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Contents

About the Authors ................................................................................. xv
Foreword to the Third Edition, by David Nilson .................................xvii
Foreword to the Second Edition, by George M. Leader .........................xxi
Preface, by Vicki de Klerk-Rubin ...........................................................xxiii
Prologue, Florence Trew 1872–1963: “I died,” by Naomi Feil ...........xxvii
Part I Alzheimer’s-Type Dementia and the
Use of Validation............................................................ 1
Chapter 1

Aging, Development, and Alzheimer’s Disease ................ 3
How I Learned: The Case of Isadore Rose:
“You Castrated Me with Words’’ .................................... 3
A Theory of Life Development and the
Need for Validation ........................................................ 7
Who Are the Old-Old and What Is Dementia? ........... 13
The Old-Old, Dementia, and Human Needs ............... 18
The Power of Empathy, by Cinzia Siviero ...................... 21

Chapter 2

The Concept and Techniques of Validation .................... 23
What Is Validation? ..................................................... 23
The Four Phases of Resolution .................................... 24
The Principles of Validation ........................................ 29
The Techniques of Validation ...................................... 31
Using Mirroring to Make Contact,
by Vicki de Klerk-Rubin ................................................... 42

Chapter 3

Using Validation with People Who Are Maloriented ..... 45
The Case of Frances, the Accuser ................................. 45
The Case of George, the Loner .................................... 47
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The Case of Jenny, the Gardener ................................. 49
The Case of June, the Blamer ...................................... 52
How to Read the Vital Signs of the Maloriented ........ 53
“Helping’’ Techniques that Make the
Maloriented Worse ...................................................... 57
Validation Techniques for Communicating
with the Maloriented ................................................... 58
The Case of Mrs. Hara, by Fumie Inatani ...................... 62
Chapter 4

Using Validation with People Who Are Time
Confused ......................................................................... 65
The Case of Martha, the Birther .................................. 65
How to Read the Vital Signs of the Time
Confused ...................................................................... 69
“Helping’’ Techniques that Make the Time
Confused Worse ........................................................... 72
Validation Techniques for Communicating
with the Time Confused .............................................. 72

Chapter 5

Using Validation with People Who Are
Repetitive Movers ............................................................ 77
The Case of Marvin, the Pounder ............................... 77
How to Read the Vital Signs of the
Repetitive Mover .......................................................... 79
“Helping’’ Techniques that Make Repetitive
Movers Worse ............................................................... 81
Validation Techniques for Communicating
with Repetitive Movers ................................................ 81
All Behavior Is Communication, by Rita Altman ......... 84

Chapter 6

Using Validation with People Who Are in
Vegetation ....................................................................... 87
The Case of Nora, the Nonmover ............................... 87
How to Read the Vital Signs of People in
Vegetation .................................................................... 89
Validation Techniques for Communicating
with People in Vegetation ........................................... 90
Combining Validation with Sensitive Massage
and Focused Touch, by Ann Catlin ............................... 92

Chapter 7

Using Validation with People with Early-Onset
Alzheimer’s Disease ......................................................... 93
The Case of Richard, the Mumbler ............................. 93
How to Read the Vital Signs of People with
Early-Onset Alzheimer’s Disease .................................. 95

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Contents | xi

“Helping’’ Techniques that Make People with
Early-Onset Alzheimer’s Disease Worse ....................... 97
Validation Techniques for Communicating with
People with Early-Onset Alzheimer’s Disease ............. 97
Luigia, a Wife: My First Experience with
Validation, by Luigia Crippa .......................................... 99
Chapter 8

Who Benefits from Validation? .................................... 101
The Benefits of Validation for Disoriented
Old-Old People ........................................................... 101
The Benefits of Validation for Professional
Caregivers ................................................................... 103
The Benefits of Validation for Families ..................... 105
Validation: Seeing Is Believing, by Rita D’Alfonso ...... 107

