Tag Archives: Support

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

 

Me, My Stammer and I

If someone had said to me few years ago that I would one day write a blog about something I am extremely conscious of, I would have laughed out loud! But here I am and this means a big step for me.

As long as I can remember, I have always stammered. I remember when I was about 5 years old and I was struggling to ask for a toy from a boy in a classroom and he said with a puzzled look, why do you talk like this? Up until then I never really noticed my repetition of words, struggling to get the words out etc.. I went home and asked my mum and she said it’s because you are still learning to speak and I believed her for a very long time!

Fast forward many years and I am still “learning to speak”! I was bullied in school for my stammering and my parents had to come for many meetings with the school to talk about it. Having any speech therapy was never an option as my parents believed it would all go away if I gave it time. My family helped me immensely by showing their support and patience, but I grew up thinking stammering was something to hide and not talk about to the world.

Despite being good academically I could never enjoy school, but my good grades and the thrive to achieve more kept me going, I always wanted to act and take part in debates and speeches, but settled for singing instead. This gave me a chance to experience the fluency I dreamt of. I used to envy people who could say what comes in their mind without even thinking about it!

waves Over the years my stammering was like waves with high and low points, but I became very critical and unforgiving of it. I would go over and over my speech and keep telling myself that I was not trying enough to speak properly. Thinking about it now makes me feel sad at how I would be divided into two with one side trying hard to communicate and the other just being negative! I hid my stammering from everyone and would cough, pause or whatever known hideaways to cover my stammer when talking to my friends and family, even at work. I managed to work as a telephone operator in a Call Centre for four years, but the constant efforts to cover up my stammering often made me extremely tired and out of breath.

It was only few years ago that I decided to try speech therapy. That decision did not come instantly as I had often thought of it, but only found enough drive to do something about it then.

The first call I made to find out about NHS speech therapy was very daunting in its own way. I was invited very quickly to the first appointment with a therapist in Chippenham, Wiltshire where I lived at that time. I went to the first session thinking there would be a magic cure waiting for me, but was also very apologetic to the therapist for wasting her time! After a few sessions, it was obvious that we needed to address my psychological approach to stammering before the physical side.

I attended a few sessions there and learned to be as kind, gentle and friendly to myself as I am to others! I know this sounds strange, but I learnt to look at me from a distance and appreciate myself. I started to take each conversation as it happened rather than thinking the whole day was a failure if I had stammered a few times during that day. Just as I was beginning to learn the positive ways to understand my stammer, we had to move from Wiltshire to West Sussex.

This threw me out of my comfort zone and I went back to my old self! It took me many more months to find out about speech therapy in the new area. I was told that there would only be one or two sessions to attend in my area before this service moved to Horsham, West Sussex. Desperate to do something about my attitude and state of mind, I took the chance. To be honest those two or three sessions probably did little to improve anything but they were reassuring enough to make me feel I was on the right track.

Finally, the speech therapist in Horsham helped me to achieve more and explore further. My anxiety was more about causing discomfort to others, but I learnt how that might not be the case and that others are not even bothered by it! We went through the relaxing techniques as well as some breathing exercises to ease the tension around my neck and upper torso, which helped a lot. I had days when the therapy or techniques were helpful, but there were also many days when I felt lost, confused and went back to my usual self-blaming thoughts!

One of my tasks set by my therapist was letting my employer know about my stammering. It happened at the right time as I was going for a job interview for a role I was extremely excited about. I went for the interview thinking there was no way I would get this job after I mentioned my stammering – I guess old habits die hard! But I was a little shocked and somehow disappointed to see that as I mentioned stammering and my therapy, they thanked me for letting them know and just moved on! I was hoping for gasps at least, but not even a slight twinge! That proved even more that my stammering was not as much of a trouble to others as it was for me.

