The Dark Art of Speech and Language Therapy

This month marks 2 years since I started my blog and although I don’t post so often these days interest doesn’t seem to have dwindled if the number of hits each week is anything to go by. Although overall I am enjoying this journey, there are times when the sheer size of the job can feel quite overwhelming. The range of valuable roles that a Speech and Language Therapist can play in the context of adult mental health is what keeps this job interesting and challenging all at the same time.

I seldom take the time these days to reflect on the breadth of roles I undertake on a day to day basis but I have a had recent cause to consider exactly that. I was asked last week what my “elevator pitch” for my service would be. If I had 10 seconds to sell myself (in a professional context obviously) what would I say?

Mental health and communication are very closely linked. The way a person communicates can tell us a lot about their mental health or even diagnosis, and conversely a person’s ability to communicate can significantly impact on their mental wellbeing. Equally, mental health workers’ ability to make appropriate adaptations to the way they communicate according to each individual’s need can make or break important therapeutic relationships.

Speech and Language Therapy has been described to me as being a bit of a “dark art” as people aren’t entirely sure what we do, and I believe that is because communication is the foundation of everything we do, not only in mental health, but in life. A Speech and Language Therapy assessment can make sure you get the right treatment by gathering information that leads to the right diagnosis. A Speech and Language Therapist can work alongside your Occupational Therapist to help you get a job. A Speech and Language Therapist can work with you to increase your self-esteem and confidence by improving your communication skills or addressing a specific speech or language difficulty you experience. The list goes on.

So what would my “elevator pitch” be?

Communication is a fundamental human right and forms the basis of all our interactions and relationships. Mental health services need Speech and Language Therapists because without the support we can offer there will be people whom services fail by not adequately addressing their communication needs. Without specialist knowledge from Speech and Language Therapists the risk of individuals becoming stuck in a downward spiral of poor communication and poor mental health increases. Services need Speech and Language Therapists because without effective communication what do we have?

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Autism: Not Child’s Play

World Autism Awareness Day on 2nd April marked the start of a month of activities aiming to develop understanding of autism and Asperger Syndrome. So I have decided to dedicate this month’s blog to talking about the work I do as a Speech and Language Therapist with and for people with autism spectrum conditions.

One of the things that often surprises people is that I work with autistic adults. Autism is something children have isn’t it? Certainly many internet searches and much media coverage could lead to you this conclusion, but strangely enough autistic children grow into autistic adults, and for many people, particularly with Asperger Syndrome, it is not until adulthood that the diagnostic process begins. This doesn’t mean that they have somehow acquired autism, but rather that it is not until adulthood that their differences start to interfere with living a “normal” life. Quirks are no longer considered “a phase he is going through”. Academic promise does not necessarily translate into vocational success. The shy girl who was praised for keeping her room immaculate is now told she has anxiety problems and OCD.  You get the picture.

The autistic adults I meet are accessing mental health services, so on that basis they are usually struggling with their mental wellbeing. Most often this is the result of living either with an undiagnosed autism spectrum condition, or with a poor understanding of the diagnosis they have received earlier in life. As a result, these individuals have not learned why they act, think and communicate in the ways they do, and have failed to develop a positive sense of self. They can feel that they are the only person who experiences these challenges, and have no or few strategies to deal with the confusing and complicated world around them.

As a Speech and Language Therapist I play an important role within our Community Mental Health Teams for not only diagnosing autism spectrum conditions in adults, but also in providing support after that diagnosis and promoting improved mental wellbeing. One of the most exciting developments I am currently involved with is a post-diagnostic group aiming not only to educate but also empower, and to create a supportive social network of people with Asperger Syndrome in a local area. It is early days yet with this pilot project but the feedback from participants so far is good and relationships are beginning to develop. Ultimately, people living with autism spectrum conditions will learn the most from other autistic people because they will always know more about how it really feels and what really works, but if I can play a part in helping people make those connections then I can be proud of doing my job well.

