What's the best way to respond to someone
with Alzheimer's or another type of dementia if she's anxious and yelling out
for her mother who passed away many years ago? The short but true answer is
that it depends on the individual- which stage of Alzheimer's disease she's in,
what approaches are typically helpful in reassuring her, and how much distress
she's experiencing.
The longer answer includes a
discussion on a couple of theories: reality orientation and validation therapy.
Historically, reality orientation has been fairly dogmatic about continually
reminding the person that she is 89 years old and that her mother passed away
20 years ago. The reasoning with this approach has been that frequently
reminding the person of reality is beneficial for her cognitive functioning.
Validation Therapy, however, places more emphasis on the possible feelings
and thoughts behind the person's behaviors, and rather than trying to force her
to be in our reality, it suggests that we join with the person in her reality.
Validation therapy would recommend that we ask her questions about her mother,
such as what she misses most about her mother and which of her mom's dinner
recipes was her favorite.
So, which is the best and most
helpful approach? And, what does research say? The pendulum has swung from
reality orientation to validation therapy and a little more back towards a more
gentle reality orientation. In the end, there's no "one size fits
all" for responding to people's confusion. However, there are a few
guidelines that usually remain constant about how to talk with people who have
dementia, such as responding with genuineness and compassion.
What Is Validation Therapy?
Validation Therapy is a way
to approach older adults with empathy and understanding. The basic premise behind Validation Therapy is that people
who are in the very old stage of life may have unresolved issues that drive
their behaviors and emotions. The way caregivers or family members respond to
these behaviors and emotions can either increase their intensity or help
resolve them.
Validation Therapy is more than simply validating a person's feelings,
although that is one component of it. Validation Therapy focuses on helping the
person work through the emotions behind challenging behaviors. These behaviors
are viewed essentially as a way to communicate those emotions, especially in
people with memory loss, confusion, disorientation, and other symptoms of
dementia.
How to Use Validation Therapy?
Imagine that your mother, who has Alzheimer's disease, lives with you in your
home and frequently calls out for her own mother. According to the Validation
Training Institute, people who practice validation therapy can use the
following techniques in that situation:
Center Themselves
Take a deep breath and slow down. Your initial reaction may be to try to use
logic when your own mother, who is 92 years old, starts calling out loudly for
her mother. But before you react, think - and breathe.
Reminisce
Ask your mother what her mom was like, and what she misses about her. Share a
memory about your grandmother with your mother, and allow her to express her
loneliness.
Use Extremes
Ask her if she always misses her mother,
or what she misses most about her mother. This can allow her to process those
feelings of grief related to losing her mother.
Match
and Express the Emotion
Join with the person in her feelings. Acknowledge the sadness of losing her
mother and what a special relationship they had with each other.
Rephrase
Rephrasing her feelings back to her can provide reassurance that you understand
and feel her loss. Saying "You must really miss your mother" can
decrease her anxiety, because she hears you expressing what she is feeling.
Use Senses
Ask questions about her mother. For example, ask about her favorite food that
her mother cooked and how it smelled, or how pretty her mother looked all
dressed up for church on Sunday mornings.
How Effective is Validation
Therapy According to Research?
Research is mixed when it comes to conclusions about the effectiveness of
validation therapy. Different studies conducted on validation therapy have
different conclusions, with some stating that it's effective, and others
determining that it's no more helpful than a placebo. A couple of Cochrane
Database Systemic Reviews conclude there's insufficient evidence to conclude
that it's effective - not meaning that it's ineffective, but that there wasn't
strong enough data to show that it is clearly helpful.
As a
clinical professional, I've seen many instances in which validation therapy has
worked beautifully, and others where it did not. Other clinicians tell of
anecdotal evidence of the effectiveness of validation therapy in decreasing
challenging behaviors and emotional distress. While there's not a definite
conclusion backed by research, it does appear that validation therapy may be a
tool that's worth understanding and using in some circumstances, for some
people.
(Source: By Esther Heerema, MSW, About.com, 27 February 2013)
