Validation Therapy and Re-Direction

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If you’ve never been around someone with memory loss, the first experience can be somewhat jarring. Communication challenges abound, not only from a difference in generations but also from differences in perceptions and realities. Before starting in the senior living industry, my only experience interacting with someone affected by memory loss was my grandmother. As I would soon realize, there is no “typical” experience when it comes to disease progression for Alzheimer’s and related dementia.

As grandma’s cognition declined, it was slight at first. Day-by-day she became more disoriented. In the beginning, it was easy to communicate with her and provide small reminders of the day and time, re-orienting her to the realities of our present day. However, as the disease progressed, communication became more difficult. The same questions that occurred once a day, now repeated every few hours, every few minutes.

It seemed that the greater the frequency of questions – and answers – the more frustrated grandma became. Almost as if she could remember asking the question, but not the answer she was so desperately seeking. Our family realized that this approach to re-direction was not working. Around this time, we discovered that our method of re-orienting was called, “Reality Orientation”.

The problem with Reality Orientation is that many use this as a cure-all. While Reality Orientation can be of benefit to some in the early stages of Alzheimer’s and dementia, in later stages, reality orientation suffers from the law of diminishing returns. For someone in the early stages of dementia, they may ask “what year is it?” and respond positively once oriented to the date and time. Later on, they may ask about a relative who has since passed, “how has Marge been doing lately?”. After the response and attempt to provide orientation, they may seem confused or even annoyed and ask the same question shortly after. In the final stages, this approach may not work at all. They may insist that it’s 1940 and they, “have to be home for dinner”. Not realizing that they are no longer a child, and their parents have passed away long ago.

For those who are living in their own reality – one that is so far removed from our own – what good can come of shocking them back into the present day? Would sharing this information help or harm them, given their current condition? Many would become frustrated upon hearing this information that runs counter to their own beliefs and reality.

In moments of lucidity, Reality Orientation can be quite successful. But ultimately, the approach should be dictated by overall care and concern for the individual’s emotions and holistic health. If Reality Orientation will cause harm and emotional distress to the individual, an alternate approach should be used that builds trust, and compassion while providing the maximum benefit for the affected individual.

Reality is what each of us holds to be true personally. This personal truth may sound far fetched at first, but it’s like the graphic below. Looking at the same situation from different perspectives will yield a different understanding of what occurred.

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The lens and position from which we view the world shapes our understanding of it.

A far better approach for many families and their loved ones is Validation Therapy. This approach meets the affected individual where they are in each moment through empathy. If they believe it is the 1950s and needs to catch the bus home, ask if you can sit and talk with them while they wait. As you’re sitting, engage them in conversation. Reminisce and remind them of their life story and experiences. Join them in their memories and validate what they are experiencing. By doing so, you will be able to honor their unique story, connect with, and redirect them in a more positive way.

Our loved ones affected by memory loss are time travelers. Each day is unique, along with the challenges they face from their disease progression. By being more supportive and understanding of our loved ones, we are able to elevate their overall wellbeing and care that they receive.

At Sinceri Senior Living, our team uses a variety of approaches to provide holistic care for each individual. Our Meaningful Moments programming helps us deliver a unique and tailored care plan for each of our residents to best meet their needs. Our team uses a compassionate and positive physical approach to engage each resident, meeting them where they are, and providing holistic care and engagement for their overall well-being. This may include some reality orientation or validation therapy based upon their disease stage and process.

Each resident will react and process situations differently. Where Reality Orientation may have once worked, the resident may now become upset and irritated at hearing anything contrary to their personal truth. At this stage, it is important to shift the approach and response to better align with their reality. This tailored approach provides families with peace of mind for their loved one’s overall care. Compassionate conversations paired with validation therapy are our preferred methods of interacting with those affected by memory loss. The result: decreased conflicts and frustration, increased happiness, and meaningful engagement.

For more information on reality orientation and validation therapy or on how to develop a custom approach for your loved one, please contact your local Sinceri Senior Living community or send us a message here: 

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