I got that job and am still working there 5 years on. Not even once has anybody mentioned that my stammering has caused them any trouble or has come in the way of my job. My confidence grew with the years and I found a relief in letting people know about my stammering. This also gave me a starting point to focus on learning new skills and making new friends rather than worrying about where I stammered or got lost for words.

As one of the three speech therapists I had once said, “there is no such thing as perfect speech! It’s all about how you get your point across.”  I still have days or moments when I find myself lost for words or feel out of control, but then I take a moment and think that as long as I am able to make the other person understand my point, it’s ok.

I decided to stop taking therapy back in July this year because I felt I had gained enough skills in order for me to find my own way to be a “happy stammerer”. This ability to be ok with stammering is something I never thought I would achieve.

As much as I appreciate all the hard work my NHS speech therapists have put in to help me achieve this state of mind, I feel this was only possible when I decided to take control of my stammering rather than being controlled by it.

Anyone out there who is wondering whether therapy is for them… or perhaps have had therapy, but did not find it much help, I would like to say it’s more like trying a hat… you will have to try a few to find the one that fits! And once you find it, it will not solve all your problems but it will give you enough lift to face life with your head high!


Amna

 

 

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

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 .

 

Transparency

I like to be really transparent. Early after a TBI, I had such magnificently apparent social communication impairments that my verbal blurts were excused. As I recovered in visual processing, attention, balance, auditory processing, and something else I can’t remember (probably memory), I looked a lot less disabled. That made the blurts more noticeable and out of place. [Side note: if you work in brain injury rehab, notice I did not include executive function in that list of improvements because that was on a painfully slower recovery trajectory.] As long as I was well-rested and with friends I could usually control blurts. Add in stressors like exhaustion, a crowd, background noise, and the blurting would let loose.

While verbal outbursts are often considered inappropriate, there’s a beautiful truth behind them. I told someone once she reminded me of algae. While she shamed me for about 10 minutes in front of other people for this transgression, what she failed to do was find out what I meant. I was attempting to give her the highest compliment I could think of. I’d been searching in my mind for how to compliment this person, and all that would come to me was a sensation of appreciation and an image of algae. So I told her about the algae.

Barton springsAlgae–the kind I was picturing–is a luscious jewel-tone, so saturated in color as to almost be unbelievable. It’s miraculous in its depth of color. It’s soft and inviting, pleasantly fuzzy even when wet. (That is so cool about algae!) Algae appears delicate but is robust, spreading its influence far and wide. You can try to stop it, but you must humbly lose. Your algae will return, and no matter how you feel about that, it will always be back: strong, resilient, soft, and green.

This was several years ago when I had no capacity to verbalize an explanation like that. It was just a sensation, the color, my childhood memories of Texas summer heat on my skin and the softness of algae on my arms as I rested in the freezing, unchlorinated waters of Barton Springs. I felt the memories, and I wanted her to be loved the way I loved playing with the stringy strips of green that floated on the clear spring water.

But no. Inappropriate. Rude, inconsiderate, oh well.

I have many Autistic and neuro-diverse friends, and we spend a lot of time communicating online. Since I now live in the frigid tundra of Portland, Oregon, I’m not hanging out at the swimming hole anyway. So I’m online a lot. I’ve learned many wonderful things about effective communication from this particular community, and I want to share two of my reflections about that here.

  1. Sometimes there is no cruel intent at all behind a statement.

Why, exactly, is it a problem if I say I don’t like your dress? I’m only saying I don’t like your dress. This isn’t to insult you. It’s 100% possible for me to dislike your dress while still holding you in the highest esteem and even asking you for fashion advice down the road.

Consider that sometimes there is no emotional baggage, ulterior motive, or crap behind verbal outbursts. They’re thoughts that come out without regard for the listener’s feelings. But that doesn’t mean they’re intended to hurt the listener.

If I say I don’t like your dress, we could move on. You’re even welcome to tell me that hurt your feelings! Then, I can say, “I’m sorry for hurting your feelings.” This is how it goes when you’re transparent with your thoughts and don’t assume someone’s trying to hurt your feelings.

