Chapter 21: Key Terms

SLPs 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 (1) communication and (2) feeding and swallowing

Areas within our boundaries include, but are not limited to, the following:

- Interviewing the client/patient and family - Presenting the diagnosis of delays and disorders - Providing information about the delays and disorders - Discussing interventions for the delays and disorders - Working with the client/patient's and family's reactions to the diagnosis - Supporting the strengths of the person and his or her efforts to regain functions and be independent - Supporting the strengths of the family to help them interact optimally with the client/patient - Creating supportive empowerment for the client/patient and family to develop the ability to manage their own problems and be independent of the clinician.

Counseling for the professions of speech-language pathology and audiology may be defined as

"an applied social science and a helping, interpersonal relationship in which the clinician's intentions are to assist a person or family members in understanding a hearing, communication, or swallowing disorder and its impact on the persons life, and ways of preventing, managing, adjusting to, or coping with their disorders"

Examples of issues beyond our scope of practice including the following

- Chemical Dependence - Child or elder abuse - Chronic depression - Legal conflicts - Marital problems - Personality or character disorders - Sexual abuse and sexual problems - Suicidal ideation

Counseling (as applied to SLPs and Auds)

An applied social science and a helping, interpersonal relationship in which the clinician's intentions are to assist a person or family member to understand a hearing, communication, or swallowing disorder and its impact on their lives, and ways of preventing, managing, adjusting to, or coping with these disorders.

Many speech-language pathologists and audiologists consider this to be one of the most crucial areas of a student's education and training

Counseling

It is from the disciplines of ___________ ___________ and _________ - __________ ___________, that most of the counseling skills that SLPs and audiologists use are drawn

Counseling psychology ; Marriage-family therapy

Variables contributing to the therapeutic relationship, from both the clinician and client, are:

Self-perceptions, needs, values, feelings, experiences, expectations, and expertise

A client with a delay, disability or disorder

almost always exists within a family context. - the communication disorder usually affects more than a single individual

For other disorders identified in the DSM-5, we may not be able to officially make diagnoses,

although we are frequently very involved in their assessment and treatment; for example, Alzheimer's disease, attention-deficit/hyperactivity disorder, autism spectrum disorders, specific learning disorders, and others.

The counseling skills Speech-language pathologists and audiologists learn and develop

are an important part of what helps them to be better people. and to be better therapists.

Beyond our boundaries for counseling are

areas or issues that are clearly out of our scope of practice, although we may believe they may have contributed to the cause or the continuation of the communication problems on which we are working - Several of these issues need immediate referral to other professionals

Empathetic understanding is the

attitude and skill of following, grasping, and understanding as fully as possible the client's subjective experience - achieving this kind of understanding can be challenging - we need to try to see the client's world from the client's perspective; it takes considerable time and patience to listen carefully, develop an understanding of our clients; experiences and the meanings they attach to those experiences, and appreciate and respect how they come to be who they are today.

ideally, every counseling statement, gesture, or silence may

be regarded as purposeful.

As clinicians, we must also be flexible and

change our style depending on the type of client or patient with whom we are working - for example, when working with a child who stutters, we may want to be rather low-key and calm; in contrast, when working with a child with spastic, quadriplegic cerebral palsy, we may choose to be exuberant and playful - Knowing in which direction to change and how much to change involves clinical intuition, which develops in clinicians over time and with experience

SLPs are qualified to make some of these diagnoses, such as

childhood-onset fluency disorder (stuttering), developmental communication disorders (e.g., language disorders, social [pragmatic] communication disorders, speech sound disorders), neurodevelopmental motor disorders (e.g., childhood apraxia of speech and dysarthria), and selective mutism.

