Maria Montessori was the first female physician in Italy, and she specialized in rehabilitative medicine and pediatrics. Her initial work was with children in a psychiatric ward in Rome, and later she developed educational programs for children in one of the poorest neighborhoods in Rome. Over time, Montessori’s method was expanded to encompass birth through high school. Our work has extended the Montessori method into adulthood, with an emphasis on working with persons with dementia, which we call the Montessori Inspired Lifestyle®.
The Montessori method is based on the values of respect, dignity, equality, and trust which are to be shown to everyone. She was a strong and vocal proponent of human rights and peaceful conflict resolution. Her rehabilitation perspective emphasized looking for the abilities within the individual and building upon those strengths and using these to engage the individual in meaningful activity. Environments are designed to support individuals such that disabilities can be circumvented using physical and social “cognitive ramps,” (similar in function to ramps that allow persons in wheelchairs to navigate their environments more independently). In addition, there is an emphasis both on regaining past abilities and in new learning, which is available to persons with dementia. This enables individuals to function as independently as possible, while fostering collaboration and a sense of community. The principles and techniques of the Montessori method recently have been expanded to improve staff engagement in senior care, as well as for coaching managers and executives. Thus, the Montessori method now is being implemented from birth through the end of life, in persons with and without cognitive impairments, and additionally in multiple industries outside of senior care.
This is a very different approach than a medicalized view of dementia as an illness, and it is easy to see how both the Montessori approach and the Validation approach are similar. Both approaches are person-centered, emphasize knowing the person and humanizing relationships, provide useful tools rather than simply recommending redirection, and result in giving staff and family care partners more confidence and less stress when interaction with persons with dementia.
As someone who has admired the work of Naomi Feil and the Validation Training Institute for some time, I can offer some thoughts from the perspective of an “outsider” who has read The Validation Breakthrough. It appears that the Validation approach is very focused on emotion expression and resolution of past crises, similar in many ways to the work of Erik Erikson. There is an emphasis on primarily working with persons with advanced dementia who have not successfully accommodated changes in their lives and have not been able to successfully resolve crises.
Here is an example of the complementary approaches. My wife (a Montessori preschool teacher for over 20 years) and I were giving a training seminar at an education center in Florida. The center was associated with a memory care residence. After a training session, attendees were asked to work with individual residents in the memory care neighborhood. In addition, my wife and I worked with residents. The executive director brought my wife a resident with frontotemporal dementia, who had the reputation of being a “problem resident.” My wife was not aware of his diagnosis but treated him as a normal individual and got to know more about him including his background and interests. My wife described the upcoming birth of our first grandchild and engaged this resident in several Montessori based activities. When he departed, he looked back to my wife and said “I hope that you have great fun with your grandchild.” Since the executive director had viewed this man as a challenging resident, which is often the case for persons with his diagnosis, she was amazed at his behavior and asked my wife “What did you do?” Of course, this was the result of treating the person like a person, getting to know him, and finding things that were of personal interest to use in engaging the individual.
I went out into the memory care neighborhood and sat down next to a woman, asking her if she would help me in creating good signage for the neighborhood. This is a way that we explain our reading capacity observation, which was one of the challenges given in our September 5th webinar on Decoding Dementia. In this case, however, the woman said “Get away from me. I hate all men.” At this point I went to the other side of the table about five or six feet away from her and began to simply write on a piece of paper. At the top of the paper, one on each side, I wrote in capital letters the words Europe and USA. Under Europe I wrote Paris. Under USA I wrote Chicago. I continued to write names of cities under each of these category labels. At that point a woman who was attending the training sat down next to the resident and asked if the resident would help in creating good signage for the neighborhood. The resident stood up and angrily shouted “I don’t want to read anything about any damned Europe or USA cities!” and then stormed off. When the resident had left, I said to the trainee that we had learned two important things about this resident. First, she obviously can read, and this is a strength that could potentially be used to create engaging activities for her. However, we need to find a way to help her deal with and work through her anger. Her anger is preventing her from having a good quality of life. This is an example of where validation techniques would be so helpful to this resident and so many like her, and where training in Validation techniques is a critical component in providing the best possible care for persons with dementia.
For those interested in learning more about the Montessori Inspired Lifestyle®, please visit our website at www.cen4ard.com.
Cameron J. Camp, Ph.D.
Director of Research and Development
Center for Applied Research in Dementia