Counseling

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					Counseling




   (adapted from Roth &
   Worthington, 1996)
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 ABC’s of fluency are more
 easily practiced and mastered.
Qualities of the effective
clinician

 Sensitivity to the client’s 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
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
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.
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
Counseling techniques

Therapeutic techniques
  Relaxation
  Desensitization
  Role playing
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
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
More...

Overuse of positive feedback can cause it to
 lose its value
Counseling should address strengths as well as
 weaknesses
Don’t push the client to do things (disclose,
 engage in desensitization, etc.) before he is
 ready
Understand your client’s specific cultural
 background and how it may affect the
 therapeutic process
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
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.
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 ABC’s of stuttering
To help clients become their own judges
 and self-reinforcers
To assist clients in obtaining a feeling of
 fluency control
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.
The relationship stage
 First steps are taken toward modifying speech and
  stuttering
 Assignments: problem solving when they aren’t done
  or don’t work well.
   Confrontation: identifying the ABC patterns that
      either facilitate or impede tx progress
   Dealing with nonverbal affective responses that
      impede tx
 Probing the client’s language: understanding what the
  client is trying to say
 Encouraging positive and negative reflections on the
  tx process
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
 client’s typical coping patterns
Developing mutually agreed-upon series of
 short term goals leading to long term goal.
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
Specific thoughts for
parents
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
Probing feelings about therapeutic
 approaches
Encouraging open discussion in the family
Probing the causes of therapeutic
 “plateaus” or “backsliding”

				
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posted:7/21/2011
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