Category Archives: Reflective Practice

Talking Mats in Practice

Following on from my last blog introducing my journey with Talking Mats (TMs), I have described below two examples of my use of TMs in practice. I specialise in working with people who have had sudden onset brain disorders, such as strokes, brain injuries and other progressive brain disorders, such as Parkinson’s disease and dementia. I work in a rehabilitation hospital where we provide a service to the elderly and to a neurological rehabilitation unit.

Talking Mats has been an invaluable picture communication tool to facilitate communication with people who present with cognitive (thinking, memory) and/or communication (talking) skills as described in the examples below:

The first example of TMs shows how it can be used to get to know someone and find out what their hobbies and interests are.

This is Bob’s Talking Mat:
Topic: Indoors activities – likes and dislikes
Bob (*name changed) had a large stroke that affected the left side of his brain. This affected his thinking and talking skills. It also affected his walking and he was using a wheelchair in hospital. Bob found it difficult to engage in conversation. The Physiotherapist and I thought that TMs may be a way to help Bob tell us about himself. We also wanted to see how he responded to using TMs to see if this would help him to think about some goals.

We started with symbols that Bob would find easiest to understand, so we explored Bob’s hobbies. The topic we picked was ‘indoor hobbies’ – this was placed at the bottom of the mat. We asked Bob how he felt about different indoor hobbies encouraging Bob to place the pictures on the mat. Using a visual scale of like/so-so/dislike at the top of the mat, Bob told us he liked music, TV, snacks, and card games. He disliked reading, arts and crafts. He felt ‘so-so’ about pets, computers, chatting, cleaning, cooking, photographs, and relaxing. Using the information in his ‘All about me’ book filled out by his family and talking to Bob more about his likes, in particular music and TV, I was able to incorporate his music choices in our music group. Bob became very vocal in the music group, happily singing away to his favourite band! Bob enjoyed TMs and it was used successfully to help Bob set his goals. The picture symbols also helped Bob’s thinking, understanding and talking. The visual framework of his hobbies allowed him time to think, process and respond.

This is Ruby’s Talking Mat:
Topic: Management of domestic life
 Ruby (*name changed), a 92 year old, was admitted to hospital with dementia following a fall resulting in a fractured hip. She lived on her own with some help from carers. As a result of her dementia, her thinking and memory were affected. The dementia also caused her to muddle her words and she would talk about her pet ‘penguin’ meaning her ‘parrot’.

The hospital team were worried that Ruby may not manage at home on discharge from hospital and that she may not fully understand the risks if she chose to go home. The Occupational Therapist and I used TMs with Ruby to look at how she felt about managing her self-care and domestic life at home. Ruby was engaged in TMs, but it became apparent that her insight and awareness was impaired. For example, Ruby forgot she had carers to visit her and that her meals were prepared for her by the carers. The hospital team were also concerned about Ruby during the night as she needed help in the hospital to get to the toilet and she would not be able to do this without help at home.

The Social Worker and I worked together with Ruby using TMs to look at her capacity to make an informed choice about her discharge destination. According to the Mental Capacity Act, “individuals must be given help to make a decision themselves. This might include, for example, providing the person with information in a format that is easier for them to understand”.

We carried out TMs as shown in the picture above. The topic, ‘domestic life’, was placed at the bottom of the mat. The top scale at the top of the mat, ‘easy’ was placed in the left hand corner; ‘so-so’ in the middle and ‘difficult’ in the top right hand corner. Ruby felt that cooking, paying her bills, cleaning, shopping, laundry and money were difficult. She felt unsure about being able to make a snack and there was nothing she found easy. When we asked her if she wanted to add anything else to her mat, she said that she was worried about ‘somebody ringing the bell’; ‘falling over’; night-time – ‘being alone’.

The Social Worker and I carried out a ‘sub-mat’ to explore with Ruby other options regarding discharge from hospital. It was felt, given the level of her care needs in hospital, that a nursing home might be the safest option.

