Some memories are painful, and painfully hard to forget.
One of my most difficult memories is a recollection of a visit to my grandfather many years ago in the nursing home where he lived. The scene is seared into my heart and involved a particular aide who was interacting with a resident who was clearly suffering from dementia.
While I forget the particulars, the sequence itself plays over and over in my mind.
The resident was convinced that she needed to call a cab in order to meet her husband at his doctor’s appointment. She was visibly anxious and distressed. The aide kept trying to explain that her husband was long deceased and therefore couldn’t possibly be meeting his doctor for an appointment.
Instead of pacifying the resident, this caused her further anguish and confusion and she began to cry in protest. I will never forget this scene and how my heart cried along with her. The pain I feel for this resident so many years later is as acute as it was when I actually witnessed it.
It wasn’t until many years after this story that I joined the world of seniors healthcare and became familiar with the concept of “therapeutic lies” and “validation therapy.”
Today we know that lying is sometimes the quintessential kindness a caregiver can offer any patient who suffers from dementia and, in particular, someone with Alzheimer’s.
In this disease, of course, the sufferer typically loses his or her short-term memory but retains a wealth of memories from the distant past — and often with phenomenal recall and in vivid detail.
This phenomena literally changes their perception of realty and causes them tremendous confusion and distress — because they often don’t recognize their surroundings and the people they are with.
Instead, they pine for the past, which they alone are living.
The validation therapy method was developed by Naomi Feil, a social worker, in the 1960s and 1970s as a holistic approach for treating Alzheimer’s patients.
It was an outgrowth of her disillusionment with the common practices she witnessed in dealing with confused seniors and dementia sufferers in particular.
In her groundbreaking book “Validation” (published in 1993), she emphasized a revolutionary approach associated with empathizing and listening — and, yes, lying if necessary, in order to validate the feelings of the patient.
This unique approach places an emphasis on the basic tenets of human dignity and on addressing the immediate needs of the patient, instead of focusing on changing what may be perceived as irrational behavior.
Validation therapy pre-supposes that older people struggle to work through old and lingering issues from past experiences and conflicts. It also argues that their confused outbursts are a manifestation of their inner pain.
Validation holds that these feelings can be diminished and that patients can find a measure of inner peace if a practitioner will show them empathy and respect so that they feel valued and not judged.
However, if these expressed feelings are ignored, or if the caregiver attempts to squelch them, the pain will only intensify and the person won’t find peace.
For this reason, it is more important to focus on the underlying emotions behind the statements of dementia sufferers, rather than on the actual facts and the veracity of their statements.
“Validation is all about living with the resident in the moment,” explains Julia Pitkin, one of the first validation practitioners in the United Kingdom.
In her book, Feil offers the following examples of the Validation Method in practice:
A physician might respond to a patient who is convinced that he is her husband, by empathizing and asking her whether she “misses him” and whether she “shared a close bond with him,” instead of ignoring her and simply prescribing medication to reduce her agitation.
A daughter who is addressing her elderly mother, who is convinced that someone is throwing away her sentimental belongings, even though she is the one who is actually hiding them, will not seek to argue the premise. Instead, the daughter will reminisce about what these belongings meant to her and of their significance.
As healthcare professionals, we are tasked not only with the responsibility to care for the physical wellbeing of our patients, but also with helping them to restore the one thing they often lack the most: their DIGNITY.
Judah Gutwein, LNHA, is the Director of Admissions, Administration, Marketing and Social Media for Regency Nursing and Post-acute Rehabilitation Centers, NJ