SPPARC

Supporting Partners of People with Aphasia in Relationships and Conversation

Sarah Lock, Ray Wilkinson, Karen Bryan

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000160871
• Edition: 1
• Topic: Education
• Subtopic: Education General

"SPPARC" highlights the importance of working with partners in order to create real life change both for partners and for people with aphasia. "The SPPARC" pack consists of a manual, downloadable resources and provides: practical resources to run, support and conversation training programmes either for groups of partners or for the partner and the person with aphasia together as a couple; conversation assessment and treatment materials, photocopiable and printable (from the downloadable resources) activities and handouts, as well as an introduction to conversational analysis; and, downloadable resources with 27 extracts of everyday conversations between several people with aphasia and their partners, which can be used as a resource both for assessing everyday conversation and for facilitating change.Theoretically validated through the 'Coping with Communicating' research project from University College London, "SPPARC" goes beyond the theory and provides a complete resource of clinically effective tools to work with people with aphasia and their communication partners.

1 Background to the SPPARC Pack

Chapter 1

Introduction

Speech & language therapists have provided support for partners of people with aphasia for many years, both on an individual basis and through relatives’ support groups (for example, Bevington, 1985; Rice et al, 1987). (For a precise definition of who we describe as ‘partners’, see Chapter 2, page 7.) Recent developments within aphasiology, however, have provided new theoretical models and practical ideas for this type of clinical intervention. Two of these developments in particular have influenced the construction of this resource pack.

First, there has been an increased awareness of the fact that aphasia can necessitate psychosocial adjustments for both people with aphasia and their partners, and that the psychosocial functioning of people with aphasia and their partners is closely interlinked (Johannsen-Horbach et al, 1993; Parr, 1994; Nichols et al, 1996). Addressing the psychosocial needs of partners is therefore important, both for the sake of the partners themselves and for the sake of the people with aphasia for whom they care, and who may be reliant upon them. Second, there has been a growing interest in applying conversation analysis (CA) to aphasia therapy, so that intervention is targeted directly at the everyday conversations of people with aphasia and their partners. There is evidence that this approach can create real life change in the interactions of people with aphasia and their significant others (Lesser & Algar, 1995; Wilkinson et al, 1998; Booth & Perkins, 1999; Booth & Swabey, 1999; Bryan et al, in preparation).

These two recent developments are in fact linked because, as Schiffrin (1988, p272) points out, ‘conversation is … a vehicle through which selves, relationships and situations are talked into being’. In other words, conversation is linked to relationships and to people’s psychosocial identity.

In aphasia, linguistic impairments compromise the person with aphasia’s ability to engage successfully and easily in conversation, and can therefore severely impact on their feelings of competence and self-image. One clinical method of dealing with this has been to train volunteers to interact with the person with aphasia in ways which will allow the person’s communicative and social competence to be displayed, and thus to lessen the psychosocial handicap of the aphasia (Kagan & Gailey, 1993; Kagan, 1995; 1998; Lyon, 1997).

However, as well as impacting on the person with aphasia’s psychosocial functioning, an impaired ability to engage in conversation can also impact directly on the relationship between the person with aphasia and his or her partner. Maynard and Zimmerman (1984, p302) point out that the relationship between people can be viewed as ‘something that is subject to the ongoing step-by-step management within talk rather than a state of affairs that underlies their talk’. This means that conversation is not only linked to relationships, but is at the root of relationships.

The person with aphasia’s linguistic impairments may cause a couple to develop patterns of interaction after aphasia which are very different to the patterns they had beforehand. (For a precise definition of what we describe as ‘a couple’, see Chapter 2.) Having considered Schiffrin’s (1988) and Maynard and Zimmerman’s (1984) insights, it is possible to see how a couple’s changes in interaction may create strains on how they construct and maintain their relationship through conversation. In working from this conversational perspective, therefore, the traditional boundaries in aphasiology between impairment and functional/psychosocial approaches begin to dissolve. By assessing how aphasic impairments impact on a couple’s moment-to-moment interaction, and by helping the couple to adapt to those impairments in everyday conversation, intervention thus focuses on something central to people’s lives: relationships.