Sub-mat exploring discharge destination options including nursing home:
Topic: Nursing home positives and negatives
 The topic placed at the bottom of the mat was ‘nursing home’. The symbol options on the previous mat that Ruby felt were ‘difficult’ were used for the sub-mat. The top scale for this mat was ‘like’, in the top left hand corner, ‘so-so’ placed in the top middle and ‘dislike’ in the top right hand corner of the mat.

Ruby put the ‘eating’ symbol under ‘like’ as it meant to her that her meals would be provided and that she would be eating with others at mealtimes if she chose to. She liked that her laundry would be done for her, and she liked the fact that she would not have to worry about the shopping, cleaning and cooking, as this would all be taken care of by the nursing home. We discussed the concerns that she had about people ringing the bell at home and that she would not be alone at night time.

We gave Ruby a copy of her TM so that she could think about what we had discussed together. A few days later, Ruby called over the SLT and Social Worker on separate occasions when sitting in the ward dining room and said she was keen to ‘get going and look at nursing homes’. I felt that the visual framework of TMs had helped support her thinking, memory and understanding. It gave Ruby ‘thinking space’ to add her concerns of ‘someone ringing the bell’, and ‘being alone’ at night. The mats showed Ruby’s problem solving, such as her difficulties at home versus the benefits of a nursing home. The Social Worker and I felt that Ruby had capacity to make an informed decision regarding where she wanted to be discharged to from hospital. I am pleased to say that Ruby was very happily ensconced in a nursing home chosen by herself and her family.

Leila Paxton

For more information about this blog and foundation training (TMs beginners) please contact me via:
Email: leilapaxton@hotmail.com
Twitter: @leilapaxton

 

 

 

My Journey with Talking Mats

Talking Mats (TMs) I hear you say, is that a mat that talks?! And so begins my story of Talking Mats. Talking mats is an evidence-based pictorial tool developed by Dr Joan Murphy in 1989. Since its creation, it is used in the UK and worldwide.

What does Talking Mats do? It gives individuals with thinking and talking difficulties a voice. This means that it gives those with difficulties expressing themselves a medium to communicate: for example, to express thoughts, make choices, have a chat. Research has shown its effectiveness with individuals who have sustained a stroke, dementia or MND as well as adults and children with learning difficulties. It is also used with individuals who stutter and asylum seekers where English is a second language.

How do you use it? Firstly, I suggest to anyone new to Talking Mats that they enrol on the day’s Foundation Training to understand the theory of Talking Mats whilst gaining the practical experience on the training. A topic is selected from a core of topics and the individual is asked how they feel about aspects of this topic, placing the picture on the mat where they feel this applies to them. There is a top scale with a range of headings depending on the question asked. For example, see the picture below – the topic is ‘hobbies’ and the top scale is ‘like – so so- dislike’:

Talking mats can be used to explore a variety of elements including the individual’s insight and awareness, their goals, exploring their views, management of activities of daily living, facilitating capacity, and facilitating conversation. The complexity arises in the use of Talking Mats and the skill in asking the relevant questions. Initial mats, can often, lead to a ‘sub-mat’. More to follow on this with case examples in my blog next month!

I initially did my foundation training in London, run by Talking Mats, in 2013. Since that initial day’s training I have not stopped using Talking Mats! In November 2015, I travelled to Talking Mats HQ to train as an accredited trainer in Stirling, Scotland. The 2-day course was inspiring and reflective. Joan, Lois and Rhona brought out the best in us and gave us constructive feedback to continue our learning. Their hospitality and the beauty of Scotland left me feeling inspired and confident to deliver their foundation training. The course participants were teachers, SLTs, OTs and a social worker. In sharing each other’s videos, we exchanged views and ideas. I came away with ideas of using TMs as an outcome tool; and to explore using TMs in our groups – I had not considered this before. It encouraged course participants to reflect on their own communication skills in their videos carrying out Talking Mats, as well as how to teach the core principles of Talking Mats to others. I am now qualified to teach Talking Mats at foundation level (beginners). So far, I have run one course in the NHS and one independently. I have enjoyed teaching Talking Mats and incorporating my own experiences of using Talking Mats. The reflective process is also transformative for the participants who have attended my foundation courses. The use of video and reflective feedback enables changes in SLT practise. Feedback from participants included their use of TMs: using TMs symbols they were able to reflect on what went well and what didn’t. The ideas and the variety of videos shared by the group participants was just as inspiring for me as a facilitator, as it was for them. Ideas such as using TMs with carers to compare their views with their relatives and using a child’s TMs picture on the front of their SLT report or school report, for example.

