Counseling as Collaboration S usan Ginley, MA CCC-S LP Clinical - - PowerPoint PPT Presentation

Counseling as Collaboration

S usan Ginley, MA CCC-S LP Clinical Associate Professor Portland S tate University

My intent for you

To learn about :

• Scope of practice for counseling
• The characteristics of an effective counselor
• Strategies to
• Use respectful listening
• Use solution focused counseling while incorporating everyone’s feelings
• Incorporate the concept of joining
• Give assignments
• Tools
• Have a framework to work within
• Self-Anchored Rating Scales (SARS)

Our proposed definition of counseling:

Use of a set of techniques that enables the clinician to respond to client and family statements, behaviors, and interactions in a manner that expands clinical effectiveness and enhances speech- language change. Infused throughout therapy Most effective when the “ family system” is the therapeutic emphasis This definition creates the opportunity for clinicians to work collaboratively with clients and/ or families

What is AS HA ’s position on an S LPs scope of practice for counseling?

Speech-Language Pathology

S LPs counsel by providing education, guidance, and support. Individuals, t heir families and t heir caregivers are counseled regarding acceptance, adaptation, and decision making about communication, feeding and swallowing, and related disorders. The role of t he S LP in t he counseling process includes interactions related to emotional reactions, thoughts, feelings, and behaviors that result from living with the communication disorder, feeding and swallowing disorder, or related disorders.

Audiology

Audiologist s counsel by providing information, education, guidance, and support to individuals and their

• families. Counseling includes

discussion of assessment results and treatment options. Counseling facilitates decision making regarding intervention, management, educational environment, and mode of

• communication. The role of t he

audiologist in t he counseling process includes interactions related to emotions, thoughts, feelings, and behaviors that result from living with hearing, balance, and other related disorders.

More from AS HA

Speech-Language Pathology

• S

LPs engage in the following activities in counseling persons with communication and feeding and swallowing disorders and their families:

• empower the individual and family to make informed

decisions related to communication or feeding and swallowing issues.

• educate the individual, family, and related

community members about communication or feeding and swallowing disorders.

• provide support and/ or peer-to-peer groups for

individuals with disorders and their families.

• provide individuals and families with skills that

enable them to become self-advocates.

• discuss, evaluate, and address negative emotions and

thoughts related to communication or feeding and swallowing disorders.

• refer individuals with disorders to other professionals

when counseling needs fall outside of those related to (a) communication and (b) feeding and swallowing.

Audiology

• Audiologists engage in the following activities when

counseling individuals and their families:

• Providing informational counseling regarding

interpretation of assessment outcomes and treatment options

• Empowering individuals and their families to make

informed decisions related to their plan of care

• Educating the individual, the family, and relevant

community members

• Providing support and/ or access to peer-to-peer

groups for individuals and their families

• Providing individuals and their families with skills

that enable them to become self-advocates

• Providing adj ustment counseling related to the

psychosocial impact on the individual

• Referring individuals to other professionals when

counseling needs fall outside those related to auditory, balance, and other related disorders.

Regardless of discipline …

• We are experts in
• Communication disorders
• WHO ICF model as applied to communication disorders
• Impact of communication disorders on quality of
• S
• cialization
• Academics
• Life
• And we can
• Listen
• Guide
• S

upport

How should we approach counseling for communication disorders?

Let’s begin by looking at what are the characteristics of a good counselor?

• Being able to
• listen
• be nonj udgmental
• use silence as a strategy
• use nonverbal communication
• ask solution-focused questions
• be genuine
• attend to nonverbal & verbal

communication

• paraphrase content
• reflect on patient/ caregiver feelings

& implicit messages

How should we approach counseling for communication disorders?

• We also need to have a better understanding of the counseling

process

• Familiar Counseling approaches are linear
• In linear thinking, we consider that one thing leads to

another in a stepwise fashion.

• A S

ystemic/ S

• lution-focused approach is unpredictable
• In non-linear thinking, we make connections among

unrelated concepts or ideas. We draw conclusions from examples coming from different perspectives.

