Validation Therapy, Redirection

Creative Techniques for Talking to a Loved One With Dementia
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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.

SEE ALSO: Find Memory Care Near You

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:

SEE ALSO: Find Memory Care Near You

  • 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:

SEE ALSO: Find Memory Care Near You

  • 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.

about 1 month ago, said...

I
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 I've been my elder brother's caregiver, afflicted with Alzheimer's, since 2011. After his initial diagnosis of this devastating disease the "A" word has never been spoken. It was easier for him to just say, "I have a little of the Alzheimer's." It appeared he took the news better than I did, but he was probably unable, even at that early stage, to comprehend the severity, the word... Show more I
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 I've been my elder brother's caregiver, afflicted with Alzheimer's, since 2011. After his initial diagnosis of this devastating disease the "A" word has never been spoken. It was easier for him to just say, "I have a little of the Alzheimer's." It appeared he took the news better than I did, but he was probably unable, even at that early stage, to comprehend the severity, the word progressive, the journey ahead for everyone. The early stages seemed to be the toughest, him fighting reality, his loss of independence and memory; me, clueless, on what to do and say, my reactions to the new normal. I soon learned the doctor wasn't being silly when she said, "Get ready for a roller coaster ride." The first year of caregiving was my new full time position and I gave it my all, old work ethics still intact. Brother/sister dynamics made it a challenge. I educated myself by attending seminars and support groups; reading; reaching out to knowledgeable people; watching documentaries and movies. I have learned to just go along with his conversations and address what is being said, to believe something he sees as a possibility or even real, and that making up stories is ok. I realize, and this took time, that I could not reason or win one of his battles, conflicts or disappointments, the disease will win each and every time. I have had to adjust to make things easy for me, to take a time out, as the doctor said, and saw this would aid us both. On this journey I know I've made mistakes, still do, but I'm human. I have questions and seek answers. I shed tears still for the past and what lays ahead. I never stop believing in faith and prayers. Family, love and memories matter. God Bless All Caregivers. Hide

4 months ago, said...

My mother is 85 and in assisted living for about 4 months. I was her sole care giver and could no longer care for her. She was sleeping until 3-4 pm and getting up every hour or two to smoke and eat a sweet snack. She lost from 125 to 108 and woul not listen to me to get up or eat better. She was also a fall risk, usually falling daily. She is often hateful to me and calls for me to take her home on days she remembers how to dial the phone. I've used techniques doctors and nurses have... Show more My mother is 85 and in assisted living for about 4 months. I was her sole care giver and could no longer care for her. She was sleeping until 3-4 pm and getting up every hour or two to smoke and eat a sweet snack. She lost from 125 to 108 and woul not listen to me to get up or eat better. She was also a fall risk, usually falling daily. She is often hateful to me and calls for me to take her home on days she remembers how to dial the phone. I've used techniques doctors and nurses have suggested but she continues to beg me, threatens to kill herself and blames me for her being there. There are more days where she forgets how to walk and must use depends because she can not make it to the bathroom or forgets. I tried to find home care but in our small town it is difficult. So I do feel guilty about her not being home. How do I redirect her better when she asks to come home? I keep telling her that the dr wants her to be where she has people to talk with and to care for her. She smokes and it was difficult for the last month she was home. I had constant headaches from the smoke but could not leave her. She can go outside and smoke whenever she wants at her current assisted living home. Please help. Hide

over 2 years ago, said...

My dad has been diagnosed with dementia and I am working full-time with my kids still at home. My mom, sister and brother-in-law are caring for him full-time and are exhausted. They are having trouble understanding that he is not "faking" his symptoms and I have done a lot of reading about it on my own and don't believe he is. I have spent time with him and have tried to reassure him when he has had times of feeling confused and I try to tell him that it is okay and he is kind of eased... Show more My dad has been diagnosed with dementia and I am working full-time with my kids still at home. My mom, sister and brother-in-law are caring for him full-time and are exhausted. They are having trouble understanding that he is not "faking" his symptoms and I have done a lot of reading about it on my own and don't believe he is. I have spent time with him and have tried to reassure him when he has had times of feeling confused and I try to tell him that it is okay and he is kind of eased through it. Lately my sister has been exasperated and I really do understand it since they are dealing with him full-time and I am not there. I just wish I could do more but just started a new job and am on probation with the job and can't miss any work and am just torn with what to do. I just needed to vent a little. I feel so badly for all four of them and wish things weren't this way. This article has helped explain about my dad's "humanness" remaining because I think that is where the confusion on their part is with thinking he might be faking. My husband and I have talked with other people who have had family members experience what my dad is going through and the symptoms are mirror images of each other and my father would have no way of knowing how to "fake" these symptoms. My family is so exhausted with the day to day care and his wandering around at night, etc., and I hate to try to be a know-it-all who isn't there. . . just feeling really sad and wish I could do more. I just feel so helpless sometimes. Thank you for this great article. Hide

