NEUROGENICS SPEECH DISORDERS:
WORKING WITH AND COUNSELING THE CLIENT
In working with our clients, speech-language pathologists do not solely offer assessment and intervention services. We can offer support, education, and can provide a safe atmosphere so the client can vent his or her feelings and thoughts. How can we, as professionals, provide counseling that is within our field of expertise?
What is the official policy of ASHA regarding counseling?
The official policy of the American Speech-Language-Hearing Association (ASHA) on the scope of practice in speech-language pathology regarding counseling states the following:
"They counsel individuals with these disorders, as well as their families, caregivers, and other service providers, related to the disorders and their management."
What other documents address this issue?
Also, the Preferred Practice Patterns (ASHA, 1993) addresses the type of counseling provided by speech language pathologist. Within the clinical process, the counseling services that SLPs provide include assessing what counseling needs are present, providing information, modifying behavior and the client's environment using different strategies, developing coping devices for emotional support, and developing and coordinating self-help and support groups for the client.
What should speech-language pathologists be cautious about when providing counseling?
- We should definitely stay within our scope of practice. We are not social workers, psychotherapists, or counselors.
- It is illegal and unethical to provide services outside of our scope of practice.
- When in doubt about our limitations in our counseling services, ask!
- Refer to the appropriate agency when necessary.
When working with neurogenic speech disorders, what are we working with?
- Suffering an illness such as Parkinson's disease or multiple sclerosis can result in the feelings of losing control, competency and independence. This can be very devastating to our clients. In their eyes, the future will hold anxiety, depression, and despair.
- With dysarthria, the loss of speech may be the most painful loss. Other people may view our clients as having reduced intelligence or as being drunk because of the changes that are occurring in their speech.
- Strokes, tumors or cerebral infections occur so suddenly and are unexpected. Initially, our clients may be terrified. It may take a long time for our clients to grasp the impairments that may always be present in their lives.
What foundations can be built in providing counseling services?
Because of the limited exposure to counseling techniques in graduate courses, an understanding of how relationships work may be beneficial. This understanding may enable us to change and help enhance any relationship between the speech-language pathologist and our client.
Relationship System Concepts
- Interdependence occurs between participants - Whatever affects one person, will affect the other. So if one person changes in the relationship, the other will have to change.
- Participants shape and sustain interactions - Multiple contributions of each participant will result in the events and experiences shared.
- Rules are formed based on the participants' behavior and expect roles.
- Stress occurs when rules are changed - Changes within a relationship can cause stress. However, the solution is not by staying in a relationship that is unsatisfactory.
- Communication can occur between participants about the relationship, actions, and events.
- Larger systems (e.g., schools, administrations, and clinics) affect relationships - These systems can affect the clinical relationship.
What characterizes a well-functioning relationship?
It is a relationship that is confined to the boundaries of what a speech-language pathologist can provide. This includes providing a supportive context for clients that allows ideas and collaboration to be shared between the speech-language pathologist and client. The strengths of the client should be identified and supported.
What characterizes a poorly functioning relationship?
It is a relationship that goes beyond the boundaries resulting in a relationship full of conflict, resistance, and power struggles. Communication is restricted between the speech-language pathologist and client. A lack of tolerance is exhibited for beliefs and feelings that are different.
What are some guidelines for counseling individuals with neurogenic speech disorders?
- Emphasis should be placed on helping the patient maintain or restore communication and maintain or restore their sense of personhood and self-worth.
- Our central aim should be to understand the meaning of what is happening to them. Stroke: A Diary of Recover (1960) by Douglas Ritchie can give us an insight to the personal experiences of an individual who suffered a stroke. Also, on the Alzheimer's web page listed at the bottom of this document, a journal of a personal account is provided. This can help us learn how to truly be empathetic (e.g., feeling for) to our clients.
- The client should always receive our full attention.
- Our duty includes "sympathetic listening" when a client is expressing himself.
- Always pay attention to facial expression. It can tell the SLP so much about how and what the client is feeling.
- Try to understand the impact of the disorder on the family of the client and the client's relations with family members and friends.
What are the steps in counseling?
- Establish the needs of communication loss and match your language to the client's needs.
- Begin a relationship with the client and family before going more deeply into their feelings about the situation.
- Explore with the client the effects of his or her situation and help to find ways of coming out of withdrawal. Means for opening the channels of communication include encouraging the client to write down his or her feelings, if possible. If this is not possible, you may try drawing. In addition, you may also use the medium of music to elicit conversation and sharing of feelings.
- Find resources for enhancing the patient's life and restoring a sense of his own value.
What is a strategy that can be used when working with the client?
Reframing positive strategies is when a behavior that a client is demonstrating is put in a new, more positive perspective.
What are some other ways the speech-language pathologist can provide effective counseling?
- Know the grieving stages (denial, anger, bargaining, depression, and acceptance) - Grieving does not just occur when someone dies. An illness can also set off the grieving process. In addition to the health problems, grieving may occur over the loss of dreams or the loss of a cherished ideal. The grieving process is different for each individual and has to be respected and understood.
- Know the difference between acceptance and adjustment - Gaining acceptance is not necessary for the client to learn how to deal with changes in his or her life. Adjustment may occur without every seeing the client accept his or her new life circumstances.
- Understand episodic loss - This is an emotional reaction to the changes that the individual is undergoing. The duration and occurrence of reactions may vary. These reactions may occur at any time.
- Reevaluate dysfunctional family responses - An incredible amount of stress has been placed in everyone's life. Just because the client or family member is denying the changes that have occurred does not mean that the individual is dysfunctional. Any reaction is considered normal. Reactions can change over time. The speech-language pathologist can help reframe these reactions. However, if behaviors begin to interrupt intervention or family functioning, then those concerns should be addressed with other professionals.
- Recognize coping behaviors that are positive - Coping behaviors may vary from one individual to another. The speech-language pathologist can explain that reactions and coping behaviors are neither right nor wrong.
American Speech-Language-Hearing Association (1997). Scope of Practice in Speech-Language Pathology [On-Line]. Available: http://www.asha.org/scope_slp.htm
Crowe, T. (1997). Applications of Counseling in Speech-Language Pathology and Audiology. Baltimore, Maryland: Williams & Wilkins.
Dalton, P. (1994). Counseling People with Communication Problems. London, England: Sage Publications Ltd.
DePompei, R. & Williams, J. (1994). Working with families after TBI: A family-centered approach. Topics in Language Disorders, 15, 68-81.
Stone, J. (1992). Resolving Relationship Problems in Communication Disorders Treatment: A Systems Approach. Language, Speech, and Hearing Services in Schools, Volume 23, 330-307.