Seeing Through Your Eyes
Process Theology, Alzheimer's Disease, and Validation Therapy
...see also Where is God in Alzheimer's Disease?...
When I wander
don’t tell me to come and sit down.
Wander with me.
It may be because I am hungry, thirsty, need the toilet.
Or maybe I just need to stretch my legs.
When I call for my mother
(even though I’m ninety!)
don’t tell me she has died.
Reassure me, cuddle me, ask me about her.
It may be that I am looking for the security
that my mother once gave me.
When I shout out
please don’t ask me to be quiet…or walk by.
I am trying to tell you something,
but have difficulty in telling you what.
Be patient. Try to find out.
I may be in pain.
When I become agitated or appear angry,
please don’t reach for the drugs first.
I am trying to tell you something.
It may be too hot, too bright, too noisy.
Or maybe it’s because I miss my loved ones.
Try to find out first.
When I don’t eat my dinner or drink my tea
it may be because I’ve forgotten how to.
Show me what to do, remind me.
It may be that I just need to hold my knife and fork
I may know what to do then.
When I push you away
while you’re trying to help me wash or get dressed,
maybe it’s because I have forgotten what you have said.
Keep telling me what you are doing
over and over and over.
Maybe others will think
you’re the one that needs the help!
With all my thoughts and maybes,
perhaps it will be you
who reaches my thoughts,
understands my fears,
and will make me feel safe.
Maybe it will be you
who I need to thank.
If only I knew how.
Validation therapy in action
In Validation therapy
An Extended Family of Caregivers
Let it be emphasized at the outset that those who care for old people with Alzheimer-like symptoms need to take care of themselves, too, and they need to receive the care of others. It takes a village to care for very old people with Alzheimer-like symptoms, and the village needs to be a multi-faceted and flexible extended family which includes relatives and friends, nursing assistants and physicians, clergy and society. This village can also include music and art, pleasant surroundings, and animals and plants. The village is an eco-village, as is the global village itself. It requires not only people who care and the beauty of an environment, but also a healthy climate:a culture of care.
If and when these conditions are in place, something good can happen, even in the context of Alzheimer's disease. This something is love and awareness, a gentling of souls and a fuller realization of what it means to be human. Despite its pain, Alzheimer's disease can be an opportunity to awaken to what process philosophers and Buddhists call the truth of inter-becoming. We are becoming together in a wider family of life. We must take care of ourselves and we must allow ourselves to receive help from others, whenever and however available. In this helping we become more who we were created to be: carriers of God's love.
The old person with Alzheimer-like symptoms is also a valuable member in this extended family. She, too, is a member of the church of compassion. Even as she has entered into a non-ordinary frame of mind -- always filled with forgetfulness and confusion, and often with anxiety and anger -- she has dignity in her own right and can serve in the role as a sage for awakening. In her own way, even in her anger or in an allegedly 'vegetative' state at the end, she is a priest in uncommon clothing, as are we all. We are priests to one another. It is in this larger context that we consider Validation therapy as a way of practicing process theology. It is a form of ministry, a way of being a priest.
-- Jay McDaniel
What is Validation therapy?
Validation is a method of communicating with and helping disoriented very old people. It is a practical way of working that helps reduce stress, enhance dignity and increase happiness. Validation is built on an empathetic attitude and a holistic view of individuals. When one can "step into the shoes" of another human being and "see through their eyes," one can step into the world of disoriented very old people and understand the meaning of their sometimes bizarre behavior.
Who can practice it?
Validation can be used by anyone who cares for very old disoriented people. Both professionals and family members can use Validation with positive results. Validation practitioners must have empathy, be non-judgmental and be able to handle their own feelings, as well as the feelings of others. In order to validate another person, the Validation practitioner must "center", observe carefully, and then step into the personal reality of the client. There are verbal and non-verbal techniques that can be learned and used to build a trusting relationship in which the clients can communicate and be motivated to express themselves.
How can Validation therapy be used:
If you are a physician
If you are a nursing assistant
If you are an adult child of an elderly person
If you are an 11 year old
Does it work? Sometimes.
Research is mixed when it comes to conclusions about the effectiveness of validation therapy. Different studies conducted on validation therapy have different conclusions, with some stating that it's effective, and others determining that it's no more helpful than a placebo. A couple of Cochrane Database Systemic Reviews conclude there's insufficient evidence to conclude that it's effective — not meaning that it's ineffective, but that there wasn't strong enough data to show that it is clearly helpful.
Validation Therapy and Process Theology
Readers who are influenced by process-relational theology will find six ideas in Validation therapy that resonate deeply with what is important to us, as listed below. This does not mean that Validation therapy is the only valuable form of therapy. Circumstances may require Reminiscence Therapy or Reality-orientation therapy, too. In the house of therapy, there are many rooms, and none of them serve all purposes. Still, Validation therapy rings true to so many of us in the process tradition. Here are six connections with process theology.
1. Dignity. Validation therapy appreciates the unique dignity of each person and recognizes that people do not lose their dignity when they are disoriented.
2. Process. Validation therapy sees life as a process, knowing that each age and phase of a person's life presents difficulties and opportunities.