The systemic/ solution-focused approach works best in counseling for communication disorders

• Emphasis on emotions, attitudes and motivation
• Focus is on changes client wants vs. disorder being treated
• A framework for counseling that is based on and connected

to the clinician’s and the client’s and/ or family’s goals

A S ystemic & S

• lution-focused Approach to

Counseling

Change takes place in the client's natural environment as well as within the client. Clinician asks “ Are there individuals in this person’s system can help me help this client? Clinician believes how people interact is as important as the nature of their speech or language disorder. Clinician & client/ family focus on the present and future, not the past. Clinician has respect for the wisdom of the client and his/ her system.

Systemic/Solution-focused approach can also be see though the lens of the positive psychology approach

• To help impaired person and their families to:
• grieve what has been lost
• understand what has happened as fully as possible
• develop coping strategies & to increase resilience
• make peace with the disorder
• make sensible adaptations to the disorder
• capitalize on strengths in order to minimize weaknesses
• live as fully as possible, despite the impairment

Holland & Nelson, 2014

Blending an effective counselor’s skills & a systemic/ solution-focused approach

Clinician skills

Listening Being nonj udgmental Using silence as a strategy Using nonverbal communication Asking solution-focused questions Being genuine Attending to nonverbal & verbal communication Paraphrasing content Reflecting on patient/ caregiver feelings & implicit messages

+ solut ion-focused

approach Emphasis on emot ions, at t it udes and mot ivat ion Focus is on changes client want s vs. disorder being t reat ed “ … places counseling int o a framework t hat is always connect ed t o and driven by t he goals of t reat ment .” (deS hazer, 1985; Egan, 2007; S klare, 2005)

= enhanced

• utcomes

Best practice for counseling in communication disorders

Let’s look more carefully at the basic skills of an effective counselor: Listening, empathy, genuiness, systemic, & solution focused

But before we do I have an exercise for you

• First break into small groups of 2 or 3
• S

econd ignore everything before this slide

• Third follow the instructions on the next slide
• Fourth share your experience

Listening exercise

Each of you think of any topic you believe they could talk about for about 3 minutes Break into groups of 3 – 4 Decide among yourselves who will take the following roles within your group:

A - S peaker B - List ener for fact s C - List ener for feelings D - (where necessary) Observer

The speaker will begin by sharing their topic for 3 minutes The listener will completely ignore them (get on your phone, dig through your bag, etc.) The observer will notice the body language, etc. of each person in the dyad

Listening

• What was it like to be the speaker?
• What was it like to be the listener?
• What did the observers notice?
• Now imagine you are someone with a communication disorder
• r the family member of someone with a communication

disorder in this scenario.

Listening habits that do not work in counseling

Celeste Headlee is the host of the Margie Public Broadcasting program "On S econd Thought." S he has previously been the co-host

• f the national morning news show The Takeaway, from Public Radio

International and WNYC. In 2016 she presented the following TED Talk https:/ / www.ted.com/ talks/ celeste_headlee_10_ways_to_have_a_b etter_conversation

Let’s look more carefully at the basic skills of an effective counselor: Listening, empathy, unconditional acceptance, genuiness, systemic, & solution focused

Listening is one of the strongest & most effective tools we

• have. Listening involves:
• Attending
• Observing
• Attending to primary sources of information
• Content
• Process

As counselors for communication disorders …

We listen to value & do so by recognizing that listening is a mutually

educative process

• There is an exchange of information, perceptions, opinions

that is all focused on the issue

• There is a cognitive- and emotionally-based interchange

that allow for sharing emotions (venting, grieving) As we listen we attend to concerns centered on communication S

• cial

Educational Employment

We listen to

Validate & provide guidance

• S

upport for concerns

• Details of clinical process
• Provision of additional resources
• Counseling
• S

econd opinion

• S

upport groups

We listen to

S hare

• We can share our
• Expertise
• Compassion
• S

upport

Being an effective counselor: Listening, empathy, genuiness, unconditional acceptance, systemic, & solution focused

• Empathy
• Primary skills
• Nonverbal & verbal attending
• Paraphrasing content
• Reflecting on patient/ caregiver feelings & implicit

messages

Joining with Empathy

Empathy involves understanding another’s world view involves understanding how the client’s beliefs and actions make sense to themselves. Counseling S trategies that Foster Empathy

• Clarification
• S

ummarization

• Reflection
• Purposeful Use of S

ilence/ breaking of silence

Clarify, Summarize, Reflect, Use silence

Clarify: Paraphrase – restate what the client has j ust said in a natural way Caution: don’ t shift the client’s meaning to your reality. S ummarize: Use your own words to highlight ambiguity or difference: A person’s competing feelings Different opinions Reflect tentatively: S howing understanding of the person’s feelings or frame of reference Purposeful Use of S ilence/ breaking of silence: Following an open question, Following a clarification or reflection When a person with a communication disorder is obviously processing

• r attempting to generate language.

