What Is Validation Therapy, And Can It Help People With Dementia?

Everyone appreciates validation — from a baby who takes their first steps and looks back at their parents for approval to adults who are unsure if their job performance has been living up to their managers’ expectations. Of course, you don’t want to get to a place where you (or a child) are in constant need of validation for even the tiniest of tasks. Still, receiving it is something that makes a real difference in our mental well-being and self-confidence. And this isn’t something we phase out of as we grow up: Older adults also benefit from validation but aren’t always in positions to receive it. That’s where validation therapy enters the picture.

Never heard of this type of therapy? We’ve got you covered. Here’s what validation therapy is and how it can benefit people with dementia and other memory- or cognitive-related conditions.

What is validation therapy?

Between 1963 and 1980, Naomi Feil — a social worker with expertise working with older adults — developed validation therapy to help older adults and other people with cognitive impairments. In a 2003 article published in the Cochrane Database of Systematic Reviews, Martin Neal and Philip Barton Wright explain that validation therapy centers on the general principle of validation. It focuses on acceptance of the reality and personal truth of another person’s experience. Validation therapy incorporates a range of specific techniques. While Feil did not develop validation therapy specifically for people with dementia, it has since been used to help people with that condition.

Since the 1990s, validation therapy has been widely accepted by medical practitioners. However, it has also been the subject of criticism. Some researchers question the evidence behind the beliefs and values of validation therapy and are skeptical about the appropriateness of the techniques. Additionally, some see validation therapy as demeaning or condescending towards those with cognitive impairments, given that it essentially involves lying to our loved ones.

Who is Naomi Feil?

Naomi Feil is a gerontologist which means she studied the aging process. Besides being the godmother of validation therapy, Feil also had a unique upbringing that helped make her into the scientist she is today. She was raised in a family home for seniors at the Montefiore Home for the Aged in Cleveland. Feil’s childhood experiences fueled her interest and passion for the elderly, which inspired her to further her education in social work at Columbia University. With the help of her husband, Edward R. Feil, this German native provided the groundwork for validation theory and created many films on her theory in relation to dementia.

How is validation therapy used for people with dementia?

Validation therapy emphasizes empathy and listening. It views people with dementia and other cognitive challenges as unique and worthwhile — and also in the final stages of life. “Basically, the thought is that these seniors are trying to resolve unfinished business so they can pass away in peace,” Dana Larsen writes for A Place for Mom. “The caregiver’s job is to offer these individuals a means for expression, either verbally or nonverbally.”

Some of the ways people with dementia seek to resolve unfinished business might look strange to the rest of us — including hallucinations or seemingly existing in their own alternate reality. As defined by Elmcroft Senior Living, validation therapy involves acknowledging a person’s words and actions with respect, instead of embarrassment, anger, or dismissiveness. “Instead of ignoring or stopping what might be viewed as irrational or illogical behavior, validation offers alternatives,” Larsen explains. “It focuses on the objective of being ‘here and now,’ and doesn’t ask why.”

Here are a few examples of what some aspects of validation therapy could look like in practice:

• Speaking in a clear, low-pitched tone of voice
• Thinking before speaking and centering yourself so you can react in a loving tone
• Making eye contact
• Avoiding debating or bickering
• Rephrasing their feelings back to them to hold space for what they’re feeling
• Asking about the who, what, when, where, and how of the situation — not why
• Redirecting conversations toward positive memories from their past that relate to something they’re doing or saying in the present
• Engaging the senses when asking questions (i.e., “What did your mom’s favorite perfume smell like?”)
• Setting your emotions aside so you can actively focus on them and respond in a way that makes them feel seen and heard

What are the benefits of validation therapy?

At this point, the research isn’t clear on whether validation therapy is, in fact, effective. But some people worth with or care for people with dementia (or other older adults with memory and/or cognitive-related challenges) indicate that they have seen improvements in someone as a result of validation therapy. According to Larsen, these can include older adults and/or those with dementia:

• Sitting more erect
• Keep their eyes open more often
• Displaying more social controls
• Spending less time crying, pacing, and pounding
• Expressing less anger
• Having a decreased need for chemical and physical restraints
• Communicating more verbally and nonverbally
• Moving better and more often
• Expressing less anxiety
• Withdrawing less
• Experiencing an improved sense of self-worth
• Assuming familiar social roles in groups
• Developing an improved awareness of reality
• Restoring their sense of humor

Because the jury is still out on how beneficial validation therapy actually can be, it’s best to discuss it with your loved one’s healthcare provider before attempting it yourself. Everyone is different, and what might work for one person could be harmful to another.

Is using validation for dementia calming or condescending?

When a person is struggling with dementia, their perception of reality differs from someone without this disease. A person with dementia may grapple with delusions or hallucinations. And although validation therapy serves to confirm their sense of reality and offer comfort, critics might view this practice as condescending or patronizing. But refuting their false experiences isn’t always the best option either. It can make them very upset and is not a helpful or effective solution. A dementia patient’s short-term memory and rational thinking are usually a bit damaged, so they cannot understand those assertions or develop a firm grasp of reality.

How do you talk to someone with dementia?

When speaking with someone with dementia using validation therapy, it’s important to be mindful of how you communicate with patients and lead the conversation.

• It’s always safe to stay within the realm of social pleasantries. Ask them how they’re doing or feeling today. Avoid asking them short-term memory questions like, “What did you have for dinner last night?” or “Where did you go this morning?”
• If they are saying or referencing an event incorrectly, move on to another conversation and don’t correct them. This is the most respectful approach.
• When leaving, avoid saying goodbye. It’s too final and can unnerve the patient. Instead, say something like, “I’m going to go pick up the kids from daycare, now,” and then make your exit.