Tag Archives: Innovation

Judged Response

One afternoon, whilst speaking to my closest friend Errin Yesilkaya, we wanted to do something. Just something. An exhibition sprung to mind, then I must have stammered shortly after this revelation. There we have it. Judged Response, an exhibition which places explicit focus on stammering, celebrating the differences of those people who stammer, demonstrating these differences and challenges through the medium of art, which has no boundaries, as you are not bound by what you can utter. The visual nature of the artistic medium allows for freedom of expression which people who stammer may struggle with otherwise. This was our idea and vision.

Errin and I brought Shahram Saadat on board as a person who stammers. After many meetings, we decided on our idea and proposed this to Arts SU, the Student Union of University of the Arts London where we all study BA (Hons) Photography at London College of Communication (LCC). We were successful in gaining an exhibition space at LCC, thus then our creation and curation of the exhibition began.

Our motivation for this stammering and art fusion was primarily the fact that stammering has not as such been greatly presented in an artistic context. This exhibition would be an accessible way for anyone, someone who stammers, someone who has knowledge of stammering, or ideally, no knowledge at all of the complexities of stammering to engage with the day-to-day struggle of speech. Ideally, this exhibition would be as public as possible, detached from the white space of the gallery and firmly placed within the public domain for maximum impact and a realisation from the public that stammering is a challenge and not something to be mimicked, laughed at or perceived as a weakness.

Audience and raising awareness was a key reason for us curating an exhibition of this nature. Stammering is something which is talked about, however, while it is talked about, it is not an easy subject to be public about due to the sensitivities of the subject matter, the differing views and effects it has on people who stammer, so any kind of public exposure of stammering has to be carefully, ethically thought through. Art, to some extent, has no limits, it is the artist’s personal perspective, not those of an organisation, so it has the potential to accurately represent (particularly if the artist stammers) the insecurities, strengths, niggles, that stammering brings up.

The three of us each exhibited a work of our own (I was the odd one out, presenting two), all communicating varying themes and aspects of the nature of stammering. Errin’s piece, £137.80, speaks for the way in which our consumerist culture may view people who identify themselves as having a disability are viewed within society. Shahram’s piece, Appropriated Reactions, focuses in on the facial expressions a person who stammers may experience when speaking with someone. My works, Subtitled Liberation and We Judge Because We Don’t Understand, through text in a physical and video sense, provides a liberating, anonymous, fluent opportunity for multiple people who stammer to express their true emotions about the struggle of having a stammer.

The Private View was extremely well attended by people who stammer, friends of those who stammer and people with no connection to stammering at all. Pertinent and important discussions were also held over an exciting, engaging Q&A session with the exhibitors plus Claire Norman, Founder of the Stammerers Through University Campaign (www.stuc-uk.org) and Tim Fell, Chair, British Stammering Association. Overwhelmingly, the most common phrase uttered to me during the night was ‘this is the start of something’ or similarly ‘you’re onto something’. Of which, I agreed with everyone who said this to me. This is the mission I’m on, to show the connection between stammering and art, through a number of mediums, to ultimately affect public opinion.

We are keen, as a collective, to develop a more ambitious exhibition, extending on the ideas raised in Judged Response, perhaps being more interactive and immersive. Watch this space.

 

Rory Sheridan

e) photo@rorysheridan.co.uk
w) www.rorysheridan.co.uk

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

 

Stammering Pride & Prejudice, City Lit, 3rd Nov 2016

I must admit I arrived with a little apprehension, this was the first time I had attended a public event related to stammering. I was aware that I was wearing two hats, as a person who stammers and a psychologist who has a special interest in working with PWS.

The opening remarks by Mark Malcomson were warm and welcoming, there was a real sense of excitement in the room around exploring this novel and perhaps controversial way of viewing stammering. As a psychologist I’ve tended to think about how a person relates to their stammer and the psychological processes that may or may not help in living well with a stammer. Whilst I have an appreciation that the social world we live in will influence this, I had never fully considered that stammering as a problem can be viewed as a socially-constructed phenomenon and so I really was intrigued to learn more about the social model of stammering.