over 2 years ago, said...

Validation is misrepresented. The information given is not correct. I feel the information given may damage caregivers' perceptions of Validation. Validation is misrepresented. The information given is not correct. I feel the information given may damage caregivers' perceptions of Validation. Hide

over 2 years ago, said...

Thank you, RN '77! I also live in MN, and I am also trained in Validation (as a Certified Validation Worker). I am glad that this article included Validation so that people become more familiar with the term, but I am afraid that it has misrepresented Validation in part. But again, thank you for even including Validation so people are aware that it exists! If caring.com ever needs new articles or guest writers, I'd love to write an article about Validation to further increase public... Show more Thank you, RN '77! I also live in MN, and I am also trained in Validation (as a Certified Validation Worker). I am glad that this article included Validation so that people become more familiar with the term, but I am afraid that it has misrepresented Validation in part. But again, thank you for even including Validation so people are aware that it exists! If caring.com ever needs new articles or guest writers, I'd love to write an article about Validation to further increase public awareness. Please contact me ashley@hearttonesmusictherapy.com Hide

almost 3 years ago, said...

Mu mom has been living with my husband andI for 11 months. She had a fall in her senior apt and doctor says she has onset dementia. I' m getting to the point with her that Im angry all the time. My husband is verbally out of control with her because he is so stressed.We are bordet low income both retired. money is issue to pay for temporary help once in while. don't know what to do. my mom is very mobile and promisd her would never go to nursing home money ti pay for Mu mom has been living with my husband andI for 11 months. She had a fall in her senior apt and doctor says she has onset dementia. I' m getting to the point with her that Im angry all the time. My husband is verbally out of control with her because he is so stressed.We are bordet low income both retired. money is issue to pay for temporary help once in while. don't know what to do. my mom is very mobile and promisd her would never go to nursing home money ti pay for Hide

almost 3 years ago, said...

My mother, with dementia, is in an assisted living facility. Millie, her old dog (16 years) is incontinent and soiling carpet and Mother's bed. The problem has become so bad that it is creating a health hazzard for Mother. Management says dog has to go. We are considering having Millie put to sleep, but don't know how to approach Mother or whether she could understand the situation. Millie also has cataracts, arthritis, and is becoming hard of hearing. She is on special food, has to... Show more My mother, with dementia, is in an assisted living facility. Millie, her old dog (16 years) is incontinent and soiling carpet and Mother's bed. The problem has become so bad that it is creating a health hazzard for Mother. Management says dog has to go. We are considering having Millie put to sleep, but don't know how to approach Mother or whether she could understand the situation. Millie also has cataracts, arthritis, and is becoming hard of hearing. She is on special food, has to have medication twice per day and the staff must provide the care for the animal, as Mother is emotionally attached but can't tend to Millie's physical needs. Would it be ok to lie and take the dog out while Mother is sleeping and tell her that Millie died in her sleep? There is no good answer here. It is a no win situation. Losing the dog will break her heart and surely take my mother down another notch in her disease. She has lost so much already. It would be near impossible to find a home for Millie under the circumstances and time constraints. Would telling the biggest lie you have ever told to your mother actually be the kindest thing? Any suggestions would be welcome. Hide

almost 3 years ago, said...

