Course content – PFLEGE-16
4. Module 3 · Communication & validation
4.1. In depth: why validation works and its limits
Why validation works and where its limits lie
Validation in practice
In concrete terms, validation means: when a person says or experiences something that does not correspond to ‘reality’, you do not contradict but respond to the feeling behind it. Example: Mrs K. says, crying, ‘I have to go to my mother.’ Instead of ‘But your mother died long ago’ (cruel, hurtful, unsettling), you validate the feeling: ‘You miss your mother very much, don’t you? Tell me about her.’ You take the longing/grief seriously, talk about the mother (positive memories) and provide a sense of security. The person feels understood and calms down – instead of experiencing the loss anew each time. Validation does not mean lying (you do not claim that the mother is alive) but accepting the emotional level and responding to it without arguing on the level of facts. It is about appreciation, empathy and taking the inner reality seriously.
Equally important is non-verbal communication: people with dementia increasingly lose their understanding of language, but they ‘read’ the emotional level very precisely – tone of voice, facial expression, posture, touch, the atmosphere. A calm, friendly, attentive manner has a calming effect even if the words are not understood; haste, tension or anger are sensed and increase restlessness/anxiety. That is why your own inner calm and appreciative attitude are so important. For care: communication with people with dementia is less a question of words than of attitude, the emotional level and the relationship. Those who communicate calmly, patiently, appreciatively and in a validating way and respond to feelings reach the person – and create security, trust and wellbeing. This communication competence is one of the most important in dementia care.
Communication in dementia
| Rule | In concrete terms |
|---|---|
| Approach | From the front, eye level, name, eye contact |
| Language | Simple, short, slow, one thing at a time |
| Non-verbal | Facial expression, touch, calm tone |
| Validation | Accept feelings, do not correct |
Why correcting does harm
The most common, usually well-meant mistake in communicating with people with dementia is constant correcting (‘No, today is not Sunday’, ‘But your husband has died’, ‘You have already had your meal’). The thinking behind it is understandable (you want to ‘help’, to ‘orient’ the person), but the effect is harmful. First, the person cannot retain the corrected information (memory no longer works) – the correction fizzles out. Second, the person experiences the correction as rejection and hurt: they feel not taken seriously, exposed and unsettled. Third, the correction can cause real suffering – anyone who learns anew each time that their beloved spouse is dead goes through the grief anew each time. Fourth, correcting often leads to resistance and conflict (the person insists on their reality and becomes angry/anxious). The result: correcting achieves nothing and does a lot of harm. The better way is validation: accepting the feelings and the world of experience, responding on the emotional level, giving security. This does not mean actively lying or ‘going along’ with every misperception (sometimes gentle distraction or redirection is better), but it does mean not arguing on the level of facts and not shaming the person. For care, this insight is liberating: you do not have to constantly ‘enforce the truth’ (which fails and hurts anyway) but may concentrate on the emotional level and the relationship. This relieves pressure and makes more caring, more effective care possible. The art lies in preserving the person’s dignity and feelings instead of insisting on a ‘reality’ that is no longer accessible to them.
This insight – not correcting but validating – is one of the most important and at the same time most difficult lessons of dementia care to internalise. It requires a rethink but fundamentally changes care for the better.
Four answers compared
Figure 3.2 compares four common answers to a statement such as “I have to go to my mother”. Correcting is the reflex of many helpers and, as the in-depth box above explains, usually brings pain without gain. Going along with the statement (“She is on her way”) may calm the moment, but it relies on a false statement. Many professionals are uneasy about this, because trust can break if the person senses that they are not told the truth. Distracting can be a kind way to move on, yet when used alone it leaves the feeling untouched, and it may return. Validating answers the feeling without claiming anything false and without arguing. This is why most professional guidance, as general practice, favours validation first, and distraction or redirection afterwards where useful.
Note that the table is a summary of general practice experience, not a measured result. Research on communication approaches in dementia care is varied, and in practice, carers combine methods according to the person and the moment. Think of validation as a stance that makes every method kinder.
The idea behind validation
Validation, as described by Naomi Feil, rests on a simple belief: behind every statement is a feeling, and every feeling has a right to be heard. It was developed for very old people with advanced disorientation. Today the term is used more widely, for an accepting, curious and warm stance. Figure 3.3 breaks this stance into six small steps. They are not a script. You will find your own words. What matters is that you slow down, hear the feeling and name it without judging.
Validation has limits. It does not replace medical care: pain, infection or fear caused by a hallucination need a nurse or doctor. It is not a way to avoid information the person needs for safety: if someone is about to leave the building in a cold night, you must act, calmly and with care. And it is not for you to use as a technique to manage people. If you do not mean it, the person will notice, since they read your tone more reliably than your words.
In Germany: truth, will and the law
Two legal ideas help to explain why respectful communication is not a “nice extra” in Germany.
- Section 2 of the Social Code Book XI (SGB XI), the law on social long-term care insurance, says that care benefits should enable a life that is as independent and self-determined as possible and that corresponds to human dignity (Bundesministerium der Justiz, n.d.-a). What you say and how you say it is part of that dignity.
- Section 1814 of the German Civil Code (BGB) covers rechtliche Betreuung (legal custodianship). A legal custodian may be appointed only if an adult cannot manage their legal affairs because of illness or disability, never against the adult’s free will, and only where this is necessary and no equally suitable help exists (Bundesministerium der Justiz, n.d.-b). The law therefore starts from the person’s will, and even a person with dementia may have wishes that count. Custodianship does not give anyone the right to decide how you speak to the person.
Module 11 returns to law and ethics, including measures that restrict freedom.
There is also a moral debate about how far “therapeutic untruths” are acceptable. Some see them as a kind help, others as a breach of respect. The approach in this course is cautious: avoid lying where you can, and answer the feeling.