The first talk was by Prof Michael Boyle who is looking at how one might go about reducing stigma around stuttering. This was an interesting look at the stereotypes around stuttering and how these are reinforced in the media. Michael is clearly doing some great work looking at ways to influence public attitudes to stammering. One of the things presented in his research was how people sometimes associate stammering with anxiety and there was the idea that this is a negative stereotype that should be refuted, with stammering presented as something separate to anxiety. I was interested to find that this evoked an emotional reaction in me. As a psychologist, I was struck by the parallels in how PWS are stigmatised in many similar ways to people with mental health difficulties. We are consistently given messages about how we ‘should’ be… whether it be happy, calm or confident. Anything other than these desirable mind states are ‘wrong’ and need to ‘fixed’ or controlled. Those of us who don’t easily fit this, again whether it be disfluency, anxiety, lack of confidence, I could go on… are given the idea, even as children, that we must change this. This can lead to a sense of shame around  normal human experiences and emotions and presents a narrow and limited view of what it is ‘ok’ to be like. My concern with some of the ideas alluded to in Michael’s talk around anxiety as separate to stammering is that we risk reinforcing negative stereotypes around mental health and potentially invalidating the experience of the many PWS (me included) for whom stammering AND anxiety are intimately interrelated aspects of ourselves. Ultimately PWS will have a diverse range of experiences and personalities, so as a community let’s celebrate this diversity.

Next up was a hard-hitting and thought-provoking talk by Katy Bailey. Katy talked about how negative attitudes toward stammering is akin to a person without legs being denied a wheelchair. How we are constantly given the message that to be different is wrong or bad. She recounted her personal experience to highlight how the way that stammering is approached, even within the world of stammering research and therapy, can reinforce this ‘damaged’ narrative. Internalisation of these narratives leads to an internal struggle to control stammering. For me, Katy hit the nail on the head here! Social and cultural norms will tell us it’s wrong or bad when we don’t fit the mould, when you couple this with our problem-solving brains that tell us we should be able to control our internal experiences in the way we can our external world, we end up with the makings of a lifelong, futile struggle to control what can’t easily be controlled. Moreover, this struggle ultimately comes at the cost of pursuing a rich, and meaningful life. PWS often sacrifice important personal values and goals in an attempt to control or hide this part of themselves. These sacrifices or costs will come in small packages, a latte when you wanted a cappuccino, and really big packages, giving up on the dream of a particular career or vocation. Katy highlighted the role of acceptance or letting go of the struggle as a meaningful way forward for her in living with and coming to find meaning in her stammer. As a therapist who teaches acceptance-based therapies (namely Acceptance and Commitment Therapy or ACT) and someone for whom working to let go of these struggles has been so liberating and empowering, Katy’s talk really resonated with me. Moreover, it highlights the need for more work clinically and research on the potential role for acceptance-based therapies (which are gaining momentum in the world of psychology) in working with PWS. Here the move is away from control and towards willingness to experience uncomfortable feelings, such as stammering, in order to move toward values life goals. This theme of self-acceptance was echoed later in discussions between Chris Constantino, Josh St Pierre and Dori Holte, and in Walter Scott’s talk about how his stammering was approached in school.

The rest of day saw talks by Iain Wilkie on the wonderful work he is doing with the Employers Stammering Network (ESN). Iain talked about how it’s to everyone’s benefit if people who stammer can feel more comfortable and able to be open about their stammer at work. Even more, people who stammer bring particular strengths and value to an organisation.

Other highlights included Sam Simpson and Rachel Everard talking about how speech therapy might inadvertently reinforce unhelpful social norms, and the need for PWS to develop a positive, empowering collective identity to be able to ‘live choicefully’. This echoed the conspiracy of silence Iain referred to earlier in the day. Sam and Rachel’s talks brought up the need to educate SLTs in this complex interplay between social, psychological and physical factors that affect how people live with a stammer.

Some light relief from the hard-hitting stuff was provided by Patrick Campbell, Ian Hickey and Nisar Bostan who entertained us with comedy and poetry. The day ended with a bang with Ian leading a reading from an excerpt from one of King George VI speeches. Anyone in the audience who was, as Ian beautifully put it , ‘lucky enough to stammer’ was invited to join in. Such a moving end to the day and truly put meaning to the idea of pride in stammering.

