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?

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.

One Year On

365 days, 21 posts, 2133 views in 36 countries, 28 comments, 23 mentions, 28 followers, 202 shares, 25 ‘likes’, and a partridge in a pear tree!

It doesn’t seem like a year since I started my blog, but they do say that the years get shorter the older you get. As I had a significant birthday this year it appears that this particular adage is holding true. Yet, despite the fact that the year has disappeared at lightening speed, I feel that I have learned a lot.

I have learned that blogging is a powerful and effective way to promote and discuss the professional issues I feel passionate about, and make connections with like minded people.

I have learned that I place exceptionally high expectations upon myself and need to moderate these to an acceptable level – Out with the Old, In with the New.

I have learned that people are actually interested in what I do – A Tweet in the Life – and that I can write in a way others find entertaining and thought provoking – What’s in a Name?.

I have learned that I can inspire others to contribute to my blog and share their thoughts and experiences too – Therapy Through the Looking Glass – and that I can be quite persuasive as well (more guest blogs expected later this year).

I have learned that writing a good blog is a craft and takes time; and gauging the right length to make it interesting and informative without boring the reader to tears is not easy.

I have learned that it is challenging to write in a professional capacity and ensure that I am not breeching anyone’s confidentiality or trust – Adding Fuel to the Flames and Communication Matters.

I have learned that I am part of a growing community of Allied Health Professionals who are spreading our message about the vital role we play in supporting the mental and physical health of people in our communities – AHPScot Blog and Ayrshire Health to name but a few.

But most of all I have learned that blogging is something I really enjoy doing and want to continue, and I intend to bring as many other people along for the journey with me as I can. So buckle up people; here comes Year 2!

But Why?

I love students. No seriously I do. My role as a clinical educator for student Speech and Language Therapists from Queen Margaret University is one of the favourite parts of my job. I love students because they ask questions. They create a situation where I am required to provide clear, rational and evidence-based reasoning for my clinical decisions. And on that basis my favourite question is WHY?

Laura is a post-graduate student who has just completed a placement with me in Tayside. She has graciously agreed to write a guest blog on her thoughts and experiences of Speech and Language Therapy in Mental Health which will feature when her academic and personal calendar allow, but until that time I wanted to share with you one of the big WHYs of Laura’s placement.

But WHY are we working with him? This isn’t Speech and Language Therapy.

Many Speech and Language Therapists work to a pretty high degree in professional isolation. By that I mean that they either work just with their client and/or that person’s parent/ spouse/ carer, or they have a well defined role within a multi-disciplinary team to tackle the communication aspects of a client’s disorder. I say this from a perspective of personal experience as I have worked as a member of many teams where teamwork is merely making sure we share information and don’t book people in for appointments at the same time! Unlike the fields of Physical Disability or Stroke Rehabilitation, in Mental Health the majority of work carried out by all team members is entirely verbally mediated. So what happens when an individual has communication difficulties that create barriers to therapeutic interaction? In this situation, the team member who can communicate most effectively with that person is most likely to affect positive change and that person may be the Speech and Language Therapist.

Laura is right; I am not doing specific communication skills development work with this client at this point in time – I have in the past and I am sure I will in the future. What I am doing is using my understanding of his subtle and complex communication difficulties to adapt and deliver a psychological based intervention that other members of the team have found it impossible to engage him in effectively. This is an intervention that will benefit his mental wellbeing and keep him positively engaged with the Community Mental Health Team; and that is what being part of a team really means to me.

Little Things Make a Big Difference.

Surprised, curious, grateful and chuffed to bits. These are just a few words that describe my emotions when I received a letter from The Encephalitis Society this week informing me that I have been nominated for a Exceptional Service Award by the family of one of my clients.

According to the Society’s website, Exceptional Service Awards are given to individuals and organisations in health, education and social care services who have really made a difference to individuals or families who have been affected by Encephalitis. “What have I done to deserve that?” I asked myself. “All I have ever done is my job.”

Craig* is in his early 20s and developed Encephalitis when he was 6 years old.  The resulting damage to his brain has left him with a range of speech, language and interaction difficulties that have become increasingly problematic and intrusive as Craig has entered his adult life; impacting on his social inclusion, self-esteem and mental well-being.

So what have I done as a Speech and Language Therapist that has really made a difference to this young man and his family? What incredible intervention have I delivered? What have I done that is above and beyond the call of duty? Here is what the family say.

Susan…used to visit [Craig] at home, she always came to our house with a friendly smile and helped Craig with a speech he had to prepare…[we] would like to thank her for bringing her professionalism and cheery personality to our home and a listening ear.

What strikes me most about the family’s statement is that what they value the most is not the clinical outcomes but how I met their priorities.

Craig finds it difficult to attend appointments independently and his mother has 2 much younger children who she also needs to look after, so providing sessions at home rather than in a clinic was really important for this family.

Craig’s therapy focussed on addressing the social communication difficulties he experiences but what he really wanted to do was write and deliver a speech about his own experiences at an Encephalitis Society conference; so I supported him to do this.

It also appears that much of what made a difference wasn’t so much what I did as how I did it. A friendly smile and cheery personality are not clinical skills but they are valued by this family and that has made a difference too. It would appear that it is true what they say Little Things Make a Big Difference.

*Craig is a pseudonym to protect client confidentiality

What’s Good Enough For You Is Good Enough For Me

Let’s start today’s blog with a quick quiz…

What tools do you use to promote your productivity and support your everyday functioning?

Did you think of any of the following?

  • Lists – to keep you on track
  • Agendas – to allow you to be prepared for meetings
  • Minutes – to remind you of discussions held and agreed actions
  • Visual Frameworks – to help you make complex decisions (e.g. SWOT analysis)
  • Mind Maps – to support formulation of your ideas
  • Diaries/ Calendars – to help you organise your time
  • Alarms – to remind you to undertake important tasks

You may not have thought about these as support tools before, but take a minute to consider how they shape the way in which you are able to engage with your world, how they support your thinking processes, and how you would function without them.

Now for your second question…

How often do you use these support tools with the people who access your service?

Always?  Regularly?  Occasionally?  Never?

In my experience, despite valuing and making regular use of a range of such tools in their own lives, few mental health professionals consider using them in their day to day practice to support communication and decision-making with their service users.

How does your service fare? Are you the exception or the rule?

How many meetings do your service users attend without having an agenda to allow them to prepare what they want to say and how they want to say it?

How often do you expect them to remember all the information from a conversation or meeting rather than providing a minute or action plan as a reference point?

How often are complex decisions made through discussion alone without use of a visual framework to provide structure to consider all the relevant factors?

A large proportion of the people I meet who use mental health services report that they experience memory problems, struggle to sustain their attention and/or find it difficult to make good choices so why would we make it harder for them than we do for ourselves?

Good communication is about more than just talking to people and we don’t need to do anything fancy in order to do it better. If a support tool is good enough for you, then it is surely good enough for the people we work with and support.