For those of you interested in Validation Therapy:

[cargal]

I found the following site which just about summarizes the classes I have been taking:

http://academic.evergreen.edu/curricular/hhd2000/Mukti's%20Notes/VALIDATION%20THERAPY.htm

VALIDATION THERAPY NAOMI FEIL

adapted from The Validation Breakthrough: Simple Techniques for

Communicating with People with Alzheimer's -Type Dementia

Naomi Feil (1993

PRINCIPLES:

All people are unique and must be treated as individuals.

All people are valuable, no matter how disoriented they are.

There is a reason behind the behavior of disoriented old-old people.

Behavior in old-old age is not merely a function of anatomic changes in the brain, but reflects a combination of physical, social and psychological changes that take place over the lifespan.

Old-old people cannot be forced to change their behaviors. Behaviors can be changed only if the person wants to change them.

Old-old people must be accepted nonjudgmentally.

Particular life tasks are associated with each stage of life. Failure to complete a task at the appropriate stage of life may lead to psychological problems.

When more recent memory fails, older adults try to restore balance, in their lives by retrieving earlier memories. When eyesight fails, they use the mind's eye to see. When hearing goes, they listen to sounds from the past.

Painful feelings that are expressed, acknowledged, and Validated by a trusted listener will diminish. Painful feelings that are ignored or suppressed will gain strength.

Empathy builds trust, reduces anxiety, and restores dignity.

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.

Technique 1. Centering

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.

Technique 2: Using Nonthreatening, Factual Words to Build Trust

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.

Technique 3: Rephrasing

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.

Technique 4: Using Polarity

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.

Technique 5: Imagining the Opposite

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.

Technique 6: Reminiscing

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.

Technique 7: Maintaining Genuine, Close Eye Contact

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.

Technique 8: Using Ambiguity

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.

Technique 9: Using a Clear, Low, Loving Tone of Voice

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.

Technique 11: Linking the Behavior with the Unmet Human Needs

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.

Technique 12: Identifying and Using the Preferred Sense

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.

Technique 13: Touching

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.

Technique 14: Using Music

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 STAGEÒ 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:

Muscles Tight,

Eyes Focused

Movements Purposeful

Speech Clear

Emotional Characteristics:

Keeps Social Controls

Avoids Touch

Avoids Expression Of Feelings

Keeps Clock Time

Frightened By Occasional Disorientation or Memory Lapse

Hoards

Repeats Unresolved Issue: i.e. Fear Of Being Robbed, Poisoned, Blames Others For Old Age Losses.

VALIDATION Helping Methods:

Resents touch. Use handshake. Keep 10" distance.

Withdraws as a Validation Group Member. Needs status.

Use One-to-One Validation:

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:

Speech Unclear, Few Dictionary Words

They Word-Doodle

Loss Of Logical Thinking & Ability To Compare

Loss Of Reflective Self-Awareness

Loss Of Chronological Clock-Time

Loss Of As-If (The ability to differentiate between similar things or people)

Emotional Characteristics:

Loss Of Social Controls

Smears Present With Past Time

Restores The Past To Survive Loneliness

Responds To Touch, Close Eye-Contact

Shares Feelings

VALIDATION Helping Methods: Touch, Close Eye Contact

Center To Remove Subjective Feelings.

Say Their Feelings Out Loud, Verbalize

Their Body Language

Match Their Feelings

Repeat Their Key Words Or Word-Doodles

Link Their Behavior To Unmet Human Need:

(1) love, (2) identity, (3) to express gut feelings

Accept All Feelings That Are Given

Do Not Insert Feelings Or Push

Travel To The Past With Empathy

Use Ambiguity (Vague Pronouns, "He," "Someone," "It," To Keep Communicating When the Disoriented Are Not Clear

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:

Adult Speech Goes

Motions Replace Words

Rhythmic Repetitive Movements

Restore the Past

Eyes, Ears, Recent Memory Worsen

Primal Behaviors Return

Movements are Purposeful

Emotional Characteristics:

Feelings Become Incontinent

They Withdraw, Shut Out External Reality

Return to Early Sensory Learning

VALIDATION Helping Methods: * USE One-to-One VALIDATION:

Nurturing Touch

Nurturing Voice Tone

Close Eye Contact

Genuinely Mirror Feelings.

Mirror Physical Motions

Use Ambiguity to Travel With Stage 3

Only Include In The Validation Group If

Touch Will Limit Repetitive Motions

(Stage 3 can create anxiety for Stage 2 group members)

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.

END PART ONE: THE THREE STAGES OF DISORIENTATION

Validation Therapy has really helped me communicate with the very old residents with dementia.

Hope the link works as I had to re link it!

Blessings,

Fixed the link. Karen

[Tweety, BSN, RN]

Thanks for sharing! (The link didn't work)

[adrienurse, LPN]

Thanks!

[semstr]

There are films about Validation too. Naomi Feil herself plays old-old women, who are then validated, I use these films in my geriatrics classes, because they are great!

PS: I made the experience, that it is not easy at all to learn how to validate (not the theory, but with the real patients), it takes quite a lot of time, plus collegues who are willing to let you do your validationthings.

Take care, Renee

[cargal]

Originally posted by 3rdShiftGuy

Thanks for sharing! (The link didn't work)

Yes, I tried in vain to get it to work, so I just cut and pasted the whole thing so that I could share. Thanks for posting.

[semstr]

Sorry guys, but I did not write anything here obscene (sp?) or something, there are little stars there. No idea, why? Please tell me!

[maureeno]

this approach works not only as 'therapy' but also as a philosophy and technique of caregiving. for me the most important points are centering myself and looking for meaning, always.

[pattyjo, MSN, RN]

Carrie: Thank you for posting this interesting link. I printed it out and will take to work with me tonight to look at. Although we try desperately not to admit dementia diagnosed patients to our unit (in-patient psych) we do see folks in the ER, and the caregivers are almost begging for some direction. I think the principles listed at the beginning of the article are easily applied, both in action and philosophically.

You mentioned a class you were taking on this subject. Is it in Pgh?

Patty

[cargal]

Pattyjo,

The class is in Hershey, Pa, and is almost JUST like what is on the link that I provided, except they instruct on a lot of excercises to center and train in the communication skills. It costs $750 and is covered in 5 blocks of 2 days every other month. Alot of facilities will pay for their staff, but I went on my own. I think it could be done in 2-3 blocks, there is alot of "down" time and fluff, but overall made me a much better nurse and aware of so many things that could help those with dementia.

The link for the Validation Therapy is:

http://www.vfvalidation.org/whatis.html and some of the classes are at

http://www.vfvalidation.org/events.html

The Institute offers workshops and seminars that may be more appropriate.

Blessings,