I’m so grateful I was able to be part of this day, I feel sure that these ideas are the start of something really important in changing and challenging how we conceptualise stammering both for PWS and crucially for the therapists working with them. Sam said it when she said PWS are best placed to challenge the status quo, from the inside AND I know therapists can play such a powerful role in empowering people to find the courage required to do this work. Let’s get to work!

 

Lorraine Maher-Edwards
Email: lorraine_maher@yahoo.co.uk
Twitter: @LorraineEdwar

 

Totally OK to Stammer at Work (1/2)

Iain smile photo “Here comes Iain WWWWilkie” was the greeting from a fluent-speaking former colleague at a reunion party in a London pub last week.

Ten years ago his words would’ve put me firmly on the back foot, but these days I grab such playground comments as an opportunity to talk about how enlightened employers are now viewing stammering as an issue to be recognised and supported. So I launched straight in and explained how two years ago the formation of The Employers Stammering Network (“ESN”) was a giant leap forward in our aim to make it “Totally OK to stammer at work”. As we chatted, my former colleague initially looked awkward but he then started listening attentively and, when I was leaving, he suggested we meet again for lunch sometime soon.

So what can we learn from this unexpected conversation about stammering in the workplace?

Firstly, the stigma of having a stammer at work is still perpetuated by many good people across many fine organisations. This is largely under-pinned by ignorance rather than malice.

Secondly, most people, including many who stammer, have never had an informed conversation about stammering in their lives. There is, as Norbert Lieckfeldt my Co-Chairman at the ESN says, “a conspiracy of silence around stammering”. Yet, once engaged in a conversation, people are often eager to learn and happy to become supporters.

Thirdly, the ESN is proving attractive to leading private and public sector employers who’ve never thought before about stammering. They’re keen to ensure their employees are not held back from reaching their full potential just because of their dysfluency.

So you might ask, what is the purpose of the ESN and how is it going after its first two years?

Put simply, our purpose is to create an employment culture in the UK where it’s “Totally OK to stammer at work”. More officially it’s “To help employers in supporting the development of their people who stammer, thereby enabling employees to achieve their full career potential, for the benefit of both the individual and the employer”. Like most purpose statements, it’s a bit of a mouthful!

Since launching with the energetic support of the Rt Hon Ed Balls in May 2013, we now have 13 [1] major organisations as members, collectively employing over 400,000 people in the UK alone. Our growth saw us recognised as one of the UK’s “Most Awesome Networks” in February 2015 by Inclusive Networks [2] and we have two more major employers lining up to join. However, it’s the support that we feel all around us that truly has Norbert, myself and many others believing that we’re on our way to achieving our transformational aim to make it “Totally OK to stammer at work”.

Most encouragingly of all, there are many employees who’ve already benefitted from their employer being an ESN member. An ESN colleague at a leading bank stepped into a much better role after gaining the confidence to ‘go for’ the job he really wanted. Another ESN colleague decided to talk openly about his stammer in front of a promotion panel in a way he’d never have done a year earlier – and got the job! And a senior manager with a pronounced stammer at my own firm told me “You changed my life!” It doesn’t get any more transformational or emotional than that!

One of the biggest challenges for the ESN is helping our members to succeed in getting stammering talked about in their own organisations. This isn’t about adding it to a wish-list in a strategy paper, but about how to change long-embedded cultural attitudes towards stammering, like those I encountered in the pub last week. It requires the public commitment of the leadership, the identification of role-models and courageous conversations that ask for and explain how to achieve that change. As Lou Gerstner, former Chairman of IBM said, “Culture isn’t one aspect of the game – it is the game” [3].

Our experience with the ESN is that it’s a tough, untrodden path that we’ve started to take; a sentiment that’s expressed beautifully in this translation from Antonio Machado’s poem Cantares:

”Pathmaker there is no path
You make the path by walking
By walking you make the path”

After all, we’re trying to get organisations to embrace something that most of us, dysfluent or not, have spent much of our lives feeling uncomfortable even talking about. However, it’s a fresh willingness to enter into courageous and vulnerable conversations that’s at the heart of the ESN’s opportunity – and in next month’s blog I’ll share insights into my own journey from a shy, underperforming employee into a more confident and fully engaged partner at EY.

