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Counseling in Communication Disorders

Michael Flahive, Ph.D.

Where We’re Going

– Examine roles and responsibilities of SLP’s regarding provision of counseling services

– Refer to the Scope of Practice and Code of Ethics in outlining professional boundaries

– Describe a simple counseling model

– Focus on the dynamic process of information exchange and adjustment facilitation

Today’s Sources

• Flasher, L., and Fogel, P. (2004). Counseling Skills for Speech-Language Pathologists and Audiologists. Clifton Park, NY: Thompson Delmar Learning.

• Holland A (2007) Counseling in Communication• Holland, A., (2007). Counseling in Communication Disorders: A Wellness Perspective. San Diego: Plural Publishing Co.

• Luterman, D., (2008). Sharpening Counseling Skills. (DVD #9600). Memphis: Stuttering Foundation of America.

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Professional Service Principles

• We hold client welfare paramount (from the Code of Ethics)

• Service provision is about them - not me (from the Chial citation on professionalism)(from the Chial citation on professionalism)

• We develop relationships as service providers

• As professionals, we know the course

Our Scope of Practice Says…

Speech-language pathologists provide clinical services that include the following:

10. counseling individuals, families, coworkers, ed cators and other persons in theeducators, and other persons in the community regarding acceptance, adaptation, and decision making about communication and swallowing;

[Ref. American Speech-Language-Hearing Association. (2007). Scope of Practice in Speech-Language Pathology [Scope of Practice]. Available from www.asha.org/policy.]

About the Reality

• Communication disorders present challenging conditions

• Those individuals and their families will have need(s) for information to;

– Understand the current state

– Make plans for the short and long term

– Appreciate what the condition means and to begin adjustment to it

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Listen as Pam recalls her experience in receiving news about her

daughter’s Down Syndrome - this is about professionals and conveying

i f ti d h t binformation…and what may be fundamental needs in these

exchanges

What Humans Do…

• Think to times in your life when you’ve been challenged - what was the course of events? How did you react?

Odd tt d d d t k• Odds are pretty good you needed to know and then, perhaps, needed time

• Luterman talks about “seeking equilibrium” -allowing ourselves opportunities to reflect and begin to accept realities

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Status Quo

E i I llEmotion Intellect

Reaction to Change from Status Quo

Counseling in CSD

• Provide individuals and/or their families with information regarding the reality of the communicative disorder and its ramifications

• Provide recommendations for Tx

• Facilitate personal adjustment, optimizing efforts at acceptance and adjustment

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Counseling in CSD

• There is an ongoing, dynamic relationship between being informed and beginning to accept and adjust to the reality

• It is impossible to appreciate the magnitude of impact a communication disorder may have

A SIMPLE Model

Informational

–Gathering information

–Giving information

Personal Adjustment

Informational Counseling

• Exchanges between client / family and the clinician

• Critical link in ongoing development of th ki l ti hi l ti hithe working relationship - relationship needs change over time

• Important in fostering rational acceptance and personal adjustment

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Informational Counseling

• Information exchanges depend upon effective dialog

• Microskills influence dialog effectiveness d th th ti i t t t d land worth the time investment to develop

strong microskill competence

(see Flasher & Fogle, 2004)

Gathering Information

• Refers to conventional process (e.g., case history, exchange of referral information, etc.)

• Often includes interviews - which provide an opportunity to begin the process of building aopportunity to begin the process of building a relationship

• One important objective is to set the stage for information giving

Gathering Information

• Gathering can also include efforts at maintaining our own repository of quality information (e.g., internet resources, listserv recommendations, community contacts, etc.)

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Listen as Lori’s describes her experiences in information

exchanges

What Did Lori Express?

• Disappointment in not completely understanding the clinical issue

• A sense of overwhelm with professional language

• It also sounds like guilt at having sought better understanding by going to the ‘net

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Information Giving

• Critical to individual and family’s understanding of the issue

• Essential for personal adjustment

• Needs for information will change as all moves forward, as Lori expressed

A Point About Clinical Style…How Do You Think This Brief Rehab

Facility Interview Goes?

