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June 15, 2013

Professional Issues Class Post: Counseling

Counseling is a critical part of the SLP’s scope of practice but not a large part of the curriculum. Consequently, many of us however are not comfortable with this topic. Why is that and what can you do to feel comfortable with the interpersonal aspects of the profession?  Should the department and/or ASHA focus more on this topic?  If so, how?

Counseling is a considerable large portion of the profession-- moreso than I ever initially gave it credit for.  The field of speech-language pathology is so integrated with many elements that make the talent of counseling an important trait to have.  It is no easy feat to approach situations where breakdowns of communication or language are apparent, and the task of discussing those challenges are given to the SLP, especially with regard to informing caregivers and family members on what the bigger picture is, considering their loved ones. Consider the following hypothetical situations in which counseling is necessary and challenging:

1. A 56 year old man suffers a CVA (cerebral vascular accident) which damages his right frontal lobe, causing Broca's aphasia.  How would you approach the family members following an evaluation and assessment in terms of reporting abilities and limitations of his communication?

2. A 4 year old boy is seen for an assessment because of his severe unintelligibility and is determined to have childhood apraxia of speech. How would you counsel his family on this condition and what it means for his speech intelligibility (among other things)?

3.  An 86 year old woman is brought to a skilled nursing facility and her family wants her to be evaluated for signs of dementia.  How would you approach the family on how the assessment is to be performed and how will you counsel them if your findings do support evidences of dementia?

See? Counseling is important! As professionals, we are taken to task the important duty of communicating to our patients and their loved ones what the larger picture is with regard to their challenges and conditions.  I've often wished that our program offered a course on counseling but have really pondered how such a course would truly address this need for practice and refinement? Would we be asked to record a counseling session for critique?  Write papers on hypothetical situations and report how we'd approach them? Are projects like these truly reflective of what the true nature of counseling really is...? I mostly think not, which is why I think a class in counseling has yet to be offered-- it is such as refined skill. I believe that no coursework in the world will prepare you for the day that you have to just jump in, perform, and hope you've done your best. Luckily, I believe the profession of communication disorders attracts very compassionate and empathetic people--something I firmly believe any strong counselor will excel in.  Without empathy or understanding, the act of counseling would feel empty and heartless.

When I first began my early endeavors in this career, the act of counseling intimidated me. It still does, to a very large degree, partly because it is never an easy feat to tell someone that there is a problem, even if there are viable solutions.  "Difficult news" is never easy news.

I've been completing my final externship with a private practice, and this environment has offered the most opportunities for me to counsel patients and family members more than any other.  For now, I feel a strong senses of intimidation and waves of nerves wash through me.  What if the parent asks a difficult question that I have trouble answering?  What if I am unable to thoroughly explain the condition and areas of breakdown so that the family can better understand the situation?  How will I react if I am met by emotional outbursts by caregivers if I deliver less than good news?  All of these questions flood my senses as I approach the act of counseling, and I can only hope that time, experience, and practice can make me a better clinician in this regard.

I think the WKU program has done a fine job of integrating the subject of counseling into each class that is offered.  I don't think a separate class is needed--as mentioned before, I don't necessarily believe any project or class requirement would adequately simulate the real counseling experience.  Sometimes, it just takes real world practice and refinement to improve a skill, which is what I expect our externships to offer.  As they say... practice makes perfect!

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