Rather than say we are "counseling" someone, we tend to use terms such as

client/patient/family training or education, conference, and consultation, particularly in reports and medical charts. - In everyday communication with professionals, we tend to use words such as "a conversation" or "interesting discussion". - we use the word "issues" because that word has no specific reference and implies that w do not want to share specifics about eh conversation (also discuss concerns, situations, or challenges)

Rogers (1957) identified there core "necessary and sufficient conditions" to help individuals with personal growth:

congruence, unconditional positive regard, and empathetic understanding. - These conditions must first be characteristics (or developing characteristics) of a clinician before they can be conditions the clinician brings to the client-clinician relationship

As burnard (2005) has observed,

counseling is never simply a matter of learning a generic list of skills that we then apply in a range of settings. instead, counseling involves facing the people in front of us, listening carefully, and using counseling skills to help with the issues at hand.

A clinician's personality is often a

crucial ingredient in determining the effectiveness of counseling - if counselors possess wide knowledge, both theoretical and practical, yet lack the human qualities of compassion, caring, honesty, realness, and sensitivity, they are merely technicians.

Studying counseling and counseling skills will help you

develop a deeper understanding of people, their problems, and their coping strategies. - You will also develop a deeper understanding of yourself, your interpretational style, and your own coping strategies. - You will learn skills that will help you manage challenging interactions with family, friends, and coworkers, and you will learn how to help other people cope with life's uncertainties and challenges.

Challenges to our boundaris can occur

during our first interactions with a client. - We always start therapy by working within our boundaries, but may sometimes encounter issues affecting the therapy that are beyond our boundaries.

SLPs counsel by providing

education, guidance, adn support. - Individuals, their families and their caregiver are counseled regarding acceptance, adaptation, ad decision making about communication, feeding and swallowing, and related disorders

A client's initial impressions of a clinician and a clinician's initial impressions of a client are often difficult to overcome,

even when further interactions differ from the expectations set in the first encounter

Children adn adult who stutter and adults who have voice disorders often

have anxieties, fears and interpersonal conflicts that affect their fluency or contribute to vocal fold and generalized tension.

When the clinician is congruent,

he/she is genuine

In counseling, we attempt to

help clients, patients, and families understand ways of preventing disorders - for example, we help children and adults understand how they can prevent further hearing loss and preserve the hearing they have - we help parents learn to be better listeners to their young children who are beginning to be unusually disfluent and to give their children more opportunities to produce fluent speech

Positive self esteem, tempered with humility, can

help clinicians cope with the trials and tribulations of therapy. - when clinicians feel positively about themselves, they tend to see the positive attributes of other people - conversely, when clinicians feel negatively and insecure about themselves, they are more likely to become defensive when suggestions are made by supervisors and employers about how to improve their work

SLPs and Audiologists who address the whole person in a

holistic approach are concerned with more than just communication behaviors ; they are concerned with the person's emotions, mind, body, and spirit.

Counseling needs to be at the forefront of students' clinical education:

however, the professions of speech-language pathology and audiology typically do not have a history of extensive training in the area of counseling.

Unconditional positive regard is an

ideal we can strive for being accepting, respectful, and nonjudgmental. - a clinician's ability to maintain this with people who have behaviors, beliefs, or attitudes that are quite different from her own

Counseling skills are used

in every encounter with every client, patient, family member, whether intentionally or spontaneously. - Strict stimulus-response therapy may not be counseling, but eye contact, facial expression, tone of voice, choice of words, posture, and body language all send strong messages about our acceptance of and feelings about the person with whom we are working. - Our feelings about people inevitably shade our interactions with them, just as their feelings shade their interactions with us.

The art aspect of counseling lies

in understanding when and how to use the counseling theories, principles, and demonstrating the interpersonal sensitivity to use the best "timing possible - includes the concept of giving of ourselves, such as through support and empathy - This giving of ourselves is a delicate, balanced process that is learned over time - that is, when to give, how much to give, in which way to give. (SLPs and Auds can give support as they empathize with their clients. - sometimes just listening carefully to clients and families may be the best gift clinicians can give at the time - listening to their suffering and helping them overcome feelings of aloneness and isolation

Sometimes counseling involves helping

individuals and their families adjust to and cope with long-lasting or even permanent communication disorders - example, a child's severe hearing loss may be a lifelong in duration ; a young adult with a traumatic brain injury may always have difficulty with communication and cognition that affects her home life and work life

