwing her precious things away. When you find her ring and her pictures, she turns her back on you and walks away, muttering "How do you know where they were? You got them out of the garbage can where you threw them." Should you:

Convince your mother that she hid her things herself. Show her where you found her things. Assure her that you do not need her things. You have your own wedding ring.

No. Your mother will argue with you because on an unconscious level of awareness, she knows you are right. She hid her precious things in the middle of the night herself, but she cannot admit it. She cannot be honest with herself. She never was. She hid her things on purpose to express her feelings of loss. Her picture albums, her scrapbooks, and her wedding ring symbolize her losses: her youth, her husband, her sexuality. She feels as if she is being thrown in the garbage. She accuses other people of robbing her because she cannot be responsible for what has happened to her. She yells at the world to relieve her anger at being robbed of her youth. When no-one listens, her accusations increase.

Use the "Therapeutic lie." Agree with her. e.g., Yes, you stole her wedding ring and picture album, but now you are returning them. She doesn't have to worry. You won't steal them again.

No. Your mother will be quiet for a moment, but she will not trust you. Deep down, she knows you are lying, patronizing her to keep her quiet. The next night, she will hide her things again. She needs to vent her feelings at being robbed, but no one hears.

Help her express her rage. Empathize with her fear of aging, dependence, loneliness, and death. Understand that her possessions are symbols of her youth. Use these Validation techniques:

Rephrase: e.g., "Your wedding ring is gone, and you say I have stolen it?"
Use the visual sense: e.g., "That was that beautiful white gold wedding ring with the date of your marriage engraved on the inside."
Reminisce: e.g., "How old were you when you were married, Mom. How old was Dad. How did you meet him?"

If you genuinely listen to her, empathizing, she will tell you how much she has lost. If you use these techniques every day, for about ten minutes, after about three weeks, her grief will lessen. She will stop hiding her possessions as much. She is not cured. You can't cure aging. It's too late to give her insight. She will not face her fears directly. But now she will feel less fearful and safe with you, because she trusts you because you listened and understood.