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Counseling and coaching in adult neurogenic communication disorders


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Title: Counseling and coaching in adult neurogenic communication disorders

Counseling and coaching in adult neurogenic
communication disorders
  • Audrey L. Holland, Ph.D.
  • Regents Professor Emerita
  • University of Arizona

  • ASHA fpr inviting this presentation
  • Marshall Goldsmith, who doesnt know me but got
    me into this anyhow
  • Martin E.P. Seligman Christopher Peterson,
    whose work is integral to my thinking
  • Karen Reivich,and the ongoing Pod, my fearless
    leaders in this work

(No Transcript)
Assumptions of this Workshop
  • Clients will refer to adults who have a
    variety of neurogenic communication disorders, AS
    WELL AS their partners, spouses, other family
  • Emphasis here in stroke aphasia, ALS
  • Counseling/Coaching in relation to communication
    disabilities is within the scope of practice, as
    defined by ASHA.
  • Counseling is the most underspecified of our
    clinical skills.

  • A Wellness perspective on Counseling/Counseling
  • Some underlying themes
  • Living the full catastrophe
  • The importance of stories
  • Sharing the expertise--a collaborative model
  • Positive Psychology -principles and relevance
  • Putting the themes into coaching/counseling
  • For yourself
  • For your clients
  • The concept of counseling moments

Why a wellness perspective?
  • The people who come to our attention differ from
    those who typically seek psychological or
    psychiatric counseling.
  • They have a high likelihood of previous
  • Something has happened, accident, chronic
    disease, etc.) that results in a fundamental
    change for them
  • Getting on with life is a fundamental goal
  • These features should significantly influence
    the nature of our counseling

The Full Catastrophe
  • It is not a disaster to be alive just because we
    feel fear and we suffer.we must understand that
    there is joy as well as suffering, hope as well
    as despair, calm as well as agitation, love as
    well as hatred, health as well as illness
  • Katazanzakis, Zorba the Greek quoted in
    Kabat-Zinn, Wherever You Go, There You Are

Counseling Implications of the Full Catastrophe
  • Underscores the importance of helping clients
    gain perspective on the bad things that
    happen(ed) to them
  • Provides a firm and realistic basis for building
    resilience and optimism
  • Foreshadows the role of growth and change in
    meeting challenges

  • My barn having burned down, I can now see the
  • anonymous

A little story..
  • A retirement
  • A decision..
  • An enlightenment.

In the words of Marshall Goldsmith.
  • Don't cling to the past, everything that
    happened in the past is past, every time you take
    a breath, it's a new you, and the whole focus is
    on looking to the future, and figuring out where
    you'd like to go. It's creating a positive mental
    set that is focused on this future life.'
  • Other aspects of Buddhist philosophy include
    taking responsibility for yourself, and not
    blaming others. When you're over 50, blaming Mom
    and Dad for your behavioral traits is weak.
  • Can you imagine a CEO sitting down with
    people and saying,'You know, I make too many
    destructive comments, and I analyzed why. It's
    because of my father.'
  • Forget it. You're an adult. Grow up. Take
    responsibility for your own behavior.

The Positive Introduction
  • Compose a brief, serious story about yourself
  • The story is called Me at my very best
  • Showcase one of your strengths
  • Choose someone sitting near you and swap your
  • Then well talk about it briefly

Domino at her best
Importance of stories
  • Telling ones story is not the same thing as
    being interviewed about ones stroke or diagnosis
    of ALS
  • Work in illness narrative has emphasized the
    healing power of ones stories
  • The aphasia group experience
  • Cynthia, Jordan and BAND OF ANGELS

Stories and counseling
  • Our counseling must provide time for listening to
    the stories of ones catastrophe--the bad and
    good parts
  • Group sharing of the stories (including our own)
  • Importance of disclosure
  • Stories hold healing power, magic, lessons to be
    learned from others, inspiration

An aside..
  • I also think that stories are central to direct
    aphasia treatment that is oriented toward
  • Discourse involving telling ones life stories
  • Conversation and the role of stories
  • Life scripts

Who are the experts?
  • Those who experience a disorder? I.e., live IN
  • Families and close others? I.e., live WITH it?
  • Those who study it and work with it? I.e., those
    whose expertise is BREADTH? US??

