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Caregiver Training Blog

Expert Interview Series: Naomi Feil and Vicki de Klerk Rubin of Validation Training Institute On Validation And How It Improves Connection With Elderly Patients

Caregiver

Naomi Feil is the creator of the Validation Method and found of the Validation Training Institute. Vicki de Klerk-Rubin is the Executive Director of the Validation Training Institute.

You started the Validation Training Institute in 1984. What did you feel was missing, in the way the elderly were being treated at that time? How does Validation help remove some of these limitations and imbalances?

I started VTI in 1984. I started Validation a lot earlier and published my first book in 1982 in the US. That was the culmination of a long process of working with older adults, trying new ideas, seeing what worked and what did not work. This creative process began in the 60s when I returned to the Montefiore Home for the Elderly in Cleveland, Ohio where I grew up. At that time nurses were using Haldol (anti-psychoic medications) and sedatives to keep residents quiet and 'happy' and tying residents into chairs if they wanted to walk- to 'protect them'. Elderly residents were becoming more and more disoriented by this treatment. They withdrew into their own worlds when the outside world would not listen.

Validation accepts the older adult as he or she is - in that moment - and trains caregivers to be comfortable with the emotions that are being expressed. A Validation Worker doesn't try to stop the emotions or keep older people 'happy and quiet' all the time. The V/W explores the emotions and needs that are being expressed. Older adults feel worthwhile, accepted and validated!

Validation is a method of working with disoriented elderly people. What are some things that are particular, about dealing with age-related impairments and aging patients and loved ones?

Disoriented elderly are busy with an important life task that is appropriate to that stage of life - they are trying to resolve unfinished business from the past. This unfinished business could be an old trauma, like a rape or war experience or abusive parents. This pain, shame and anger was repressed over many years. In old age, with the losses that normally come with aging, these feelings bubble over and spill out. These feelings demand attention - finally. Disoriented elderly are desperately trying to die in peace and want to resolve the pain.

Validation is meant to reduce the stress on caregivers, when working with elderly patients. First of all, how does Validation make caregivers job less stressful? What are some of the benefits of having calmer, more centered caregivers?

It's easier to go with people than fight against them. When caregivers accept the older person's needs as more important than their own needs, there is less stress for both individuals. It's not so much that caregivers are calmer. It's that they can pace the emotions and needs of the residents and are not afraid of emotions.

Validation helps build an empathetic attitude and a holistic attitude to help understand the meaning of their behavior. What are some unexpected ways that empathizing with elderly patients can make someone the best caregiver they can be?

What makes a good caregiver? That's the question here. In my opinion, a good caregiver gives the client what he or she needs in that moment whether that is physical, psychological or spiritual. That is holistic. When a caregiver can work in a respectful way, paying attention to all the needs of the client and feeling capable of handling whatever emotions arise, work becomes easier, more joyful, giving more energy.

You describe the first component of Validation as 'Malorientation', where the patients express past conflicts in disguised forms. First of all, what are some common conflicts that you've noticed among the elderly patients you've worked with? And what are some different ways they tend to manifest?

Malorientation is the first phase of resolution. People in malorienation often blame others so that they can deny their own losses. For example, an elderly woman blames a caregiver of stealing because she can't accept that she is becoming forgetful and misplaced something.

Another common component of Validation is 'time confusion', which is very common with aging patients suffering from dementia. What are some signs that a patient is suffering from time confusion? What are some things a caregiver can do, to get around this difficulty?

The second phase of resolution is Time Confusion which is when people withdraw into their own personal reality.

Some examples:

  • a woman in Time Confusion who lost her mother when she was just 6 years old sometimes thinks the caregiver is her mother and clings to her;
  • a man who was a bank manager gets dressed and 'goes to work' every morning, even though he has lived in assisted living for years.
A V/W accepts that this disoriented behavior is self-healing and sees the need behind each behavior. She doesn't try to change the client; she enters into their world, exploring and giving room for the older person to express what needs to be expressed. This doesn't take a lot of time, it takes concentration and being centered for 5 minutes and can be done throughout the normal working day.

Validation is built around the premise that the very old are very valuable and worthy of respect. What are some ways that the elderly enrich in our society and our lives? And what are the risks of having a society without those traits?

Our elders carry experience and history. When one has lived so many years and had so many experiences, there is wisdom. Valuing experience and history is losing value in our society and that is a shame. When a society ignores history and tradition, it keeps making the same mistakes over and over. It can't learn and grow; it devolves.

Do you feel that people are paying more attention, or making more of an attempt to connect and care for the elderly, in today's society? What areas still need to be improved?

I think some people in some places are paying more attention but not everywhere. Finances are taking priority. There's no money for training staff, no incentive for taking the time to really change the way staff think and automatically react. I see so many 'person-centered' trainings that are just lectures and there's no practice involved, there's no follow up. You can't change the way people behave unless you train person-to-person. People need feedback; they need to see new behavior demonstrated and they need to practice it and get coaching. This takes time and investment.

Do you feel that people are better at empathizing, at this point, thanks to technology and the amazing array of different perspectives and viewpoints we encounter, in any given day? Or is empathy atrophying, like others claim? And how can empathy help someone not only be the best caregiver they can be, but also the best Human Being possible?

No I don't think people develop empathy thanks to access to different viewpoints. I think people search for the information that supports their own views - what they call the information bubble.

Empathy is often misunderstood. In Validation, empathy is the skill where you put your own emotions, judgments and extraneous thoughts off to the side and enter into the emotions of the other person. This is different than understanding or caring or having sympathy.

Being able to really step into the emotions of another person brings deep connection. It's a way to be a better human being and a better caregiver.

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