In the ESN, we’re learning to be patient, to take the knock-downs and to overcome our doubts. Yet in just two years since launching, with the changes that we’re increasingly seeing in employees who stammer and with ever-expanding awareness of stammering amongst employers, it’s already become “OK to Stammer” in some parts of the UK workplace. Now that really is a path worth walking.

Iain Wilkie

Iain Wilkie is a Senior Partner at EY and the Co-Chairman of the Employers Stammering Network   (“ESN”). All views and opinions expressed in this article are entirely his own.

If you or your employer would like information about the ESN, please email either iwilkie@uk.ey.com or Norbert Lieckfeldt at esn@stammering.org or mail@esn.org.uk

 

[1] Current ESN members: A4E, BrightHouse, CitiGroup, Defence College for Health Education & Training, DHL, EY, First Group, Lloyds Banking Group, Prudential, RBS, Santander, Shell, & Warrington Borough Council.

[2] Inclusive Networks www.inclusivenetworks.co.uk

[3] Louis V Gerstner Jr, “Who says Elephants Can’t Dance?”, Harper Collins

 

 

 

Yoga and Brain Injury

Mail AttachmentI have never written a blog before, but the invitation to do so is a timely one as I ‘grow up’ and find my way with social media on my freelance ‘adventure’. Since I took early retirement from my role supporting people with Creutzfeld Jacob Disease (CJD) and their families in the NHS, my goal has been to develop all the different aspects of my work and life that I am passionate about, and link them in a coherent ‘whole’.

Working with a person’s experience of cognitive impairment, living with the risk of an inherited dementia, my family, travel, yoga …. and my travelling companion Personal Construct Psychology (PCP) are the key things I knew I wanted to be part of this new phase of my life. I worried about keeping focused without the structure of a job to go to in order to keep focused, so with the luxury of now being able to make my own timetable, I went to an early morning yoga class three times a week.

I started to elaborate my sense that yoga could bring relief for my clients living with cognitive impairment. I undertook yoga therapy training for people working with children with special needs with Jo Manuel at the Special Yoga Centre, and started to engage one of my elderly clients in a gentle yoga practice. It is striking how she can remember movements and postures from the previous week, whilst she is unable to remember what has been said just five minutes beforehand. This in itself is a major opportunity for validation in people with cognitive impairment, the critical essence of person-centred interventions, however yoga has a great deal to offer people with brain injury on many levels: rehabilitation, health and well being, managing cognitive impairment and emotional consequences of brain injury.

A year of weekly yoga therapy with a woman who was bed bound following three strokes and diagnosis of dementia, with neurogenic pain and deemed unsuitable for rehabilitation, is now moving herself around her bed, up to sitting, transferring without the use of a hoist. She is also now able to discuss the nature of her difficulties and articulate the changes she experiences in her body. The role of yoga in rehabilitation, promoting and maintaining mobility, breaking down the goals into small and manageable steps for people with neurological challenges and cognitive impairment has huge potential, not least because of its focus on awareness.

Peter Blackaby (2014) explains how it is feeling movement that brings about learning (sensory motor cortex), and not ‘telling’ our muscles to move (motor cortex). He quotes a study where monkeys have had the motor cortex for a skilled movement removed from their brain and yet can still make that same skilled movement. Another part of the brain takes over. However, when the sensory motor cortex is removed for that same skilled movement, the movement can no longer be made at all. Critically it is the noticing involved in the practice of yoga that brings about change in body and mind.

Yoga is well known for the links between mind & body, and yoga practice is in fact a physical and tangible route to achieving a state of meditation, which has evidence based health benefits in generating the opposite of the stress response in the body. There is increasing evidence for change in circulatory, emotional and mental health, in addition to changes at a cellular level in people who are recovering from cancer. From a psychotherapeutic perspective, yoga is also a way of working with the aspects of ourselves that are not easily put into words, and may never even be articulated. In this way yoga brings therapeutic intervention within reach of people with severe communication disorders.