Chapter 9

How Validation Differs from Other Therapies
Used with Old-Old People ............................................ 109
Reminiscence ............................................................. 110
Life Review ................................................................. 110
Reality Orientation .................................................... 111
Remotivation ............................................................. 112
Behavior Modification ............................................... 113
Diversion and Redirection ......................................... 115
Patronizing with the Therapeutic Lie ........................ 116
You Can’t Fool Millie ................................................. 117
A Reminiscing Group or a Validation Group?
What Is the Difference? ............................................. 121
Get Her Outta’ Here ................................................... 121
Psychotherapy ........................................................... 123
My Meeting with Mrs. Buchmann,
by Christiane Grüenenwald ........................................... 125

Part II Validation in Practice ............................................. 127
Chapter 10 Communicating with People Who Are
Maloriented ................................................................... 129
Ellen, the Hoarder: “When You Listen,
I Speak Clear” ............................................................. 129
Lucy, the Spitter: “Bitch! Get Out of My Room!” ..... 135
Sadie, the Martyr: “One Mother Has 10 Kids.
Ten Kids Can’t Care for One Mother!” ....................... 139
Peg, the Worrier: “There’s a Man Under
My Bed!” .................................................................... 145

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Stewart, the Complainer: “You’re Killing
Me Here!” .................................................................... 152
Chapter 11 Communicating with People Who Are Time
Confused ....................................................................... 159
David, the Toucher: “I Am Not Dr. Willard:
He’s on an Extended Holiday!” ................................. 159
Margaret, the Mother: “I’m Living in My Own
Home, These People Don’t Belong Here!” ................ 166
Harry, the Hitter: “Come in, You Old Battle Ax!” ..... 172
Validating at Home: Karl, the Flasher ....................... 175
Relieving the Fear, by Cinzia Siviero ............................ 179
Chapter 12 Communicating with People Who Are
Repetitive Movers .......................................................... 181
Isobel, the Poet: “I Untangle the Noodles in
the Mirrors of My Mind” ........................................... 181
Mary, the Pacer: “I Am Not a Sheep!” ........................ 183
The Wisdom of Disorientation, by Heidrun Tegeler .... 188
Chapter 13 Communicating with Maloriented and Time
Confused People Living in the Community ................. 191
The Apartment House Manager, the Policeman, the
Emergency Medical Squad, and Thomas Konig ........ 191
The Mailman, the Grocery Clerk, the Hairdresser,
and Millie Stonewall .................................................. 194
The Doctor, the Meals on Wheels Volunteer, and
Samuel Goode ............................................................ 199
Chapter 14 Validating Family Members .......................................... 203
Ann and Her Mother, Trudy ...................................... 203
Validating a Family Member ...................................... 204
Tips For Family Members Who Want to Validate
Disoriented Relatives ................................................. 205
Ann and Trudy—with Validation .............................. 206
Frequently Asked Questions About Validation ......................................... 209
Part III Group Validation ................................................... 213
Chapter 15 Setting Up Validation Groups ....................................... 215
The Value of a Validation Group ............................... 215
Who Benefits from Group Validation? ..................... 217
The Role of the Validation Group Worker ............... 218

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The Role of the Validation Group Co-worker .......... 220
Establishing a Validation Group ............................... 222
Conducting a Validation Group Meeting ................ 230
Example of a Validation Group ................................ 235
Who Can Practice Validation? .................................. 239
Appendix: Experiences of Professionals in the
United States and Abroad .................................. 241
Implementing Validation at Country
Meadows Retirement Communities ......................... 241
Using Validation as a Consultant in a
Richmond, Virginia, Continuing Care
Retirement Community ............................................ 245
Using Validation in a 60-Bed Skilled Medicare
Facility in the Kansas City Metropolitan Area:
An Administrator’s Perspective ................................. 249
Using Validation at a 422-Bed Veterans’ Home
in Minneapolis, Minnesota ....................................... 253
Using Validation at a Newly Purchased Facility
in Maine .................................................................... 255
Using Validation at an Urban Nursing Home
in Brooklyn, New York .............................................. 259
Using Validation in a 28-Bed Dementia Unit in
Rural Wisconsin ........................................................ 261
Using Validation at a Rural Nursing Home in
Missouri ..................................................................... 265
Using Validation at Eldercare in South Australia ..... 267
Using Validation at the South Port Community
Nursing Home in Australia ....................................... 271
Using Validation at a University Hospital in
France ........................................................................ 275
Authorized Validation Organizations ................................................ 279
References ........................................................................................... 283
Index ................................................................................................... 285

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