The concept of shared expertise
  • Good clinical work in general involves
  • Crucial to the counseling process
  • Honoring the expertise of the others is a key to
    good counseling/coaching getting other
    participants to buy in.
  • Without shared expertise, there is no counseling,
    only handing out information

Interviewing, counseling, consulting, coaching
Life Coaching a Special Type of Counseling
  • Geared to increasing job or life satisfaction in
    individuals who are relatively free from
  • Fits well with goals of counseling individuals
    with communication disorders and their families
  • Focuses on change
  • Can incorporate principles of positive
  • A collaborative partnership

Why a coaching perspective?
  • Coaching emphasizes wellness and developing
    behavioral solutions and alternatives
  • Thus, appropriate to our goals
  • Increasing understanding of the disorder
  • Coping with loss
  • Learning to live with a disorder or a
    disability--developing resilience
  • Dealing with changes in societal roles
  • Managing changed responsibilities
  • Dealing with anger and frustration

Implications (contd)
  • Getting through? Getting over? Getting on!
  • There is life after stroke and aphasia There is
    life still to be lived with deteriorating
  • Playing the cards you are dealt

Counseling CoachingSimilarities
  • Both provide information, guidance support
  • Both depend on active listening skills
  • Both can guide persons to choose their own goals
    and ways to meet them
  • Both honor and understand the importance of
  • Counseling focus is on Why?--Coaching focus is
    on What next?
  • Coaching more feet to the fire--Coaching
    centered in problem solving
  • Coaching believes individuals hold key to

Coaching also differs from consulting
  • Does not set the agenda or provide solutions
  • Persons being coached are considered to be among
    the experts
  • Coaches
  • listen
  • support
  • clarify, elaborate, reframe, guide
  • Coaches might share their expertise, but they
  • Also request changes
  • Request that actions be taken
  • Hold clients accountable for taking actions
  • Provide opportunities to experience a fuller life
    (especially important in disability coaching)

Summary Coaching
  • Coaching is oriented to action and to change
  • Coaches collaborate with clients to develop
    doable plans of action related to reaching
    goals and achieving success
  • Coaches hold individuals accountable for
    completing their action plans.
  • Coaches assist individuals to maximize the
    meaning in their lives.
  • Approach is geared to CHANGING What Is, not to
    understanding WHY What Is
  • Coaches are not distant from the process.
  • They use disclosure to catalyze and challenge
    their clients
  • Coaching has as its goal to enhance a clients
    life despite disability.

Positive Psychology
Goals of this section
  • Get a taste of Positive Psychology
  • Learn about your signature strengths
  • Begin to consider ways to apply positive
    psychology to communication counseling and to
    your life

Costs of a disease model in psychology
  • Victimizers and Pathologizers
  • Little concern for improving normal lives,or
    nurturing and fostering talents
  • Therapy model was adopted, rather than a coaching
  • Whats wrong with you? vs
  • Whats right with you?

Nor for psychology either!! ENTER POSITIVE
  • Medical models are losing their foothold in many
    health professions
  • Progressive abandonment in rehabilitation and
    thereafter for an emphasis on wellness and
    re-establishing societal roles
  • Whats RIGHT with people, despite chronic
  • Parallel change in mental disease
  • Mental HEALTH is finally getting its due

Tenets of Positive Psychology
  • As concerned with strength as with weakness
  • As interested in building the best things in life
    as in repairing the worst
  • As concerned with making the lives of normal
    people fulfilling as with healing pathology

Translating the tenets to neurogenic
communication disorders----
  • To maximize recovery or to make remaining life
    fulfilling, it is important to focus on personal
    strengths, in both individuals and partners.

  • The proper focus of our coaching counseling is
    maximizing the quality of life post illness

  • Most people with communication problems have
    little or no psychopathology
  • Therefore, we can focus on fulfilling lives, not
    on healing psychopathology

The three pillars of Positive psychology
  • Positive Emotion--The Pleasant Life --
  • Past life satisfaction contentment
  • Future optimism and hope
  • Present pleasure
  • Positive Character--the Engaged Life--
  • Gratification and flow
  • Positive Institutions--The meaningful life
  • The greater good

Pillar I Positive Emotion--The Pleasant Life
  • Past life satisfaction and contentment
  • Present pleasure
  • Future optimism and hope

Pillar II--Positive Character
  • The Engaged Life
  • Gratification
  • Flow
  • Csikszentmihlyi,
  • Being there

Pillar III--Positive Institutions
  • The meaningful life
  • Attachment to something beyond oneself
  • The greater good

A Quick Trip through Positive Psychology What
We Know
  • Most people are happy
  • Happiness is causal, not epiphenomenal
  • Most people are resilient
  • Happiness, strengths of character and good social
    relationships are buffers
  • Crisis reveals character
  • Other people matter
  • Work matters
  • Money is important, but only to a point
  • Happiness trumps pleasure
  • The heart matters more than the mind
  • The good life can be taught/learned

