Deborah Mullins, a social worker at The Royal since 1999, has been talking to her clients and families about validation as a communications skill for many years. With a smile, she recalls one client who shared his own take on validation – that what she was teaching was simply “good manners.” Defined as the act of acknowledging and accepting a person's thoughts, feelings, and experience, validation is a polite way of interacting with friends, colleagues, and family members, but there’s more to it than that.
“Validation is a skill to build trust, and like all skills it must be practiced repeatedly,” says Mullins. “Someone with good manners does not build trust or bring a loved one closer, although you might receive another dinner invitation!”
Mullins, who is presenting a family support group and information session about validation on Feb. 21, says when we consistently communicate to loved ones in a way that is emotionally validating, it can help strengthen those relationships.
While she describes validation as an excellent communications technique anyone can learn, she says it plays a particularly important role in mental health settings.
“When you're a caregiver of someone who has a mental health issue it’s very hard to problem solve until you have a trusting relationship – to convince someone to take their medication for a schizophrenia spectrum disorder, for example,” says Mullins.
Psychosis is a condition that affects the way the brain processes information. Conditions that are known to trigger psychotic episodes include schizophrenia, bipolar disorder, and severe depression.
Psychosis involves hallucinations (visual or auditory experiences that are not real) or delusions (false beliefs not based in reality). During a period of psychosis, a person may have difficulty understanding what is happening in real life, and what is not.
“Trying to talk someone out of their psychosis is like someone trying to talk you out of something you know to be true,” says Mullins.
She gives an example of a person who was diagnosed with a schizophrenia spectrum disorder and has delusions about being wanted by the police.
So what could validation look like in this case, and in a moment of crisis?
Mullins suggests looking for what is true in what the person is saying. In this example, that does not mean agreeing or confirming the person is wanted by the police, it means trying to understand how they feel in that moment.
Mullins offers this sample script for the caregiver in this scenario: You must be so scared. I would be too if this was happening to me. I’m sorry this is happening to you. What can I do to help? This could be followed up with: What would you find helpful? Would it be helpful if I called your doctor or your social worker? Would it be helpful if you took your medication?
For some families and caregivers, it can be hard to practice validation in a heated or fearful moment – especially if they find themselves close to burn out – so rehearsing key phrases can be helpful.
If a caregiver can't find the right words in the moment, Mullins says the best validating action they can take is to turn their body towards the person so they know they are listening, make eye contact, and nod their head. No words necessary.
“Truly being present is sometimes the very best we can do as caregivers. And that's validation as well.”
Six levels of validation
Mullins refers the families and caregivers of her clients to the six levels of validation. The higher the level, the more intense the validation.
- Level 1: Being attentive
Simply listening and observing what a loved one is saying and doing. Listening is a key part of validation at every level. Pay attention to your own body language and give the other person your full attention.
- Level 2: Reflecting back
Repeating to the other person what you heard them say – without judgemental language or tone – in a genuine way. “This helps your loved one know you are truly engaged,” says Mullins.
- Level 3: Empathic mind reading
Articulating the un-verbalized. In other words, helpful guessing about what the other person may be experiencing, or may need. Try this level if a loved one signals non-engagement, withdrawal, or appears to be shutting down. Be aware of body language and remain sensitive to what is not being expressed. Check in with them about your accuracy about how they might be feeling: “Did I get it right?”
- Level 4: Based on your history
Considering the history of your loved one and trying to understand what they have been through in the past. For example, “It makes sense to me that you are feeling anxious about attending a party where alcohol is being served, considering your history with alcohol.”
- Level 5: Normalizing
Validating based on current context or circumstances with the understanding that sometimes a behaviour makes sense for anyone. “It makes sense that you’re frustrated. I would be too if my calls weren’t being returned.”
- Level 6: I believe in you
This level is referred to as ‘radical genuineness’ and involves recognizing your loved one for who they are, and seeing and responding to their strengths and capacities while having an empathic understanding of their actual difficulties.
Mullins wants people to know that validation is not about controlling outcomes, it is about building relationships and bringing people closer – and it takes practice.
“This is a skill you use and build until it becomes automatic for you to use. You build trust in that relationship so the person will turn to you when they're scared and frightened,” says Mullins.
To learn more about validation, watch the video below for a presentation by Deborah Mullins.