SLP 481B Chapter 10 Review Questions

What does it mean to counsel?

Provide information, guidance, and assistance. The main purpose is to reduce the impact that negative reactions have on the therapeutic process and to promote positive progress in therapy. 

What is the role of the speech-language pathologist in counseling?

The role of the SLP in counseling is to recognize emotions, thoughts, and behaviors of patients and caregivers that are directly related to the disorder.

What are the 5 stages of the grieving process?

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

What is denial?

Patients believe that nothing is wrong and that there will never be anything wrong with their speech, language, cognition, or affected abilities. Individuals might confabulate and fabricate reasons for the change in their communication, blame others for communication difficulties, and dismiss evidence of a communication disorder. Speech-language pathologists must be clear, straightforward, and use objective data such as charts or standardized testing results to make it easier for the individual to see the reality of their problems.

What is anger?

Patients often feel lack of ownership and frustration because they feel out of control. Speech-language pathologists should remain calm, not become defensive, and validate patients’ feelings.

What is bargaining?

Patients are searching for hope by looking to a higher being to make a deal.

What is depression?

Patients have lost their sense of purpose and can appear apathetic, unmotivated, and discouraged. Speech-language pathologists must help encourage and refer to a medical professional if clinical depression is suspected.

What is acceptance?

This stage is where acceptance of deficits and disorders occurs, which enables an individual to move forward to progress in therapy. Speech-language pathologists must set appropriate goals and make a plan to achieve those goals while keeping the patients’ quality of life in mind.

What are some signs and symptoms of depression?

• Anxiety/ agitation

• Irritability or uncharacteristic anger

• Crying for no apparent reason

• Persistent feelings of sadness, hopelessness, pessimism, guilt, helplessness, worthlessness

• Lack of interest in things that once brought pleasure, including hobbies and sex, abnormal levels or fatigue

• Sleep changes: difficulty sleeping or sleeping too much

• Appetite changes: eating too little or eating too much

• Changes in weight

• Thoughts of dying, death, or suicide

• Restlessness

• Difficulties with concentration, memory, and decision making

How might depression and demotivation affect the therapy process?

• Depression can be evident in patients and caregivers with any etiology that results in neurogenic communication disorders. It is important to recognize the symptoms of clinical depression because appropriate treatment of any psychological problems increases the likelihood that the patient will achieve the therapeutic goals. 

• Demotivation is the inability to feel connected to goals by purpose, growth, and ownership. Therapy progress suffers if any of the connections are faulty or missing. Individuals feel apathetic, bored, and frustrated. SLPs must determine the right balance of tasks that are challenging though not too challenging and find ways to balance the connections among purpose, growth, and ownership.

How might anxiety and disassociation affect the therapy process?

• Anxiety. This is when frustration becomes extreme and an ownership disconnection is present. Anxiety could lead to irritability, crying, anger, striking out, withdrawal, fainting, or depression. Speech- language pathologists must try to restore ownership within the individual or refer to a psychologist or psychiatrist.

• Disassociation is when patients or caregivers unconsciously remove themselves emotionally from painful, stressful, or upsetting situations to alleviate the emotional stress. Speech-language pathologists must stay attuned to patients’ and caregivers’ reactions during interactions, encourage the discussion or expression of their feelings, and keep the patient company to help the patient feel comforted.

How might the speech-language pathologist tailor therapy sessions to a patient with avoidance or escape behaviors?

Speech-language pathologists might tailor therapy sessions to a patient with avoidance or escape behaviors by stepping back and making tasks/exercises more achievable so the patient is not resistive to therapy, which may cause the patient to become overwhelmed, obsessed, or frustrated.

How might the speech-language pathologist tailor therapy sessions to a patient with displacement or projection behaviors?

They should encourage patients to talk about their emotions and then validate patients’ feelings with empathetic responses such as, “I can see that you are very frustrated right now” or “you seem more upset today than you were yesterday.” Provide time for patients to respond. SLP should focus on building trust with the patient to create a safe space and a judgment free zone. Also, it is important to provide time for patients to respond.

Describe how you would counsel a patient that is passive-aggressive.

Provide an open, nonthreatening environment for patients to discuss their feelings and emotions.

Describe how you would counsel a caregiver that is passive-aggressive.

A caregiver who is passive aggressive can be counseled by the clinician by being open to suggestions by the caregiver; being patient, yet direct, with the caregiver about the importance of therapy; and not becoming defensive when speaking with the caregiver.

Why might the Counseling-Integration Matrix (CI Matrix) be useful?

The Counseling-Integration Matrix would be useful because it pairs the patient’s’ perceived negative impact of his or her disorder on his or her quality of life with the patient’s’ willingness to change. Speech-language pathologists can use the CI Matrix to continually assess the individuals to tailor the focus of counseling and the strategies needed along with the necessity of therapy.

Give an example of an individual who would be placed in quadrant 1 of the CI Matrix and a way in which counseling would be helpful.

An example of an individual who would be placed in quadrant 1 of the CI Matrix would be an individual who is experiencing a negative impact on his or her quality of life, although he or she is motivated and eager to begin therapy. A way in which counseling would be helpful would be to provide information about the disorder or disease progression, create goals and design a treatment plan with both the caregiver and patient, and keep both the patient and caregiver’s emotional reactions in check.

Give an example of an individual who would be placed in quadrant 2 of the CI Matrix and a way in which counseling would be helpful.

• Patients with a high negative impact on their quality of life and a low willingness to change. These patients are frustrated, unhappy, resistant, or defeated. Counseling is necessary in this quadrant because their willingness to change begins to lessen.

• A way in which counseling would be helpful would be to determine which connections to the goals have been lost, such as purpose, growth, and ownership, and counsel the patients to re-establish those lost connections.

How might an individual feel if he is in quadrant 3 of the CI Matrix?

Individuals in this quadrant are complacent, uninvolved, uncooperative, or indifferent. These are patients with a high negative impact on their quality of life and a low willingness to change.

How might an individual feel if she is in quadrant 4 of the CI Matrix?

If one is in quadrant 4 of the CI matrix, they may have a low negative quality of life impact, and a high willingness to change. Patients in this quadrant are often reaching the maintenance and generalization phase. These clients may feel comfortable, agreeable, controlling, and ready to affect change.

In your opinion, what characteristics would the ideal patient display?

The ideal patient is one who is motivated, supported, patient and demonstrating willingness to participate and engage with therapy tasks. They are consistently attending therapy sessions and are also willing to practice therapy skills outside of the therapy room. They are agreeable, and vocal about his or her concerns.

In your opinion, what characteristics would the ideal caregiver display?

Ideal caregivers' characteristics include supportiveness, motivation, helpfulness, and empathy towards patients’ situations. These caregivers can deal successfully with or put aside their own feelings of loss to better facilitate the recovery of their loved ones.

How are supporters and detractors different?

Supportive caregivers have a positive impact on the motivation of patients and the progress that patients make in therapy, whereas detractors can have a decidedly less positive impact. Where supporters encourage patients and do not take time away from therapy, detractors diminish the importance and value of the therapy, often causing negative reactions by patients and lost time during the treatment sessions. 

How are helpers and enablers different?

•  Helpers understand what speech-language pathologists teach and generalize those ideas outside of the therapy session.

• Enablers believe they are helping the patient, though their words and actions, to go against the speech-language pathologists’ recommendations or suggestions.

Why might sympathizers be detrimental to the therapy process? 

Sympathizers are caregivers who feel sorry for the patient and show little understanding of the patient’s emotions. They can be detrimental to the therapy process because they aren't attune with the patient nor learning about the disorder to understand how to help.