The role of the SLP in the 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

Evolution

is a long term slow process of development and improvement. - example, growth from infancy to toddlerhood to early childhod and so on. - In your own education, you have "evolved" from primary school to high school to college adn to more specifically, from introductory courses to advanced courses to graduate school

Revolution

is an event that suddenly and dramatically changes a person - example: having a powerful religiosu experince or getting married orhaving a baby or perhaps finally realizing what you really want to do in your life

Diagnostic and Statistical Manual of Mental disorders (DSM-5), American Psychiatric Association

is the set of standards used by psychologists, psychiatrists, and other mental health professionals

Having extensive knowledge about communication disorders is not sufficient to be a good or excellent clinician:

it also takes the ability to enter into the person's world and develop a strong therapeutic relationship - this relationship has dynamics that are inevitably affected by what the client and the clinician bring to it

Although SLPs and As incorporate counseling and use counseling skills in our daily work,

it is not appropriate to identify ourselves as "counselors". - we are not psychologists or counselors, but we study , understand and use concepts of psychology and counseling.

The ability to be encouraging and to instill hope

may be one of the most important qualities of clinicians. - we need to be the client's cheerleader and support the client's gradual progress. - encouragement helps people learn to believe in their potential for improvement - being encouraging also implies that we have confidence that our clients can improve and that we can be helpful in promoting their improvement. - our encouragement should be realistic and tied to the therapeutic goals we are addressing - if we cannot be encouraging, then we need to question whether we are working on the appropriate goals for the client

If both the clinician and the client bring considerable strengths (e.g. knowledge, experience, understanding, insight, patience) to the relationship,

more issues may be addressed. - We also need to ask ourselves what "baggage" (the thing that bothers or limit us) might be affecting our best therapy with clients. - we need to focus on the client's experiences and not our own. - we must always do our professional job no matter how we are feeling and we must maintain stable, predictable boundaries and a therapeutic environment.

Resolution

occcurs when a person makes a conscious and determined decision about what he or shee needs to do - example: to stop using drugs or alcohol, get a job, go back to school, ros tart workign bothharder and smarter to accomplis his or her goals. positive change takes resole.

Clients and patients - particularly tose with neurological disorders - are

often confused enough without SLPs confusing them more by saying one thing with their words and something else with their body language, facial expressions, and tone of voice.

All professiionals working with people use some counseling skills as

part of their interactions with clients, patients, and families. - while counseling comes more naturally to some individuals, counseling skils can be laearned.

Corey (2013) has noted that counseling is a

process of engagement between two people, both of whom are bound to change through the therapeutic process.

The study of counseling is not the study of psychology or psychopathology, but

rather the study of helping ordinary people - our clients, patients, and their families - deal with the personal, family, and our social challenges that their communication, swallowing, and hearing disorders create

The term helper often appears in the counseling and psychotherapy literature,

refers to several kinds of professionals who are trained in and use counseling skills as their ways of helping people. - our goal for helping a person (with all the forms of help we provide) is for the person to not need our help andy longer, to become independent of us, and to become a self-helper. - our job is to work ourselves out of a job

When we consider the hardships, difficulties, and tragedies people may have experienced in their lives,

we can often be more accepting and have more empathy than when we simply consider those individuals' immediate, overt behaviors. - for example, when a person is angry, that surface behavior may be readily seen, but behind the anger is often fear, anxiety, embarrassment, or other emotions - look for what is behind the surface behavior so you can be related to the deeper emotion, which may help you feel some empathy.

Although sometimes our best intentions may not always be as helpful as we would like,

we must always have the client's best interests as our primary goal.

For clinicians to be most effective,

we must deal with the client anf at least some of the important people (family and sometimes close friends) in the client's life, as well as other professionals on the treatment team - Our focus must always be on the communication problems and how they are affecting the client's and family's coping abilities.

Experienced clinicians in the field consistently report that counseling is something they do with every person they work with,

whether it is a child, adolescent, adult, or elderly person. - Often the clinician is involved in counseling family members as well, including parents, grandparents, spouses, siblings, and children.