I highly recommend the accredited training for those that have completed their foundation Talking Mats training and have experience of using Talking Mats in practice.

 

Leila Paxton

For more information about Talking Mats, please visit: www.talkingmats.com
For more information about this blog and foundation training (TMs beginners) please contact me via:
Email: leilapaxton@hotmail.com
Twitter: @leilapaxton

 

Supervision keeps us awake!

I have been fortunate in my career to have some really excellent supervision, but all too often I hear from colleagues that the service they work in does not offer quality supervision. I regularly hear that for many it becomes a tick box managerial function, concentrating more on the doing of therapy rather than the being or becoming a therapist. Yes, we need to have time to check on whether we are using the right procedures, we need affirmation that we are abiding by the right policies, but this should not form the main focus of supervision sessions. I have found it helpful when supervising colleagues to devote some time in each session to the doing, i.e. the day-to-day activities of the job, but to ensure that there is enough time to talk about the being and becoming, i.e. to explore our emotional and psychological responses to our work and how the work is affecting us. Geller in Fourie (2011) rightly says that “attention to the affective and intersubjective aspects of clinical relationships has been neglected in speech-language pathology” (p. 197).

We encourage students at the Universities at Medway programme to use reflection from day 1 to explore their feelings about their experiences in becoming a therapist. We need time to explore our emotional responses and reflective writing offers a chance to do this. In professional contexts we could learn so much from colleagues in psychology about issues related to transference and countertransference. One particularly useful session I recall was where I was encouraged by an experienced supervisor to unpack the feelings that had been aroused by working with a family where there were bereavement issues, which in turn had awoken emotional responses in myself. This allowed me a safe space to reflect on my role with this family and to make me more aware of my own responses.

Nicky Weld’s book on transformative supervision for the helping professions has been very influential for me. She points to a fear of people having emotion-based conversations in supervision for fear of not being able to manage what comes forward. This lack of acknowledgement of our emotional responses can ultimately lead to a risk of burnout. In the context of ever-reducing funding, I would urge colleagues to ensure that quality supervision is provided and that time is made to attend to creating, through supervision, a safe, protected environment for learning, personal and professional development without which we will stop growing. Ryan (2004) says of supervision: “It wakes us up to what we are doing. When we are alive to what we are doing we wake up to what is, instead of falling asleep in the comfort stories of our clinical routines” (p.44). Let us stay awake and not fall asleep on the job by falling back into familiar routines. Supervision can help us unpack received wisdom.

photo-feb-2016

 

Jane Stokes
Senior Lecturer, Speech and Language Therapy
Faculty of Education and Health
University of Greenwich

 

 

 

 

See further reading:

Geller E. (2011) Using oneself as a vehicle for change in relational and reflective practice. in R. Fourie (ed) Therapeutic Process for Communication Disorders. Hove: Psychology Press, 9.195-212.

Ryan S. (2004) Vital Practice. Portland UK: Sea Change Publications

Weld N. (2012) A Practical Guide to Transformative Supervision for the Helping Professions; Amplifying Insight. London: Jessica Kingsley

Stuttering Pride

img_550c7b384eebdAs a speech and language therapist who works in the field of stuttering who doesn’t stutter, I’ve lately taken an interest in the notion of “dysfluency pride” or “stuttering pride”. I have been drawn to “stuttering pride” because of the similarities I see in the “gay pride” movement. As a gay man who felt a lot of shame about my own identity growing up, I noticed some common parallels that people who stutter and the LGBTQI faced (feeling isolated, passing as fluent or passing as straight because of societal pressure).