  1. Be so transparent that it hurts.

I like to use HTML mark-up. You don’t have to understand computer code to do this, and in increases the odds that your intentions will ring loud and clear online.

If I want to be sarcastic, I make that into HTML-type instructions. (Instructions are inside <>):

<sarcastic>I don’t like your dress.</sarcastic>

(Of course, I don’t get why someone would say that sarcastically, but they might.)

If I need you to know that I sincerely love your dress:

<sincere>I love your dress.</sincere>

In real life, I speak in HTML opening mark-up. I say, “It doesn’t sound like I mean it, but I really like your dress.” Or, “Don’t be fooled by my tears; I’m really happy. I’m just crying.”

When someone with executive dysfunction blurts, even if they say something hurtful, you’re not obligated to assume it’s supposed to be hurtful or inappropriate. There’s always the possibility that the words came out in an unintended tone of voice, the wrong words came out, or that they were exactly the right words, but you didn’t want to hear them.

I want to make sure that we find partnerships in communication. People with brain injury are expected to curb our verbal outbursts, think before speaking (who really does that?), and be more kind and polite. I would ask that as we work on steps in that journey, listeners explore their listening and investigate the ways in which we are just as likely to misunderstand what someone said (or meant) as we are to sometimes say something that didn’t work out. Transparency, not resentment, might be a great key to helping us get through the awkward blurty times, whether we’re the listener or the blurter.

Cheryl Green, MFA, MS

Cheryl-with-waterfallCheryl creates media that combine personal narrative, humor, and social critique to create dynamic, accessible tools for cross-disability justice. She is on the board of Disability Art and Culture Project and served on the board of Brain-injury Information Referral and Resource Development (BIRRDsong). She volunteered with the National Black Disability Coalition and the Portland Commission on Disability.

info@storyminders.com
www.WhoAmIToStopIt.com
Stories from the brainreels podcast

 

Putting the Relationship in Supervision

images-9Supervision. The word invokes many different thoughts for me. The many supervisors I have had, and the many people I have supervised. And the formality of the word. I got a bit stuck when trying to move past this, so I read through multiple blog posts about having one’s communication shaped, ‘therapyed’ or embraced. These posts brought to my mind the way that we as Speech and Language Therapists (SLTs) advocate for all of this communication, in whatever form is successful or possible for each individual, yet when it comes to shaping my own supervision, the same rules just don’t apply. I turn up to therapy sessions with clients. But at times, have found it hard to access my own unique communication space (which will help in those therapy sessions I turn up to), why is that? We want our accountants to be au fait with current tax law, our mechanics to put the right parts in our car, yet for some reason there are times when we turn up to sessions not having invested in our knowledge space, which is essential to providing therapy. Why do we not seek it out if we don’t have what we need or want?

Reasons I have not accessed supervision include that I have worked outside of the NHS and just haven’t got round to getting any, I have had managers who haven’t seen its benefits (I have also had managers who have ‘over-supervised’!), and I have had supervisors where their style of supervision is just not my cup of tea. There have also been times when I’ve not been linked into a neat network of Speech and Language Therapists. At times I have craved this ‘simple’ structure of one senior SLT supervises me, and then I supervise an SLT below me. But currently that isn’t an option available to me. I am an overseas trained SLT, who has spent some time as a permanent staff member in the NHS, a wee stint working privately and am currently working as a locum in the NHS. My life is soon changing as I am looking to return home.

Right now, I am lucky, especially as a locum. I have regular supervision. I also give regular supervision. I have a clinical team leader (CTL) who is not an SLT, but who always has an open ear, and filing cabinet full of ideas, especially around complex issues such as safeguarding and setting up a service. But, we have both wondered on occasion, if she was an SLT, would we come up with the answer to a curly clinical quandary more quickly?

