ABSTRACT
This chapter considers the merits of approaches that are specifically relevant to confusion: reality orientation (RO), time-shift collusion and validation. 'There can be few people working in dementia care who have not come across RO. 'Formal' RO groups are best seen as social gatherings whose benefits, whether these be interpersonal or cognitive, are rapidly lost once the session ends. Holden advocates a hybrid of RO and distraction known as 'time-shift' when communicating with a person who steadfastly holds onto their reality. Collusion has a role to play in dementia care, but in a way similar to that proposed for behaviour management. It is a psychological response of last resort when working with confusion. Unlike resolution therapy, where meaningful and empathic interpersonal contact is the vehicle to appreciate the changes required to meet someone's needs, validation is the necessary change when working with confusion. Ill-being is replaced by relative well-being and the episode becomes a 'holding' experience.
