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Validation Therapy, Redirection

Creative Techniques for Talking to a Loved One With Dementia

By Gilbert Guide
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If you have a loved one with Alzheimer's or dementia, then you know how difficult it can be to communicate with him or her. Maybe there are good or bad days. Maybe there are certain times of the day that are better or worse. The following are techniques that can be used improve communication with the person you love.

Put Yourself in Their Shoes

Imagine, for a moment, that you are getting dressed for work. You've worked in the same office for thirty-five years, and today is like any other weekday. Perhaps you're having trouble tying your tie, which makes you wonder whether your daughter is home; she's great at fixing your tie. You call out her name. She comes into the room and asks where you're going. You tell her you've got ten minutes to catch the train or you'll be late for work. Your daughter tells you that there is no train and you've been retired for 10 years; you have no job, but you do have dementia.

Reawakening a person to the fact that he or she has dementia used to be the social norm, even for caregivers. It was even considered a "gentle reminder" or "correction." However, we know better now. These small reminders shatter that person's reality, and repeated experiences can be psychologically damaging. Dementia affects the brain, but the person retains his or her humanness, and still has a mind, an ego and feelings that should be respected. It's cruel to force a person with dementia to accept aspects of reality that he or she cannot comprehend. So if, for example, your loved one is excited about a new job (that doesn't exist), it's better to offer congratulations than to correct him or her. Of course, this is sometimes easier said than done. The main coping skills you'll need to improve communication with your loved one are redirection and validation.

Redirection

People with dementia sometimes display behaviors that seem out of character or are far too emotional for a specific situation. Sometimes their behaviors are due to delusion or hallucination. Redirection techniques divert those individuals' attention away from the stressful event to something that is more pleasant. The following is an example:

JOE [agitated]: I need to get to work. I'm going to miss my train!
MARY: Okay, Dad, but I just made breakfast. How about you eat with me first and then I'll drive you to the station. You'll make the train and get a good meal that way.

Obviously, techniques and their usefulness depend on what seems sensible in the situation. You'll need to be creative and experiment to see what works and what doesn't with your loved one.

A few pointers on redirection techniques:

  • People with dementia pick up on body language. Be warm and open when redirecting, to reduce stress levels and/or tension.
  • Ask pointed questions. Try to get to the bottom of any unexplained behavior. It will make it easier to redirect if you understand the context.

Validation Therapy

Validation therapy, first conceived of by Naomi Feil (MS, ACSW), runs the fine line between bluntly explaining reality and simply allowing a person with dementia to believe what he or she wants. Validation therapy often integrates redirection techniques, but it is not solely about moving an individual's attention from one thing to another; it is also about validating feelings and emotions.

Validation therapy is based on the idea that a person with dementia may be sorting through past issues (albeit somewhat disguised) in the present. Some may even retreat to the past significantly, to restore a balanced feeling, especially if his or her present memory has begun to fail. Proponents of validation therapy say that allowing the dementia patient some measure of control will aid in self-worth and will reduce the occurrence of negative behaviors.

A few pointers on validation therapy:

  • Try to understand why your loved one is behaving a certain way; what's the trigger or underlying concern? Then figure out a way to address it. So, for example, if your loved one is hoarding or hiding items, ask what he or she is fearful of losing. Give a "safe box" that can be used to store those items.
  • Don't get caught up in whether or not something makes sense. A person with dementia may not be able to piece everything together, but their emotions are still valid. In fact, their distress or anxiety can be amplified when they aren't being understood. Accept that your loved one's emotions have more validity then the logic that leads to them.
  • Ask specific questions about how certain actions or situations make your loved one feel. After you receive an explanation of those feelings, validate them with phrases that show your support, such as, "I'd be upset too, if that happened to me" or "I understand why you feel that way."
  • Allow your loved one a graceful exit and be mindful of his or her ego!

Hallucinations and Delusions

People with dementia sometimes experience delusions and/or hallucinations. Hallucinations can involve any of the five senses-a person with dementia may see, hear, smell, taste or feel something that isn't there. Dementia affects the brain, and as a result, people who suffer from this disease can experience delusions that stem from distorted ideas and false beliefs.

Some people understand that their minds are playing tricks on them, even in the midst of experiencing a delusion or hallucination. Others are completely absorbed in the experience and believe that it is really occurring. Whatever the case, understand that these experiences can be quite vivid and upsetting. Ask simple questions to determine whether the experience is causing any anxiety and take it from there. Instead of trying to talk your loved one "out of it," try redirecting his or her attention, and make sure that he or she knows you are trying to help.