Caregiver’s Corner: The 6 Levels of Validation and Soothing Dementia Communication

Despite the fact that the word “validation” has hit the mainstream in the American culture of active listening practices, I don’t feel like it’s particularly well-understood.

It doesn’t mean that we agree with someone, no matter how much we are opposed to their behavior legally or ethically. It doesn’t mean that we’re doormats, accepting everything another person does and not standing up for ourselves. And it isn’t lying, saying things we don’t mean in order to make someone else feel better.

What it does mean is that you seek to understand the other person’s thoughts and feelings, doing your best to suspend judgment while you listen to them. It’s the skill of noticing, naming, and joining the feelings underneath the words and behaviors without arguing the facts.

When it comes to dementia care, validation is a person-centered method of communicating and is associated with less distress, better connection, and easier redirection for your loved one.

But how do you validate your loved one when you can’t understand what is being communicated. This is a regular issue for me when I’m spending time with my mom. Her sentences don’t make sense anymore: they’re too vague and scattered for me to understand what she’s getting at, so what can I do to validate that?

In her book, DBT Skills Training: Handouts and Worksheets, Marsha Linehan describes 6 different levels of validation that can be tailored to the moment. Validation isn’t a single thing, so you can use different methods for different situations. Which one seems like the best fit for your loved one? Read the excerpt from her book below and see if any resonate for your situation. (Keep in mind that this is not a book for people or caregivers dealing with dementia. It’s for a general audience.)

There are different models of validation out there, but this is the one I like best because it’s the one I used to get a handle on being a better listener, and I think it has some nuance that others lack. If you don’t love it, though, search for one that resonates better for you.

I find I can always do #1, even when I have no idea what’s going on. In fact, it’s almost easier when I don’t understand the other person. I have to be intent, focused on what they’re saying, if I want to decipher their meaning.

#2 can be difficult: how do we say back what the person said when they may not be clear on it themselves. Seeking clarity may actually cause more frustration than it solves. However, avoiding judgmental language—You’re not making any sense!—is always a good idea here.

For #3, you may not be able to “read minds” in the conventional way—remember that Linehan’s book is not targeted toward dementia care. However, non-verbal cues like facial expressions are still critical in discerning meaning.

Next, can you understand context and causes as level #4 suggests. Again, this might be really difficult to understand when communicating with someone with dementia, but whenever you can determine where the other person is coming from, you will better understand how to empathize and respond.

#5 is, to me, a big one for understanding my mother with Alzheimer’s disease. Current facts—as she sees them—can be difficult and I rely on all of those contextual cues from the previous levels to help me understand the “facts.” I think the most important thing here is simply understanding that we’re operating under different sets of assumptions about the world around us, and that’s ok. Even if we aren’t quite in the same reality, we’re on the same side. The rest is details.

And #6: respect and equality. Last week I sent out a survey in this newsletter asking several questions about senior living to people 55+. One of the questions asked, “Which factor is most critical to feeling truly listened to and respected?” 88% of respondents said the most important thing was “no elderspeak”—talking down to people because they’re older.¹

By the way, the above is one of the reasons I HATE the comparison of dementia elders to children. It’s not respectful of the lives they have lived and their experiences. The people around me could certainly testify—though hopefully they won’t!—that I can act like a child sometimes too. However, people don’t talk about me like I have no agency or understanding just because I got annoyed at not getting my way with something.

At the end of the day, validation is about really listening to another person. It can be people with dementia, or it can be anyone in your life. When you recognize the other person’s words and feelings as valid, seeking to hear and understand, a new world of communication opens up to us, even when we don’t understand what is being said.

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