Counseling and the Speech-Language Pathologist (SLP)

Brittny Ball M.A., CCC-SLP

Counseling regarding a communication disorder is a vital component of the services that SLPs provide to their patients and families.
According to Roth and Worthington, counseling is defined as an interpersonal relationship intended to alleviate emotional stress arising from or contributing to the primary communicative disorder (pg. 44).
An ongoing process.
Should involve the multidisciplinary team to ensure consistency in approach.
A relationship that takes time to build.
Requires sensitivity and empathy.
Respect for the individual.
Honesty
Active listening
Advocating for your patient.

Education is a key reason for counseling.
Helping patients and families cope with the rehabilitation process and the disorder in general.
Providing resources to patients and families.
Developing strategies for managing the disorder.
Allows clients to communicate their feelings and fears.
Allows a space for clients to target and experience attitude and behavioral changes.

Counseling vs. Psychotherapy:
- Psychotherapy: Involves looking for unconscious patterns in behavior to make personality changes.
- Counseling: Involves assisting a client to acknowledge feelings and emotions and appropriately implementing problem-solving to assist the client with adjustment.

SLPs are not psychologists.
There are boundaries with topics discussed.
- Examples of topics that are outside the scope of SLP counseling:
  - Marital problems
  - Chronic depression/Anxiety
  - Unrelated health issues
It's important to recognize when you feel uncomfortable and to refer when necessary.

Appropriate sharing: Being intentional about the information you share and do not share about yourself.
Non-Judgmental: Being aware of your biases and never pressing information as “good vs. bad” or “right vs. wrong.”
Comfortable with tears and emotions: Resisting the urge to re-direct and providing a space for the patient/family to process emotions.
Keeping the focus on the patient/family: Determine their specific needs and be flexible.
Not being solution oriented: Focus on the patients and what they are communicating and not on finding a solution to their problems.
Ability to terminate the relationship: Set your patients up for success with discharge.

Desensitization: Targeting the alleviation of anxiety about triggering situations.
Relaxation: Training your patient to use strategies to relax.
Counter-questions: Using questions to determine what the patient/family is really seeking.
Reframing: Directing the patient’s/family’s attention to the positives.
Open-ended/Indirect questions: Encourages individuals to share more than a one- or two-word answer.
Role playing: Prepping your patient for anxiety-producing situations.
Empathetic listening/Paraphrasing: Active listening with rephrasing of their shared feelings.
Silence: Gives the individual space to formulate thoughts and often share more.

Parents of a 5-year-old boy with autism who is non-verbal ask you: “Will he ever talk?”
A spouse of an individual who has sustained a significant stroke leaving him with left-sided hemiplegia and severe Broca’s aphasia asked you, “How long before he is normal again?”
A 25-year-old female individual who stutters tearfully states, “I hate how lonely I am! I don’t think I am ever going to find a man who will love me because of the way I talk.”

Roth, F. P., & Worthington, C. K. (2016). Treatment resource manual for speech-language pathology. Cengage Learning.