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Validation Therapy

By  Naomi Feil, M.S., A.C.S.W.

 

In the Alzheimer’s wing of the nursing home, 93-year-old Ellie Turner stuffs more napkins into her worn-out black purse. The tarnished gold clasp clicks into place for the one hundredth time in one hour. “I have to fix the Underwood,” she says as she moves toward the bathroom to change her pants.

Mrs. Turner is called Alzheimer’s demented, but I have found that her behavior—and the behavior of thousands like her—makes sense. Her behavior is caused not only by damage to her recent memory, her logical thinking, and her inability to tell clock time, but also by the way she has lived her life. If someone enters her world, accepting or validating her needs, she will not become one of the living dead. She will die with dignity and self-respect.

As a bookkeeper and file clerk for a large electric company, Mrs. Turner used an Underwood typewriter for 50 years. When she was retired against her will at the age of sixty-five, she put her trusty office companion in her dining room. Every morning, Mrs. Turner’s daughter found her typing for her “company.” Mrs. Turner knew she was retired, but she could not accept the reality of her situation. Her work was the most important thing in her life, and she could not give it up. When, at age 93, she could not accept the fact that she was losing bladder control, she associated the loss of her Underwood with the loss of control. She went to the bathroom to fix her machine. The Underwood became a symbol of her old-age losses.

Very old people who have not prepared for the physical and psychological blows of aging often use symbols to express their needs. They have not learned to face pain, anger, frustration, shame, or guilt. Throughout life, they have denied painful emotions. In very old age, the denial worsens, and they blame others for their own failures. Each age has its own, unique tendencies. A three-year-old who talks to an imaginary playmate is not hallucinating; she is developing her imagination and verbal skills. If, at age 13, she talked to an imaginary playmate, we would worry. By the same token, an 85-year-old is very different—physically, socially, and psychologically—from a 70-year-old. We lose thousands of brain cells each year, beginning in our late twenties. Not surprising, this loss of brain tissue can affect our logical thinking areas after eight to 10 decades of wear and tear.

Many autopsies have uncovered Alzheimer plaques and tangles in brains of very old people who were never diagnosed with dementia. Many very old people, 85 to one 100, are interested in the outside world. They have learned to roll with the punches of aging; they do not hang onto outworn roles. They accept what they cannot change. But there are many very old people who have never learned to deal with their losses or their emotions. They cannot face the loss of memory, job, mobility, or control. These are the people who must now look inside. Their job is not to know the outside world. In their old age, they are simply preparing for their final move. They no longer care about the present.

Caregivers can help these people communicate their feelings and put past issues to rest. Rather than viewing them as diseased, we can see them simply as very old people in their final life struggle. When we tune into their inner world, we begin to understand that a retreat into personal history is a survival strategy, not mental illness. Then we are better prepared to listen with empathy rather than frustration when they step away from reality.

This is validation therapy—a tested method that can be used by both professionals and family members. I developed the therapy in 1963 when, as a social worker, I became frustrated with traditional, reality-oriented approaches to dealing with confused elders age 80 and older. Since then, it’s become state of the art and has been embraced by more than three thousand agencies nationwide. For many decades, validation therapy has helped the very old restore the past, relive good times, and resolve past conflicts. In doing so, it has reduced their stress, enhanced their dignity, and increased their happiness and sense of well-being.

 

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