At no time should the SLP or audiologist say that he or she is doing psychotherapy,

though some disorders lend themselves to more of a counseling or psychotherapeutic approach

In the field of Psychology, Counseling psychology goal is

to assist individuals to manage personal challenging life situations that do not involve psychologicall disorders.

Learning the essentials of counseling skills will help you

understand the inevitable challenging situations and behaviors that arise in therapy.

The term helper is

useful to us in our understanding of counseling.

The ASHA's Scope of Practice in Audiology (2004) states, under "Professional Roles and Activities",

Audiologic rehabilitative management plans include counseling related to psycho-social aspects of hearing loss, and other auditory dysfunction, and process to enhance communication competence.

As an applied social science, counseling has the weight of a considerable body of literature behind it.

Because it is a helping, interpersonal relationship , counseling involves at least two people and a relationship, no matter ow transient or superficial, always develops - The helper and the "helpee" - The therapists has the intention to assist or help the client - these intentions are the moment-to-moment purposes behind the counseling

People change in essentially three ways:

Evolution, Revolution and Resolution

Any interaction with a client, patient, or family member involves

using counseling skills, even though you may not be doing "counseling" per se. - It is the emotional and social effects on the people with whom we work that require our most astute counseling skills

Self-Awareness is related to other concepts of self, such as

self acceptance and self-esteem. - having a positive sense of self an being comfortable "in their own skin" is important for SLPs and audiologists to maintain their emotional stability - also helps us appreciate our strengths adn recognized our limitations - we are aware that we need much more education and training, and we develop awarenes of how we can help others in their education and training. - there is a general sequence in our educational and professional lives that is passed on from generation to generation: "i need help" (education, training, experiences); "I can do it alone" (I am able to be independent now,); and then "I can help you" (I'm ready to help, educate, train, and provide experiences for you).

One of the hallmark characteristics of SLPs and audiologists is patience - that is,

the ability and willingness to persevere during the often long, slow road of speech adnlanguage development or rehabiltiation of our clients and patients. - we need to practice "patience". - the challenge for many people we work with is their impatience to improve, to be able to communicate without difficulty - in other words, the slow process of change

Congruence implies that

the clinician is in touch with her own thoughts and feelings, and voices them when it is perceived to be helpful, and that the clinician's facial expressions, body language and tone of vice mirror her words and comments.

Standards for certification and minimal competencies for the provision of SLP and Audiologic rehabilitation services, as well as best practice, emphasize

the importance of counseling in our professional roles

The client-clinician relationship includes teh affective mode because, as in any relationshp,

the interaction has an emotional quality - the client and clinician influence each other as their relationships evolve. - how the client behaves towards us is invariably linked to how we think and feel about them - the relationship can change subtly or even significantly from session to session and sometimes from moment to moment. - mutual respect and trust help the client and clinician through the "rocky" times of their therapeutic relationship

Within our boundaries for counseling are

the legitimate, broad areas within the scope of practice of SLPs and audiologist, - Most new clinicians learn to develop some level of comfort with these during their clinical training

One of the challenges of counseling with individuals with communication disorders is

the possibility that their communication disorders may interfere with their ability to understand some of the more subtle (or even the most direct) messages and information we present. - their communication disorder can interfere with their ability to explain to us what they are thinking or feeling.

The science aspect of counseling involves

the understanding of psychological and counseling theories, principles, and skills,a dn teh resarch that supports their use. - their care is unique to professional helpers and differentiates them from nonprofessional helpers

When working with the families of some clients and patients,

there is the possibility that family members may have their own problems with auditory processing, language, and cognition that prevent them from fully understanding and appreciating what we are trying to communicate, or from clearly expressing their thoughts and feelings.

As clinicians, we need to actively practice

those things we find helpful to maintain our own good mental health - Many clinicians think in terms of staying "centered" or knowing "I'm okay. I usually do things well, I'm a good person, I'm a good clinician, I'm a happy person. People are basically good". - Clinicians who have attended many counseling seminars have suggested a variety of strategies they find helpful in caring for themselves.