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 o Use respectful listening o Use solution focused counseling while incorporating everyone’s feelings o Incorporate the concept of joining o Give assignments • Tools o Have a framework to work within o 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? Audiology Speech-Language Pathology Audiologist s counsel by providing S LPs counsel by providing information, education, guidance, education, guidance, and support . and support to individuals and their Individuals, t heir families and t heir families. Counseling includes caregivers are counseled regarding discussion of assessment results and acceptance, adaptation, and treatment options . Counseling decision making about facilitates decision making communication, feeding and regarding intervention, swallowing, and related disorders. management, educational The role of t he S LP in t he counseling environment, and mode of process includes interactions related communication . The role of t he to emotional reactions, thoughts, audiologist in t he counseling process feelings, and behaviors that result includes interactions related to from living with the communication emotions, thoughts, feelings, and disorder, feeding and swallowing behaviors that result from living disorder, or related disorders . with hearing, balance, and other related disorders.
More from AS HA Audiology Speech-Language Pathology • • S LPs engage in the following activities in counseling Audiologists engage in the following activities when persons with communication and feeding and counseling individuals and their families: swallowing disorders and their families: • Providing informational counseling regarding • empower the individual and family to make informed interpretation of assessment outcomes and decisions related to communication or feeding and treatment options swallowing issues. • Empowering individuals and their families to make • educate the individual, family, and related informed decisions related to their plan of care community members about communication or • Educating the individual, the family, and relevant feeding and swallowing disorders. community members • provide support and/ or peer-to-peer groups for • Providing support and/ or access to peer-to-peer individuals with disorders and their families. groups for individuals and their families • provide individuals and families with skills that • Providing individuals and their families with skills enable them to become self-advocates. that enable them to become self-advocates • discuss, evaluate, and address negative emotions and • Providing adj ustment counseling related to the thoughts related to communication or feeding and psychosocial impact on the individual swallowing disorders. • Referring individuals to other professionals when • refer individuals with disorders to other professionals counseling needs fall outside those related to when counseling needs fall outside of those related auditory, balance, and other related disorders. to (a) communication and (b) feeding and swallowing.
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 ocialization • 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 • be genuine • listen • attend to nonverbal & verbal • be nonj udgmental communication • use silence as a strategy • paraphrase content • use nonverbal communication • reflect on patient/ caregiver feelings & implicit messages • ask solution-focused questions
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 olution-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 olution-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: o grieve what has been lost o understand what has happened as fully as possible o develop coping strategies & to increase resilience o make peace with the disorder o make sensible adaptations to the disorder o capitalize on strengths in order to minimize weaknesses o live as fully as possible, despite the impairment Holland & Nelson, 2014
Blending an effective counselor’s skills & a systemic/ solution-focused approach + solut ion-focused = enhanced Clinician skills approach outcomes Listening Emphasis on emot ions, Being nonj udgmental at t it udes and mot ivat ion Using silence as a strategy Using nonverbal communication Focus is on changes client Best practice for want s vs. disorder being Asking solution-focused questions t reat ed counseling in Being genuine communication “ … places counseling int o a Attending to nonverbal & verbal disorders framework t hat is always communication connect ed t o and driven by t he goals of t reat ment .” Paraphrasing content (deS hazer, 1985; Egan, Reflecting on patient/ caregiver 2007; S klare, 2005) feelings & implicit messages
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 or 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 of 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 ocial Educational Employment
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