Validation: a special understanding

Kristine Berey

The Alzheimer Groupe has been helping Alzheimer’s patients and their families for 25 years. In her work as director of support services, Marva Whyte has had to evaluate different ways of dealing with the challenging behaviours typical of the illness. “We experience what works and what doesn’t work five days a week,” Whyte said. One of the most effective approaches she uses in support groups is the Validation Method, pioneered by Naomi Feil in the 1970s. At last month’s educational conference, Vikki de Klerk-Rubin, Feil’s daughter, was the keynote speaker.

“Mom [Feil] was a social worker and started working in the nursing home where her father was the administrator and her mother head of social work,” de Klerk-Rubin said. “They lived at the back of the nursing home.” Feil, who wrote Validation: The Feil Method in 1983, had a very straightforward philosophy. “As human beings, we are connected to one another in a way that has nothing to do with religion, race or culture,” she said. As dementia sets in, Feil said, people still have issues to resolve, but become terribly isolated as a result of the illness and worseneing condition. “It’s not only a physical deterioration, but a psychological need to die in peace.” Feil says that at all stages of the illness there is a desperate need for human connection and the person needs to be reached on an emotional level. “If a person is left alone, that human being will deteriorate and will become a living dead person,” Feil said.

There are four levels of training, given by the Validation Institute in Cleveland and one that de Klerk-Rubin oversees in Europe, where the method is better known. (Feil’s book has been translated into several European languages.) But anyone working with the elderly with cognitive problems can benefit from learning some of the techniques and the philosophy of Validation, de Klerk-Rubin says. “Validation can be practised in the course of your other work. … It’s about communication.”

Key to Validation is the ability to enter the person’s reality while reserving judgment. “The goal is to accompany the person in the resolution of their issues. We never finish it; it’s a process that goes on until they die. We just don’t want them to be alone in it. Also, we believe that even very badly deteriorated people in the back of their minds know the truth.”

De Klerk-Rubin said that most caregivers want to make the client happy but they apply a definition of “happy” that is their own reference. “By trying to get them to be that way I’m trying to change them, not accepting them the way they are.”

Whyte gives an example of something that happens all the time. “Someone is asking for their parent, and says ‘my mother is waiting for me’, when the reality is that this 85-year-old’s parents passed away a long time ago. To say ‘your mother is dead’ would be totally cruel, but to say ‘you miss your mother’ gives the person a chance to talk about their mother, and by talking you are providing the person with the caring, the love and the attention they needed.”

There are learnable techniques, such as mirroring gestures, adjusting one’s tone of voice to the client’s, special ways of touching the person, which help this process.

The Alzheimer Groupe team Photo: Susan Gold

By looking at behaviour in the context of the client, it takes on meaning that makes it easier to understand and deal with. “That’s where we have to be careful with judgments,” de Klerk-Rubin says. “Maybe [that behaviour] is the perfect thing for [the client] to be doing at this point. And if I walk with her on this arduous path, she feels understood and maybe feels a little better. What we find is that if at least the basic attitude and most important principles of Validation are used [in an institution] you will see a significant reduction in burnout, sick days, and it will reduce staff turnover.”