How to use Validation–
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.
- 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?”
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.
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.
Your 88 year old grandmother constantly criticizes you and insists that you are her sister, Gwendolyn. You have tried to tell her “the truth” but it hasn’t helped.
1. Write her a letter to tell her that she is wrong:
You really hurt my feelings when you said I am fat. You are much fatter than me. I am 11 years and you are 88 years old. I asked my mother and she told me,definitely, that Gwendolyn, your sister, died before I was born, at your house, while she was eating the baked apple with caramel sauce that you cooked. Please answer or I will show this letter to my mother.
Eloise, aged 8 years
P.S. What did you put in the caramel sauce??
Your Grandmother has very poor vision. She cannot read your letter. Also, her brain cells are damaged, and she can no longer tell clock time. She doesn’t know the day or the date, so she can travel back in time and see her sister. You have the same color eyes and hair as her sister, Gwendolyn. Your grandmother did not cry when her sister died. She buried the fact that Gwendolyn was no longer alive. She felt so bad that she didn’t feel anything. Your grandma needs to talk to her sister. She looks at you and sees Gwendolyn. Your grandma cannot accept the fact that Gwendolyn is dead. You cannot convince her.
2. Agree with your grandmother, and gently lie to her:
“You are right, Grandma. My name is Gwendolyn and I am fat.”
No. You never lie to your grandmother or to anyone. Deep down, buried inside, your grandmother knows that Gwendolyn died, but she doesn’t want to know that. If you lie, your grandmother will not say anything, but she will know that something is wrong, and she will not trust you.
3. Center! Take a deep breath in through your nose and out of your mouth when your grandma criticizes you or calls your Gwendolyn. Put your finger on the spot just below your belly button. This is your Center; where you are very strong. Imagine the deep breath coming out of your Center. Follow the breath with your imagination back to your nose. Take 5 deep breaths in through your nose and out of your Center. LOOK at your grandmother very closely. Try to see yourself as she sees you. Ask her to tell you more about Gwendolyn: “Grandma, is Gwendolyn very fat? Is she pretty? What do you like the MOST about Gwendolyn. What don’t you like about her?..”
Your grandma will feel so good to be able to talk about her sister, and if you listen well, and help her say as much as she needs to, after awhile, your grandma may say: “Gwendolyn is gone. Eloise, you have such beautiful blue eyes and blond hair. You look just like her.