Some consequences of being happy(Lyubomirsky,
King Diener, 2005)o,
  • More success at school work
  • Better social relationships
  • Better health and longer life
  • Why?
  • Happiness broadens and builds
  • Happiness can be a buffer
  • Happiness opens doors

Life Satisfaction ScaleEd Diener, U of Ill.
  • Rate from 1strongly disagree to 7strongly agree
  • ___In most ways my life is close to my ideal.
  • ___The conditions of my life are excellent.
  • ___I am satisfied with my life.
  • ___So far I have gotten the important things I
  • want in life.
  • ___If I could live my life over, I would change
  • almost nothing.
  • Sum your ratings

  • 31-35extremely satisfied
  • 26-30 satisfied
  • 21-25slightly satisfied
  • 20neutral
  • 15-19 slightly dissatisfied
  • 10-14 dissatisfied
  • 5-9 extremely dissatisfied

How do people get happier?Increase life
  • Many ways, including a number of the exercises
    and interventions described in Authentic
    Happiness and in Petersons Primer, and on the
    authentic happiness websites (see handout)
  • Including the Positive Introduction we started
  • Many come with efficacy data
  • Too many to talk about, too little time

Building the best things in life
  • In this, and other, ways, PP recognizes its debt
    to CBT.
  • Some examples of assessments
  • VIA
  • Life Satisfaction Scale
  • Grit
  • General Happiness
  • Some examples of exercises
  • Gratitude visit
  • Forgiveness letter
  • Savoring activities
  • 3 Pillars exercise
  • 3 Good things

Lets play around with one
  • Knowing and using your strengths
  • Capitalizing on strength rather working to
    overcome weakness
  • Learning how to count on strengths and use them
    in new ways
  • Recognizing others strengths and respecting them

Character Strengths Virtues
  • Result of great study and scholarly cooperation
  • Hinduism to Hogwarts--universal
  • Manual of the Sanities

Character strengths and virtues
  • Strengths of Wisdom Knowledge
  • Creativity
  • Curiosity
  • Open-Mindedness
  • Love of Learning
  • Perspective
  • Strengths of Courage
  • Bravery
  • Persistence
  • Integrity
  • Vitality
  • Strengths of Humanity
  • Love
  • Kindness
  • Social Intelligence
  • Strengths of justice
  • Citizenship
  • Fairness
  • Leadership

Character Strengths and Virtues
  • Strengths of Temperance
  • Forgiveness and Mercy
  • Humility and Modesty
  • Prudence
  • Self-regulation
  • Strengths of Transcendence
  • Appreciation of Excellence Beauty
  • Gratitude
  • Hope
  • Humor
  • Spirituality

Get out your strengths list
  • Read the list
  • Work down the list, checking one of the three
  • Me,not me, ???
  • NOW, identify those most like you, and pick 5
    that REALLY resonate with you.

(No Transcript)
Values in Action (VIA)
  • This is the quick and dirty VIA,
  • The real one is available on the websites, but
    this is a reasonable approximation.
  • Look back to your Positive Introduction.
  • What strengths can you identify that relate to
    this exercise?

The VIA Some further considerations
  • It is a work in progress.
  • Flexible, open to change
  • Given the universality of its goals, there is
    little consideration of culture specific virtues.

Petersons list of American virtues
  • Achievement, assertivenss autonomy, celebrity,
    competitiveness, fitness, happiness, looks and a
    whole lot of money, personal control, redemption,
    self-esteem, toughness uniqueness.

My Candidate for Americas Most Virtuous
Lots of ways to go with this..
  • Was this easy or hard to do?
  • Did you surprise yourself?
  • Did your strengths reflect the same core value
    (ie, all the same color)or were they spread out?
    Does it matter? WHY?
  • What about the not-like me?
  • Is this where you go for self-improvement stuff?
  • Do you care?
  • Other insights?

Top five strengths most closely associated with
personal happiness
  • Curiosity and interest in the world
  • Zest, enthusiasm, and energy
  • Capacity to love and be loved
  • Gratitude
  • Hope, optimism, and future-mindedness

What can the workplace teach us about working
from strength?
  • Speed and Simplicity
  • People operating from strengths learn the role
    faster, adapt to more variance in the role
    faster, and need less complicated systems to do
  • Productivity and Precision
  • People operating from strengths produce
    significantly more at higher quality.
  • Longevity and Attendance
  • People operating from strengths stay longer, miss
    less work, and build stronger client

Capitalizing on strengths (lessons from the
  • You will truly excel much more by maximizing your
    strengths, seldom by fixing your weaknesses.
  • You do not have to have strength in every aspect
    of your role to be successful. (Myth Excellent
    performers must be well-rounded.)
  • You CANT have all the VIA strengths. Some are
    even opposites.
  • Consider those out of the range of 1-8 to be
    non-strengths NOT weaknesses.
  • Five creative strategies
  • Get a little better at it.
  • Design a support system.
  • Use one of your strengths to overwhelm your
  • Find a partner.
  • Just stop doing it.

