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Snap. Click. Snap. Click. Snap. Click.

The old lady snaps open her worn black purse, stuffs in paper napkins and clicks it shut 100 times an hour.

Day after day.

"I have to fix the Underwood," she says. "I have to fix the Underwood." Then she heads for the bathroom to change wet pants.

Alzheimer’s-type dementia, her medical chart reads.

Makes no sense, her caretakers say.

But this old lady, like hundreds of thousands of other seniors with dementia, is trying to explain something — if her caregivers would only listen with empathy, says Naomi Feil, the creator of the Validation method of communicating with confused older adults.

To understand, you have to become a detective: Listen carefully and her behavior and her words will make sense, and she will become calmer because she finally has been heard, says Feil, a Cleveland-based geriatric social worker whose communication techniques are taught worldwide.

"If we tune in to the inner world, we begin to understand that a retreat into personal history is a survival strategy, not mental illness," Feil says.

Many confused elders withdraw, even into dementia, to escape painful life losses.

Instead of learning throughout life to roll with the punches — to look loss and disappointment square in the eyeballs, to acknowledge the hurt and damage they inflicted, and then go on living life fully — some people carry heavy excess emotional baggage until they are very old, she says in a phone interview.

Physical problems and brain degeneration exacerbate unresolved emotional problems, Feil continues.

Energy lessens, and with it the ability to fend off unresolved conflicts. By very late life, it’s often too late for insight therapy — getting counseling to understand the origins of anguish in order to change thinking and behavior.

Instead, people speak and behave in peculiar ways. They blame others, who are substitutes for hurtful people in the past. They accuse, pace, moan, wander, yell, pound.

Or, as she writes in "The Validation Breakthrough," "disorientation in a very old person may represent the normal struggle of the old-old person who has lost recent memory and surrenders present-day factual thinking in order to restore the past to heal old wounds before death."

To do that, "they use the mind’s eye to see; they recall familiar voices from the past, which sound real to them," she says.

"To relive the sense of usefulness they experienced when they were working, they move their hands and feet in the same way that they may have done in their jobs. Once they lose the ability to communicate through speech, they blend sounds to express their emotions."

For example, the purse lady had been forced to retire at 65. After she retired, she dressed for work and sat typing all day at her old office Underwood "for the company." In that way, she stayed in control and didn’t have to face the devastating emotions she felt when she lost her job.

When she became incontinent in her 90s, the Underwood became a symbol of her loss of bladder control. She went to the bathroom to fix her machine. She hoarded napkins in her purse to feel in control. The purse symbolized her efforts to keep herself together.

Feil knows the old well: She grew up in the home for the aged her parents directed. After professional education, she also went into geriatric social work.

The techniques she was taught in graduate school didn’t work with aged people with Alzheimer’s-type dementia. Reasoning didn’t. Asking "why" didn’t. Trying to orient the confused to reality didn’t. Insight therapy didn’t. Trying to modify behavior didn’t.

Through trial and error, Feil found things that did work: Believing people with dementia are making sense the best they can. Understanding that they’re trying to tell someone who will listen what is bothering them so they can finish legitimate developmental tasks and, as Feil says, "die in peace."

Feil calls the method of things that worked Validation.

"Validation provides disoriented old-old people with an empathic listener, someone who does not judge them, but accepts their view of reality and realizes they’re trying to tie up loose ends," Feil continues.

"As the trust between the old-old person and the validating caregiver grows, anxiety is reduced, the need for restraints lessens and the sense of self-worth is restored. Physical and social functioning improve, and withdrawal to a vegetative state is prevented."

She will teach her communication methods from 9 a.m. to 5 p.m. Saturday at Lakewood Manor, 1900 Lauderdale Drive. The workshop is designed for ordinary people — family and professional caregivers, clergy, aides, nurses and business people — who encounter disoriented elders in their family and professional lives. The cost is $20 in advance. Call (804) 828-9060.

"Validation reduces frustration in caregivers and in the person with dementia," Feil says. "They won’t be arguing with the people they are working with, and the caregivers will see changes.

"After Validation, people aren’t as aggressive. They talk more. Their anxiety is reduced. They do not deteriorate and go inward as much. Dormant speech often returns. Negative behaviors, such as crying, pacing, accusing, wandering and pounding, decrease. As they age, people continue to communicate to the maximum of their potential, and they end up dying with dignity. They don’t become ‘living dead’ people."

For example, a mechanic used Validation with an elderly customer who thought he wasn’t repairing his car properly. The real problem was that the old man was afraid he was breaking down and losing his ability to drive.

In another case, an empathic listener found that an old man in the nursing home who pounded his fist on his wheelchair tray all day long was trying to drive in a nail straight. When he was a boy, his father had harshly criticized him for not hammering a nail in straight.

"You don’t have to know why they’re doing what they’re doing, but you have to know that what they’re doing is helpful. That’s when you listen, and you help the person do whatever it is that they need to do," Feil says.

"The techniques aren’t hard."

However, "you have to get into the world of the old person, and you have to feel what they feel. That’s hard for some people. You have to lay aside your own judgments that people should be a certain way," Feil says.

For instance, "if your mother sees her mother, you may want to say, ‘Come on, Mother, your mother’s dead’ or ‘Act your age.’ Those judgments have to be put away. You have to step into the emotional world of your mother. Your mother has damage to her brain, and she is now time-confused, but she needs to go back to her past and see her mother in her mind’s eye."

If the adult child "can step into her mother’s world and accept that her mom is healing herself with her behavior, there’s a lot of healing in that for the daughter and for the mother. The daughter can think, ‘Mom is preparing to die and she needs to talk to own mother, and let me help her as much as I can,’ " Feil says.

"You get a good feeling because you have a genuine communication. You learn a lot about your own parent that you didn’t know before. You get a real good feeling when you see your parent make closure and become peaceful."

This method contrasts sharply with approaches that assume that the very old "should act the way they used to act," she adds.

Feil issues a warning: "As more and more people in the United States and elsewhere in the world reach old-old age, more and more families and institutions will be confronted with bizarre and upsetting behaviors.

"The need to find some way of understanding and communicating with disoriented people is overwhelming." 

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