Empathetic Communication with the Older Adult
by Debbie Hommel, ACC/MC/EDU, CTRS

One of my responsibilities as a new activity assistant, way back when, was to run Reality Orientation groups.  I would gather a few memory impaired elders into a room, give out paper and pens and begin to talk about reality – our reality.  We wrote down the current date, the weather and that we all lived in the nursing home.  If they didn’t get it right the first time, I was told to repeat the information until they remembered.  Every day, I broke the news to these folks that they were in their 80’s and 90’s and now living in a home with other older people. Every day, it was as if they were hearing it for the first time.  Needless to say, this did not always go well.

Around the same time, Naomi Feil, a Social Worker in Ohio, was running the same type of group in Cleveland with the same sad results.  However, Ms. Feil was more experienced and she questioned the methodology of reality orientation. She knew there must be a better way to communicate with the elderly.  Through extensive studies and group work, Ms. Feil created a new approach called Validation Therapy which is widely practiced today.  Validation therapy is based on empathetic communication, accepting the elder for who they are and where they are and validating the emotions expressed by the elder.  Ms. Feil was the first person to suggest that we should listen to what the elder is saying even if the words did not make sense.  Some of the goals of Validation therapy are to restore self-worth, resolve unfinished business from the past, reduce tension and increase verbal and non-verbal communication.

It would be difficult to fully explain the concepts of Validation Therapy in this short article.   It far more involved than just asking the right questions and trying to make sense of any unresolved issues that some of our disoriented old-old residents are expressing.  Many caregivers do not understand the full scope Validation which is truly hearing what the elder is trying to say and how to truly validate the feelings that are being expressed.  Some people feel it is simply agreeing with what the elder is saying and not pushing our reality. This could be nothing further from the truth.

Validation therapy is based on empathetic listening which is placing yourself in the other person’s position or trying to see things through the other person’s eyes.  Empathetic listening requires just that – listening with your ears, eyes and heart.  Empathetic listening builds trust between the caregiver and the elder, allowing for open discussion without judgement.   With appropriate Validation approaches, it is hoped over time that the elder will find peace and not withdraw into a state of Vegetation as defined by Ms. Feil.

For more information on this subject, check out the following:

Official Validation Therapy website:  This site has videos, articles and lots of information on the subject. This is a great place to start your studies on the subject.  Almost anything you need to know about Validation can be found here.

Attend a Validation Workshop: Naomi Feil is the consummate workshop presenter.  She shares her information in an interesting and engaging manner.  Check out the workshop listing on the Validation web site.

Videos – Conduct a search on You Tube of Validation Therapy and you will find many videos listed.  One of the more popular videos is of Ms. Feil with Gladys Wilson, a very impaired woman who eventually responds to Ms. Feil’s approach.  Other videos to look for are Stages of Resolution and Naomi Feil on Ted Talks.

Books and other resources – Ms. Feil has written several books and created a number of training videos on the subject.  Video clips can be viewed on the site or ordered from this site.  http://www.edwardfeilproductions.com/

Validation Therapy is an approach that all caregivers give strong consideration.  It is more than just agreeing with the elder.  It is a process which is based on years of study, theoretical concepts and a variety of communication techniques. 

You can find out more through our newest independent study program “Empathetic Communication with the Cognitively Impaired Elder” which is based on the book – “Validation – The Feil Method” by Naomi Feil.    This course is NCCAP pre-approved for 8.5 hours.