Outcome of Empathic Listening

Y

• ur client and client’s family feels accepted

Their feelings and perspectives are validated Y

• u begin to hear exceptions
• Instances when the client and/ or family does not experience

problems with communication.

• Instances when communication is more successful or more

comfortable.

Being an effective counselor: Listening, empathy, genuiness, unconditional acceptance, systemic, & solution focused

Genuiness

• Being free of one’s self
• Unconditional positive regard
• Acceptance plus a caring & a nurturing presence

Being an effective counselor: Listening, empathy, genuiness, unconditional acceptance, systemic, & solution focused

“ To view all behavior as making sense from the person’s perspective” S trategies that Foster Unconditional acceptance

• Clarification or reflection of ambivalence
• Clarification of different perspectives
• Reflection of “ negative feelings or perspectives

Being an effective counselor: Listening, empathy, genuiness, systemic, & solution focused

Following a systemic & solution focused approach

• Assisting client/ family to be specific about issue(s)
• Using questions to seek clarification
• Using open ended questions
• Facilitate conversation

Here is a tool/ strategy to accomplish this type counseling

The S elf-Anchored Rating S cale (S ARS )

• A technique borrowed from counselors
• Evaluates life participation outcomes
• Helps clients and families calibrate their expectations
• Helps partners collaborate to develop treatment options
• Shows how client and partner opinions and actions contribute to

goal achievement

S ARS in AUD or S LP counseling

• A means of working collaboratively with clients and families
• An easy place for you to start being solution-focused
• Facilitates the process of conducting systemic, solution-focused

intervention

S teps in creating a self-anchored rating scale

1. Join with the client; listen respectfully to their description of the problem. 2. S tart S ARS by drawing a vertical line on blank paper. 3. Write a 10 at the apex and 0 at the base. 4. Describe communication when the condition was at its worst. 5. Each participant sets a value that describes the status.

S teps in creating a self-anchored rating scale

• S

tart by drawing a vertical line on a new sheet of blank paper

• Describe communication when the condition was at its worst (narrowing the focus)
• Describe & set a value for communication right now
• Describe a long term goal & set a value on the scale
• Describe a short term goal
• Work with the client and partners toward small changes
• S

earch for exceptions

Then we add the giving of assignments & describing change

• 1. S

tart by drawing a vertical line on blank paper

• 2. Describe communication at its worst
• 3. S

et a value for communication right now

• 4. Describe a long term goal
• 5. Describe a short term goal
• 6. Work toward small changes
• 7. S

earch for exceptions

• 8. Give assignments that expand exceptions
• 9. Describe change and assign values

Now a case study using S ARS

Meet a couple living with aphasia and their clinician

Wayne

• Age: 71 years
• 27 months post onset

aphasia Margie

• Age: “ over 21”
• Length of marriage: “ 41

happy years and 5 years

• f silence”

Wayne & Margie’s communication

• Wayne tries to use speech to communicate with Margie and his

friends.

• He has two communication books, but they aren’ t used.
• Margie wants Wayne to say words, so she pushes hard
• Wayne gets frustrated and reacts negatively
• They share a good sense of humor & many years together. This gets

them through!