I have been elaborating this idea from the perspective of PCP. Our theories about the world around us exist at all levels of awareness, and while psychotherapy might advocate that its role is to help people articulate their construing at lower levels of awareness, I personally wonder whether that is always necessary for change and wellbeing? In PCP we see words as merely what we use to convey our discriminations and conclusions about the world around us, and there will always be much of our construing that remains inaccessible… that part of our construing which is non-verbal, intuitive, or was developed before spoken language. Yoga enables us to experiment and elaborate ourselves at that nonverbal level and so is it surprising that the practice of yoga brings about changes in our thinking and our emotions?

There are many different forms of yoga, and increasing research evidence for the health benefits of yoga in general, and for yogic breathing techniques and mindfulness in particular. For me, I am interested in what all yoga has in common rather than a specific approach, and its contribution in the process of achieving and practising mindfulness, with a view to developing yoga as a therapeutic intervention with people with dementia and other forms of brain injury.

I am currently taking referrals for one to one work and I go into residential and day care facilities. l now look forward to teaching the first 25 hour yoga training for people living or working with people with dementia and other forms of brain injury in March 2015 at Special Yoga in London. It’s a course for family members interested in exploring ways to engage with their relatives with brain injury, for health professionals interested in the application of yoga with people with brain injury, and for yoga teachers and practitioners wanting to understand more about the experience of cognitive impairment, whether this is stable and resolving, or progressive and/or fluctuating. The flyer can be found at http://specialyoga.org.uk/teacher_training/yoga_dementia/ or you can contact me directly.

Clare Morris
07545 287139
clrmrrs@me.com
www.claremorris.org.uk
@ClareMorrisPCP

News Group: Behind the Scenes (2/2)

I wrote last month about how some of our neuro-rehabilitation service users benefit from the experience of attending the news group we run on the ward.

news2

 

As a service, we have found that we can use our group provision for a number of purposes:

 

We can use the group to provide different packages of care to different service users within the same session. We may invite people to attend news group as part of their goal-based therapy. For example, they may be working towards a more consistent use of intelligibility strategies, or demonstrating increased communicative confidence by facilitating discussion or presenting a news item as part of the session.

Some people know they are able to participate relatively independently in group conversation. However, they may continue to benefit from support, for example to counter the effects of fatigue or distractibility. Further speech and language therapy (SLT) input for these people beyond discharge from our ward may not be indicated, but there are benefits to them continuing to attend the group while they are with us. This monitoring and maintenance package allows room for fine-tuning and further confidence boosting prior to discharge. Such people are also often positive role models for other group members who may require higher levels of support to engage in group conversation.

Some group members still early on in their admission, or newly referred to SLT by others in the multidisciplinary team, may join us for a number of assessment sessions. This may be because the group setting reveals more interactive skills than they are able to show in the often more transactionally-based ward setting. Alternatively, for some there may be an indication of higher-level language processing or social communication difficulties, which do not impact particularly on the ward. Attending the group allows further assessment of the impact, which their impairments may have in more complex group conversation. It can also provide a concrete starting point from which to discuss these subtle difficulties with the service users who may not themselves necessarily consider any difficulties to be present

Group sessions provide rich observation opportunities for new staff and students. Over the past year, we have been joined by students from nursing, medicine, physiotherapy and occupational therapy. We invite new staff members to join us as part of their induction. The richness of the experience of coming to the group as an observer is that there is the opportunity to meet people with a number of different communication diagnoses, and to see in action the strengths and needs these diagnoses may create. A further positive is that none of our observers is passive; anyone coming to visit our group is invited to participate, thus enriching their own experience and learning, while providing further positive role modelling for our service users. Our own SLT students will often take on facilitation of the group for the duration of their placement, which works particularly well with peer placements.

The news group is a joint project between occupational therapy (OT) and SLT. We have found that we need to meet frequently to review and discuss the strengths, needs and progress of each participant to ensure we keep our input focused. Otherwise, there can be a risk of running a session which goes through the motions of looking at recent news stories, but which gives no specific input to any of the packages of care identified for each service user. I will admit that this has happened at times especially if staffing is low or the ward very busy. After a ‘going through the motions’ session, I feel I have facilitated an opportunity for social interaction and the chance for some people perhaps to take on a bit of information about current news events. However, I also feel that the same session could have been facilitated by an enthusiastic volunteer with no specific training in or knowledge of communication impairment.

