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Validation Therapy for Dementia

Written by Dana Larsen
 about the author
7 minute readLast updated March 28, 2023

Validation therapy is a holistic approach to dementia care. It prioritizes connecting with seniors through listening and providing dignified care in their final stages of life. With a little patience and observation, validation therapy also offers a glimpse into the human brain, stages of dementia, and the desire for peace before death.

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We still have a lot to learn from the human brain. The validation method provides insight into behaviors and thoughts for those who suffer from Alzheimer’s disease or dementia. Making an effort to communicate with them, even though they may be disoriented and suffer from hallucinations, offers not only a practical way to help reduce their stress, enhance their dignity and increase their happiness, but also learn from their disease and understand the meaning of their sometimes bizarre behavior. Learn more about using validation therapy for dementia.

The history of validation therapy

Validation Therapy provides an insightful and kind way to gain knowledge while comforting dementia sufferers. Much like De Hogeweyk’s Dementiaville in Amsterdam, an Alzheimer’s community where everyday life caters to the disease’s hallucinations, patient compassion contributes toward elder happiness and better quality of life.
Naomi Feil, a Munich native who grew up in a family home for seniors in Ohio, decided to work with the aging population after receiving her degree in social work from Columbia University. Growing up with elders in tandem with her social work education, she believed she could help seniors who suffered from Alzheimer’s.
Between 1963-1980, Feil developed the validation method as a response to her dissatisfaction with traditional methods of working with severely disoriented old people, and published a book on it called “Validation: The Feil Method” in 1982.
Another book, “The Validation Breakthrough,” followed in 1993. In addition to workshops offered through her Validation Training Institute, Feil and her husband have produced several films and videos about aging and validation therapy for dementia.

What is validation therapy and how does it work?

Validation emphasizes empathy and listening. It views Alzheimer’s-type dementia patients as unique and worthwhile and as being in the final stages of life. Basically, the thought is that these seniors are trying to resolve unfinished business so they can pass away in peace. The caregiver’s job is to offer these individuals a means for expression, either verbally or nonverbally.

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As ALZWell Caregiver Support explains, validation is about the person’s needs. Instead of ignoring or stopping what might be viewed as irrational or illogical behavior, validation offers alternatives. It focuses on the objective of being present and doesn’t ask why.
The following are the principles of validation therapy, as discussed in Feil’s book, “The Validation Breakthrough”:
  1. All people are unique and must be treated as individuals.
  2. All people are valuable, no matter how disoriented they are.
  3. There is a reason behind the behavior of disoriented old-old people.
  4. Behavior in old-old age is not merely a function of anatomic changes in the brain, but reflects a combination of physical, social and psychological changes that take place over the lifespan.
  5. Old-old people cannot be forced to change their behaviors. Behaviors can be changed only if the person wants to change them.
  6. Old-old people must be accepted nonjudgmentally.
  7. Particular life tasks are associated with each stage of life. Failure to complete a task at the appropriate stage of life may lead to psychological problems.
  8. When more recent memory fails, older adults try to restore balance, in their lives by retrieving earlier memories. When eyesight fails, they use the mind’s eye to see. When hearing goes, they listen to sounds from the past.
  9. Painful feelings that are expressed, acknowledged, and Validated by a trusted listener will diminish. Painful feelings that are ignored or suppressed will gain strength.
  10. Empathy builds trust, reduces anxiety, and restores dignity.

The validation method in practice

Validation therapy advocates that, rather than trying to bring the person with dementia back to our reality, it is more positive to enter their reality. In this way empathy is developed with the person, building trust and a sense of security. This in turn reduces anxiety. Feil’s key components of validation therapy are as follows:
  • Older people struggle to resolve unfinished issues. To work through these issues, they will express past conflicts in disguised forms; retreat inward, rely on movements instead of words, and potentially shut out the world.
  • To help elders suffering from Alzheimer’s-type dementia resolve past issues, validation practitioners listen, showing empathy and respect so the person feels valued, not judged.
  • Validation can apply to an individual’s or a group’s needs.
These components can be used in practice by both a caregiver or physician. Feil offers examples of validation in practice:

Caregivers and Validation Therapy

Caregivers can use the validation therapy for dementia in everyday life. For example, if the mother believes someone is throwing away her precious belongings, such as scrapbooks and photo albums — when in reality these items are being hidden by the mother — the caregiver might respond in this way:
  • “Your wedding ring is gone. You think I’ve stolen it?”
  • “It was a beautiful ring…”
  • “How did you and Dad meet?”

Physicians and Validation Therapy

Physicians use validation therapy to talk and comfort the elder, rather than telling the senior he or she is wrong if they’re suffering from hallucinations. Instead of prescribing medications to reduce patient anxiety, the doctor tries to have meaningful conversations discussing what the elder is experiencing by matching emotions through empathetic statements.
For example, if the elder thinks the physician is her husband who had passed away five years earlier and she wants him to take her to their home, the physician might respond in this manner:
  • “You miss him…”
  • “You want to be back in your house.”
  • “What would you do there?”
By having a meaningful conversation with the elder, the physician is able to get a glimpse into the patient’s suffering and reasoning and is able to soothe her by having a comforting conversation.

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By rephrasing the situation and reminiscing about the mother’s youth, the caregiver is able turn the conversation into a positive one.

Validation therapy: A method used by many

Family members, professional caregivers, nurses, home health aides, physicians and social workers, to name a few, can benefit from learning validation techniques. In fact, over 10,000 agencies in the U.S., Europe, Japan and Australia use the Validation Method, according to the Validation Training Institute.
Feil notes other benefits of Validation:
“Disoriented old-old people respond to Validation. Change in behavior is slow and fluctuates from day to day, but permanent change does occur.”
Here are some of the results you can expect:
  • Residents sit more erect
  • Residents keep their eyes open more
  • Residents display more social controls
  • Residents cry, pace and pound less
  • Residents express less anger
  • There is a decreased need for chemical and physical restraints
  • Residents communicate more verbally and non-verbally
  • Residents often move better and more often
  • Residents express less anxiety
  • Residents withdraw less
  • Residents experience an improved sense of self-worth
  • Residents may assume familiar social roles in groups
  • Residents develop an improved awareness of reality, even though this is not a goal of Validation
  • Residents’ sense of humor is often restored
  • Deterioration is often slowed
  • Staff morale is increased and burn-out is decreased
  • Staff members express a greater sense of fulfillment at work
  • Staff members feel more capable of handling difficult situations
  • Families visit more
Through empathy and respect, validation practitioners help people with Alzheimer’s and dementia feel listened to and supported. They can regain the dignity their disease has stolen, and, ideally, feel a greater sense of peace in their final stage of life. This comfort may not cure the disease, but it helps with the symptoms and offers better quality of life for senior loved ones.


Meet the Author
Dana Larsen

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