My husband suffered with Alzheimer's.You mention leading them in a more positive direction.One night in the nursing home found him at glass door. He said to me our son was running back and forth across the door but would not come in. Relizing it was his own reflection he was seeing.I said you know Gordy he is always on the move cant't stay in one place long. He laughed and said to me "I sure do know Gordy" End of anxiety. I might add that to get into his world a little bit we both could... Show more My husband suffered with Alzheimer's.You mention leading them in a more positive direction.One night in the nursing home found him at glass door. He said to me our son was running back and forth across the door but would not come in. Relizing it was his own reflection he was seeing.I said you know Gordy he is always on the move cant't stay in one place long. He laughed and said to me "I sure do know Gordy" End of anxiety. I might add that to get into his world a little bit we both could laugh and enjoy each other for a while longer. Before he passed away he looked at me and said you know June I am happy. Hide

almost 3 years ago, said...

My boss has early onset dementia and I don't know what to do. Although most of her work responsibilities have been given to others, she still insists on coming to the office every day. She is still driving and she calls the office 20 times a day to get directions home from where she is. I'm not in a position where I can change what's going on. Her family seems to be allowing her to do what she wants, when she actually should be working with a therapist or other professional on how to... Show more My boss has early onset dementia and I don't know what to do. Although most of her work responsibilities have been given to others, she still insists on coming to the office every day. She is still driving and she calls the office 20 times a day to get directions home from where she is. I'm not in a position where I can change what's going on. Her family seems to be allowing her to do what she wants, when she actually should be working with a therapist or other professional on how to cope with her new diagnosis. I'm so anxious and stressed out, I am about to snap. This is really a giant problem and I have no standing to do anything about it. If someone has any ideas I would greatly appreciate it. Hide

almost 3 years ago, said...

Validating what I hoped I was doing all along once I recognized and realized that my mother was going through this disease. I am grateful! Validating what I hoped I was doing all along once I recognized and realized that my mother was going through this disease. I am grateful! Hide

almost 3 years ago, said...

It is really good.I can see how redirecting their thoughts could be a big help. It is really good.I can see how redirecting their thoughts could be a big help. Hide

almost 3 years ago, said...

This article has been very helpful. My mother was 90 on May 2nd, and has been in assisted living for over a year while I clean out her house, not an easy task, and will be taking her to live with me and my daughter in Myrtle Beach SC. We've arranged for additional home care assistance, but I will take all the advice I can get! This article has been very helpful. My mother was 90 on May 2nd, and has been in assisted living for over a year while I clean out her house, not an easy task, and will be taking her to live with me and my daughter in Myrtle Beach SC. We've arranged for additional home care assistance, but I will take all the advice I can get! Hide

over 3 years ago, said...

is it o k to bring people into the dementia patients room that they really like to vit to see if they recognize that person is it o k to bring people into the dementia patients room that they really like to vit to see if they recognize that person Hide

over 3 years ago, said...

It was very informative for me due to the fact that I lead in services on how to approach you residemt It was very informative for me due to the fact that I lead in services on how to approach you residemt Hide

over 3 years ago, said...

I am taking a Personal Support Worker program and these re direct,validate are helpful.. I am taking a Personal Support Worker program and these re direct,validate are helpful.. Hide

over 3 years ago, said...

When mystery see stuff and we don't should we validate When mystery see stuff and we don't should we validate Hide

almost 4 years ago, said...

I just wanted to share a couple of helpful resources for those of you who might like to talk with someone about caregiving strategies (e.g. bathing, wanting to "go home", etc.), find support groups, etc.. One is the Alzheimer's Association-there are local chapters in each state, as well as a 24/7 Information & Support line staffed by social workers-not a machine. You can search by state at www.alz.org, or call 1-800-272-3900. Also, an amazing educator and trainer (who has been a caregiver... Show more I just wanted to share a couple of helpful resources for those of you who might like to talk with someone about caregiving strategies (e.g. bathing, wanting to "go home", etc.), find support groups, etc.. One is the Alzheimer's Association-there are local chapters in each state, as well as a 24/7 Information & Support line staffed by social workers-not a machine. You can search by state at www.alz.org, or call 1-800-272-3900. Also, an amazing educator and trainer (who has been a caregiver many times over and an OT) by the name of Teepa Snow can be found on YouTube. You will discover videos that cover many care giver challenges-and from the perspective of the person with Alzheimer's or a related dementia. Hope this helps! Hide