Barbara Wilkinson
Speech and Language Therapist,
Broxtowe and Hucknall PCT
Tel: 0115 9709221
Email: barbara.wilkinson@qmc.nhs.uk
Summary:
This counselling service has been developed for clients who have suffered a stroke which has resulted in a long-term communication disability. Having aphasia brings feelings of devastation, loss and loneliness, which can lead to psychological distress if left unacknowledged. This initiative seeks to formally address the psychological elements of care.
Existing counselling services are often inaccessible to people who have language impairment. By combining specialist skills of speech and language therapy with professional counselling knowledge, this counselling service specifically addresses and overcomes these barriers and invites clients to use verbal, nonverbal and creative methods to engage in the counselling process.
Outcomes of the initiative include changes in self-understanding, in interpersonal relationships and in overall quality of life for clients. Impacting also on clients' responsiveness to the rehabilitation process, prevention of chronic depression and reduction in use of psychiatry services.
Abstract:
This service change means formal psychological support is now available to stroke and elderly people with communication difficulties who require additional help adjusting to their illness and loss. The importance of acknowledging the psychological elements of care has been recognised within the National Service Framework and Royal College of Physicians Rehabilitation Interventions. The implementation of a person-centred counselling approach also accords with social model principles, valuing autonomy, control and choice and also recent healthcare policy initiatives, which seek to promote informed choice and shared decision making.
Management have fully supported the development of this initiative and required professional supervision has been agreed.
Training the speech therapy team to use the counselling service has been important to embed and sustain the change within our service.
Regular liaison with speech therapists and other involved professionals ensures that practical and therapeutic issues are discussed and that the counselling service continues to be flexible to the needs of both clients and other support services.
The views of speech and language therapy users with experience of living with long-term communication disabilities has enabled this initiative to be both flexible and responsive to users' priorities and concerns and assisted in the collaborative process of developing an aphasia-friendly counselling leaflet.
Informal discussions with professionals at Connect (Communication Disability Network) have also enabled further specialist expertise to feed into and support decisions and direction of this initiative.
The introduction of the combined role as speech and language therapist/counsellor is a specialist resource for both clients and other speech therapists within the team. Speech and language therapists are able to consult the specialist and develop their own level of expertise in using counselling skills alongside their intervention with clients. Joint working and workshops also enhance the service offered to clients.
The introduction of this specialist resource is a pioneering development nationally and one could assume that enhancing our reputation nationally is likely to attract staff.Given the communication difficulties experienced by clients accessing our service, traditional quality of life measures and conventional questionnaires are often unsuitable as they rely too heavily on linguistic skills. The use of 'Psychlops', which is a client-generated, psychometric instrument, is a useful tool for evaluating the effectiveness of this counselling intervention. It helps to seek the client's perspective on their psychological distress in terms of problems, functioning and well-being and measures the change.
Clients are indicating that the counselling is providing an invaluable opportunity to reflect on their communication disability and gain deeper understanding of their needs.
There is little research of counselling clients with complex communication disorders and therefore pioneering a new venture will be enriching our understanding of clients' perspectives and also enabling our service to address the psychological needs of clients more fully in the rehabilitation process.
An audit of client satisfaction via client/carer questionnaires will provide further insights into the impact of this service development on patient experience.
Psychotherapy and counselling are often called the 'talking cure' yet for clients who have an acquired language disorder following stroke, the ability to communicate verbally is lost and creative ways of expression need to be employed. This counselling service differentiates itself from other psychological support services by its sensitivity to clients' compromised verbal abilities. Respecting clients' individual forms of communication and acknowledging the important role of verbal and non-verbal channels of communication as well as creative forms of expression such as imagery, arts and music as a means of building inner strength and working through feelings of loss.
The service strives to ensure an attitude which is open to exploring ways of being inclusive/open to inclusivity. The emphasis being on establishing dialogue with clients and not making assumptions about their needs.
Practical arrangements for attending counselling accommodate individual differences and there is a readiness to provide the service in an alternative way if required.
Throughout the development of this project, liaison with both speech therapy and counselling professionals has enriched the quality of the service and ensured that changes have been smoothly integrated into the whole patient pathway.
On a national level, attendance at special interest groups and national study days, and publications in national counselling and speech and language therapy bulletins ensures that this initiative is shared with a wider audience.
Nottingham speech and language therapy department is pioneering an investigation into a facet of counselling which is relatively unexplored. As a team, we are formally acknowledging the emotions underlying communication disability. Emotions which often never see the light of day in more surface-level therapeutic relationships and yet when given a voice may be the opening for therapeutic breakthrough.