A Sensational Life

A change of topic from my 3 best things this week as I have not been doing my normal clinical work. Instead have been attending a course on Sensory Integration and I would like to share my thoughts on what I have learned with you.

What do you think of as a sensory based difficulty? It is far more than a hearing or visual loss. Our understanding of the sensory aspects of the world in which we function tends towards the more traditional senses of sight, hearing, taste and smell but we seldom consider the significance of information we gain from touch and movement.

Sensory issues are being increasingly recognised as being a core part of Autism Spectrum Conditions and these is very well described by Cynthia Kim in her blog Musings of an Aspie, but I wonder how many other individuals who access Mental Health services experience sensory processing and integration difficulties.

The reason I say this is that I now have a very different understanding and perspective on the link between our sensory processing and emotional state. Our brains receive and start to process sensory information in the same areas that control our emotional and physiological responses. An unexpected loud noise will initially elicit a “flight or fight” reflexive response from us but it will subside if we don’t actually need to act to protect ourselves. But how would you feel and function if your neurological system could not integrate this sensory information sufficiently to allow you to return to your normal level of arousal within a short period of time? Or if this level of high arousal was elicited by activities that others did not find stressful such as the movement of riding on a bus or the feeling of the label on the T-shirt you are wearing? And what would it do to your ability to use your higher cognitive skills and therefore your thinking patterns?

This is a very simplistic summary of how sensory integration difficulties could impact on our mental health and well-being but a good place to start. By using “sensory glasses” to consider human behaviour and interpreting what we observe in relation to neurological processing of this information, sensory integration seems to me to offer an exciting new perspective on the way we can provide meaningful support people who experience mental health difficulties.

Simply the Best: Teach Me How

This week’s 3 best things have a learning theme.

1. Second Time Lucky – While I usually work with a person because their mental health problems are causing communication difficulties, I also occasionally work with people who have lost their communication skills and as a result of this loss are experiencing problems with their mental health. Harriet* had a brain haemorrhage several years ago which resulted in a significant loss of her communication skills. This loss had a profound impact on Harriet’s sense of self and her social role, and she became depressed which in turn had a significant impact on her ability to engage in rehabilitation. Many mainstream therapy services may not be able to adapt their input to address the mental health components of an individual’s rehabilitation journey and for Harriet, the perceived inability to engage resulted in her being discharged. A change in approach that has acknowledged the mental health component of Harriet’s difficulties has allowed her to re-engage with Speech and Language Therapy and she is starting to make progress again.

2. Train the Trainer – Each year NHS Education for Scotland offer funding for Allied Health Professionals to undertake training or experiential learning to progress their career and improve the services they provide. This week I learned that I have secured funding to become a Talking Mats Accredited Trainer. This will allow me to offer training in this extremely useful communication approach in my local area and I am so excited about the ways in which this will improve communication practice in our mental health services.

3. Family Ties – Our relationships with family and close friends are key in supporting our mental wellbeing, but for the people with communication difficulties these often impact on interactions with these important people. An individual’s communication barriers are only half the story though; the other person’s understanding of these difficulties and how to cope with them are just as important. This week I have had the opportunity to do some very rewarding work with a number of families; supporting understanding, increasing skills and ensuring these important relationships are maintained.

* Harriet is a pseudonym to protect client confidentiality.

Simply the Best: Nurture

My 3 best things about being a mental health SLT this week appear to have a nurturing theme – conversations that nurture understanding, nurturing the learning of others, and nurturing skills and self-reliance…

1. Talk to Me – When a client walks in to clinic distressed and is able to walk out calmer and with a sense of direction and achievement I know what I do is worthwhile. There are times when we need to talk through our difficulties in order to sort things out and to feel better but this is much more difficult if you also have a communication difficulty. When you cannot find the words to express how you feel or explain why you are feeling that way, others find it that much harder to help you find the right solution. When you cannot organise information in a meaningful way you can feel that others are not listening to you or even find that you get yourself even more confused than before. John* arrived for his appointment this week in a very flustered state. He had been feeling overwhelmed in recent weeks and this was impacting on his ability to discuss his worries with his family and friends. By creating a structure around the conversation and providing appropriate feedback, John was able to organise his thoughts and we were able to work through his problems, and he left his appointment much happier and calmer than before.

