adapted from The Validation Breakthrough: Simple
Techniques for
Communicating with People with Alzheimer's -Type Dementia
Naomi Feil (1993)
PRINCIPLES:
TECHNIQUES OF VALIDATION:
The techniques of Validation are simple to learn and can be
performed within the course of atypical day. By using these techniques,
caregivers can improve the lives not only of the people for whom they care, but
for themselves as well. Different Validation techniques are appropriate for
different stages of Resolution.
1. Focus on a
spot about two inches below your waist.
2. Inhale
deeply through your nose, filling your body with air. Exhale through your
mouth.
3. Stop all
inner dialogue and devote all of your attention to your breathing.
4. Repeat this
procedure slowly, eight times.
People in Resolution do not want to understand their feelings. They retreat when confronted with their feelings. Caregivers should avoid asking disoriented older people why something happened, or why they did what they did. Instead, caregivers should focus on factual questions - who, what, where, when, and how.
People in Resolution often find comfort in hearing their own
words spoken by someone else. To rephrase, the caregiver repeats the gist of
what the person has said, using the same key words. The tone of voice and the
cadence of speech should also be imitated. If a person speaks quickly, also
speak quickly.
The technique of polarity involves asking the person to
think about the most extreme example of his or her complaint. By thinking about
the worst case, the person being Validated expresses his or her feelings more
fully, thereby finding some relief. For example, to Validate a woman who
complains that the food is inedible, the Validating caregiver asks, "Is
that the worst chicken that you ever ate?" The caregiver knows that
the woman is venting her frustration over her poorly fitting dentures. She
knows that the woman needs someone to listen to her anger. By letting
her release this anger by complaining about the food, the caregiver helps
relieve the women's anxiety.
Imagining the opposite often leads to the recollection of a
familiar solution to the problem, providing the old-old person trusts the
Validating caregiver. An 85 - year - old woman complains that a man enters her
room each night. To Validate her the caregiver asks her to think about times
when the man does not appear: "Are there nights when he doesn't come?"
By prompting her to think about a situation in which the man does not appear,
the caregiver helps the women recall how she dealt with a similar situation
earlier in her life.
Exploring the past can re-establish familiar coping methods
that the disoriented person can tap to survive present day losses. By using
words such as "always" and "never" the
caregiver can trigger earlier memories. For example, by asking, "Did you
always have a hard time sleeping, Mrs. J., even when your husband was
alive?", the caregiver may help trigger earlier memories of coping with a
problem that the person had forgotten. Technique 5 and Technique 6 are used
together. One technique follows the other to help the old-old restore familiar
ways of overcoming stress.
The very old person in Time Confusion and Repetitive Motion feels loved and secure when the nurturing caregiver shows affection through close eye contact. Even older people with impaired vision sense the concentrated focus of the Validating caregiver who looks directly into their eyes. Their anxiety is reduced. Often, they will become aware of present day reality.
Time Confused people often use words that have no meaning to
others. By using ambiguity, caregivers can often communicate with the Time
Confused even when they don't understand what is being said. For example, a
Time Confused person may cry, "These catawalks are hurting me!" The
caregiver can respond by asking, "Where do they hurt?" The pronoun
"they" substitutes for the unknown word "catawalks." Using
"he" "she" "it" "someone" and
"something" fills in for the non-dictionary words. Time Confused
people keep communicating and withdrawal to Vegetation is prevented.
Harsh tones cause disoriented people to become angry or to
withdraw. High, soft tones are difficult for many older adults to hear. It is
important to speak in a clear, low, nurturing tone of voice. Often, a nurturing
voice triggers memories of loved ones and reduces stress.
Technique 10: Observing and Matching the Person's Motion and Emotions (Mirroring)
People in Time Confusion and Repetitive Motion often express
their emotions without inhibition. To communicate, it is important to take
stock of their physical characteristics and the ways in which they move. The
caregivers should observe their eyes, facial muscles, breathing, changes in
color, chin, lower lip, hands, stomach, position in the chair, position of the
feet, and the general tone of their muscles to match these postures. When the
person being Validated paces, the caregiver paces. When the person being
Validated breathes heavily, the caregiver breathes heavily. Done with empathy,
mirroring can be effective in helping to create trust. It allows the caregiver
to enter the emotional world of the Time Confused person and to build a verbal
and nonverbal relationship. Mirroring the sometimes bizarre motions of
disoriented people can be an upsetting experience and not all caregivers will
want to try this technique.
