Counseling

1
Counseling

• (adapted from Roth Worthington, 1996)

2
Functions of counseling

• Allows clinician to convey basic information to
  clients and families
• creates opportunities for clients to express
  feelings, emotions and doubts
• creates a supportive environment in which changes
  in the ABCs of fluency are more easily practiced
  and mastered.

3
Qualities of the effective clinician

• Sensitivity to the clients feelings and beliefs
• Respect for the client
• Empathy
• Objectivity
• Honesty
• Tact
• Ability to motivate
• Ability to listen
• Ability to set boundaries and recognize when
  issues have exceeded the scope of practice or
  clinical expertise

4
Stages of Counseling

• Establishing the relationship
• Providing information about the disorder,
  therapeutic options and techniques, prognosis
  determining mutual goals and responsibilities
• Implementation
• Primary focus issues that impede therapeutic
  progress
• Terminating the relationship
• Helping the client become his own therapist

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How do people react to communicative disorder?

• Grief the sense of loss.
• Guilt self-blame, often found in family members.
  Contrast with shame.
• Anger often arises from feelings of fear and
  powerlessness.
• Anxiety about the therapeutic process, about
  outcomes
• Inadequacy may result in overdependence upon the
  clinician.

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Counseling techniques

• Conversational techniques
• Counter-questioning used to determine the
  reasons behind a line of questioning
• Open-ended and indirect questions
• Empathetic listening and reflecting
• Silence

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Counseling techniques

• Therapeutic techniques
• Relaxation
• Desensitization
• Role playing

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Group counseling concerns

• Appropriate size?
• Procedures and rules for the interactions
• Atmosphere of trust, unity and mutual respect
• Gradual fading of clinician influence
• How to encourage risk-taking
• Managing confrontation
• Seeing hidden agendas
• Knowing when outside resources are appropriate
  and necessary

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Some things to consider

• The clinician must be personable, but not get
  personally involved
• Summarize the end of a counseling interaction to
  highlight the major points
• Feelings and attitudes do not readily yield to
  rational argumentation alone
• It is normal for clients and families to show
  reluctance, opposition or even resentment at some
  points in therapy

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More...

• Overuse of positive feedback can cause it to lose
  its value
• Counseling should address strengths as well as
  weaknesses
• Dont push the client to do things (disclose,
  engage in desensitization, etc.) before he is
  ready
• Understand your clients specific cultural
  background and how it may affect the therapeutic
  process

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Counseling specific concepts for the
fluency-disordered client

• Adapted from Cooper (1997)
• Crowe, T. (ed.) (1997) Applications of counseling
  in speech-language pathology and audiology.
  Baltimore Williams Wilkins

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Specific goals

• To create client-clinician relationships that
  help clients to identify and explore feelings,
  behaviors, and attitudes toward themselves and
  stuttering
• To help clients identify the nature of the
  stuttering problem
• To help clients develop a realistic perspective
  on fluency as it relates to their sense of
  well-being and life goals.

13
continued

• To assist clients in identifying typical ABC
  coping patterns and their relative success and
  worth
• To assist clients in applying successful coping
  techniques to the ABCs of stuttering
• To help clients become their own judges and
  self-reinforcers
• To assist clients in obtaining a feeling of
  fluency control

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The orientation stage

• Explaining that therapeutic success depends on a
  mutually open, honest and respectful relationship
• Previewing possible negative responses to therapy
  and the clinician
• Establishing mutual goals
• Exploring stuttering the Stuttering Apple -
  core behaviors and responses (ABCs) when and
  because a stutter happens selecting goals for tx.

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The relationship stage

• First steps are taken toward modifying speech and
  stuttering
• Assignments problem solving when they arent
  done or dont work well.
• Confrontation identifying the ABC patterns that
  either facilitate or impede tx progress
• Dealing with nonverbal affective responses that
  impede tx
• Probing the clients language understanding what
  the client is trying to say
• Encouraging positive and negative reflections on
  the tx process

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The adjustment stage

• Altering misperceptions about stuttering
• Developing a realistic perspective on the ABC
  ramifications of their stuttering
• Identifying existing coping patterns
• Enhancing self-reinforcement skills
• Selecting the most appropriate strategies for
  achieving fluency control, in light of the
  clients typical coping patterns
• Developing mutually agreed-upon series of short
  term goals leading to long term goal.

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The action stage

• The client is ready to extend in-clinic
  techniques when
• he can effectively self-monitor and reinforce
• he understands his typical coping strategies and
  has a repertoire of replacement strategies
• the client has a realistic sense of self-worth
• the client is willing to expend the psychic
  energy that is required in pursuing fluency
  control

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Specific thoughts for parents
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• Defusing guilt
• Providing information/disabusing misinformation
• Providing fact-based schema for decision-making
• Being realistic about spontaneous recovery
• Being realistic about the impact of the problem
  on the child

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• Probing feelings about therapeutic approaches
• Encouraging open discussion in the family
• Probing the causes of therapeutic plateaus or
  backsliding