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Quick Critique…

Moving On…Why We Care So Much About Effective Information

Exchanges

Margolis (2004)

• Information retention factoids:

– 40% - 80% of information provided by healthcare workers can be forgotten immediately

– Of the information recalled, half may be remembered incorrectly

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Margolis Principles

• Recommends:

– Be sure you understand the client’s beliefs concerning the problem

Gi d i t i t ti– Give advice as concrete instructions

– Use easy to understand language

– Follow primacy effect

Margolis (2004)• Also:

– Use explicit categorization

– Don’t present too much information

– Repeat important points

– Supplement verbal information with written, graphic or pictorial materials

Healthcare Advocates Rx

• Teach Back method - as the term implies, you request the client provide you with instruction to verify their understanding

• Detail on this method can be found by• Detail on this method can be found by Googling

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From Information Exchanges, Some Parental Reflection/Advice

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Return to the Model

Informational

–Gathering information

–Giving information

Personal Adjustment

Personal AdjustmentCounseling (a view)

• Involves the emotional component to communicative disorders

• Integral to the working relationship we establish

• Influenced by our skill in informational counseling

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Evidence

• Listen for evidence of the emotional impact with these individuals who had suffered strokes - their emotional reactions are real

And Another

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Personal AdjustmentCounseling

• Holland’s (2007) disposition to helping agrees with our values and style

Her alignment with the ideals of positive• Her alignment with the ideals of positive psychology prompt her glass half fullmindset

• Holland’s goals are to promote resilienceand acceptance

Ideas from Holland (2007)

• A wellness perspective might be akin to “For me, stuttering just is. I will change what I can and learn to live with what I cannot. I need to move on, beyond the identity as just someone who stutters ” (p 143)who stutters. (p. 143)

• Holland also notes, counseling includes:

– Helping parents find help and to advocate– Listening to parents tell their stories

Principles from Holland (2007)

• Promoting the positive, for example:

– Employing positive talk time

– Measuring personal virtues and focusing on g p gthem

– Cultivating areas of strength

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Luterman as a Resource

• Luterman’s disposition differs from that of Holland

• His DVD (Stuttering Foundation, 2008) pro ides a helpf l orientation to fosteringprovides a helpful orientation to fostering personal adjustment

• He provides direction on deep listening -an important a skill for us as helpers

Luterman

• Luterman discusses empowering clients -to promote the ability to make decisions for themselves

• Counseling is not cheerleading our job is• Counseling is not cheerleading - our job isnot to help individuals feel good

• Clients need to take responsibility, to own their problem - we assist them

Take Away’s

• Counseling is important in quality service provision

• It is among the services we provide, di t S f P tiaccording to our Scope of Practice

• Counseling effectiveness is strongly influenced by our engagement style

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Take Away’s• About information exchanges:

– Good command of microskills will promote effective and efficient give and take

B ild / t i d t f– Build / retain a good system of resources to share

– Follow Margolis’ suggestions for information giving

Take Away’s, cont.

- Consider using a teach back strategy

- Explore Holland’s focus on principles of positive psychologypositive psychology

- Review Luterman’s suggestions regarding deep listening

Take Away’s, cont.

- Skill enhancement will be a function of practice - find a small group of professional colleagues, identify collective goals and practice

- Utilize the Holland text or Luterman DVD to assist in working toward enhanced comfort with your counseling efforts

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are needed to see this picture.

Michael Flahive, Ph.D.flahive@SXU eduflahive@SXU.edu

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Resources

• American Speech-Language-Hearing Association (2010). Code of Ethics [Ethics]. Available from: www.asha.org/policy.

• Avent, J., Glista, S., Wallace, S., Jackson, J., Nishioka, J. & Yip, W., (2005). Family information needs about aphasia. Aphasiology. 19:3, May.

• Chial, M., (1998). Conveying expectations about professional behavior. Audiology Today, 10 (4), p. 25.

• Chial, M., & Flahive, M., (2010) Simple Counseling(DVD). San Diego: Plural Publishing

Resources

• Egan, G. (2007). The Skilled Helper, 8th Ed. Pacific Grove, CA: Brooks/Cole.

• Flasher, L., and Fogel, P. (2004). Counseling Skills for Speech-Language Pathologists and Audiologists. Clifton Park, NY: Thompson Delmar Learning.C to a , o pso e a ea g

• Holland, A., (2007). Counseling in Communication Disorders: A Wellness Perspective. San Diego: Plural Publishing Co.

Resources

• Kuster, J. Internet Home Page for Speech-Language Pathologists and Audiologists. http://www.mnsu.edu/comdis/kuster2/welcome.html

• Luterman, D., (2008). Sharpening Counseling Skills. (DVD #9600). Memphis: Stuttering Foundation of ( #9600) e p s Stutte g ou dat o oAmerica.

• Margolis, R., (2004). “In One Ear and Out the Other -What Patients Remember.” http://www.speechpathology.com/articles

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Resources

• Peterson, C. (2005). A Primer in Positive Psychology.New York, NY: Oxford.

• Seligman, M.E.P. (2002). Authentic Happiness. New York, NY: Free Press.