Many definitions of stuttering unknowingly situate stuttering as something that needs to be ‘fixed’ or ‘treated’. For example the International Statistical Classification of Diseases and Health Related Problems (ICD-10) defines stuttering as “a speech disorder characterized by frequent sound or syllable repetitions, sound prolongations, or other dysfluencies that are inappropriate for the individual’s age. Similarly, the US National Library of Medicine’s website, MedlinePlus states that stuttering is “a speech disorder in which sounds, syllable, or words are repeated or last longer than normal. These problems cause a break in the flow of speech (called dysfluency)” (author’s own italicised words for emphasis).

Although helpful in the medical world, where science’s role is to fix the human body and to reduce impairment, these definitions do nothing to reduce the stigma attached to stuttering. One can look at how far the Deaf community has come along with human rights, advocacy and resistance against the removal of sign language (promotion of oral education). I often read about Deaf pride and the acceptance that being deaf is seen as a unique difference rather that a disorder that needs to be treated. An excellent book that discusses the tension between the medical model and the social model of disability is Andrew Solomon’s book, Far From the Tree. One of my favourite quotes from Solomon’s book is “Fixing is the illness model; acceptance is the identity model; which way any family goes reflects their assumptions and resources.” (pg. 37). Solomon’s book uncovers the complex journey parents embark on when their children are radically different to themselves. Solomon interviews parents of children with Autism, parents of children who are Deaf and many other parents of children who are different. Stuttering does not feature in Solomon’s book, but the content is relatable to parents of children who stutter nonetheless.

Following the International Stuttering Association World Congress/National Stuttering Association in Atlanta (July 5th – July 10th), my hope is that one day the world understands stuttering as much as it understands deafness. In the Deaf community, the use of sign language is central to Deaf identity, and attempts to limit its use are viewed as an attack. In a similar vein, for a person who stutters, stuttering is central to Stuttering identity and that society’s expectation for communication to be fluent places unfair demands on people who stutter.

I conclude this post with a wonderful poem by a student who I’ve been working with. This remarkable individual has taken ownership of her stutter and together we are working on ‘letting her stuttering out’ and for her to ‘give herself permission to stutter.’ I encourage you to see stuttering as a unique difference, one that celebrates diversity of the human race and one that teaches the world how to really listen.

Stuttering by Brenna (aged 10)

Stuttering is good, stuttering is bad,

Stuttering can make you happy, stuttering can make you sad.

Stuttering can teach, stuttering can learn,

Stuttering can cost, stuttering can earn,

Stuttering can grow, stuttering can shrink,

Stuttering can be stupid, but it can make you think,

Stuttering can be anger, stuttering can be fine

Stuttering belongs to lots of people, but stuttering is mine…

 Voon Pang

Picture1Voon Pang, Bsc HCS, MNZSTA, CPSP is a speech-language pathologist at the Stuttering & Treatment Research Trust in Auckland, New Zealand. Voon blogs for the Stuttering Foundation of America and has travelled to the United States, United Kingdom and Australia to be better equipped at helping those who stutter.

 

 

 

 

 

 

Finding meaning in therapy

As a speech and language therapist and researcher, Mark Ylvisaker inspires my work. Mark was both a speech and language therapist and philosopher, and someone who passionately devoted his life to working with people with brain injury. Back in 2007, he said “in the absence of meaningful engagement in chosen life activities, all interventions ultimately fail”. A phrase like this really resonated with me as a therapist. Therapy needs to be meaningful. However, it wasn’t until a few years ago when a Professor asked me “but what is meaning?” that I started to consider the importance of this term.

