Which Is Best? Validation Therapy vs. Reality Orientation in Dementia

Older woman on bench holding her head
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What's the best way to respond to someone with Alzheimer's or another type of dementia if she's anxious and yelling out for her mother who passed away many years ago? The short but true answer is that it depends on the individual — which stage of Alzheimer's disease she's in, what approaches are typically helpful in reassuring her, and how much distress she's experiencing. 

The Theories

The longer answer includes a discussion on a couple of theories: reality orientation and validation therapy. Historically, reality orientation has been fairly dogmatic about continually reminding the person that she is 89 years old and that her mother passed away 20 years ago. The reasoning with this approach has been that frequently reminding the person of reality is beneficial for her cognitive functioning. It's hoped that this approach can jog her memory and keep her functioning at a higher level.

Validation therapy, however, places more emphasis on the possible feelings and thoughts behind the person's behaviors, and rather than trying to force her to be in our reality, it suggests that we join with the person in her reality. Validation therapy would recommend that we ask her questions about her mother, such as what she misses most about her mother and which of her mom's dinner recipes was her favorite.

Which To Use?

So, which is the best and most helpful approach? And, what does research say? The pendulum has swung from reality orientation to validation therapy and a little more back towards a more gentle reality orientation. In the end, there's no "one size fits all" for responding to people's confusion. However, there are a few guidelines that usually remain constant about how to talk with people who have dementia, such as responding with genuineness and compassion.

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