What Are Validation and Reminiscence Therapy?

If you have a loved one dealing with MCI or dementia, two types of therapy developed in the second half of the last century may equip you with tools or techniques to help you with some of the challenges that often come with the terrain. Although developed by psychologists and usually practiced by professional caregivers, validation therapy and reminiscence therapy are based on principles that anyone can apply to their interactions with people struggling with cognitive decline.

What is the Main Idea behind Validation Therapy?

The “Validation Method” was developed by a clinical social worker named Naomi Feil during the 1970s and early 1980s, a time when adults with dementia were classified as “senile psychotic” and treatment consisted of attempting to reorient them back to reality. Feil’s primary insight was that such methods were not only fruitless but cruel. Feil had come to believe that the behaviors of dementia patients, however odd or random they might seem, were derived from basic human needs such as the need to resolve unfinished issues, to make sense of one’s surroundings, to reduce pain, or to feel productive. Because every person with dementia is a unique, valuable individual, caregivers should accept them as they are rather than attempt to change them.

Validation therapy holds that, when a person with dementia makes a statement that conflicts with our reality, even in the throes of a hallucination, it should be met with close listening, empathy, patience, reassurance, and validation rather than with argument, gentle correction, or tough love. The same is true of oppositional behaviors and errors caused by memory loss. The goal of validation therapy is not to restore the person’s memory or to somehow reverse their dementia. It’s to help both the person with dementia and the caregiver achieve peace and calm, which may help with the person with dementia’s thinking.

Proponents of validation therapy say that it helps people with dementia to communicate more, have improved mood, display less aggression, and require less psychotropic medication. But the evidence of its effectiveness is mixed, with some studies showing benefits and others failing to find statistically significant differences between it and other approaches. However, no studies have found validation therapy to be harmful, so there’s nothing to be lost by attempting to incorporate some of its philosophy and techniques into your interactions with someone with dementia.

Validation Therapy Techniques

When you’re entering into a conversation with a person with dementia, make use of the following practices:

• Get centered.Take a moment to rid yourself of distracting thoughts and concerns so you can give the patient your undivided attention.

• Measure and match.Carefully observe the patient, taking their emotional temperature, and then consciously calibrate your demeanor to match theirs. If the patient seems sad, match their vibe as you begin to engage them in conversation.

• Talk as equals.Monitor your tone of voice. Rather than talking down to the patient as if he or she were a child, use an adult-to-adult tone of respect.

• Look them in the eye.Approach the patient from the front, at eye level, and keep good, respectful eye contact while you speak.

• Be mindful of social space. Getting too close to a person with dementia might make them feel that you’re invading their personal space, and staying too far away can feel like you’re not really engaged. The right proximity will depend very much on the patient, but usually is easily sensed through their response.

• Reassure.Ask open-ended questions, rephrase the patient’s statements to validate them, and generally adopt an accepting and warm demeanor. Don’t attempt to lead the patient toward a “correct” version of reality.

What Is the Main Idea Behind Reminiscence Therapy?

As with validation therapy, reminiscence therapy does not seek to cure or reverse dementia but rather to help dementia patients feel safe, valued, and at peace, and to improve their communication and quality of life. In reminiscence therapy, which was also developed in the 1970s, patients are encouraged to access their long-term memories, often with the use of photographs, texts, videos, music, and other props.

This therapeutic approach leverages two key characteristics typical of older adults with dementia:

• Their dementia is often accompanied by depression, and
• They often have better recall of distant events than of recent ones.

By engaging with the past through various mementoes, they are able to converse with authority, self-assurance, and dignity, while revisiting cherished parts of their lives. This often helps them make a stronger connection to the present.

Reminiscence therapy has been studied repeatedly for its effectiveness on improving patients’ mood, communication, and quality of life. Unfortunately, as with validation therapy, the evidence supporting reminiscence therapy’s effectiveness is not overwhelmingly strong.

Reminiscence Therapy Tools and Techniques

Chances are, you’ve already engaged in a form of reminiscence therapy if you’ve ever asked an elderly relative to tell you stories about the old days. And while simple story time and Q&A can certainly be effective, experts suggest helping the dementia patient “go there” by tapping into all five of their senses.

• Sight.Pictures from decades past, especially of the patient’s formative years, can be a great way to kickstart their reminiscence. So, obviously, can videos, old movies, and vintage magazines. But don’t overlook personal keepsakes such as the patient’s mother’s butter dish, the patient’s own Scouting neckerchief, newspaper clippings about sporting feats, or ticket stubs from the patient’s honeymoon trip.

• Sound.Music can immediately transport us to another time and place. If you know some of the patient’s go-to or most cherished songs, that’s great. But today it’s easier than ever to call up a playlist of popular music from a certain era. Let the nostalgic music play in the background while the patient talks about the past. Or, if that proves to be too much stimulation, let the music be the focal point of the reminiscence.

• Smell.The perfume that the patient’s wife used to wear, bug repellent, the whiff of a newly opened bag of black licorice, the odor of saddle leather…look for creative ways to fire up the olfactory sense, which is closely linked to memory.

• Touch. Dig up artifacts from the patient’s life story, or find some close approximations thereof. Holding onto a wooden-handled tool or a length of hemp rope, a spouse’s favorite garment, a tin toy, a family bible, or the backpack that the patient once carried through Europe can be an immediate passport to their past.

• Taste.Start the session with a snack or meal consisting of foods from long ago. Think especially of the treats the patient enjoyed during special times and holidays…kettle-cooked popcorn, classic children’s cereals, pancakes from scratch, cotton candy, root beer, organic apples, pumpkin pie.

Using both validation therapy and reminiscence therapy, either separately or at the same time, can be a great way to reframe your interactions with the dementia patient. Rather than struggling against their cognitive problems, you’re accepting the person as he or she is right now and helping them feel valued and worthy of esteem. This can bring peace and improved well-being to them and to you.