How the Validation method can help care partners find the reasons behind challenging behaviours.
This article was written by a guest contributor, and the views, thoughts and opinions expressed in this article belong solely to its author.
Let’s start by looking at the term challenging behaviours. Because this phrase is used from the perspective of the care partner, it describes an older adult’s behaviour that is hard for the care partner to manage, deal with or change.
But if the care partner can better understand these behaviours and have tools to help with communication, it can become less challenging.
One of the principles of the Validation method is: there is a reason behind the behaviour of very old, disoriented people. This principle states that the reasons underlying a behaviour can be one or more of the basic human needs.
These needs are to:
reduce pain and discomfort
have sensory stimulation
be nurtured and feel safe and secure
be loved and belong, including the need for human contact
express feelings and be heard
be listened to and respected
be useful and productive
have recognition, status, identity and self-worth
make sense of an unbearable reality
restore a sense of equilibrium
resolve unfinished issues to die in peace
Here are some examples of how to understand the meaning behind some behaviours of disoriented older adults:
Example 1: Sarah
Sarah Friedman is 85 years old and lives at home with the help of her three children, who live nearby. She calls them each several times a day with her many worries.
“Do you think there’s a leak in the pipes? I can hear water trickling all the time,” she says, or “I think I’m coming down with pneumonia, I can hardly breath.” Or even, “There was a man walking close to the house — do you think he’s going to rob me?” And so on, and on, every day.
Photo courtesy of Getty Images.
What could be behind Sarah’s behaviour? To find out, it helps to look at her past:
Sarah was always a ‘worrier’. Her parents were strict and punished her when she made mistakes. Nothing she did was good enough. She could lean on her husband while he lived, but when he passed away, she lost her support and security. As she experiences normal losses that come with old age, her lack of security grows. She can’t see as well, so the man walking “close” to the house may be simply on the sidewalk — she can’t tell. And perhaps her tinnitus sounds like water trickling, so she hears it all the time.
It could be that Sarah is trying to feel safe by leaning on her children, as she leaned on her husband. She does not have, and has never had, the internal strength, so she can’t change now. But by understanding this, her children can take turns being her safety connection. Instead of correcting, diverting or trying to calm her, they can explore and help her express her fears.
"Talking about a painful emotion to someone who really listens with empathy can help ease the emotion."
– Vicki de Klerk-Rubin
Example 2: Darren
Darren Woodman is 90 years old and lives in a senior care home. He has been disoriented for the past two years and can no longer live at home on his own. Every day around 3 p.m., he wants to go home. He says his parents are waiting for him and will worry if he’s not there. He goes to the front door and tries to slip through when no one is watching.
Photo courtesy of Canva.
When his children come to visit every week, he doesn’t recognize them and keeps asking about people they don’t know. He repeats the same stories, such as: Lester and he skipped school and played cards with older boys, and he knew it was wrong but did it anyway. He still gets worried his parents will find out.
How can his children better understand Darren? Like with Sarah's children, it can help them to look at his past:
Darren is clearly drawn to the time of his life when he was a schoolboy living with his parents. He is worried about his naughty behaviour and about disappointing his parents. This could be an unresolved issue that he has carried with him for 80 years. He never talked about these events with his children before, but in his current environment, his unresolved guilty feelings are spilling out.
By exploring what happened, Darren’s children can help him express, and even resolve, that issue. As we all know, talking about a painful emotion to someone who really listens with empathy can help ease the emotion.
Example 3: Larry
Larry Beaman is 70 years old and lives at home with his wife. He was diagnosed with a neurocognitive disorder due to Alzheimer’s disease. Sometimes he recognizes his wife, Carla. Other times, he screams at her to get out of the house because ‘his wife will come home soon.’
It is hardest for Carla when he calls her a whore or a slut, and she just walks out and cries.
Photo courtesy of Canva.
How can Carla understand Larry’s bitterly painful behaviour? Again, Larry’s personal history can help us gain insight into what is going on:
Larry’s parents were quite strict. He wasn’t allowed to date until he was 18, and even then, he had to be home by 11 p.m. He never had a chance to express his sexuality as a teenager or to rebel against his parents. He was a good boy.
But when he went to college, his life flipped upside down with the drinking, sex and rock ‘n’ roll going on around him. With feelings of both guilt and relief, he experimented with everything. Unfortunately, his girlfriend got pregnant. Her parents blamed him, she left school and Larry never heard from her again. Larry’s parents didn’t stop telling him what a depraved person he was, and unfortunately, Larry believed them deep in his heart.
After that, Larry lived a ‘perfect’ life. He got married, had two children, never strayed and tried to be a good father. But now, due to his cognitive decline, his old feelings have come back and demand resolution. Instead of screaming at himself, he screams at the woman in the house.
By looking back, Carla can see that perhaps Larry wants to express his rage at being called depraved by his parents and his guilt about what happened.
Photo courtesy of Pexels.
As Sarah’s, Darren’s and Larry’s stories show, when care partners look at a person’s past, they can better understand what might be behind a disturbing behaviour. They can then see the behaviour as an expression of needs and feelings, gain a bit of perspective and not take the behaviour personally. Once a care partner understands this, a world of exploration can follow.
GET MORE INFORMATION
Learn more about using the Validation method by viewing the many video examples on the Validation Training Institute's YouTube channel.
Vicki de Klerk-Rubin is the Executive Director of the Validation Training Institute and is a Validation Master. She lives in The Hague, Netherlands. She has a BFA from Boston University, an MBA from Fordham University and did her nursing degree at Higher Technical School of Amsterdam.
Together with her mother, Naomi Feil, she revised the books, Validation: the Feil Method and The Validation Breakthrough. She authored Validation Techniques for Dementia Care: the Family Guide to Improving Communication and a workbook titled Communicate with older adults with cognitive decline: Validation for First Responders.
Since 1989, Vicki has given Validation workshops, lectures and training programs in Austria, Belgium, China, Denmark, England, Finland, France, Great Britain, Germany, Ireland, Israel, Italy, Japan, Jordan, Luxemburg, the Netherlands, Spain, Sweden and the United States. She has also worked in nursing home facilities in Amsterdam, leading Validation groups and training staff. Vicki is proud of her contributions to the development of Validation certification levels, curricula, the VTI quality standards, guidelines and the Authorized Validation Organization (AVO) structure for offering training around the world.