News group review has now evolved into a joint SLT and OT review of the needs of whoever is on our ward at any given time, and whether there are other groups we could run. This can often change from month to month as we aim to create group opportunities for the people we have on our ward, rather than to try to shoe-horn people in to a fixed format. For example, in the last fortnight we find we have several people with specific comprehension needs and have this week started a ‘points of view’ group structured with a very low language load, but providing opportunities for interaction and expression of likes and dislikes through music appreciation (a clear split in today’s group between heavy metal and the Jackson 5!), chocolate tasting, TV reviewing and more as we plan it..!

Nic Martin

News group: ‘being part of something’ (1/2)

10.30am and this week’s News Group is about to start on the neuro-rehabilitation unit where I work as a speech and language therapist. As I arrange chairs and sort through the newspapers, John arrives without any prompting, having remembered to consult his diary for his programme for the day. John is working on strategies to compensate for memory impairment.

Steve is next to walk in. He has come prepared with a couple of news stories to present to the rest of the group. Steve has had a long hospital stay and is close to getting home now. He wants to fine-tune his speech intelligibility strategies as he hopes to make moves to a gradual return to his job where speaking to small groups is a significant component. The plan is that next week he will co-facilitate the group with me as he has enjoyed re-exploring the nurturing side of his nature; discovering that he can be supportive of others here in hospital just as he has done in his work role in the past.

Jan arrives on time having consulted her diary too. She announces that she has ‘done her homework’. She spent a session with the speech and language therapy assistant yesterday selecting and preparing a news item to present to the group. Jan has used the group to rebuild her communicative confidence. This was low when she first came to us due to difficulties with verbal explanation as a result of generally slowed processing. Like Steve, Jan has now become a supportive member of the group, using sessions both to challenge herself to convey information and her own opinions concisely, as well as to encourage other group members to contribute to the discussion:

‘Other people share topics and I’m learning more. It’s like educating. I’m learning about more and different things. I’m speaking loudly. Preventing other people from butting in because before I just whispered. Now I don’t shut up talking. Definitely more confident. I can tell people ‘shut up, I’m talking!. I won’t cope with rudeness. I liked having the chance to prepare the day before.’

‘I was worried at first about coming but then I actually really enjoyed it.’

news2

As Steve and Jan organise their notes, Hashim comes in, with my occupational therapy colleague and co-facilitator. Hashim finds it difficult to inhibit voicing his every thought, which as well as impacting on conversation, is affecting his ability to engage and benefit fully from his other therapy sessions. We will agree as a group before we start that we will endeavour to let everyone have a turn at getting their point across, and that we will supportively highlight when any group member may be returning to a theme they have already clearly expressed in whatever way they can. This provides a structure for giving direct feedback to Hashim as necessary. He also has the opportunity to interact with positive role models such as Steve and Jan throughout the session’s discussion on world news, sports news, celebrity gossip, local news or perhaps even a bit of light-hearted ‘ward gossip’. More serious ward issues may arise at times. The group is a safe place to express any frustrations and to problem-solve with others possible courses of action. As staff members, we may be able to take an opportunity here to provide information, or to offer to take on an advocacy role for a given issue if needed.

Now Val walks in with a student nurse who wants to learn more about the role of the SLT on the ward, and who will join our group today. Val has marked expressive aphasia. In a group setting, she has been able to show that her functional communication skills far outweigh her abilities in more specific word-finding tasks and in the limited, often practitioner-led, task-focused conversation opportunities which she is most frequently exposed to on the ward.

Vladan too has aphasia. Previously a keen daily newspaper reader, he has said he enjoys the group as it allows him the extra time he needs to absorb information about what is going on in the world. Participating in the group also provides Vladan with unpressured space to try out compensatory strategies, such as drawing or circumlocution, when word finding difficulties arise. 1:1 support from one of the two co-facilitators is available. Any encouragement to verbal output from Vladan is in response to whatever course the group discussion is taking. There are no test questions or situations where Vladan is expected to attempt to convey information already known by others in the group. Some weeks, with his strong auditory comprehension abilities, Vladan may choose to participate primarily by listening and commenting with facial expression (often cynical!), a laugh or a nod.

