This is the third edition of a book first published in 1993 intended to deliver techniques for communicating with people with Alzheimer's disease and other dementias. It is aimed at practitioners working with people with dementia in all settings, but particularly in settings where people who are frail, confused and disoriented live.
While it is clear that the authors intend to promote an approach to communication and interaction with people with dementia that offers dignity and respect, to my mind there are several weaknesses to the book that undermine its goals. First, While there are some theoretical foundations put forward for the Validation technique (Maslow's hierarchy of needs; Erickson's Eight ages of man), these are under-developed and under-referenced and it is unclear how such different theories contribute to this approach, or where the authors’ own theoretical positions are derived from.
Second, there is scant empirical evidence for many of the statements and claims made, making it difficult to evaluate them or draw one's own conclusions. For example, there is no supporting evidence for the list of fundamental humanistic principles that underpin the validation approach, nor is there a convincing theoretical basis for the four phases of Resolution, which appear to be the basis for using the approach. Of the 35 references cited, 15 are the first author's. The lack of supporting evidence base, along with a weak theoretical base, means that concepts such as Malorientation, Time Confused, Repetitive Motion and Vegetation are insufficiently defined: this makes linking these concepts to the case studies and drawing logical conclusions from them a difficult and uncertain process.
Third, the use of labelling language such as ‘the blamer’ (p. 45), ‘the pounder’ (p. 77), the claim that ‘blamers are mean old men and women’ (p. 132) or description of objectifying practices such as ‘toileted’ (p. 87) do little to promote respectful practice, instead they perpetuate the negative stereotype of people with dementia. There also appears to be an unquestioned assumption that the levels of aggression expressed by some of the people with dementia in the book are attributed to their dementia rather than a result of the difficult social and physical environments they find themselves in – a more critical stance, supported by reference to relevant literature, would very much have strengthened this aspect of the book.
Fourth, there are, at times, unquestioned descriptions of deficiencies in basic practice that may have contributed to a person's behaviour (see e.g. on p. 78, a description of a member of staff stating she will have to wait a couple of hours to get help to change an obviously very wet and distressed male resident, along with sweeping assumptions of his lack of awareness of his plight that might have been incorrect). It would seem that respectfully attending to his physical and psycho-social needs as they arise rather than prescribing validation for the resident for three minutes four times a day, might be a more appropriate and meaningful approach. There are also some disturbing descriptions of lack of attention to possible pain experienced by residents and lack of compassion shown to residents by care staff – these are issues that are fundamental to good practice and highlight the need for basic staff training. Addressing these basic deficiencies in practice might be a first step towards respectful, dignifying care.
A strength of this book lies in its descriptions of the plight of people with dementia in settings where there is little understanding of their perspectives, unique needs or attempts to communicate with others. These descriptions contribute to the ever-increasing body of evidence of poor practice, insufficient staff training and understanding of dementia, insufficient leadership and mentoring of staff that characterises many care settings for people with dementia. A validation approach that is integrated with everyday practice should be included in the repertoire of skills held by care staff and, as such, this book, used critically, will contribute to this set of skills.