Lets think about this one simple exercise.
  • Can it translate to you?
  • Can it translate to persons with ALS aphasia, to
  • How could it influence their lives? ?

Lets try anotherThree good things
  • Think of three good things that happened to you
  • Practice daily for a week
  • Write them down every night before you sleep.
  • Adapt it to Spouse
  • Use it as a discussion exercise

And another---
  • The Gratitude Visit
  • Think of someone who has very positively
    influenced your life, but whom you have never
    properly thanked (ie, to your satisfaction)
  • Write a 2 page (max) letter thanking him or her
  • Schedule a time to visit with that person, or if
    too difficult, to have a long phone call.
  • Read the letter to the person

Adapting the gratitude visit
  • For a spouse
  • Think of someone who has helped you a lot in
    getting through this stroke. Write the letter.
    Make the visit.
  • For someone with ALS
  • Think of someone who has been helpful to you in
    dealing with it. Write the letter, make the
    visit or the phone call. Or even send it.

Depression Caveats
  • Few of us are trained psychotherapists
  • Dilemma of the talking therapies for
    communication impairments
  • We lack skills in most effective methods of
  • CBT, CBT antidepressants
  • Critical to know when to refer and to whom
  • But a growing awareness that principles of
    positive psychology, applied to SOME depressive
    conditions can be helpful.

Overarching counseling/coaching needs
  • Support
  • Information
  • Hope

The point is
  • Much of this work can be applied
  • Some requires adaptation, particularly the
    wordier exercises

Family issues
  • Time-sharing with disabled/non-disabled children
  • Sharing responsibilities
  • Behavior management

Some more examples
  • Subtle, but debilitating problems that follow
    mild TBI or mild stroke.
  • Getting back to work issues
  • Interpersonal interaction issues
  • Re-establishing focus
  • Developing new goals for a changed life
  • Learning to know and like who you have become
  • Feeling safe, feeling well again--dumping your

After moderate stroke and aphasia
  • Retirement and family issues
  • Family roles
  • Unplanned-for changes in income
  • Developing a wellness (as opposed to illness)
    focus to the rest of your life
  • The move from PT(physical therapy) to PT(personal
  • Dumping your invalid
  • Living positively and successfully and
    resiliently despite chronic problems

More examples
  • Preventing problems that occur in the wake of a
    diagnosis of progressive disease.
  • Adapting to changing skills, deteriorating
  • Living as fully as possible
  • Being well despite illness
  • Planning for a different future
  • Developing patterns and rationales for coping
  • Getting your ducks in a row
  • Reaching out to friends
  • Asking for what you want

Still more.
  • Assisting grown children of ailing parents
  • Getting local supports in place
  • Dealing with issues of long-term placement
  • Knowing the resources
  • Finding out whats best
  • Learning to live with it (the children, that is)
  • Giving yourself permission to feel good about
  • Defining and refining the concept of the dutiful

  • Unique problems facing counselors of individuals
    and communication problems
  • Overlay of problems on mostly previously okay
  • Problems result from potentially catastrophic
  • Confusion about the counseling responsibility
  • Difficulties that many psychotherapists/social
    workers may have in communicating with our
    population--thus, we are frequently
    counselors/coaches despite ourselves

But when do we have TIME??
  • The Concept of Counseling Moments
  • Few of us have TIME for an hour or so of
    counseling, even sporadically.
  • We are stuck with fitting counseling in around
    our more direct clinical activities

One suggested way
  • Be on the alert for family/client counseling
  • The times to put on your counseling hat
  • These typically occur at the beginnings or at the
    ends of clinical sessions

  • Unique problems facing counselors of individuals
    and communication problems
  • Overlay of problems on mostly previously okay
  • Problems result from potentially catastrophic
  • Confusion about the counseling responsibility
  • Difficulties that many psychotherapists/social
    workers may have in communicating with our
    population--thus, we are frequently
    counselors/coaches despite ourselves

In closing.
  • Our responsibilities involve providing
  • HOPE.

Wanna talk more?
  • http//
  • 1-800-854-9594
  • 520-293-2926

Relevant Websites
  • http//
  • For Authentic Happiness assessments--free
  • http//
  • Website for on-phone coach training
  • http//
  • Website for on-phone coach training
  • http//
  • Website for Seligman Positive Psychology Course