Validation Therapy, by Naomi Feil, identifies several techniques to assist in communicating with those who have dementia. Not all techniques work, but some do.

Use the preferred name. Never use pet names (honey, sweetie). Begin by calling the confused person by his or her title and last name, unless he or she gives you permission to call her or him by her or his first name, a nickname or another preferred name. Use a clear, low, warm and loving tone of voice. Practice speaking at a slower pace and lower pitch. Adjust your voice to the person’s emotions. Confused people search for a loving, accepting person. When a voice reflects concern and love, the confused person will open his or her eyes and communicate positively through verbal and body language. The face will become less tense and more animated.

Respect personal space. Refrain from invading the confused person’s space. Most people feel comfortable with at least 12 inches between them. Hugs make some people uncomfortable. A sincere handshake or gentle touch on the forearm is more acceptable and less threatening. Always let the confused lead and initiate closeness. Never approach a person from behind or in a hurried manner. One of the goals is to reduce agitation. A wrong approach may heighten anxiety.

Use direct, prolonged eye contact. Caring is communicated through the eyes. When effective eye contact is made, confused people will feel nurtured and safe. They may begin to talk after a moment of genuine eye contact. All communication between caregiver and receiver should be on the same level. If the confused person is sitting, the caregiver should also sit.

Use re-phrasing. Repeat in your own words what the confused person has said using his or her key words. A genuine expression of empathy helps the confused person feel understood. Re-phrasing must be sincere and not mocking. “I wish that old bat would go away!” Response, “You want the lady to stop bothering you.” Use polarity.  Confused people respond best to being asked to describe the extreme form of their experiences. Use words like “always” or “never” in your questions during the conversation.  “There doesn’t seem to be rules anymore.” Response, “The rules are always broken?”

Use the preferred sense.  By listening to and observing carefully, you can identify which sense he or she prefers. When asked to describe a previous experience, a visual-dominated person will use sight words. “She wore a red dress.” Auditory dominated persons will use sound words. “I heard the bird sing a melody.” A touch dominated person will use practical, hands-on, touchy and felt words in his or her conversation. “I could not get my arms around it.” In the conversation use the same type of words of the preferred sense.

These techniques will give the caregiver an opportunity to relate effectively to those who have cognitive impairment. We may be pleasantly surprised, that the confused person can relate better than we may have assumed.