Validation Therapy for Dementia: A Guide for Caregivers

Behavioral and psychological symptoms of dementia (BPSD) are among the most challenging aspects of dementia caregiving. Coping with behaviors such as agitation, irritability, and apathy can take an emotional toll on caregivers. It can be tricky to provide validation for the feelings driving these behaviors but not necessarily the behaviors themselves. 

Fortunately, several therapy-based interventions can help caregivers address some of the more difficult emotions and behaviors. Validation therapy aims to validate these feelings while alleviating negative emotions and enhancing positive emotions.

This article will discuss the basics of validation therapy for dementia and how it’s used in dementia care.

Validation Therapy for Dementia

As humans, we all need some degree of emotional validation. It provides us with comfort knowing those around us understand and accept our feelings. This concept of emotional validation serves as the foundation for validation therapy for dementia.

Between 1963 and 1980, Naomi Feil developed validation therapy for older individuals with cognitive impairment, and it has since been applied in the dementia caregiving space. Validation therapy for dementia focuses on understanding and accepting the reality of the person living with dementia.

How Validation Therapy Is Used in Dementia Care

As dementia progresses and more cognitive abilities are impacted, the needs and abilities of people living with dementia change. During the later stages of dementia, communication can become challenging. Validation therapy utilizes several communication techniques that may help overcome communication barriers and has been found to decrease agitation, apathy, irritability, and nighttime disturbance. General communication techniques used in validation therapy include:

• Using non-threatening words to establish understanding
• Rephrasing the person’s words
• Maintaining eye contact and using a gentle tone of voice
• Responding in general terms when meanings are unclear
• Using touch when appropriate

Verbal and Non-Verbal Validation

It’s important to understand that there is a reason behind the behavior of the person living with dementia. While their behaviors and emotions may seem irrational to you, they may seem normal to them. Using verbal and non-verbal validation techniques provides a means to better understand the emotions behind behaviors rather than redirecting the conversation. 

Below are examples of verbal and non-verbal validation techniques that may be used by caregivers:

• Empathize: Set your emotions aside and try putting yourself in their shoes. Determine what emotion they are feeling and say the emotion out loud while matching the emotion.
• Focus on phrasing: When trying to understand the feelings of a person with dementia, the way you phrase your questions matters. Ask “who,” “what,” “when,” “where,” and “how.” Avoiding asking “why,” as this implies cause and effect and can be a cognitively challenging question to answer.
• Fall back on repetition: If you’re not sure you understand what the person with dementia is trying to say or you can’t think of the right thing to say, don’t be afraid to fall back on repetition. Repeating key words or phrases from what the person said can validate their feelings even if you don’t fully understand.
• Mirror their preferred sense: Take note of how the person with dementia communicates. Determine if they prefer using visual-, auditory-, or kinesthetic-oriented words. For example, if they use words such as “seeing,” you can mirror this by using words and phrases such as “look like” or “appear.”
• Stay connected: Remember that validation therapy for dementia is much more than saying you understand. Maintaining eye contact, using physical touch when appropriate, and matching their movements lets the person with dementia know that what they’re saying is important to you and that you are there for them. 
• Incorporate music: In Alzheimer’s disease, the most common cause of dementia, the brain regions linked to musical memory are relatively undamaged. Singing or listening to a familiar song that matches their emotion can validate these feelings or even allow them to reminisce on a positive memory.