Validation Therapy: A Case for Empathy

Webcast interview with Naomi Feil

Last week I had the privilege of viewing a webcast  interview with Naomi  Feil, MS, ACSW, Executive Director of the Validation Training Institute, Cleveland, Ohio and founder of the Validation Method.  Ms. Feil was interviewed by Joyce M. Konczyk, LSW, Geriatric Care Manager/Virtual Media Consultant.  Ms. Feil’s compelling, compassionate technique of communicating with persons with dementia is practiced around the wold.  You can view the archived webcast at:

http://www.helloworld.com/joycek

then:

*   Click on the broadcast tower icon (upper middle of page, hover to see “joycek’s shows”)

*   Look on the left column “Past Shows” and click on the photo/graphic to the left of the text

Ms. Feil started her work in the 60’s and has continued to refine and improve it.  Some years ago, I read her book called The Validation Breakthrough and found it so interesting.   I never took the opportunity to go through the training program she initiated, but did refer to it in a very simplistic way during the time that I was an educator and trainer for the Alzheimer’s Association.

Feil’s theory advocates validating the emotions that underlie patient concerns that do not appear to be based on reality (it is common for a disoriented person to insist to staff they he or she is waiting for his/her mother to come to the nursing home to visit when the parent has been dead for 30 years) or when the patient’s communication skills are impaired to the pointed that he or she appears to be talking gibberish.

In the first instance, it is tempting to tell the person that  his/her mother has been dead for 30 years and she surely will not be coming to visit today.  This would be very harsh and unkind, and, for a person with memory loss, may be a shock and lead to grieving the death every time someone “sets him/her straight.”   Feil’s work with severely disoriented elders has led her to believe that a better response would be based on the emotion you see the person showing with the words.  If the person appears to be happily anticipating the visit, you might say, “Oh, Martha, you look so happy when you talk about your mother; tell me what she was like.”    If the person appears distraught, one might say, “Martha, you seem very sad when you talk about your mother, do you miss her?”

In the second example, where the person’s speech does not make sense, one can still look at the emotion under the nonsense sounds and comment about what their facial expression tells you.  By using yes and no questions, you can keep the person engaged.

Feil believes that “communicating with the very old is a moral imperative of our time.”  She says that when we keep people engaged and communicating, even non verbally (with a nod of the head or a gesture,) that person is alive.  A basic principle of Validation Therapy is that when feelings are expressed to someone who is listening with empathy, the difficult struggles can be resolved.

Ms. Feil believes that all of us have to deal with life struggles at the time they occur or they will come out later in life.  Her experience with behavior problems in nursing home patients led her to believe that many times the behaviors were the result of these old, unresolved struggles.

For more information about Naomie Feil and the Validation Method, see the following:

http://www.vfvalidation.org

http://www.memorybridge.org.  (On the Memory Bridge site, under “watch video clips,” click on the 2nd and 3rd videos to see Naomi Feil in action.)

There are also some videos available that illustrate how Validation Therapy works.  Fortunately for us all, Ms. Feil’s husband has filmed some of her work or dramatizations of it with her portraying the patient.  One of my favorites is called  Myrna, the Mal-Oriented.  In this touching video, 86 year old Myrna deteriorates physically and mentally, blaming her family and friends for her losses. She thus drives away her friends and frightens her family. Terrified of losing her identity, she accuses her caregiver of stealing her things.

Part Two:
Myrna refuses help. Sally Ames, a Validation^® worker slowly builds trust, makes mistakes and learns thereby. Myrna comes to trust the worker, and expresses some buried emotions. Her hostility lessens, and she develops a measure of peace.

Video-graphics are used to pin-point Validation^®principles and techniques.

I will be taking a short leave of absence from blogging while I have my left shoulder replaced.   Since I will be in a sling for about 4 weeks post-op, my keyboarding will be limited.   I will be checking e-mails and responding (briefly.)  My work e-mail address is:

crseniors@usfamily.net

Think good thoughts,

Marilyn Christenson

Seniors Choice at Home

Plymouth, Minnesota

Minnesota Care Givers Know How to Make a Difference

Monthly Newsletter Helps Seniors’ Choice Employees With Senior Care

Every month I write a newsletter for Seniors’ Choice at Home employees.  I tried to include some fun things like recipes and jokes, some recognition for successes with clients and some pointers for working with clients who have memory loss.  The Alzheimer’s Association (www.alz.org) is always a great resource for me.

