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


Therapy Through the Looking Glass

I recently completed an Adult Mental Health placement where Susan was my Clinical Educator.  She asked me if I would be interested in writing up a reflection of my placement as her first guest blog.  My first thought was “Oh no, another writing assignment to top off my already busy workload”.  My second thought was “blogging – how trendy!” And so I agreed to take on the task granted there was no deadline.
My experience was as fascinating as it was eye-opening and the best way to describe it is through analogy.

Picture a well set table including a table cloth, plates, cutlery and glasses.  The table cloth represents the medical model that forms the basis of Speech and Language Therapists’ practice in the majority of care settings. The items on the table cloth represent the clients we work with, the other health professionals and support staff, our skills and knowledge base, tools and assessments, and so on. Now imagine that cloth being whipped away from the table while all the items remain standing.  At first you are awed by the trick and feel surprised at how all the objects managed to stay standing without being thrown to the ground.  You then begin to wonder how it happened, and you feel confused as you would assume that some items would have fallen over. 

This may seem confusing and hard to follow, but that’s the point.  Mental Health is an emerging area in Speech and Language Therapy, and providing services in this area is confusing for someone who has only thus far been exposed to the ever-dominating medical model of communication disorders.  I saw that medical mind set and approach being pulled away in front of my eyes, yet everything else was left standing just as it should be.
Mental Health is very different from the other clinical areas Speech and Language Therapists traditionally work in but it is not difficult working in this area; it just requires lots of adjustment. We also need to see past the overshadowing stigma. The service users I met on placement were the friendliest bunch of people who had been dealt a bad set of cards in the game of life.  They opened my eyes and made this placement a truly special one.  As Susan said, “You have all the skills and knowledge it takes to work in this field…all you need to do is simply apply them with confidence”.

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.