3. Listening. Validation therapy emphasizes deep listening: that is, stepping inside the shoes of another person, both imagining and feeling the world from his or her point of view.
4. Relational power. Validation therapy finds power in the felt relationship of caregiver and recipient, knowing that both are enriched by the relationship. It emphasizes relational power rather than unilateral power.
5. Primacy of present moment. Validation therapy appreciates the primacy of the present moment, knowing that in each moment there is a calling -- a grace - sufficient to the moment at hand. It emphasizes "being centered" and "living in the moment."
6. Creativity. Validation therapy emphasizes creativity: that is, the discovery and embodiment of novel ways of responding to the needs of others.
To these six ideas process theology adds some more, collectively forming what might be called a Process Theology of Caring for Old People with Alzheimer-like Symptoms.
7. Practicing the presence of God. Validation therapy is a way of practicing the presence of God in daily life. In stepping inside the shoes of the very old, Validation therapy both incarnates and brings to earth the ongoing compassion of God, who is stepping inside the shoes of each person at every moment. It is God's love in action.
8. Care for the Caregiver: God's love in action entails at least two kinds of love: love for other others and care for oneself. Those who love people with Alzheimer-like symptoms need to love themselves, to take care of themselves, and they need the support of others who will help them do this. Sometimes -- oftentimes -- they take too much onto themselves, refusing help or not accepting opportunities for help. They give up too much, and end up lacking the kind of centered quality that is good for them and for the person with Alzheimer-like symptoms. A process theology of care includes self-care as well as other-care, self-love as well as other-love.
9. Cosmology. Validation therapy is a practice that is consistent with the very nature of the universe. The universe is a network of inter-becoming, evolving through time, amid which beings are forever in transition from one state to another. In the life of an individual person as in the life of the universe as a whole., the transition involves a perishing of subjective immediacy followed by a transition into something new. Validation therapy is a way of assisting in the transition.
10. Continuing journey. Some process theologians believe that the journey of a human mind or soul is not entirely dependent on brain chemistry, and that the transition into something new is an entrance into another dimension of existence where the lure and love of God will continue to be present. If this is true, then Validation therapy is a way of helping a person enter into that next phase of life.
11. Ecological Civilization. Validation therapy is part of a larger hope, namely that we can develop cultures of respect and empathy in which the very old are understood, not as recipients of pity, but as fellow travelers in the journey of life. We speak of this culture of respect and empathy as an ecological civilization. Such a civilization consists of local communities that are creative, compassionate, participatory, ecologically wise, humane to animals, and spiritually satisfying -- with no one left behind. Validation therapy is a way of making sure that very old people who are disoriented are among the many beloved persons who are not left behind.
12. Young and Old. Process theology proposes that lives are enriched through felt connections with other people, including people who are different from each other. In a culture that is youth-preoccupied, older people are sometimes shunned or placed in settings where they are denied their dignity and agency, as if they are no longer worthy of life or worthy of being claimed as beloved members of a community. But process theology invites us to recognize that felt connections among young and old can be of great benefit to both. Young people need old people in order to be whole, and old people need young people, too. In the making of whole persons, young and old need to be together.
13. The Extended Extended Family. In process theology as in many spiritual traditions around the world, the notion of family is extended beyond biological kinship. We are to be sisters and brothers to others even if we are not related by blood or legal adoption. This extension of "extended family" is not only an obligation, it is an opportunity. Our horizons of life's inter-being widen and we become aware of connections which transcend biology. In relational gerontology, nursing assistants and physicians, friends and clergy all become family to the person with Alzheimer-liked symptoms -- and sometimes the non-biological family are closer to the person than the biological family. Thus we realize that extended families are themselves a process of becoming, with changing relationships in changing circumstances.
14. Mentor-for-the-Occasion. A person who loses recognition of her biological kin still needs and deserves family, and she provides an opportunity for all to realize that family is more than biology. But of course she may not be aware of them as "family." His or her life is moment-by-moment and filled with forgetfulness. Nevertheless, she can function as a sage, a mentor, in that she opens up possibilities for widened consciousness. In particular, in their very caring for him or her, their own consciousness is widened and their overwhelming focus on "normal" consciousness as normative can be relativized in a healthy way. They can realize that there are many ways of being in the world, that wisdom is not reducible to "cognition" as understood by conventional society, and that family is more than biology. The person with dementia becomes a mentor-for-the-occasion, with a ministry of her own.
15. Improvisation. From a process perspective, the universe itself is an ongoing act of improvisation: that is, of improvising fresh responses to given situations. Sometimes these responses build upon the habits of the past, but sometimes they must find "third ways" beyond existing binaries of "this way" or "that way." Caring for a friend with Alzheimer-like symptoms is an ongoing process of seeking, and sometimes finding, third ways. Often the seeking and finding is collaborative. A group of people come up with new solutions together, and the person with Alzheimer-like symptoms likewise plays a role in the improvisation. It is a theatre art.
-- Jay McDaniel
Enjoy the story in This American Life. You'll hear two people who use the Validation method.