Sep 27, 2014 8 min read

How can you communicate with a loved one who has lost touch with reality? When there’s bewilderment on both sides of the relationship, yelling, confrontations and arguing will lead to frustration. Avoiding each other may not be much of a solution.

Cleveland social worker Naomi Feil began working with the disoriented elderly some five decades ago, trying a host of therapies. “I found that the nursing home residents retreated inward,” she wrote in response to an email.

After 25 years, she formulated what she eventually named the Validation Method, and she is now, at age 82, the executive director of the Validation Training Institute.

“When I started listening with empathy, and feeling their emotions, they responded. Anger lessened, speech improved and people expressed feelings of well-being. Slowly, from 1963 to 1980, I developed validation verbal and nonverbal helping methods and the Validation principles. I found that the residents return to the past to heal themselves, and a trusted caregiver needs to listen. Validation developed through trial and error, learning from my mistakes.”

The Validation Method is used in many countries in Europe and Japan.

While some refer to it as validation therapy, Country Meadows Retirement Communities, including its location in South Fayette Township, has wholeheartedly embraced it, using the term “Validation Method” and training not only its own staff but workers from other facilities. Thirteen years ago, County Meadows became the first authorized Validation organization in the United States, and it requires each member of the memory support program staff to earn certification as a Validation associate.

There is a natural tendency to disconnect or distance oneself from a person who has memory impairment because it so drastically changes the dynamic of long-term relationships.

“That happens with family members because they’re looking at their loved one with the same eyes that they always have,” explained Maureen Sirianni, memory services coordinator and Validation teacher and training coordinator at Country Meadows of South Hills in Bridgeville. The family member’s reaction may be along the lines of, ‘You look like my aunt. Why aren’t you acting like my aunt?'”

Sirianni said the clash between reality and the view of the person who has been diagnosed with Alzheimer’s disease or dementia can be “very brutal sometimes. You have to remember that people who have memory impairment are like time travelers, and things, people, experiences and current reality can trigger feelings, memories and emotions as though they are real and true in that moment.

“We want to meet them where they are so they don’t have to do this alone. The perception is that all old people are ‘cute’ and we want to keep them happy.”

The Validation Method seeks to aid those who have dementia or Alzheimer’s connect their words to how they’re feeling at that moment and communicate their emotions, their needs and their concerns to a capable, trusted and caring listener.

“Then empathy kicks in, and we not only want to put ourselves in someone else’s shoes, we want to put our heart in someone else’s heart. We want to feel what someone else is feeling at that moment so they’re not alone.”

It’s helpful to know that when you are spending time with someone who has memory impairment, they lose their filter, Sirianni said.

Before interacting with someone who has Alzheimer’s, memory impairment or dementia, Sirianni said the first step is to “center yourself. Clear your mind. Think, ‘I don’t know what’s going to happen when I walk into this room. Never plan your agenda. Look at that person’s body language. Observe those emotions and physicality. Match your energy level to that person. Change your tone of voice. See things from their point of view when we enter their world.”

It’s easy to enter a room where everyone is smiling, Sirianni said. The Validation Method helps a caregiver or visitor to cope with more difficult situations, such as encountering someone who is sad or crying.

Ask what, who, when, where and how questions. Encourage them to find their words.

Notice the absence of the word “why.”

“Why can come off as a very demanding question,” Sirianni explained. Although it might sound like an obvious question, ‘Why are you crying?'” may be impossible for the one who is suffering to answer.

“They don’t care why,” Sirianni said. Accept that this emotion “is just me in this moment.”

Even when dealing with someone who has lost the ability to speak, eye contact and touch are tools worth using. Body language is important to consider. Standing over someone who is seated places the person who is standing in a dominant position, so this stance is to be avoided.

“If someone is crying, I lower my face, voice and change my body language so I’m at eye level or lower so I don’t appear demanding. In a soft voice, a family member or caregiver can say, ‘You have tears. What made you sad? Is it scary?'” The person with memory impairment may not answer, or may not have the ability to answer immediately, so the pace of a conversation may be quite slow.

“For many family members, it is very hard to be comfortable with the silence. The person may take up to a minute or more to process. Even when we know they are wrong, we have to appreciate their perception. Empathetic listening teaches you how to be comfortable with the silence.

”We can’t rush them. It’s not our agenda. We have to meet them in their moment. And we also have to respect the fact that even when we know they are wrong, we have to appreciate the fact that is their perception. It’s real and true to them, even if we don’t understand it. It is their journey – it is that elder’s journey, and they’re trying to tie up loose ends. I always tell staff or caregivers it’s important to know a resident’s life story. We encourage family members to write down as much as possible. It’s important to know who your loved one is.

“Sadly, they may not remember your name, but they know, ‘There’s my person. When she comes, she’s good to me.'”

The Validation Method recognizes four phases of memory impairment.

In the first phase, someone knows where he or she is. With some guidance and support, they can get through the day.

The second phase is time confusion. This person may or may not have lost judgment, and may, at this point, wander.

The third phase is repetitive motion, going through the motions of sewing, for example, or repeating a sound.

The final phase is a vegetative state, the end stage of the disease process. “We’re not able to know issues or concerns they’re resolving, if they’re resolving anything,” Sirianni said.

Sirianni said use of the Validation Method helps those with memory impairment to remain engaged. She has seen among its long-term benefits: “Cognitively, emotionally, they plateau. It buys about two years’ worth of time before there’s a level of care change.

Even when someone has lost verbal ability, eye contact, touch, music and religion can continue to motivate the person who has Alzheimer’s or dementia.

“Not every person can be validated, and not everyone can validate,” Sirianni said. But, on the other hand, “Validation has never hurt anyone. It’s never damaged anyone. Validation is not going to fix them, and it’s not going to change them.

“It might not work the first time. We just keep trying.”

Maureen Sirianni, memory services coordinator and Validation teacher and training coordinator at Country Meadows of South Hills in Bridgeville, will present “Dealing with Emotional Losses: How the Validation Method can help families engage and support their loved ones who have dementia” from 6 to 7:30 p.m. Nov. 18, in Building 1, 3560 Washington Pike, Bridgeville. Space is limited, and participants must register by Nov. 14 with Erika Seibel at 412-257-4566.