Most people need to be loved and nurtured, to be active and
engaged and to express their deep emotions to someone who listens with empathy.
Ex: A 93 year old woman lovingly smoothes out each wrinkle of a paper napkin.
Nothing is out of place. A waitress who does not understand Validation takes
the napkin out of the old woman's hand and shakes it. The old woman begins to
yell at the top of her voice, "Help! Help!" Instead of medicating or
restraining, the Validating caregiver gives the old women the napkin. Together,
they fold it carefully, lovingly, smoothing out each wrinkle. "Does this
make you feel safe and warm?" asks the caregiver. The old woman smiles.
She strokes the napkin, "Ma, I love you." Somehow, the napkin has
become a soft, loving mother for this old woman. The caregiver links the
folding to the human need for love. When the old-old pound, pace, rub, or pat,
the Validation caregiver links the behavior to one of 3 human needs - love,
usefulness (restoration of movements associated with work) or the need to
express raw emotions.
Most people have a preferred sense. For some that is vision;
for others it is the sense of smell, for yet others it is the sense of touch.
Knowing a person's preferred sense is one way of building trust, since it
enables the caregiver to speak the person's language, to step into the person's
world. One technique for determining which sense a person prefers is to ask
that person to think about and describe an experience from the past. The first
sense the person uses often reveals the person's preferred sense.
Touching is a technique that is usually not appropriate for
Maloriented people, but is often effective with people in Time Confusion.
People in Time confusion no longer distinguish between people they have known
all their lives and people they have never met before. The Validating caregiver
can instantly become a loved person, since people in Time Confusion can
incorporate strangers into their world. People in Repetitive Motion are no
longer aware of where they are. To communicate with them, the caregiver must
enter their world and touch them in the same way a loved one touched them. To
use touch with a Time Confused person, the caregiver should approach the person
from the front, since approaching the person from the side might startle the
person. Touching another person is an intimate act and caregivers - both
professionals and families - must respect that some people, even when their
controls are damaged do not want to be touched. Any sign of resistance to
physical contact should indicate to the caregiver that touching is
inappropriate. The personal space of all people, whether they are disoriented
or not; must always be respected.
When words have gone, familiar, early learned melodies return. Stored forever in the brain's circuit, early learning, reinforced through the years, remains. People in Repetitive Motion who no longer retain the ability to speak can often sing a lullaby from beginning to end. When a former sailor, now 95 years old and in Repetitive Motion, paces back and forth, his daughter Validates him by singing "Anchors Away, My Boys." The sailor stops, looks at his daughter, smiles and sings with her. The sailor does not recognize his 60-year-old daughter, nor does he know the name of the song, but he sings each word. His daughter can now communicate. She sings with her father since he can longer talk.
People in Repetitive Motion will often say a few words after singing a familiar song. Music energizes people in Time Confusion and Repetitive Motion.
THE
STAGE BEYOND INTEGRITY FEIL's
RESOLUTION vs. VEGETATION STAGẺ of life.
STAGE 1 STAGE 2 STAGE 3 STAGE 3
|
|
Malorientation |
Time
Confusion |
Repetitive
motion |
Vegetation |
|
BASIC
HELPING CLUES |
-use
who, what, where and when type questions |
-use
feeling words (I see...), (I feel...) |
-use
touch and eye contact |
-mirror
movements |
|
|
-use
minimal touch |
-use
touch and eye contact |
-pace
to person's movements |
-use
sensory stimulation |
|
|
-maintain
social distance |
|
|
|
|
ORIENTATION |
-keeps
time |
-does
not keep track of clock time |
-shuts
out most stimuli from outside world |
-does
not recognize family, visitors, old friends or staff |
|
|
-holds
onto present reality |
-forgets
facts, names, and places |
-has
own sense of time |
-no
time sense |
|
|
-realizes
and is threatened by own disorientation |
-difficulty
with nouns increases |
|
|
|
BODY
PATTERNS |
-tense,
light muscles |
-sits
