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author: PhDr. Lucie Procházková, Ph.D. title: The Validation Method – Supporting Work with Disoriented People type: Príspevok language: English published: 18 Feb 2012 updated: 10 Aug 2014 category: Sociálna práca source: https://www.prohuman.sk/socialna-praca/metoda-validace-podpora-prace-s-dezorientovanymi-lidmi
Living with older people and providing daily care for them can sometimes present very challenging situations. This is especially true for individuals with a certain degree of disorientation. The validation method was created to handle these situations. It is designed for caregivers and shows how to communicate appropriately with disoriented people or people with dementia and support them.
Since the mid-20th century, global demographic aging of society has been occurring. Both the average age and the age at which men and women live to are increasing. According to long-term forecasts, this trend will continue, with the proportion of older people expected to grow in particular. Experts anticipate a rise in the proportion of the population in post-productive age. As the population ages, the prevalence of dementia also increases. According to the Czech Alzheimer Society, dementia occurs in approximately 1% of people in the 65–69 age group, while for people over 85, this proportion reached 20% (in men) and 28% (in women) across Europe in 2009.
The most common cause of dementia is Alzheimer's disease. It causes a decline in cognitive functions, including memory, thinking, and the ability to make judgments. Among the primary symptoms are worsening memory and disorientation. A person becomes disoriented in both space and time. Dementia refers to a syndrome that encompasses a wide range of symptoms. Dementia is generally characterized as an organically conditioned, chronic, and progressive loss of cognitive functions. However, there are multiple causes of disorientation, which is why the validation method speaks not only about people with dementia but rather about disoriented people.
The Validation Method
The validation method was created by Naomi Feil, an American gerontologist and social worker. She responded to the reality that the methods commonly used up to that point were ineffective in her work with older and very old people. She therefore tried different approaches and techniques, from which she developed the validation method. The goal of validation is not to improve the health status of very old disoriented people. Rather, it is about changing the approach of caregivers so that they can empathize with the personal reality of the disoriented person and adjust their behavior and actions accordingly.
Target Group
The people for whom the validation method is intended are referred to by N. Feil as disoriented very old (in the original English "old-old") people. She intentionally uses the term "disoriented." For the people this method is intended for, there is a different perception of reality. Every person sees the world and perceives reality in a different way, yet there are certain generally accepted norms by which we often orient ourselves. In validation theory, disorientation is understood as a person's inability to process the increasing physical, social, and psychological losses that are age-related. This inability leads to isolation; the person withdraws into themselves and into the past. The past becomes more important than the present. In the lives of these people, the past comes alive, and they often reminisce about it. They want to re-experience pleasant events. They want to relive situations when they were young, capable of handling everything, and useful — when life had meaning. Sometimes memories of unpleasant experiences may return, which these people want or need to process and resolve. However, it is difficult for them to remember these things and speak openly about them. That is why it is important to choose the right approach in which we are available to the person, listen, support, but do not exert pressure. It is also very important not to critically evaluate the actions or decisions that the person has made. They certainly had their reasons for acting as they did. Our task is to share the experiences.
Basic Principles
Validation is based on several fundamental principles.
1. Insufficiently oriented and disoriented old people are unique and valuable.
. Each person must be approached as an individual and respected. This is reflected, for example, in the way we address them — we do not say "grandpa" but rather "Mr." and the surname or title, if the person so wishes. This shows respect for the person. 2. Insufficiently oriented and disoriented old people should be accepted as they are: we do not try to change them. We should accept a person as they are and should not judge them or their behavior. We do not try to change a person's behavior but rather try to meet individual needs that may be expressed through certain actions. For example, older people in institutional settings sometimes complain that they are not getting food. They demand food even though they ate a short while before. Their hunger, however, is usually not about food. N. Feil refers to this as "psychological hunger," in which people are starving for attention, missing their family, and feeling lonely. A validation approach then does not mean explaining to them that they have already eaten, but rather discovering what would "satisfy" them — what would fulfill them.
3. Empathic listening builds trust, alleviates fear, and restores dignity.
Older people may feel ashamed of things they can no longer manage (e.g., keeping their room tidy) or of things that appear anew and are related to age or health conditions (e.g., incontinence). In these situations, they come up with explanations and blame others (that someone is hiding their things so they cannot keep order, that someone spilled something on them, etc.). We try to share feelings, understand their importance, because they weigh on the older person but they are unable to speak about them openly. We do not focus on the facts and truthfulness of the information conveyed but rather empathically share (and subsequently respond to the situation). 4. When painful feelings are expressed, accepted, and validated by a trusting listener, they weaken. Painful feelings that are ignored or suppressed gain strength. We try to be open to the feelings that older people want to express. Often these are memories of a time when they were still productive and useful — they talk about needing to cook for their children or iron their husband's shirts. Our task is again not to explain that this is no longer necessary but rather to engage with the reminiscence. In a broader context, these can also be feelings of the caregivers themselves. They too often struggle with feelings of helplessness, sadness, and anger and need to share them. If they were to suppress these feelings, they would only grow and deepen.