In our interactions involving people with brain injury the term “meaningful” is regularly used; meaningful goals, meaningful activities, meaningful roles, meaningful participation and meaningful engagement. But what I found particularly interesting to learn was that philosophers couldn’t agree on the definition of meaning owing to its complex, fluid and multifaceted nature. In fact, philosophers argue that meaning does not surrender itself to a definition. They do agree however, that meaning is comprised of three features: connectedness, coherence, and subjectivity. Connectedness refers to the linking of experiences so that they can be understood and interpreted. Coherence refers to a person making an evaluation of their life or experiences as making sense or being coherent. This is usually done within a bigger context that may include a goal, motivation or life at large. Both connectedness and coherence relate to meaningfulness, as a disconnected and fragmented (incoherent) life is considered meaningless. Subjectivity refers to the subjective experience of connectedness and coherence, as the experiences in a person’s life have no meaning unless they are meaningful to someone.

This started me thinking about how we as therapists create meaning for people with brain injury. Some people may have a notion of what is meaningful to them but need our help to connect and make sense of their experiences. Others have lost meaning in their lives so we need to help them find it again. Meaning can be derived in many ways, from multiple contexts (or sources). An activity or action alone cannot create meaning. It is the emotional response to those activities or actions and the link to a higher purpose, motivation or goal, which is important to the creation of meaning. As a therapist, I’m often left wondering how to do that for people with brain injury. A few years ago, I came across some research by Levasseur and colleagues (2010) who described contexts according to a person’s involvement in an activity (alone through to interaction with others) and the goals of that activity (to satisfy basic needs through to helping others and contributing to society).

Taxonomy

 

 

 

 

 

Proposed taxonomy of social activities

This “taxonomy” made me realise that much of the therapy I was offering was at some of the lower levels (individual or small group activities focused on fulfilling basic needs e.g. buying a coffee, ordering lunch, having a conversation). Little therapy was focused on helping others or contributing to society in interaction with others. That is not to say we should do that, but rather, doing therapy in multiple contexts (or sources), which includes Levels 4-6, may serve to increase opportunities in which a person with brain injury can derive meaning.

The creation of meaning during the therapy process is considered essential for a person with brain injury to engage with the rehabilitation process. People with brain injury just want to take part in something, give something back to others and be someone important, in spite of their injury. If we can help people with brain injury take part in meaningful activities reflective of their desires, they may also report a better quality of life, which some would consider the ultimate goal of therapy. Some ways in which we could achieve this include: individual and group therapy; therapy in real-life contexts chosen by the person with brain injury; video-taping interactions involving people with brain injury and family members, friends and/or significant others; completion of projects designed to help others learn more about brain injury or help brain injury survivors cope with the experience of sustaining a brain injury; setting goals that relate directly to something bigger (e.g. getting a girlfriend, getting a job). These are just some examples of the contexts that may help people with brain injury find meaning in their lives.

Ultimately, I wrote this blog to convey a simple message: how important it is to help a person with brain injury find meaning in their lives. This message attests to Mark’s legacy who was dedicated to making lives for people with brain injury both meaningful and satisfying. Not losing sight of what is meaningful to our patients and clients is what we can do as therapists to take his life’s work forward.

IMG_2900

 

Dr Nicholas Behn
Speech and Language Therapist
City University London

 

 

Inside Culture Club

Dom: ‘Post brain injury life is about staying busy and in touch with the world. To that end one of the things I go to is a group set up by my counsellor Cathy that we tentatively call ‘Culture Club’. No, we don’t sit around and discuss Boy George! Once every two months a group of about 6 brain injury survivors plus Cathy sit in a pub in Teddington and discuss anything we’ve been up to. We’re all at different post brain-injury stages; we’re all different ages and very different people. Lotte is the cinema expert; I tell bad jokes and tell Martin I find modern art questionable. He sighs, I’m sure they all do. Cathy tries to stop me swearing. More sighs. The point is it is something to do rather than just sitting at home which seems to be the all too often fate of the brain injured. We have one thing in common, it’s not much, but it’s enough.’

