Validation Carmen Bowman, MHS Certified Validation Worker and Group Practitioner EDU-CATERING Catering Education for Compliance and Culture Change in LTC carmen@edu-catering.com 303-981-7228
Validation: accepting the disoriented old-old adult who lives in his/her past, acknowledging feelings, validating. Denying a person s feelings invalidates. Implements the helping creed to accept people where they are. Originates after unsuccessful attempts of reality orientation.
Erik Erikson s 8 Stages of Development: 1. Trust vs. Mistrust 2. Autonomy vs. Shame 3. Initiative vs. Guilt 4. Industry vs. Inferiority 5. Identity vs. Confusion 6. Intimacy vs. Isolation 7. Generativity vs. Stagnation 8. Integrity vs. Despair
The Importance of Life Tasks When life tasks are not completed, they re-emerge. If continually denied, the task waits for old-old age when controls are weakened. The task waits until we forget our lines. Then it moves in. Therefore, Feil added a 9th Stage: Resolution vs. Vegetation
The Four R s of Resolution RESOLVE unfinished conflicts by expressing hidden feelings RELIVE past pleasures, replace intellect with feeling RESTIMULATE sensory memories to relieve boredom and stress RETREAT from painful feelings of uselessness and aloneness
Persons who live in the past: Must tie-up living to prepare for dying. Struggle to resolve past conflicts and restore their past for closure/justify life. Replace intellectual thinking with early learned emotional memories. Need emotional memories to be validated in order to regain dignity.
Characteristics of the disoriented old-old: 75 years old + led relatively happy, productive lives denied severe crises hold rigidly onto familiar roles permanent damage; brain, eyes, ears, mobility subliminal level of awareness to retreat from painful present choose to survive reality by recreating the past to substitute outlived the ability to defend against losses and stay oriented have lived too long to cope with present reality so move into feeling areas. No longer motivated to conform to society s rules to contain emotions or control instincts or feelings. Stopped-up, bottled-up feelings spill and demand resolution.
Feeling mode with intuitive wisdom: with failing eyesight, they see who patronizes them with diminished hearing, they hear the pretender know the quality of touch - the putdown pat or respectful warm contact EXERCISE they are not mindless although they do not use reason; they cannot compare - if something feels like something else, it becomes that thing, i.e. the back of a chair that feels like a father s shoulder, becomes the father they replace damaged logical thinking with feeling they return to past pleasures to survive their bleak present focus on resolving reason for having lived, struggle to justify existing their tense changes; past time becomes present time they ignore, withdraw or get angry at people who will not listen to them or who argue with them - this is invalidation
How Validation works: empathizes builds safety which builds strength and renews feelings of self-worth feelings of worth reduce stress and may lead to no longer needing fantasy since feel strong and worthwhile in the present acceptance instead of judgment, doesn t tell what to do or not to do, i.e. You don t need to feel sad..., respectful, no expectations doesn t analyze, give opinions or advice, only acceptance never forces feelings, simply validates those presented
Ten Principles of Validation 1. All people are unique and should be treated as individuals. 2. All people are valuable, no matter how disoriented they are. 3. There is a reason behind the behavior of disoriented old people. 4. Behavior in old age is not only a function of changes in the brain's anatomy, but reflects physical, social and psychological changes that take place during the lifespan. 5. Behaviors of older people can be changed only if the person wants to change them. 6. Old people should be accepted non-judgmentally. 7. Each stage of life has particular life tasks to be completed. Failure to complete these tasks may lead to psychological problems. 8. When recent memory fails, older adults restore balance to their lives by retrieving memories from the past. 9. Painful feelings that are expressed, acknowledged and validated by a trusted listener will diminish. Painful feelings that are ignored will gain strength. 10.Empathy builds trust, reduces anxiety and restores dignity.
Basic Validation Techniques Genuine touch - to feel the presence of another human being. Genuine, close eye contact leads to feelings of being loved and secure Clear, low, loving tone of voice - harsh tones cause disoriented people to become angry or cry or withdraw, high, soft tones are difficult for older adults to hear, a clear, low, nurturing tone of voice can be heard, triggers memories of loved ones and reduces stress Genuine warmth Empathy
What is empathy? The ability to put yourself in another person s shoes. Entering the other person s world. Feeling what they are feeling. Mirroring the way they feel. Exquisite listening
Empathy is not and Validation replaces: Sympathy Redirection or diversion Therapeutic fibbing Reality orientation EXERCISE
An empathetic listener: does not judge or try to change their reality sees the older person as someone who still has wisdom despite their confusion accompanies and finds ways to meet their three basic needs
Basic Human Needs The Three I s: IDENTITY valued as an individual INTIMACY accepted and loved INDUSTRY life has purpose
The Four Phases of Resolution vs. Vegetation: 1. Malorientation 2. Time Confusion 3. Repetitive Motion 4. Vegetation
Phase One Malorientation Phase One Characteristics Phase One Example Phase One Techniques
Phase Two Time Confusion Phase Two Characteristics Phase Two Examples Phase Two Techniques
Phase Three Repetitive Motion Phase Three Characteristics Phase Three Example Phase Three Techniques
Phase Four Vegetation Phase Four Characteristics Phase Four Example Phase Four Techniques
Validation Techniques Use Non-threatening, Factual Words to Build Trust Rephrase Imagine the Opposite Reminisce Open ended questions
Validation Techniques Use Ambiguity Match/Mirror Motions and Emotions * Link the Behavior with the Unmet Human Need * Clear, Low, Loving Tone of Voice Maintain Genuine, Close Eye Contact Touch Tell me about (best line every time)
Validation Outcomes Studies show the following positive results: less negative affect - crying, pounding, hitting speech improved adult controls returned, including continence more positive affect - smiling, talking, helping others some choose to return to present reality less staff turnover more meaningful interactions for family members
Putting Validation into Practice: Know your resident s social, family and work histories well. What crises, losses or conflicts did they face? How well did they face them? What were their roles - in their family, at work, in the community? Learn all there is to learn, read the books, share with others. Include person-appropriate Validation techniques in care plans. On the personal side, what crises or conflicts have you not resolved?
Resources The Feil Method The Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer s-type Dementia Validation Training Institute Website: www.vfvalidation.org Naomi Feil, Executive Director
Validation Certifications Certified Validation Worker Certified Validation Group Practitioner Certified Validation Teacher Where you can get certified: George M. Leader Institute Hershey, Pennsylvania Pinon Management, Denver, CO Volunteers of America, MN
Do you role with the punches?
... and get right back up?
Validation: Continuing to Change the Culture of Dementia Care EDU-CATERING Catering Education for Compliance and Culture Change in LTC 303-981-7228 carmen@edu-catering.com