Dealing in Emotional Truth

Caregivers frequently report that their loved one says – and clearly believes – things that are untrue. The person may, for example, say that she plans or wants to visit her parent that afternoon (but the parent died many years ago). The person may say he’s looking forward to visiting a country home that was sold long ago. This kind of incorrect thinking can take other forms that are sometimes less clearly associated with losses in thinking ability (for example, asking questions or telling stories over and over, making things up, or even using the same phrases over and over).

Statements like these emerge from the confusion and cognitive losses the person is experiencing. They may be triggered by something the person sees or hears, or they may just come from a random recollection. In any case, in these situations, the caregiver is faced with having to respond.

In these moments, caregivers may feel confronted with an impossible choice. They can either confront the person about the factual truth of the statement, or they can deal in what they may feel would be a deception – pretend that the statement is true and make something up to placate the person in the moment. To many, this latter choice feels like lying to the person, and that makes caregivers understandably uncomfortable.

There are a number of reasons why confrontation and insisting on the truth of a statement would be unproductive. Given the losses the person is suffering, it is likely the effort to “convince” the person (i.e., reason with him/her) will be unsuccessful. Almost certainly, the person will not remember whatever is at issue. Moreover, asking the person to look at an uncomfortable truth might lead to greater confusion and upset. From the perspective of the savvy caregiver, it is preferable to validate and deal with the “emotional truth” of the situation. Validation is a strategy pioneered by Naomi Feil that accepts that what a person says may be a clue to what s/he is feeling, regardless of the accuracy of the statement. Validation directs caregivers to use the person’s words – and the emotion underlying them – as a way to connect with the person. Validation here means that there is a recognition of the genuineness of feelings and of their source. In a way, validation is a special kind of listening – it is a listening to the feelings and yearnings of the person who may no longer be able to reliably express them. The Validation Training Institute website (http://www.vfvalidation.org) provides further information about validation therapy. The site also provides links to books and articles on the topic. 

The content you have to work with in validation is often content that is contrary to fact. Persons may speak of family members who are dead or distant (a daughter’s visit; yearning for a parent). They may speak of events long past or that never happened (a wedding or family event or trips to exotic places). They may speak of events or occurrences that will never happen (getting a driver’s license; going to a summer place).

In validation, you accept the person’s feeling about the content and then use that feeling to move the person to a different activity, one that may involve the content in some other way. For example, a person for whom you are caring might say to you “Mary (her daughter) is coming to visit me this afternoon.” You know, however, that you could respond with the “truth” of the situation (the daughter lives out of town and hasn’t visited in six months) or you could look for a way to respond to the fact that, for whatever reason, the person’s family has come to mind. So, taking a validation approach, you might respond: “I miss Mary, too. Let’s look at some pictures of her and your grandchildren.” What you are hoping to accomplish is that the person will take pleasure in the pictures and the feelings of family they might stimulate and that she will be diverted from thinking that her daughter is coming to visit.

The suggestion is not to lie (don’t, for instance, say that the daughter will be visiting tomorrow or next week – in the hope she will forget the whole thing). Instead, search for what the person may be feeling regarding the topic he or she is bringing up, and do something that works positively with that feeling. So, whether the person is talking about a long lost parent or place or a distant child or friend or a favorite spot or pastime, engage the person in something that taps into those feelings. Try to get the person to talk about the topic; look at pictures that relate to the topic; tell your own stories about the topic. Let the person have time in the emotional moment, and then work to move him/her on to some other task or activity.