Josie completes the group for this week’s session. It is not easy for Josie to remain orientated to time and place. The group provides an opportunity for her to receive gentle orientation as we will generally begin by checking the date on the newspapers, again avoiding any direct testing. The daily news then provides ready-made, genuine material for orientation to the times we are living in as the group as a whole attempts to piece together the facts on any given news story before moving on to opportunities for discussion and debate.

‘It’s lively and thorough and makes me feel as though I am part of something.’

Although definitely a place for rehabilitation, our ward does feel very much like a medical ward with people spending large amounts of time at their bed-space on a bay when they are not engaged in therapy sessions or activities. Group members have frequently reported that they enjoy the opportunity to socialise with other people they may otherwise not meet; people from so many different backgrounds and ways of life:

‘Works as a social mechanism – that’s important for people with communication problems. It helped me to work on volume and voice but it was more about confidence.’

Group members consistently express how they enjoy the group sessions and will talk about the news group during their other therapy sessions that day. The group membership can change from week to week according to the admission and discharge patterns on the ward. However, the format of the group is such that as long as we have news to discuss, there will be people on our ward who can benefit from and simultaneously contribute to what the news group has to offer.

 Nic Martin

Please note all names have been changed to protect identities.

 

Who or what helps us make the changes we strive for? (1/2)

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As we step into 2014, we may have exciting new projects ahead. The weather is starting to change, there may be a spring in our step and our goals for the year may seem more possible. New growth feels achievable! So how do we each go about attempting to make the changes we are striving for? Do we launch into the new adventure with planning and preparation? Do we consider who or what we might need to set up the new experiment and how we might sustain the changes? This month we hear from three colleagues who share their experiences of embarking on a change. Next month we hear the voice of our clients. What emerges from these stories is the unique and different ways people approach change, using a combination of personal knowledge & resources and the process of reaching out to others for help to start out on a new path.

Sarah reflects on how she set up a change to her life recently. Sarah starts with turning to others: ‘Doing it with another person e.g. spouse, who wants to make the same change for the same reason; doing it together can make all the difference. Having others around me who have made this change or a similar one and seeing the benefits it has brought them can be inspiring. Also, being confident and assured that those who may be supporting me in change are well equipped, be it in terms of qualifications, emotionally, intellectually etc.’ And then looking to her own resources: ‘I have found taking smaller regular steps is more likely to result in lasting and actual change. Seeing benefits (albeit small) can spur me on and be very motivating. Being flexible and open to adjusting my expectations or goals in light of new information can keep the momentum of change and stop me from going backwards. I often think of the wheel of change we sometimes use in therapy and how easy it is to slip backwards if new habits aren’t maintained!’

Nic knows what works for her: ‘My projects usually start as an idea while I’m cooking tea for my 3 kids. In between peeling, stirring and then usually overcooking, I brainstorm ideas on the pile of scrap paper I keep in the kitchen for this very purpose. The next step is to talk to my trusted, enthusiastic, inspiring, always encouraging colleagues and my service manager who generally tell me to ‘go for it’. I must then set myself a strict deadline to ensure the idea is not squeezed out by the pressure for face to face clinical contacts.’

Mark: ‘In my experience support for ‘new growth’ comes from clinical supervision, sharing of ideas and projects with supportive and motivated colleagues, good team dynamics, and a supportive line manager. I found the opportunity to talk through the situation in relation to a big job change recently really helpful, especially my feelings related to it. It felt invaluable to do this with someone unconnected to the situation in any way (in private clinical supervision), as their distance and impartiality, not to mention enormous skill in listening and hearing the real issues, really helped me to see what was happening and to tease out why I was feeling such mixed emotions.’

New growth depends on many factors, including reaching out to a variety of people (both those within and outside a situation), being flexible enough to adjust expectations, setting useful deadlines and knowing what works for you as an individual. We invite you to email us with your stories of change and growth. What helped or hindered you to move in the direction you wanted? What lessons have you learned that you are carrying forward into your next innovation?

Thanks to everyone for their contributions so far!

