Therapeutic Processes for Communication Disorders

A Guide for Clinicians and Students

Robert J. Fourie, Robert J. Fourie

• Publisher: Psychology Press
• Year: 2010
• ISBN:
  9781136886485
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Why do many people with disorders of communication experience a sense of demoralization? Do these subjective experiences have any bearing on how such problems should be treated? How can professionals dealing with speech, language, hearing and other communication disorders analyse and respond to the subjective and relational needs of clients with such problems?

In this book, authors in the fields of communication disorders analyse the psychological, social and linguistic processes and interactions that underpin clinical practice, from both client and clinician perspectives. The chapters demonstrate how it is possible to analyze and understand client-clinician discourse using qualitative research, and describe various challenges to establishing relationships such as cultural, gender and age differences. The authors go on to describe self-care processes, the therapeutic use of the self, and various psychological factors that could be important for developing therapeutic relationships. Also covered are the rarely considered topics of spirituality and transpersonal issues, which may at times be relevant to clinicians working with clients who have debilitating, degenerative and terminal illnesses associated with certain communication disorders.

While this book is geared toward the needs of practicing and training speech, language and hearing clinicians, other professional such as teachers of the deaf, psychotherapists, nurses, and occupational therapists will find the ideas relevant, interesting and easily translatable for use in their own clinical practice.

Part I
Focussing on the client

1
Ruminations of an old man

A 50-year perspective on clinical practice

David Luterman
Emerson College, Boston

INTRODUCTION

I have been blessed with 50 years of active clinical involvement. I began my professional life as a diagnostic audiologist and morphed into a rehabilitation audiologist, specializing in helping families of newly diagnosed hearing-impaired children make the transition to their new reality. I feel incredibly fortunate to have stumbled into my life work and have found a niche that nourishes me and at the same time benefits others. To participate in and facilitate the personal growth of clients provides moments of grace that makes our profession so worthwhile. Immersed in my life journey it seemed disjointed; from this vantage point it seems inevitable. At this stage in my life, I find myself more reflective with a strong desire to look back, distil my clinical experience and pass it on to current and future generations of clinicians. Here then is the “Luterman 10.”

1 GRIEF IS NOT PATHOLOGY

At heart, we are grief workers. We are dealing with people undergoing transitions in their lives because they have lost the life they thought they were going to have; whether this is the parent of an autistic child or the spouse of a patient with aphasia or the adult child of a parent who is living in a nursing home and who has a swallowing disorder. Grief is not culture bound or disability specific: it is endemic to disability. While many things have changed in our profession, the human equation is unchanging; we are dealing with clients who are emotionally upset not emotionally disturbed. Grieving and the concomitant feelings are a normal response when a person is suddenly confronted with a life challenge for which there was no preparation; as a profession we need to give ourselves permission to do the necessary grief work. While technology may have altered the therapeutic landscape, it does not bypass the need to interact with our clients on an emotional plane.

2 IGNORING THE EMOTIONAL COMPONENT CAN BE PERILOUS

When people are emotionally upset they cannot process information well. I had to learn this the hard way as a practicing diagnostic audiologist. After making the diagnosis of hearing loss in a child, my notion of counseling at that time was to give information. I rapidly developed set speeches about the audiogram, hearing aid maintenance and educational options. I gave these mini-lectures without recourse to the parent’s emotional state. What I learned on subsequent evaluations, much to my dismay, was that they retained almost nothing of what I had said. They were much too upset to retain much content and, in fact, I had overwhelmed them with information and contributed to their fear and anxiety. Especially in the early stages of diagnosis, people are helped best by being allowed to grieve.

I have found that people are seldom allowed to grieve as most people conspire to make them feel better. They do this by instilling hope (“they will find a cure”) or by positive comparisons (“It could be worse he could have …”). All this serves to do is to emotionally isolate the person and deny them the freedom to grieve. What people in emotional pain often need the most is to be listened to and have their feelings validated. This is counterintuitive for most people as the tendency is to want to take the pain away by solving the problem or distracting them. I have learned that I cannot take the pain away; these disabilities represent a loss and that loss will always be there, despite anything I might say or do. What I can take away is “feeling bad about feeling bad.”