At the time of Bob’s stroke our future seemed to fall apart … the closeness of our marriage had depended over the years on our ability to talk everything over together and on a constant stream of lively exchanges about all the many things we were interested in.

Lauren (partner)

As has been shown already, using clinical resources to support partners can be justified on several grounds. First, by being given an opportunity to gather and discuss information about changes resulting from stroke and aphasia, partners may be able to make sense of why these changes have occurred to their loved one, and to explore how these changes impact on their everyday life and relationships. Through information and support, partners themselves are helped to cope with the significant emotional, financial and role changes they may experience in living with a person with aphasia.

Second, changes in the ability of partners to deal with aphasia are likely to have a beneficial effect on the psychosocial functioning of the person with aphasia, and on the couple’s ability to interact together successfully in everyday life (Gainotti, 1997; Hoen et al, 1997).

By supporting the partner’s psychosocial needs and providing conversation training, you, the clinician, can help the partner and person with aphasia to adapt in their relationship and develop new ways of interacting together which work well for them.

I just think it was an excellent programme and I think we were really very very very lucky to have had it, and, that’s why I think it’s so sad that you’ve got all the other thousands of stroke victims who haven’t had this opportunity.

Jane (partner)

Chapter 2

How to Use the SPPARC Pack

INTRODUCING THE PACK

The SPPARC Resource Pack consists of three parts:

1 The Clinician’s Manual. This contains the background information that you will draw on to run the programmes. The manual consists of:

general background to the pack and to the two programmes;

introduction to the Support Programme and the steps involved in carrying out the sessions;

introduction to the Conversation Training Programme and the steps involved in carrying out the sessions. The Conversation Training Programme uses a conversation analysis approach. Since this approach is still relatively new in clinical aphasiology, step-by-step instructions on using this approach for aphasia assessment and treatment are provided, and a case study of using this form of intervention approach with one couple is included.

2 The Support Programme. This includes plans for eight support and information-giving sessions. These outline possible activities for intervention, and include a series of photocopiable handouts which can be given to participants of the programme.

3 The Conversation Training Programme. This includes plans for eight conversation training sessions and photocopiable handouts.

The pack also includes a videotape consisting of extracts of everyday conversations between people with aphasia and their partners. This can be used by you both as an aid to assessing the everyday conversations of the people you are working with, and as a therapy aid during intervention to raise awareness of issues in aphasic conversations.

Our aim in producing the SPPARC pack has been to avoid being prescriptive, but rather to provide material that can be used in various ways as you feel is appropriate for your own circumstances. Ways in which the materials in the pack can be used include the following:

You can run the Support and Conversation Training Programmes as they are presented in the pack, or you can use the materials as part of your own intervention programme. Each session presented here corresponds broadly to a two-hour session, and therefore running both programmes on a one-session-a-week basis would take 16 weeks. When we ran both programmes, the feedback from participants was that they preferred the Support Programme first, followed by the Conversation Training Programme.

The materials can be used for intervention with groups (for example, relatives’ support groups), or for working with couples or with individual partners. While the handouts in the pack are designed primarily for use with partners of people with aphasia, you can also use them with couples, by adapting the way you present them.

Although the pack provides a large number of materials and ideas for their use, we found it important in using the materials to personalise them to the specific needs of each partner or couple, where possible. Our experience has been that, while there are similarities across couples, each one adapts to aphasia in slightly different ways, and therefore has slightly different needs. It is important for intervention to recognise and respond to this. We provide suggestions at appropriate points in the programme sessions as to how the materials can be personalised.

Throughout the pack we include quotes from partners and people with aphasia with whom we have used this intervention approach. These quotes come from semi-structured interviews, conducted as part of our post-programme evaluation by one of the partners who took part in the programmes, and who is by profession a psychotherapist and an experienced interviewer. We hope these quotes bring to life the perspectives of the partners who took part in these programmes, and who are living with people with aphasia. We also hope that they reflect our belief that people living with aphasia as part of their everyday lives have their own unique ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• List of Tables and Figures
• About the Authors
• Foreword
• Preface
• Acknowledgements
• 1 Background to the SPPARC Pack
• 2 Background to the Support Programme
• 3 Background to the Conversation Training Programme
• 4 Appendixes
• Bibliography