Communicating with someone who is confused can be frustrating.  And yet, somehow caregivers need to listen and speak in a way that builds trust and lowers anxiety.  Anxiety only heightens uncooperative, difficult behavior and impedes communication.  The goal is to provide as much quality of life as possible for the confused person by lowering the distress that can accompany difficult moments.

Therefore, it is important to prepare for the relationship with a confused person.  Naomi Feil in her book, The Validation Breakthrough, speaks of the value of ‘centering.’  Caregivers must be in the right frame of mind in order to handle the complicated thoughts, feelings and behaviors that may come to the surface.  ‘Centering’ begins when the caregiver acknowledges his or her own feelings.  It is important to find a way to express them so they are not imposed on the relationship.

The exercise of certain relaxation techniques by the caregiver is helpful.  For example, the practice of deep, slow breathing calms the internal being.  The imagery of slowly breathing in new fresh air and expelling old stale air (thoughts and feelings) can be therapeutic for the caregiver.  Positive self-talk can sweep away worrisome and needless thoughts before and during an exchange.  This intentional effort will prepare the caregiver for empathetic listening and unconditional acceptance.

Joy Goodwin, who introduced Validation Therapy to The Baptist Home in the 1980’s, gave this good advice.  “Relax; the confused or disoriented do not have to live in our reality.  It’s okay to allow them to have their own reality as long as they are not in physical danger or a danger to others.”  Insisting that the confused person live in the caregiver’s reality does not work.  Reality Therapy attempts to correct the confused with verbal and written cues.  However, this is often found to increase agitation and is generally not beneficial for effective communication.

The caregiver may miss an opportunity of understanding the underlying thoughts and feelings by becoming too obsessed with making sure the facts are correct.  The confused person is probably speaking in symbolic language and not interested in facts anyway.  He or she may be subconsciously creating fantasy to express deeply felt needs.  Correction interrupts this process and will more than likely be met with stubborn resistance and increased hostility, agitation and withdrawal.

Spouses and adult children of the confused may find this approach difficult since life lived in the family unit and workplace often involves correction.  However, the caregiver’s feelings of anger, fear, embarrassment and guilt must be put aside.  Accepting the confused person’s condition frees the caregiver to find effective ways to have a meaningful conversation.  This builds greater understanding by allowing deeply felt needs to be expressed in a safe and nonjudgmental way.

This approach builds trust; however, it is also essential not to patronize, lie or play along with the mistaken reality.  On one level the confused person may realize you are toying with them.  This does not make for a good relationship or meaningful experience.  Next time I will address some important ways to build trust without patronizing.