Once as I was beginning to facilitate a support group for parents of newly diagnosed deaf children, one mother looked at me and said “you are going to make me cry” and I said to her “No. I am going to give you permission to cry,” whereupon she started to cry. In the past I would have felt guilty that I caused that parent to cry; what I have come to understand is that I am not putting the feelings in but creating the conditions that enable the feelings to emerge. What I have also come to understand is that feelings just are; you do not have to be responsible for how you feel but always for how you behave. This notion has enabled me to enter the realm of feelings with clients to their benefit because embracing painful feelings is the first step in healing. The current emphasis on evidence-based practice I find worrisome because emotional growth does not readily lend itself to measurement, yet it is in the emotional realm where a great deal of the action takes place. Communications are best achieved when there is both content and affect components present. I hope we can learn, as a profession to balance our content counseling with our affect counseling and value both equally.

3 COUNSELING IS NOT ABOUT MAKING CLIENTS FEEL GOOD

The purpose of counseling is not necessarily to make people feel better, the entertainment industry does that. The goal of counseling should be to empower clients so that they can make self-enhancing decisions for themselves and their family members. In the course of the counseling experience, painful feelings will emerge including anger. I have always seen the emergence of the painful feelings as a positive sign because these clients are not in denial and if I am mindful of my role, they will take ownership of the communication disorder; there can be no meaningful change without ownership of the problem by the client. This ceding of responsibility to the client is often in itself painful for clients, as frequently they prefer a passive role in the habilitation process hoping and expecting the professional to “fix” it.

4 LISTENING IS OUR MOST IMPORTANT CLINICAL TOOL

As a beginning clinician I assumed my professional role was to give information and direction to the client; that I needed to be a very active participant in the therapeutic process. I had a “lesson plan” mentality with specific goals in mind and my scripted mini-lectures were designed to ensure that clients left our encounter with the information that I thought they needed. In retrospect, I can see that the set speeches and advice giving were a reflection of my own insecurities and need to limit the clinical interaction in predictable, content-based ways that I could manage. Listening to the client without a preconceived “lesson plan” enables the client to participate more fully in the therapeutic endeavor; it forces clients to be active in the relationship. Listening for client affect and reflecting it back enables the client to identify their feelings and express them in a safe relationship; this attenuates client isolation and validates their feelings. Listening deeply to our clients is a great gift we can give them.

As I have become more self-confident in my clinical skills I have been able to cede more and more control of the therapeutic process to the client. Learning proceeds best when the learner is an active participant in the process. Listening enables the clients to reveal themselves allowing me to find ways to be most helpful; the client will teach us if we listen. I had to learn to cultivate the art of not doing and at the same time being present for the client. The irony here is that often the less I do the more the client learns.

5 OVER-HELPING TEACHES HELPLESSNESS

In the early stages of diagnosis, clients are usually overwhelmed and feeling very inadequate to cope with the disability. This is a critical juncture for the clinician because the tendency is to want to rescue the client from their actual and felt inadequacy. If we rescue by advice giving and taking responsibility away from the client we can contribute to their fear and sense of inadequacy. It is very easy to teach helplessness and create the dependent client who then accepts a passive role, expecting the clinician to fix it. I have had to learn how to be responsible to my clients rather than being responsible for them. Finding the therapeutic equator of helping is not easy because it is constantly shifting with each client and at different times with a client. I have had to learn to trust clients to eventually make the best decision for them, and that wisdom resides w...

Table of contents

• Contents
• Figures and tables
• Contributors
• Preface
• Part I Focussing on the client
• Part II Focussing on the clinician
• References
• Appendix
• Author index
• Subject index