The Laureate Way

Articles to Help Families and Older Adults Manage the Challenges of Aging

Reality Orientation Therapy versus Validation Therapy

Reality Orientation Therapy versus Validation Therapy

I once attended a Dementia Friendly Community Forum in Oconomowoc, where former Governor Martin Schreiber shared touching stories about his personal experience as caregiver for his wife, who had Alzheimer’s disease. His stories related to the topic of reality orientation therapy and validation therapy.

Reality orientation and validation therapy are tools to help us respond to confusion brought on by Alzheimer’s disease and other forms of dementia in a positive and beneficial way. We want to increase happy emotions and reduce distress and anxiety.

What is Reality Orientation Therapy?

In my earlier years of working with older adults, we were trained in reality orientation. This therapy is meant to help a person with dementia to see the error in their thinking and return to “reality.” It involved asking the person a series of questions that would lead them down a logical path. In my experience, it never really worked, and most professionals found it to be uncomfortable and ineffective.

What is Validation Therapy?

In contrast, validation therapy’s goal is to validate the feelings of the person, not necessarily the factual content that is presented.

For example, let’s say that someone with dementia mentions they are waiting for their mother to come and get them. The mother passed away many years ago. One might respond by saying: “You must be thinking about your mother today. Tell me a little about her.”

This could lead to an affirming moment of reminiscing that will prove to be therapeutic for both the story-teller and the listener. It is not necessary to “pretend” that mother is still living, nor to say that she is dead. 

Today, validation therapy has been applauded by professional and family caregivers as a gentler, more compassionate approach.

How to Use These Therapies:

We all need to have lots of tools in our toolkit when we work with people with dementia. What works today at suppertime, might not work tomorrow at lunch.  

For example:

I was working in my office when Sarah came through the door. Sarah had Alzheimer’s disease and appeared somewhat agitated. She approached me and said: “Can you help me find my car? I can’t find it anywhere. I have to find my car.”

Immediately, I used my validation therapy. So, I said: “Sarah, you must be thinking about your car today. Tell me about your car. What kind of vehicle did you drive? Did you go on any long road trips…”

Sarah stopped me abruptly and said: “I don’t have time for this. I have to find my car,” then turned around and left. 

Just outside my office was the reception desk. I could hear Sarah approach the receptionist and ask: “Do you know where my car is?  I can’t find my car.”

The receptionist kindly used reality orientations to say:  “Sarah, you sold your car years ago. You don’t have a car anymore.” Sarah made loud huff and said: “Why didn’t someone tell me that?” She thanked the receptionist – and left relieved. 

The Moral of the Story  

During the presentation I mentioned earlier in this article, Governor Schreiber talked about using “therapeutic fibbing.” He said that when his wife wanted a glass of wine at nine o’clock in the morning, rather than trying to explain that this was not the appropriate time for an alcoholic beverage, he would simply say: “red or white.”

The moral of Governor Schreiber’s presentation was you can never be absolutely sure the best way to handle a situation at that moment in time. But you can be sure that if you develop a relationship with the person with Alzheimer’s disease and dementia, try to remain sensitive to their feelings and needs. When you respond out of care and concern—you will most likely get it right. If not, come back and try again.