Angela: ‘Everyone is friendly. I look forward to it a lot. I like the variety of topics. I find it funny and Dom makes me laugh. If I could sum up Culture Club in one word, I would use the word “stimulating”. I find the group as a whole, stimulating. I find it hard to communicate which can be frustrating. It helps when Cathy sits next to me as I feel as if I have a friend. I would recommend the group to other people.’

Toby Art 2016Toby: ‘A group for people with speech issues. Although it is called the culture club, it is basically a group for people to get together and chat. Topics could be theatre, comedy, film, TV…basically anything that is NOT sport or politics!
It is a fun and supportive group of people where you will not feel judged. I’m using it to focus on turn taking and concentrating on anything cultural that I might encounter. There is also a marvellous selection of biscuits made available! I do my artwork at:   www.workshop305.com

Martin: ‘Culture Club is a group. I didn’t want to be part of it. I didn’t want to have a stroke – but I did. We all have reservations and might be cautious about coming to a group like this. But once you are there, it’s friendly, inclusive and accepting. We are all different but have things in common. You can say and share as much or as little as you like. You should dare to join us and take that leap.’

Culture Club takes place every other month on a Tuesday morning. Check out the website for more information: www.intandem.co.uk/pdf/groups/cc2016_2.pdf or contact Cathy: cathy@intandem.co.uk .

 

Stammering activism and speech and language therapy: an inside view

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This month Sam is guest blogger for the Did I Stutter? Project – you may read her blog here

Stutter-Affirming Therapy: Removing the Obstacles to Spontaneous Speech

isad_ribbonHow can we help people who stutter come to understand stuttering as something other than the negative opposite of fluency? We can begin by exploring with them the mechanisms of ableism that position those with disabilities as inferior. People do not exist in a vacuum. Discourses that give meaning to our world pre-exist our births. Our experiences and the meaning we make of them are contingent on these discourses. For example, the narratives circulating in our milieu surrounding masculinity, femininity, sexuality, race, and disability will drastically impact the experiences we have and how we make meaning of them. However, it would be overly simplistic to see stuttering as merely a problem of able-bodied oppression. People who stutter come to us with a very real embodied complaint that speech is difficult and effortful. They are not able to say what they want to say when they want to say it. Can we address both the social reality of ableism and also the individual reality of tense, effortful speech without appealing to fluency? Absolutely! Ableism and tense, effortful speech are both obstacles to enjoyable, spontaneous communication. When we focus on removing the obstacles to spontaneity we both work within a framework that does not privilege fluency as more desirable than stuttering and also honor people who stutter’s lived experiences of struggling to speak.

Obstacles

Privileging Fluency

  • Many people take for granted that the preferred outcome of therapy is fluency.
  • Focusing on spontaneity leaves the outcome of therapy open-ended, recognizing that communication is dynamic, sounding different in different situations with different individuals.

Discrimination and Stigma

  • We can encourage people who stutter to see their stuttering as an act of civil disobedience. Each and every time they stutter they are engaged in a political activity. They are refusing to let ableism silence their voices. They are stuttering even though society would rather them speak fluently or not at all.

Coping mechanisms

  • Often coping mechanisms that have been developed to help mitigate the experience of daily stigma and discrimination prevent spontaneous speech because they prohibit open stuttering and attempt to obfuscate it.
  • These can include the addition of starter sounds, silent blocking, hesitant pauses, changing words, tensing of articulators, and avoiding speaking altogether.
  • People who stutter can be encouraged to break up these coping patterns. Together, we can find easy, enjoyable, and pleasurable ways of stuttering.

