Therapies & communication approaches
Three approaches to communicating with people with dementia – Validation Therapy, Music Therapy and Reminiscence are briefly explained in this section. Many families and carers find these approaches helpful in providing support that is respectful and dignified when communication is difficult.
Communicating effectively with a person who has dementia becomes an increasing challenge as the person progressively loses their memory and their ability to organise and express their thoughts. For many, the loss of recent memory means that the past begins to merge with the present resulting in additional difficulties for family and carers.
A number of alternative communication approaches have been developed which attempt to provide the trust and support so necessary to a person’s wellbeing. Many family members and carers will be instinctively using some of them without realising their formal names.
Validation Therapy advocates that, rather than trying to bring the person with dementia back to our reality, it is more positive to enter their reality. In this way empathy is developed with the person, building trust and a sense of security. This in turn reduces anxiety. Many families and carers report increased benefits for themselves, as well as for the person with dementia, from a reduced number of conflicts and a less stressful environment.
Validation Therapy is based on the idea that once the person has experienced severe short term memory loss and can no longer employ intellectual thinking or make sense of the present, he or she is likely to go back to the past. This may be in order to resolve unfinished conflicts, relive past experiences or to retreat from the present over which they have little control. Some people will go in and out of the present.
Some family members and carers express concern that validation involves lying to the person with dementia about reality. However a more accurate description is that it avoids challenging their reality. For instance, if a person with dementia believes that she is waiting for her children, all now middle aged, to return from school, family members and carers who use validation would not argue the point or expect their relative to have insight into their behaviour. They would not correct their beliefs. Rather, the validating approach proposes acknowledging and empathising with the feelings behind the behaviour being expressed. In this way the person’s dignity and self-esteem is maintained.
Activities that involve music are another effective way of communicating with a person who has dementia. Often when other skills have gone, the person can still enjoy old familiar songs and tunes. A certain piece of music can unlock memories and feelings. It is important to be prepared to respond to the release of these feelings.
The big advantage of music is that it does not require a long attention span and it can also be a valuable trigger for reminiscing. Knowing a person’s musical likes and dislikes is vital for this to be a successful approach.
Music can be used as a formal therapy or simply for enjoyment. It can also help in the management of difficult behaviours. Music therapists have extensive training in the use of music with people with dementia and can address some very complex behaviours.
Reminiscence is a way of reviewing past events that is usually a very positive and rewarding activity. Even if the person with dementia cannot participate verbally it can still give them pleasure to be involved in reflections on their past. It can also be a means of distraction if the person becomes upset. While reviewing past events can provide a sense of peace and happiness, it can also stir up painful and sad memories. It is important to be sensitive to the person’s reactions if this happens. If their distress seems overwhelming then it is better to use another form of distraction to reduce anxiety.
This Is Your Life book
Making a chronological history of the person with dementia can help with reminiscence and provides information for people who may interact with them. A This Is Your Life book is a visual diary. Similar to a family photo album, it can also include letters, postcards, certificates and other memorabilia.
A large photo album with plastic protective sheets over each page will last indefinitely and can withstand a lot of use. Each photo needs to be labeled to avoid putting the person with dementia on the spot with questions such as “Who is that?” It is best to limit the information on each page to one topic, and to have a maximum of two or three items on each page.
The following list may help in getting a book started:
- Full name and preferred name
- Place and date of birth
- Photographs and name of mother, father, brothers and sisters
- Photographs of partner and wedding day
- Photographs, names and birthdays of children and grandchildren
- Photographs of family friends, relatives and pets
- Places lived in
- Occupation and war service
- Hobbies and interests
- Favourite music
- Holiday snapshots and postcards
- Letter, certificate, diagram of family tree and short stories about specific incidents.
This book can provide a great deal of pleasure and pride for a person who may be feeling increasingly bewildered in the present.