Memory Loss

*   Accept the memory loss; don’t think that if the person tried harder, she or he would remember.

*  Answer questions each time as if it was the first time they were asked.  If you run out of patience answering questions over and over, write the answer on a recipe card (a black, felt tip  pen works well for this, ) hand the card to the person, and direct him or her back to it when s/he repeats the same question.

Planning, Organizing and Carrying out Complex Tasks

*  Know that what may seem simple to you (brushing teeth) becomes complex to the person as dementia progresses.  Break directions down into simple steps and offer only one step at a time.

*  Use simple and direct language–the more advanced the disease, the fewer words.  If you want someone to stay seated, say, “Please sit,” rather than “Don’t get up.”  With limited memory, the person may forget the “don’t” and actually get up, because that’s the last thing he/she heard.

*  Be sensitive to emotions–frustration, fear of falling–and offer support and encouragement.

*  Because judgement is sometimes a problem, keep the person’s safety in mind.

Disorientation

*  Use reality orientation carefully.  It may be helpful for some people, especially in the earlier stages, but in some cases, it can be confusing and even hurtful.  Commonly, patients ask for “mother” even though she has been dead for years.  Rather than say, “Oh, your mother has been dead for 20 years,” you might say something like, “Do you miss your mother?”  I bet she was a wonderful person.  Was she a good cook?”

*  Pick your battles.  If she says the sky is green, don’t bother arguing about it; just say, “Wow!  that sure is an interesting color?”  If they ask for the salt for their cereal, and you know they mean sugar, don’t bother correcting them; just pass the sugar.

Go with the flow; meet the person in the reality where he or she is living.   Don’t argue; you will just upset both you and the care recipient.  Remember that “therapeutic fibbing” is OK, and that this disease is different for every person.  It helps to acquire a “bag of tricks”, so that that you can pull one out and try it when needed.  It may not work, so be ready to try another.  It may not work today, but it may be just the thing at another time. 

Seniors’ Choice at Home care givers amaze me every week with their patience and creativity when they work with clients with memory loss.  One care giver made a daily schedule on white paper with a felt tip pen for a gentleman who was continually agitated.  She had the schedule laminated (a plastic cover would work well too,) so he could carry it with him throughout the day.  It seemed to provide him with the sense of security and calmness he needed to know what was happyening next, so he could go through the day with less anxiety.

For more information about Seniors’ Choice at Home in the seven counties in and round dthe Twin Cities of Minnesota, call 763-546-1599, or check out our website at www.seniorschoicemn.com.

The Music and Rhyme of Poetry

Help The Person You Care for Thrive

Many care givers, family and professional, say they wish they knew of ways to better spend their time with people who have memory loss.  We would all like to have those we love thrive, not just survive.  In an earlier post, I wrote about the magic of music.  Poems, like music, seem to be a source of great enjoyment for people of all ages.  Sometimes you can simply start the line of an old familiar poem, “I think that I shall never see…” and the listener will say the next line, “A poem as lovely as a tree.”  (Trees, by Joyce Kilmer.)  Poetry, like music, may be stored in the long-term memory of a person with dementia and can be easily recalled.

In the early stages of Alzheimer’s disease, poems can help people express their own emotions.  They can help initiate conversations and reminiscing.  Later in the disease process, just the sound and rhythms can be soothing and can help a person connect with the long term memories that often remain in tact. 

There is something about the rhythms of both poetry and music that help organize the brain;  both can somehow move people into accomplishing activities of daily living (singing a song or reciting a rhythmic verse sometimes helps with reluctant bathers.)  Poetry can lift one’s spirits and feed a sense of humor.  Even though people with dementias experience significant losses, many times, a sense of humor is something the person retains.  Make use of it and provide opportunities for laughing.

Here’s a poem that might be fun after dinner on Thanksgiving Day:

I ate too much Turkey, I ate too much corn,

I ate too much pudding and pie.

I’m stuffed up with muffins and too much stuffin’

I’m progably going to die.

I piled up my plate and I ate and I ate,

But I wish I had known when to stop.

I’m so crammed with yams, sauces, gravies, and jams

That my buttons are starting to pop!

I’m full of tomatoes and mashed up potatoes

My stomach is swollen and sore,

But there’s still some dessert, so I guess it won’t hurt if

I eat just a little bit more!

–Author Unknown