Saturday, May 3, 2014

Dementia - Validation and Redirection

Happy Saturday!  The last couple of weeks have been extremely busy and my writing to you has tapered off.  Today's topic is getting back on track to our series of working with people with dementia.

A very important technique for working with dementia is called Validation and Redirection.  Whether on a conscious or unconscious level, one of the things I have experienced is the struggle by clients to retain some degree of control over their lives as their cognitive strength decreases.  As caregivers we often experience this as resistance to simple requests or suggestions.  From the client perspective, it is the ability to control their environment.

Think about putting yourself in the shoes of someone who is having increasing difficulty in making decisions, understanding circumstances, and knowing how to handle a situation.  Something as simple as deciding where to go for dinner can become insurmountable.  A husband asks his wife, 'where would you like to go to dinner?'  The wife can no longer remember the names of the different restaurants in the area, let alone her favorite.  She may not even remember her favorite cuisine, such as Italian or Greek.  She may become combative as a way to hide the fact that she can't remember, which may express as, 'Why are you asking me such a silly question?  I don't want to go out!'  The agitation may continue to increase as the situation does not feel resolved in her own mind.

The way out of this is for the husband to validate and redirect.  An example may be, 'You are right.  That was a silly question.  What was I thinking?  It's much too early to think about dinner.'  Whether or not it is too early is irrelevant.  The idea is to validate the wife's feelings and create a feeling of closure about the issue.  And the next time do not offer options.  Simply tell them where you would like to go to dinner.

One of our clients came to me with the issue that his wife kept telling him that he was trying to divorce her.  This wasn't true but it kept coming up again and again.  He addressed this by turning the tables a bit.  He begged her not to leave or divorce him because he loved her so much.  It worked!  He has faced other challenges but with each one we discuss what is going on and come up with a strategy to address it.

Sometimes the issue is related to significant time and space disorientation.  One of our clients thinks he is living 30 years in the past.  We work with him from that perspective.  You cannot tell someone who thinks he is at his office that he is 30 years older and in his home.  You have to validate and redirect.  Sometimes that redirection will be to make up a story of needing his advice about a problem he can help solve.  If you try to tell him the truth about his situation it will most likely increase agitation and not re-orient him.

Whenever you are dealing with resistance from your loved one just remember the old Star Trek adage, resistance is futile.  Resistance from either you or your loved one will also increase stress for both of you.  Your resistance may stem from the idea that you have to convince them of the truth of the situation.  Resist that urge!  The kindest thing you can do is to validate.  It will make your life a lot more peaceful.

I've had clients express that they feel bad about lying to their loved one.  Yes, there are times that you will not be telling the truth but, in this case, the truth will not set you, or them, free.  Just be kind.  If you can help them to be happy and peaceful that is the kindest thing you can do.

One of our clients keeps saying that she wants to go home to her parents.  Her husband tells her that is a great idea and that he is working with a travel agent to get everything scheduled.  Her parents are long gone but she will not remember the lie from one hour to the next and, in that moment, the idea of going home gives her peace.  Validation and redirection.

Have a wonderful rest of the weekend.  Back to you soon!

Laura Barish

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