Wayne & Margie’s initial S ARS

• Margie gives it a .5; Wayne gives it a 1.0
• Initially, greatest concerns were physical
• Couldn’ t walk
• Couldn’ t say any words
• Hospital routine made communication

less important

• Margie anticipated Wayne’s needs.
• At home, Wayne could say three or four

words at most

• Could cuss

10 = No issues with communication 0 = can’ t say words 1 = can say a few words

Long term goal – when communication is “ good enough”

• If Wayne could do anything he wanted to

do

• Driving
• Independence for both
• Telling j okes
• Having conversation with friends and

relatives

• “ S

ay what you mean and mean what you say”

• Replace body language with words

9 = having conversations, aying what he means

“ How do you communicate now? ”

• Margie gives it a 5; Wayne rates it at

5.5

• Margie anticipates Wayne’s needs less
• Margie makes Wayne work for words
• Wayne needs patience and extra time

to get his words out

• Wayne has a communication book, but

he doesn’ t use it often 5 = words are coming faster, more time to respond

“ What would a small change look like? ” (short term goal)

• We ask, “ what would it take to

bump this up by .5 or .75 points?

• They tell us:
• Writing words more
• Wayne uses his book more
• More use of gestures

5.5 = making Wayne work for his words instead of saying for him, writing more words, using his communication book

Exceptions

• Exceptions are examples of times when communication was successful
• Clinicians search for them by asking open-ended questions
• Has there ever been a time when using the book, writing or using

gestures worked well/ a little better?

• Tell me about what happened when
• Acknowledge client/ family member’s (Wayne & Margie’s in our case

study) own solutions.

• Clarify to highlight the purpose and benefit of their solutions.

Assignments

• Noticing: assigning the task of noticing & documenting exceptions
• Wayne & Margie asked to report back on successful communication

exchanges

• S

hared that when writing & drawing were used their conversations were better

• Behavioral: assignments that instruct the client and/ or family to

purposefully repeat behaviors that were described in exceptions.

• Wayne & Margie creat ed a paper t ableclot h where t hey wrot e and drew as

t hey t alked.

• They used gest ures, drawing, and writ ing t o help Wayne get t he words out .
• Margie accept ed anot her mode if a word wouldn’ t come.
• Wayne used ot her communicat ion modes wit h Margie and ot hers.

The process of S elf-anchored Rating S cales

Goals S mall changes Assign Follow up S cale

How the clinician facilitates the process

• More clarification/ restatement responses than question

responses.

• S

ummarize from time to time to assure accurate understanding of the client and family's reality and concerns.

• Identify anticipated and unanticipated exceptions.

Counseling and quality of life

We can counsel as to The impact of the communication challenge in relationship to participation (ICF model) We can Listen Guide S upport

Thank you

S usan Ginley sginley@ pdx.edu

References

• Andrews, J. & Andrews, M. (2000) 2nd Edition. Family-Based Treat ment in Communicat ive Disorders: A S

yst emic

• Approach. DeKalb, IL: Janelle Publications.
• Andrews, J. & Andrews, M. Podcasts: http:/ / web.pdx.edu/ ~cgfl/ RespectfulListening.html or find them on iTunes

as Andrews Podcasts (iTunes may have better audio).

• Andrews, J. & Andrews, M. (1995). S
• lution-focused assumptions that support family-centered early intervention.

Inf ant s & Y

• ung Children, 8, 60-67.
• Fox, L. E. (2012). AAC Collaboration using the S

elf-Anchored Rating S cales (S ARS ): An aphasia case study. Perspect ives in Augment at ive and Alt ernat ive Communicat ion. 21, (4), 136-143.

• Fox, L. E., Andrews, M., & Andrews, J. (2012). S

elf-anchored rating scales: Partnering for post-aphasia change. Neurophysiology and Neurogenic S peech and Language Disorders, 22, (1), 18-27.

• Gough, D. (2004). Disability, Loss and Grieving: Implications for S

peech-Language Pathologists. Perspect ives on Language Learning and Educat ion, 11(1), 18-24.

• Holland, A. l. & Nelson, R.L., (2014). Counseling in Communicat ion Disorders, 2nd Ed.: A wellness perspect ive.

Plural Publishing Inc.

• Nelson, L. (2004). Using self-anchored rating scales in family-centered treatment. Perspect ives on Language

Learning and Educat ion, 11(1). American S peech-Language Hearing Association, Division 1.

• Tellis, C. M. & Barone, O. R., (2018). Counseling and int erviewing in S

peech-Language Pat hology and Audiology: A t herapy resource. Jones & Bartlett Learning.