Stuttering as hardship

  • The experience of stuttering is often presented exclusively in terms of suffering and hardship.
  • Fortunately these problem narratives can never capture the full richness of people who stutter’s lived experiences. They will have plenty of material from which to craft new narratives with new meanings.
  • We can assist people who stutter to uncover moments and memories that contradict these problem narratives by exploring their past experiences for times that stuttering was not unpleasant or worrisome. Maybe there were even times they enjoyed stuttering.
  • Ableist discourses run deep in our society and often people who stutter will need additional support crafting stutter-affirming narratives. We can invite them to roleplay stutter-affirming communication both in the therapy room and outside of it. How would someone who enjoys stuttering act? How would they speak? What would their stuttering sound like? What would it feel like in their mouths?

iStock_000012551980XSmallStutter-Affirming Therapy
By welcoming people who stutter to address the above obstacles to spontaneity we can support them in making new meanings of their experiences. They can come to understand stuttering as a valuable part of their lived experience and not merely the negative opposite of fluency. By affirming the experience of stuttering we open up its meaning to a myriad of possibilities. Its unpredictability can be fun and exciting rather than a source of fear. The movement of lips and tongue can be pleasant rather than frustrating. The sounds of repeated syllables can be desirable rather than embarrassing. We must not restrain these new meanings with any preconceived notions of what success looks, sounds, or feels like. Instead we can help people come to take pleasure in their speech no matter its form, to help them find a stuttering aesthetic of their very own.

Happy stuttering!

Christopher Constantino

Christopher Constantino is a PhD candidate at the University of Memphis and a speech-language pathologist at Shelby County Schools. His research interests include the discursive and material production of disability, the therapeutic process, and the facilitation of agency. Chris enjoys riding his bicycle. Contact him at christopher.d.constantino@gmail.com

There is always an alternative!

letitgobyleunigYou could call me a supervision junkie. I love it! I always have. To be honest I find it hard to understand those who don’t feel the need for it as for me it is like oxygen. It is one of life’s essentials. Essentially it keeps me, a speech and language therapist of nearly 25 years (very scary!!), breathing deeply and steadily, in the demanding and often surprisingly formidable and sometimes treacherous environments of schools of South London and Surrey. I know that if I did not have regular supervision, I would not have the stamina to continue to be fit to practice and I would have choked under the heavy pollutants of managing unrealistic expectations and negotiating the smoke screens and barriers to providing the best care for my clients. Supervision in all its forms – 1:1 with a supervisor for overview of my work; peer supervision with someone working with a similar client group; group supervision in a wider geographical area; occasional supervision with a specialist in a specific field – I access all and need each.

Supervision is like a filter, it gives an opportunity to sort out the stuff that needs sorting and provides a cleaner, more concentrated view of the contents. Over recent years, I’ve been on the two supervision courses by intandem on “Being Supervised” and “Being a Supervisor”. I have attended a practical course on Personal Construct Psychology (PCP) (Kelly) to improve my problem solving and questioning. Through the Counselling CEN, I’ve attended a Brief Solution Focussed Therapy course and have learnt a lot about active listening by being a member of an Action Learning Set. All of these opportunities have provided me with tools for ‘filtering’ my clinical and supervision work, so that I have a way of looking at things with clarity and with new ideas distilling through from the process.

Here are the top 5 ‘gems’ which I have learnt so far that help me in my role as a supervisor and as a person needing supervision:

  • There is always an alternative way of doing things (Kelly, PCP)
  • If someone has a problem, ask them what they think could help. It is often easy to forget to do this! (Kelly, PCP)
  • Supervision comes in lots of forms, but the 1:1 face-to-face session is the most powerful. To be listened to, properly, without interruption and with the full attention of another person, allows the person being listened to, to think more clearly than you would ever expect. Give this to your supervisees and clients and they will be very grateful. (Action Learning)
  • We are what we do! Always find out what sort of supervision history people have had in the past and what they have done. Asking them to draw a timeline of this can be very useful. (intandem courses)
  • “What else?” This is a very useful question to ask and opens up a million and one possibilities that might not have come to mind if the question had not been posed (Brief Solution Focussed Therapy)

Final thought: No one likes to be told what to do. Supervision should not be about being told what to do. It can be a very rich and fertile opportunity to grow and be nurtured and do things a different way. I challenge you to give it a try.