5. The behavior of very old and/or disoriented people has some reason.
Sometimes the behavior of older people may seem incomprehensible to us. Behavior reflects physical, social, and psychological changes as well as life experiences. Our task is to help express feelings and overcome unresolved problems (which may stem from the distant past). 6. The reasons for the behavior of insufficiently oriented or disoriented very old people stem from basic human needs. People in advanced age tend to withdraw from the present and return to the past, when they did everything themselves, when they were useful, and had no major health problems. We accept the person's personal reality, the return to the past, because the present is sometimes very difficult to handle and accept. 7. Previously learned patterns of behavior return when verbal abilities and short-term memory fail. People who are no longer able to express themselves adequately verbally replace speech with movements. Lip and tongue movements, gestures replace words. By mirroring movements and sounds, we reach the same level, which creates a greater sense of security and belonging. 8. Personal symbols used by insufficiently oriented or disoriented older people represent people, objects, or concepts from their past and are filled with emotions. People in the present may stand in for people from the past — the care home manager replaces the father, the caregiver replaces the neighbor. Objects also carry meaning: a wedding ring represents love and a relationship, a handbag represents identity. 9. Insufficiently oriented and disoriented older people live on different levels of consciousness, often simultaneously. Disoriented older people may at one moment be looking for their parents or claiming to have seen them, and when we ask where they saw them, they answer that nowhere — that they are already in heaven. We do not deceive old people; subconsciously they often know the truth but simply do not want to accept it. 10. As senses weaken, insufficiently oriented and disoriented older people engage in self-stimulation. They use their "inner words," see with their inner eye, and hear sounds from the past. Older people can have very vivid memories — they hear their child crying, see their husband. Again, this is their personal reality; they did not have enough time to grieve and cope with loss, and their brain is stimulated, producing vivid memories. 11. Events, emotions, colors, sounds, smells, tastes, and images happening here and now trigger emotions that bring up similar emotions from the past. Things from the present can evoke memories from the past. Some very old people still experienced war or concentration camps — loud sounds like a door slamming or the rattling of a food cart can trigger negative memories. The smell of certain foods may recall a time when people did not have enough food and ate only simple, repetitive things (e.g., soups). Or people tend to hoard food because they experienced hunger and fear that this situation could return.
Conclusion The validation method provides an approach to disoriented older people. It is suitable both for family members and for workers in home care or residential settings. According to this method, one responds appropriately to certain behaviors and reactions of older people that may, from our perspective, seem strange, inadequate, or even inappropriate. Often we try to explain to the disoriented person that things are different, and when accused, we tend to defend ourselves, which further upsets older people because it implies they are wrong. Through the validation approach, it is possible to ease the atmosphere and establish contact; we learn to properly handle our own feelings and reactions. The validation method is not a treatment method or therapy. It seeks to point out that every behavior, even one that is incomprehensible to us at the moment, has its reason, and that by responding differently from what we are accustomed to, we can prevent tense situations, irritation on the part of the older person, and hurt feelings on our part. Naomi Feil emphasizes: "The validation method supports the very old person in reaching their goals, not ours." PhDr. Lucie Procházková, Ph.D. This text was prepared with the support of FRVŠ project no. 2460/2011 titled "Innovation of the Course Special Andragogy of People with Disabilities." References Prevalence of Dementia [online], Czech Alzheimer Society. Available at www: http://www.alzheimer.cz/alzheimerova-choroba/vyskyt-demence/ [22 Nov 2011]. FEIL, N. Validation. 5th edition. München: Reinhardt-Verlag 2007. ISBN 3-497-01914-3. FEIL, N., de KLERK-RUBIN, V. Validation. Ein Weg zum Verständnis verwirrter alter Menschen. 9th revised and expanded edition. München: Ernst Reinhardt Verlag 2010. ISBN 3-497-02156-7. de KLERK-RUBIN, V. Mit dementem Menschen richtig umgehen. Validation für Angehörige. München: Reinhardt Verlag, 2009. ISBN 978-3-497-02080-5.
Professional Journal Social Services - 2/2012
The professional monthly Social Services is the most widely circulated periodical in the field of social services in the Czech Republic. Its publisher is the Association of Social Services Providers of the Czech Republic (APSS ČR), the largest professional organization bringing together providers of all types and kinds of social services in the Czech Republic. Its membership currently consists of more than 720 organizations, representing over 1,600 registered services.
Cover and contents of the issue HERE (PDF, 360KB)
The Social Services journal was created in 2009 through the transformation of the previous APSS ČR Bulletin. It is published ten times a year on 36–48 pages in A4 format with a print run of 3,500–4,000 copies for approximately 16,000 readers among providers, founders, and users of social services, representatives of public administration, students, and university faculty in both the Czech Republic and Slovakia.
More information can be found on the websites http://www.socialnisluzby.eu and http://www.apsscr.cz.
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