Validation therapy: Should I correct someone with dementia?

One of the harder things to navigate when caring for somebody who has dementia is knowing when to correct them.

As dementia progresses, a person can become extremely muddled with day-to-day living and eventually start to forget long-term memories.

It’s not uncommon for people in later stages of dementia to hallucinate, have false memories or even forget significant life events.

Should I correct someone with dementia?

It may seem like an automatic response to correct somebody with dementia who is saying something you know to be untrue, whether they have got dates mixed up or something more serious, like asking where their long-deceased parents are. Being honest with them goes hand in hand with treating them with dignity and respect, as the adult they are.

However, blunt honesty can sometimes do more harm than good. People with dementia still need meaningful communication, as we all do, but being corrected on everything can be stressful, which in turn can muddle them even more and damage their confidence. Some topics can also be very distressing to relive.

Validation therapy: focusing on the true emotion

Validation therapy was developed by Naomi Feil, an American gerontologist, in the 1960s and 70s; she then published Validation: The Feil Method in 1982.

An alternative to the older method of ‘reality orientation’, which consistently brings the person back to reality, validation is a way to communicate effectively with somebody who has dementia, upholding their dignity and emotional needs without lying to them or contradicting them.

It focuses on the emotions behind what the person is saying, rather than the content being factually correct.

What is validation therapy and how does it help people with dementia?

Validation therapy is a therapeutic way to communicate with somebody with dementia. It focuses on the emotions behind what they are saying.

Dementia can cause people a number of difficulties in managing and communicating their feelings. 

As well as struggling with short-term memory, they can fight to find the right words and make sense of the world around them. All this can be extremely stressful to experience, and many people who have dementia are aware of their condition and that it will likely get worse.

It’s essential that people be supported to communicate, to support their mental health and to prevent them from feeling isolated. It is possible to be lonely, even when surrounded by people, if you are not having meaningful social interaction. Loneliness carries serious risks to mental and physical health – it has been found to increase risk of death by 26% and can even be as bad for health as smoking 15 cigarettes a day.

Benefits of validation therapy

Validation therapy techniques can be therapeutic and boost mental health in a number of ways.

• Calming effect – The person is supported in their narrative by focusing on the true emotions, rather than being contradicted about facts. This can decrease agitation and stress, which can in turn help with symptoms.
• Greater self-esteem and confidence in speaking to others.
• Quality, stimulating social interaction.
• Helping them to talk through emotions that they are struggling to communicate.
• Keeping their cognitive and communications skills active.

How can I use validation therapy to support a loved one with dementia?

You can use validation techniques in everyday interactions with somebody who has dementia. 

1. Listen actively and use physical contact. It’s advisable to sit where they can see you but not directly opposite them as this can be intimidating. Sit next to the person and giving them plenty of time to speak without interruption. Holding their hand or other physical contact can be reassuring for them.

2. Think about the emotion behind what they are saying and doing. For example, if they are checking their locks and not wanting to go outside because they believe they see somebody in their drive at night, the feeling behind this could be fear and that they don’t feel safe living alone. Or they keep recounting a story about their deceased wife that you know is incorrect, perhaps they are missing her and are trying to talk about her with you. 

3. Decide if it’s necessary to correct them. Does their mistake or false belief have any detrimental effect on them? Will they be more distressed if they feel you don’t believe them? If you do feel it’s in their best interest to correct them, support them to remember the information with a memo or a call to remind them.

4. When you respond, focus on the true rather than the false. Instead of concentrating on the incorrect elements of what they’ve said, validate what they got right and ask about the true emotions they are feeling. For example, they might say, “It’s my sister’s birthday today, I phoned her this morning.” You know they’ve got the date right, but that their sister died some years ago. Instead of reminding them of that, you could say yes it is her birthday and encourage them to recount fond memories of their sister.

5. Support them to express their feelings through additional means. As well as in conversation, you could support them to manage their emotions through creative means, such as arts and crafts (needlework, photography and model making all count), music or writing. Exercise is extremely effective in managing emotions and boosting mental health, so supporting them to do so, if possible, could be beneficial.  

You can take proper training in validation therapy through online courses.