Ann-M Farquhar

B App Sc (Speech Pathology), MSc (Human Communication)

Speech and Language Therapist in Independent Practice

Interests in: Language Disorder, Social Communication and Supervision of Speech and Language Therapy Colleagues.

See my YouTube     https://youtu.be/5rZwG7IAzhg

 

Supervision at the fork in the road

image1We all start out with dreams and ideas about how our careers will go. It’s hard to foresee when, where or why the forks in the road will come, but it is almost certain that they will. This blog post explores two key ways in which supervision helped me to negotiate a fork in the path, keep hold of my dreams and step into independent practice.

Seventeen years ago, I embarked on a career in Speech and Language Therapy, with a dream to become a neuro rehab therapist. In the early stages of my career I was fortunate to have some great supervisors (also my managers), who nurtured my enthusiasm for neuro rehab.

In 2008, I took a senior post in a small department without access to clinical supervision within the organisation. I was holding a complex caseload, but for the first time also dealing with wider departmental and organisational issues. I felt the need for external supervision to develop my practice and take care of myself as I entered a more challenging stage of my career.

My line manager continued to oversee my work in post, particularly supporting my CPD, and helping me develop the SLT department. The separation of my clinical supervision to another time and place enabled me to attend to the needs of my clients, as well as my own needs, within this increasingly challenging work context. Through external clinical supervision, I had the freedom to reflect on the needs of my clients more deeply and my own journey more broadly.

Hawkins and Shohet (2007) discuss self-care as an important aspect of clinical supervision. Drawing an analogy between the ‘good enough helping professional ‘ and Donald Winnacott’s concept of the ‘good enough mother’. The ‘good enough mother’ may struggle to cope with the rigours of motherhood without the help and support of another adult, just as the helping professional may struggle to cope without the support of a supervisor. At this point in my career, I was faced daily with the devastating reality of people’s lives following brain injury. I was starting to develop quite strong ideas about addressing these needs with clients but also felt frustrated by the difficulties of achieving gains for my clients. I could easily have been worn down by these frustrations, but with wise and meaningful supervision, these difficult experiences ‘….. were survived, reflected upon and learnt from’ (Hawkins and Shohet, 2007). Through supervision, I became much more conscious of my concern to address my client’s ability to participate in their chosen life roles and started to think about how I could facilitate this for them.

It was at this time that my own personal circumstances changed. With a young family I was keen to be as present at home as much as possible without completely losing connection with my profession. I started to explore how to manage this change in my life and find a way to continue working within my chosen specialism.

Cathy and Sam have written about the changing role of supervision which ‘….. has now extended to one that supports and facilitates emotional resilience, opens up possibilities where there seem to be very few and fosters an individual’s personal/ professional resources to manage change’ (Bulletin, February 2013).

With this changing picture, refined by my professional interest and constrained by my personal circumstances, my supervisor helped me to consider diverse options as I stood at this fork in the road. I don’t remember who initiated the idea of independent practice, but I know that this path seemed daunting, much less travelled and insecure. I didn’t know how to begin walking away from the security of paid employment.

The supervisory relationship was a place of safety that allowed me to: test out ideas, evaluate the pros and cons of working independently, make plans and connections, review early steps and ask silly questions. I saw my first independent client in 2009, nearly six years ago. The transition to independent practice has been necessarily slow as I have been at home with my family, but this has brought with it opportunity to reflect on each small step in supervision and build slowly in confidence. With my supervisor’s support this process has been much smoother and more satisfying than it might have been as early ideas have come to fruition.

Work is not how I envisaged it seventeen years ago, but it does really work for me in the context of my life now. However, I could so easily have missed this path if I had not been able to access great supervision at the fork in the road.

Mary Ganpatsingh
www.communicationchanges.co.uk
@Comm_Changes

References
Supervision in the Helping Professions, 3rd edition (2007), Hawkins, P. and Shohet, R.
Supporting robust supervision practice, Sparkes, C. and Simpson, S. (February, 2013) Bulletin