In plain English
Validation Therapy, developed by Naomi Feil, is a communication approach for people with dementia that focuses on the emotional content of what they say rather than the factual accuracy. It substantially reduces distress and improves the carer-person relationship.
The principle
When a person with dementia says "I need to pick up the children from school" the factual response ("They are 50 now and at work") often produces distress and does not change the request. The Validation response ("It sounds like you are thinking about the children. They were lovely at that age") acknowledges the emotional truth, opens conversation, and reduces distress.
Validation Therapy is not lying. It meets the person in the emotional reality they are in, recognising that the underlying feeling is real and deserves response.
The technique
Listen for the emotion
Beyond the words, what is the person feeling? Anxiety, sadness, loss, frustration, longing? The Validation response acknowledges that emotion.
Reflect rather than correct
Acknowledge what is said. Repeat or paraphrase to show understanding. Avoid contradicting unless safety requires.
Use open phrases
- "It sounds like..."
- "That must feel..."
- "Tell me more about..."
- "It was hard when..."
Reminisce rather than re-orient
Where a memory is being relived, talk about that time period rather than dragging the person back to the present. The conversation usually settles naturally back to the present after a few minutes.
Use touch and tone
Gentle hand on the shoulder, eye contact, a calm voice, an unhurried pace. Body language carries the validation as much as the words.
Common difficult scenarios
"I want to go home" (when at home)
This often expresses feeling unsettled or uncomfortable, not a literal wish. "It sounds like you are not feeling quite right. Let's have a cup of tea first" acknowledges and redirects.
Asking after deceased relatives
Repeatedly delivering the news of death is distressing and rarely retained. "She was so funny, wasn't she. Tell me about that holiday" honours the feeling without forcing the fact.
Wanting to go to work (when retired)
"It sounds like you were a busy person. What was your favourite part of the job?" engages the underlying identity.
Accusations of theft
"It's so frustrating not being able to find it. Let's look together" sidesteps the accusation and helps practically.
When Validation is not enough
Validation Therapy is not appropriate when:
- Safety information must be communicated clearly (a medication, a hot stove);
- The person is in Delirium and acute medical assessment is needed;
- An immediate factual answer matters and the person can accept it without distress.
In these situations, clear simple communication is preferred, with Validation principles still informing tone and pacing.
For Carers
Validation can feel uncomfortable initially, particularly if the family value of "always be truthful" is strong. Many carers come to see it as the more humane option, recognising that the alternative often causes distress without changing the underlying belief. Carer Validation training is available through the Alzheimer's Society and dedicated providers.
Evidence
Cochrane reviews find limited but positive evidence for Validation Therapy on agitation, anxiety and behavioural symptoms. The strongest evidence is for the underlying principles (emotional acknowledgement, avoidance of confrontation) rather than for the formal therapy in its strictest form. UK practice incorporates Validation principles into routine dementia care.
Frequently asked questions
Is Validation Therapy the same as lying?
No. Validation acknowledges the emotional truth without making false factual statements. 'It sounds like you are thinking about the children' is true, even where the literal request cannot be met.
Will my parent feel patronised?
Done well, no. The aim is genuine emotional acknowledgement, with the person's dignity at the centre. Patronising tone is the failure mode, not the approach itself.
Is reality orientation ever appropriate?
Yes. Gentle orientation (the time of day, the day of the week) can help when it does not distress. Forceful or repeated reality orientation is generally counterproductive.
What if my parent is convinced of a delusion?
Validation acknowledges the feeling without endorsing the delusion. 'It must be frightening to feel like that' is supportive without confirming the false belief.
Can children use Validation?
Yes. Children often pick up Validation principles naturally when shown. It is one of the more child-friendly approaches to engaging with a grandparent who has dementia.
References
- Feil N, de Klerk-Rubin V. The Validation Breakthrough. Health Professions Press.
- Neal M, Barton Wright P. Validation Therapy for dementia. Cochrane Database 2003.
- Alzheimer's Society. Communicating well with people with dementia.
- Royal College of Psychiatrists. Dementia care training.