2. Look to the Future – As part of my job I am involved in the clinical education of student Speech and Language Therapists from Queen Margaret University. My current student is approaching the end of her placement and it makes me so happy to watch her confidence grow and her skills develop. This is one of the very few adult mental health placements available in Scotland currently and it is wonderful to be involved in developing clinical interest and skills for this client group in our emerging workforce.

3. First Steps – Our new group for clients who have recently been diagnosed with Asperger Syndrome started this week. The purpose of the group is to provide information about Asperger Syndrome; helping these individuals to have better understanding about the ways in which they communicate, think and act differently from others, to develop coping strategies, and to establish relationships and gain support from peers who are “the same as me”. First sessions are difficult for everyone – especially people with Asperger Syndrome – but by creating an Asperger friendly environment and pacing information and demands correctly our group was a great success.

John* is a pseudonym to protect client confidentiality

Sorry Miss, My Life Ate My Homework

Today I was asked “What’s happened to your blog? I really enjoyed it”. Always one to respond well to flattery, it has given me the proverbial kick that I needed, but it has also made me think; what did happen?

Promoting the work I do and discussing my ideas through my blog is something I feel very passionately about and I certainly haven’t run out of ideas and topics. My last blog was exactly one month ago but it feels much, much longer than that because the last month has been a pretty busy one. With additional work commitments which, like buses, have all come at once, and in my own time a hectic rehearsal schedule for a forthcoming concert, even finding time to spend with my family has been a tall order. All in all, it has been an exhausting month, and no matter how often I thought about writing a new blog, life just kept getting in the way.

Reflecting on this has given me a new perspective on exactly what I am asking of people when I give them homework to do. We all have varying capacity in our lives to find the time to do that one extra thing. Sometimes, even when we know something is important and we really want to do it, our lives seem to conspire against us achieving it. It is easy to forget that whilst few of the people I work with have the traditional pressures of juggling work and family, they have many other things to cope with which will impact on their ability to achieve their goals; not least of all the demands of seeing a myriad of different professionals. Without a good overview of what else is going on in that person’s life at that moment in time it is impossible to determine how realistic it is for them to do that one little thing I am asking.

So I have decided to set myself a more realistic goal; to continue to write regularly but not add the pressure of making this a weekly blog, and also to seek to understand and give more consideration to how realistic the ‘homework’ I set for others actually is.

Why Do We Need An SLT? Our Job Is All About Communication.

Being the new kid on the block is never easy; something I know on a personal level having attended 5 different schools between the ages of 5 and 18. You need to find out how the various cliques work, who you have something in common with and, even better, who has the potential to be your new best friend. Setting up a brand new service within such an established area as mental health was no different.

One of my first tasks was to discover where I would fit into existing Community Mental Health Teams and identify potential allies. It became evident pretty quickly that the people I spoke to fell into two distinct camps. The majority saw no obvious role for a Speech and Language Therapist on the basis that mental health professionals are already good communicators. However, there was also a small proportion who were curious: to quote one Community Psychiatric Nurse “I don’t know what you’ll do, but I’m looking forward to finding out”. What both groups had in common was a lack of understanding about what Speech and Language Therapists do. So let me clarify for those of you who are, as yet, uninitiated.

Speech and Language Therapists are experts in the multi-faceted aspects of human communication. We possess in-depth knowledge of typical speech and language development and of the ways in which physical, sensory, neurological and psychological factors can lead to communication difficulties, impairments and disorders. We assess communication with reference to such things as phonetics, semantics, syntax and pragmatics, and possess the knowledge and vocabulary to accurately describe how people communicate, down to the finest detail. We also have at our fingertips an extensive range of tools and techniques which can be used to compensate for communication difficulties or rehabilitate speech and language function.

So, surely mental health services should actually be saying “Our job is all about communication. Why do we not have an SLT?”.