Cathy

Therapy in Waterstones

Behind most books lies a tangle of anxiety about perception, rejection and word-choice. So the laden shelves of Waterstones in Teddington seemed a perfect backdrop for the local launch of ‘Stammering Therapy from the Inside – New Perspectives on Working with Young People and Adults’. Like publishing, the event pulled together an array of knowledge, experiences and feelings into full public view: therapists, people who stammer, people who don’t stammer. To my left was a man who, like me, knew the authors through therapy. To my right was a father whose son stammers; he had dropped into the shop out of curiosity. Elsewhere in the audience was Norbert Lieckfeldt who for many years has campaigned as head of the British Stammering Association. Speech therapy, whether private or in groups, is so easily hushed away like an embarrassing medical operation. The King’s Speech helped slash the stigma and fuel media interest, but hearing Sam, Carolyn, Rachel and others talk publicly about the evolution of their work seemed to take this one step further – from screens and newspapers into real-life.

Over many years I have been inspired by all three
authors at various stages of therapy. This event was a
reminder that I have struggled to communicate to
others what this therapy has been all about. For all they know I’ve been star-jumping and balancing
marbles on my tongue, like Bertie under Lionel Logue’s instruction. I suspect they are unaware of the
emotional mechanics at play. It was provoking to hear two people talk publicly about their own therapy. As Yahoo’s head of retail, Dan Durling has to (in his own words) ‘talk a lot’. He had at first approached his intandem therapy with frustration, wanting not to ‘talk’ about his stammer but just get a cure. It had taken him some time to realise that his friends and colleagues actually cared much less about his imperfect speech than he did. This was an important step in his journey toward acceptance and modification.

Similarly Cara Steger, an amateur violinist, in a display of ‘therapy in action’, talked of her struggle with the passive-sounding idea of ‘acceptance’. By contrast Cara had been used to a physical struggle in trying to be fluent. She compared her speech to learning the violin. The initial controlling impulse is to grip the bow tightly, but with learning and hard work comes a realisation that a lighter touch produces a better sound from the instrument. That had felt similar to learning to work with, not against, her stammer. It is rare that I hear other people stammer, and ironically I find it difficult when I do. Dan and Cara were largely fluent as they spoke, but where they did stammer I felt initial frustration for them, before focusing on the content of what they were actually saying. I wondered if others went through a similar process, and I reflected this might be how people feel when I speak.

Stammering is complex, uncertain and serially misunderstood. There is much to be gained from opening up a traditionally internalized experience, against our media backdrop of polished fluency and rapid delivery. For communities, schools, employers or whoever else, perhaps poignant local events like this are the way to go.
Walter Scott

Kinship and worship

International Stammering Awareness Day, 22nd October 2013

Over the summer I went travelling throughout Vietnam – a wonderful country where I had the pleasure of meeting many warm, openhearted people, eager to share their fascinating history, rich cultural heritage and exquisite cuisine.

Throughout my travels, I was frequently moved by the important role ‘kinship’ plays in Vietnamese culture, evidenced in strong family values and a deep respect for the other. So very contrasting to the Western emphasis on individualism and personal gain.

I was also struck by how central the practice of ‘worship’ is to Vietnamese life regardless of religious denomination. I returned home inspired by these important principles of community and celebration; and deeply committed to integrating them more fully into my work.

Tuesday 22nd October 2013 is International Stammering Awareness Day: an ideal opportunity to unite the community of people who stammer in order to give voice to the lived experience of stammering and raise public awareness.

intandem will be marking the occasion in two ways this year:

  • The Fluency Network – I will be taking part in a question and answer session via teleconferencing to mark the official launch of The Fluency Network, a newly established adult stammering service attached to the University Of Auckland, New Zealand
  • Book launch at Waterstones Teddington – on Wednesday 23rd Oct we are co-ordinating a local book launch to mark the publication of ‘Stammering Therapy from the Inside – New Perspectives on Working with Young People and Adults’. Do come along and offer your support
    – Click here for details

Through these two events we hope to bring together people who stammer, their families and friends as well as therapists and other people with an interest in stammering in order to foster new connections, open up dialogues and establish greater collaboration at both local and international levels.

Through kinship and the gathering together of the stammering community, we hope to extend our thinking about stammering, to celebrate developments in stammering therapy and to signpost relevant services in the voluntary, educational and independent sectors.

‘Alone we can do so little; together we can do so much’
-Helen Keller

Sam