(The Validation Method)
By: Eric Portnoff
If you find yourself caught between truth and lies when it comes to dealing with a loved one with dementia, you’re not alone. Caregivers and family members often find themselves questioning whether to correct, deny, or go along when Mom continues to ask for her daily medication, when it was given hours ago. Dad wants his car keys to get to work, when he retired years ago. Your husband or wife wants to know “when can we go home,” after you’ve moved into an assisted living community.
“Should I tell the truth?”
“Make up a comforting story?”
“Change the subject?”
Well-intentioned family members are often at a loss as to how to respond. As a result, they sometimes avoid or reduce communication altogether, leading to more distance in the relationship and further isolation for the person living with dementia.
Thankfully, this painful reality does have a remedy. During the ‘60’s and ‘70’s, a pioneering social worker named Naomi Feil developed the Validation Method, a therapeutic approach to communicating with those afflicted with dementia. Through years of careful clinic practice, Feil discovered that there’s a middle ground between the extremes of confronting the individual with the objective truth on the one hand; and lying to or misleading them on the other. Example:
Mom: “Honey, have you seen Dad? It seems like he’s been gone for a very long time and I’m worried about him.” Perhaps it’s the third time Mom has asked you this question since you came to visit her. At this moment, she doesn’t seem to remember that Dad passed away earlier this year.
What are your options?
- At one extreme is the cold, hard truth: “Mom, Dad passed away last May. Don’t you remember?” Many people instinctively recoil from this option, and for good reason. Depending on Mom’s cognitive and psychological status, she may react to this answer with shock, grief, and a repetition of the pain and loss she first experienced months ago. If her short term memory is very poor, this painful scenario could repeat itself again and again.
- On the other extreme is the so-called “therapeutic” lie: “Oh, Dad’s on a business trip. He’ll be back in a few days.” This response may leave you feeling guilty—after all, Mom always taught you how important it is to tell the truth. Another problem with this approach is that people living with dementia retain memory, reasoning ability, and emotional intelligence that may challenge this approach. Mom might remember that you told her this same story several days ago and Dad never came home. Or, your response might not feel right because deep down she knows it’s not true.
In either case, this strategy can damage trust, which is arguably the most important condition for family members and professional care providers to maintain. Maybe you’ve come to terms with these “little white lies” as a necessary evil, but is there a better way?
There is, and it’s found in the middle of these two extremes. Instead of confronting Mom with the truth or making up a comforting lie, you can ask Mom questions that explore her own perception and understanding of the situation. There are many possibilities: “What is the last thing you remember about Dad? What worries you the most about not seeing Dad? Are you missing him, Mom? What do you miss about him the most?” These responses give Mom a chance to express her feelings, reflect on her memories, and communicate with you about something that’s on her heart and mind without confirming or denying the objective truth. This is the middle path between the two extremes of reality orientation and “therapeutic” lies, and it often yields the best results.
At Oakmont Senior Living, we train our care providers to use advanced communication techniques focused on meaningful conversations to find this middle ground. We delight in sharing these possibilities with family members who are looking for a better way to communicate with their loved one who is living with dementia.
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About The Author
Eric Portnoff is VP of Memory Care & Resident Programs for Oakmont Senior Living. He is responsible for ensuring that Oakmont’s memory care programs are progressive, innovative and industry-leading. Prior to joining Oakmont, Eric helped a young, Chinese assisted living company open some of the first memory care environments in China and established a certification program there to teach The Validation Method®. Eric has been interested in helping people living with cognitive impairment since he volunteered in a special education class at his elementary school. After college, Eric worked with people with developmental disabilities and mental illness in community residential settings, eventually becoming a non-profit Executive Director. In his free time, Eric enjoys meditation, racquetball, craft beer, the outdoors, and spending time with his wife and teenage son. An avid traveler, Eric feels most himself when he’s shouldering a backpack and crossing international borders.