February 26, 2009
By Linda Espenshade, Staff Writer
Lancaster Intelligencer Journal
View the Article at Lancaster Online
In the beginning stages of dementia, the 80-year-old woman who recently moved to a retirement community couldn’t understand why her children wouldn’t come and take her back home.
They had promised they would, she insisted.
“What’s going on?” Stephen Klotz, validation director for Country Meadows Retirement Communities, including a branch in Lancaster asked. “You really seem unhappy here.”
“Well, it’s not that it’s so bad here,” the woman said. “It’s just not where I should be. I should be at home,” she said emphatically.
“You really want to go home because this isn’t your home,” Klotz said rephrasing what she had said with the same intensity.
“You’re darn right this isn’t my home,” she said.
“What’s your home like?” Klotz asked.
“Those are all things that you miss,” Klotz said. “It’s not the same here, is it?”
Klotz recounted this story as he explained how the validation method, developed by Naomi Feil between 1963 and 1980, can help people with dementia express their emotions and needs, both past and present.
Although the concept of validation is not new, it has garnered some extra attention recently when dementia support groups at Landis Homes and Lancaster General Hospital offered meetings on validation.
Country Meadows Retirement Communities, based in Hershey, has integrated the topic in all training sessions for new employees who will work with residents who have dementia. Country Meadows on Elm Avenue, Lancaster, is no exception.
Simply put, validation is a communication method that allows elderly, disoriented people to express their feelings to a caring listener, Klotz said. As the listener genuinely engages the elderly person on a feeling level, the disoriented person will begin to trust and express more.
“A basic principle of validation is that feelings that are expressed are feelings that are relieved. Not fixed but relieved,” Klotz said.
A person who feels validated is more likely to cooperate, feel safe, be less frustrated and to keep communicating, Klotz said.
Caregivers know how frustrating it can be when their patients or a loved one with dementia keeps going to the door repeatedly, saying, “I need to go find your father” or “I need to go find my husband.”
Validation doesn’t confront the woman with the reality that her husband has been dead for five years. Instead, validation looks for emotion behind what she is saying. Perhaps she is angry at being left alone; perhaps she is sad that he isn’t alive.
A son using validation with his agitated mother who wants to go see her dead husband will first calm himself down and set aside his own agenda. Then he will pay close attention to his mother’s mood, energy, the emotion.
Then, although this will feel unnatural, Klotz said, the son will match the emotion as genuinely as possible. Even the person who is disoriented can tell if you’re pretending, he said.
“You really need to go see Dad, don’t you,” he might say with the same intensity. “What’s it like when you can’t go see Dad?”
Underlining the entire approach is respect and value for the person, Klotz said. As the caregiver shows that he is willing to accept what that person is feeling, trust grows, even in the mind of the woman who no longer knows her son’s name.
“This is a person who has a lifelong set of experiences,” Klotz said. “This is a person for whom I need to show their value and give them some trust, rather than me trying to correct them, rather than me trying to change them.”
Klotz, who teaches validation around the country, recognizes the approach requires time and commitment from caregivers, but he is convinced the method is more effective than the more commonly used ones of distraction and consoling and appeasing or correcting that caregivers often do with dementia patients.
Simple validation techniques can be used by caregivers who attend a workshop, like the one coming up at Landis Homes. However, becoming skilled at validation requires intensive training, said Vicki de Klerk-Rubin, European manager for the Validation Training Institute.
Fourteen Authorized Validation Organizations provide training around the world, with only three of those organizations in the United States.
More intensive training in validation includes learning techniques, like asking question with words that have extremes: best, worst, hardest and easiest. Others techniques include asking “what if” questions and using reminiscing to help them find coping skills.
Trainees learn about the use of touch and how it can help a person to release emotions, especially as the elderly person becomes non-verbal. They learn to lead validation groups with residents – helping them help each other.
Jamie Kerchoff, coordinator of the dementia “neighborhood” at Country Meadows – Lancaster, said the training she received makes validation come naturally now.
“I use it with pretty much anyone,” she said. “I use it with co-workers. It’s just being able to put yourself in someone’s shoes.”
The approach can work in simple conversation; it can help when a resident is being uncooperative; or sometimes it can go deeper and touch an old emotion, she said.
She recounts a story of a war veteran who was a very private man. He was in need of an immediate shower, but he refused to go. The more staff arrived to help and the more they tried to convince him to go for a shower, the more aggressive he became.
When Kerchoff arrived, she asked him what was wrong.
“We’ve got to get out of here,” he told her. “They’re coming to get us.”
Kerchoff, who knew his history, understood that he emotionally was back in the trenches. Acting as one of his comrades, she assured him she would help him, and they marched toward his room.
Every time someone tried to talk to them, he said no, and they both kept on walking.
When he was finally in his room, he thanked her. “I thought they were going to kill us, especially you, ” he said.
“You needed a friend, didn’t you?” she said.
“My comrades were always there for me,” he told her. As Kerchoff helped the man clean up, they continued to discuss his experiences in the war.
Kerchoff believes her validation helped him to express some fear that he felt during the war but probably always suppressed. Entering into the experience with him and validating his emotion was a gift Kerchoff was thrilled to be able to give.
“He just touched my heart,” she said.
Supporting each other in validation groups
At retirement communities where the validation method has been integrated into their treatment protocol, residents participate in validation groups.
Six to eight residents with dementia meet once a week for the purpose of supporting each other.
Though it may seem unlikely that people who are disoriented have much to offer each other, Klotz said the power of these groups is surprising.
Each person is assigned a role, based on what he or she can do. It may be as simple as calling the meeting to order or as intense as being the group comforter. The roles affirm each person’s value.
The meeting follows a schedule, which provides a sense of security for the participants: Call to order, song or prayer, discussion, active game, social time and adjournment.
The discussion topics are based around the common experiences or concerns of the residents:
What’s it like not to have a job anymore?
What do you do when you miss someone? How can we help each other when we’re missing someone?
What are you afraid of?
Sometimes the groups are powerful and sometimes it seems like nothing happens, Kerchoff said.
But sometimes, even when you think nothing is happening, you’re surprised, Klotz said.
He recalled a group where they were talking about the most important things in life. One man who looked like he was asleep, spoke up when the leader asked for his opinion:
“The most important things in life are the people you love and the people who love you,” he said.
What: “What the Validation Process Can Do for You and Your Loved One” by validation therapist Stephen Klotz. A public meeting for caregivers of persons with memory loss and other forms of dementia.
When: Tuesday, April 28, 7 p.m.
Where: Landis Homes, 1001 E. Oregon Road, Lititz, in the Warwick Room of the Heritage.
Info: 581-3939. Respite care is provided on site with 24-hour prior request.
To learn more
LNP Editor’s note: For a video example of how validation works, visit http://www.thereisabridge.com.
Email the author at Linda Espenshade
© Lancaster Newspapers 2009
