White Coat, Black Art·White Coat Black Art

How to reach the person inside the dementia

Therapist Naomi Feil helps people with dementia find peace in their final years through a groundbreaking method she developed called Validation.
Naomi Feil uses the Validation Method to reach and communicate with people who have advanced-stage dementia.

*This episode originally aired on October 1, 2016.

If you've visited a retirement home or a dementia unit, you've likely noticed the perplexing behaviour of some residents. 

They repeat the same phrase non-stop or restlessly do one motion over and over,  banging on a wheelchair or tapping their fingers on a table. 

Usually, a caregiver will redirect them, or just ignore them because it seems meaningless. 

But what if it's not? 

Social worker Naomi Feil believes that those seemingly innocuous actions may be the key to making a breakthrough connection with people who have dementia. 
Listen to personal care assistant Star using the Validation Method with Jeanette, a patient

"What I did was I linked the behaviour to the human need," Feil, now 85, tells White Coat, Black Art host Dr. Brian Goldman on this week's episode. 

Feil is the creator of Validation, a method  of communicating with elderly people who suffer from dementia. Its basis is a deep empathy with the person who has dementia - and the idea that patients are trying to resolve an issue from their past.

She describes the case of a woman with severe dementia who would not stop kissing and caressing her own hand. 

"Her hand was a baby...People use parts of the body in order to express their feelings they haven't expressed. This particular woman had lots of children. She was almost 50 when she had this last child. And she didn't pay enough attention to it, and she felt guilty, but she never told her daughter. So she kept that in, and in her old age, she had to use her body to express it," Feil says. 

She says even if caregivers can't figure out what the issue is, techniques like mirroring the movements and emotions of patients allows them to express their feelings, even when they've been incommunicative.

Feil was uniquely placed to develop the method, given that she literally grew up in the nursing home which her parents ran. She founded the Validation Training Institute in 1984 and has taught her method to caregivers around the world. 

"It's about going in and being open and feeling and being with them. The only thing that matters is them," Lorrie Quick, a practitioner from Pennsylvania tells Dr. Goldman. "It's not about what you're feeling at that time. It's about what they're feeling. Letting them express their feelings and whatever they want to talk about. That's what is important."

Naomi Feil says the repetitive movements or phrases may symbolize what the person did in their prime and acknowledging the behaviour helps the person maintain a grasp on their identity in the here and now.

If a man is pounding and his son says 'my dad is crazy'. Oh no he's not. Your dad was a master carpenter. He doesn't see his fists but he sees a hammer and he sees a nail. Your dad is working. He's maintaining his identity. He's going to die a master carpenter.- Naomi Feil

Like the woman who repeatedly kissed her hand, the person may be trying to solve issues or come to terms with deep-rooted feelings. Feil calls this process 'resolution' and says that people are dealing with "unfinished issues, mostly with their parents, anger, feelings that they've never expressed, sexual feelings that have never come out, that need to come out now, in old age." 

While the methods are not scientifically proven and more about intuition, Feil believes when people with dementia are allowed to pursue resolution, they can find peace in the last phase of their lives.

 "It gives relief. They don't have to go back to the past anymore. They can make relationships. They keep communicating to the maximum of their ability and they don't die living dead people. A big goal is that people do not turn inwards and vegetate and just sit there and be non-people."