upright but relaxed |
-slumped
forward |
-placid |
|
muscles |
-usually
continent |
-unaware
of incontinence |
-unaware
of incontinence |
-little
movement |
|
|
-quick
direct movements |
-slow,
smooth movements |
-restless,
pacing |
-no
effort to control continence |
|
|
-purposeful
gait |
-dance-like
gait |
-melodic |
-frequent
finger movements |
|
vocal
tone |
-harsh,
accusatory, and often whining |
-low,
rarely harsh |
-slow,
steady |
|
|
|
-can
sing |
-signs
and laughs readily |
|
|
|
eyes |
-focused,
good eye contact |
-clear,
unfocused |
-eyes
usually closed |
-eyes
shut (face lacks expression) |
|
|
|
-downcast,
eye contact triggers recognition |
-repeats
early childhood movements and sounds |
-self
stimulation is minimal |
|
EMOTIONS |
-denies
feelings |
-substitutes
memories and feelings from past to present situations |
-demonstrates
sexual feelings openly |
-difficult
to assess |
|
|
-usually
carries a cane, blanket, or sweater |
|
|
|
|
PERSONAL
CARE |
-can
do basic care |
-misplaces
personal items often |
-few
commonly used words |
-responds
to tone and touch |
|
|
-seeks
personal reminders |
-creates
own rules of behavior |
-does
not listen or talk to others |
|
|
COMMUNICATION |
-positive
response to recognized roles and persons |
-responds
to nurturing tone and touch |
-is
not motivated to read or write |
-none
readily apparent |
|
|
-negative
response to those less oriented |
-smiles
when greeted |
|
|
|
MEMORY
AND INTELLECT RULES |
-can
read and write unless blind |
-can
read but no longer writes legibly |
-early
memories and universal symbols are most meaningful |
-difficult
to assess |
|
|
-sticks
to rules and conventions |
-makes
up own rules |
|
|
|
HUMOR |
-some
humor retained |
-will
not play games |
-laughs
easily often unprompted |
-difficult
to assess |
|
|
|
-humor
not evident |
|
|
|
|
REPRINT
FROM V/F VALIDATION® THE FEIL METHOD 1982.
Copyright ® 1982 Naomi Feil. A.C.S.W.
All Rights Reserved
Objective: To teach
families and staff of disoriented old-old people empathy and specific
Validation methods that restore dignity.
WHAT IS VALIDATION? Validation is a helping method that restores
dignity and well-being to disoriented old-old people by accepting them the way
they are. The Validation Worker does not expect them to act the way younger
people do. The worker is non judgmental, and accepts the physical and intellectual
losses that hit in old-old age. Validation respects their intuitive wisdom.
What they do and what they say has meaning.
BASIC PRINCIPLES: (One) When eyesight, hearing, and recent
memory go, early, emotionally-tinged memories return. (Two) Disoriented old-old
people enter a new life-stage: Resolution vs. Vegetation. They struggle to wrap
up unfinished business, to make peace in the final stage. Often, they restore
the past in order to resolve it.
SCENE I:
STAGE 1: MALORIENTATION
Physical Characteristics:
Emotional Characteristics:
VALIDATION Helping Methods:
Non-threatening exploring factual
words.
Example: who? what? How did it
happen? Where? When?
Repeat their key word or phrase.
LISTEN
WITH EMPTY!
* DO NOT INSERT NEW MEANING TRY TO
FIX, OR JUDGE!
It is often too late for Maloriented to achieve integrity. With 5-10 minutes Validation, at least 3 times per week, the blaming lessens, anxiety is reduced, facial muscles relax. Maloriented keep communicating in present time. They do not withdraw to Time Confusion.
SCENE 2:
STAGE 2: TIME CONFUSION
Physical Characteristics:
Emotional Characteristics:
VALIDATION Helping Methods: Touch, Close Eye Contact
(1)
love, (2) identity, (3) to express gut feelings
STAGE 2, Time confused benefit from a validation group. They
do not move to stage 3, repetitive motion. They share intuitive wisdom, restore
former social roles, identity, a sense of well-being, speech Improves, social
controls improve, energy heightens, they express feelings of joy and loss of
fear and anxiety.
Stage 2, TIME-CONFUSED, benefit from one-to-one VALIDATION and from a VALIDATION GROUP. Speech improves, anxiety lessens, they express feelings of well-being, happiness, and restore identity. They do not withdraw to stage 3, Repetitive Motion.
STAGE 3: REPETATIVE MOTION
Physical Characteristics:
Emotional Characteristics:
VALIDATION Helping Methods: * USE One-to-One VALIDATION:
CONSISTENT One-to-One VALIDATION can prevent Vegetation. Mirroring repetitive motions in a genuine relationship often restores dormant speech and triggers some awareness of present time and place.