Counseling in Communication...
Transcript of Counseling in Communication...
7/29/2010
1
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.
7/29/2010
2
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
7/29/2010
3
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
7/29/2010
4
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
7/29/2010
5
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
7/29/2010
6
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.)
7/29/2010
7
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
7/29/2010
8
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?
7/29/2010
9
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
7/29/2010
10
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
7/29/2010
11
From Information Exchanges, Some Parental Reflection/Advice
7/29/2010
12
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
7/29/2010
13
Evidence
• Listen for evidence of the emotional impact with these individuals who had suffered strokes - their emotional reactions are real
And Another
7/29/2010
14
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
7/29/2010
15
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
7/29/2010
16
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
7/29/2010
17
QuickTime™ and aTIFF (Uncompressed) decompressorTIFF (Uncompressed) decompressor
are needed to see this picture.
Michael Flahive, Ph.D.flahive@SXU [email protected]
7/29/2010
18
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
7/29/2010
19
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.