I also have, until recently, received private supervision from an SLT. On writing this I reflected about what brought me to private supervision, and it struck me that I was looking for that ‘simple’ hierarchical structure that I mentioned above. However, what came out was something different. I had the freedom to discuss anything as my supervisor was able to look at my thoughts and issues through a different lens, removed from the need to be managerial. Someone who was intrigued to help me find the balance in relationships, who did not have a stake in the outcome and, therefore, was able to challenge me in order to help me create boundaries within my work. In her removed position, she was able to help me understand what areas to drive forward clinically. However, this separation from my day-to-day work existence, meant at times I would need to go back to my CTL to float the ideas discussed.

It took me a while to access private clinical supervision. I would often go to my sessions with the anxiety that one has when the ‘to do’ list takes up three sides of paper. But when I would leave it was like a weight had been lifted off my shoulders – the exact same feeling that I have when I meet with my CTL. Although both of my supervisors are interested in serving the same purpose – making sure I don’t burn out – they come at it from differing perspectives.

The biggest thing I will be taking from my recent supervision experience is that it is all about relationships. The relationship with the supervisor and myself, but mostly the content of discussion is how I am relating to others. I have sated my need for the neat little SLT supervision structure. It is not a necessity to be supervised by your own discipline or receive clinical support from your own workplace. A perfectly excellent job can be achieved outside of these arrangements, as long as your supervisor knows what kinds of questions to ask, and is humble enough to say “Hmmm, is this what that looks like? If not, tell me more…” I can feel myself now asking similar-structured questions to the Occupational Therapists and Physiotherapists, who ask me how they should manage a particular situation. I pride myself on my ability to relate to my colleagues, clients and wider community as an SLT, but I need to leave my guilt at the supervision door because if I am not showing up to my own unique communication space then the relationships in my work just won’t work.

Anna Childs (nee Wivell)

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

 

 

 

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.

 

Reflections on my first BSA Conference: inspiration, connection, courage and community

photo

A week later and I am still feeling buoyed up by the positivity of the British Stammering Association’s National 2014 Conference, held in association with the Scottish Stammering Network in Glasgow. I was not sure what to expect as I made the long train journey north on Friday 22nd August, arriving just in time to attend the City Hall drinks – a grand and fitting social event to mark the beginning of the conference.

Conversations flowed as readily as the wine – with old friendships quickly renewed and new friendships founded. I was struck by the warmth, energy and harmonious chatter as the evening progressed – and which set the tone for the rest of the weekend. People mixed and mingled freely at mealtimes, between presentations and late into the night. It soon became apparent that the social aspect was an integral part of the conference’s success for many of the delegates – as the early morning photos at George’s Square clearly testify!

Significant highlights for me included:

  • Iain Wilkie’s keynote on ‘Transforming Employability’. Drawing on research highlighting employers’ ignorance and misunderstanding of stammering, Iain outlined the evolution of Ernst and Young’s ‘Stammering Network’ since its inception in 2011, which led to the launch of the ‘Employers Stammering Network’ (ESN), a BSA supported initiative, in 2013. Combining personal and corporate narratives interspersed with thought-provoking quotations, Iain advocated a cultural shift towards diversity and inclusiveness underpinned by flexible support processes involving the shared commitment of both employers and employees. To this end he invited all present to open up dialogues about stammering at work in the understanding that ‘there is no courageous conversation without vulnerability’. More information can be found on the BSA website: www.stammering.org/help-information/professionals-and-business/businesses/unlocking-talent-employers-stammering-network
  • Co-presenting with Katy Bailey (www.free-speech.org.uk) on the relevance of the social model of disability for stammering and employment. Relocating the problem of stammering in society and offering participants a chance to identify the physical and attitudinal barriers experienced in the workplace enabled us to explore how prevailing norms, language and stereotypes can go unchallenged and become insidiously internalised. Practical ways of managing these oppressive external and internal barriers were then discussed. Here is our handout if you are interested in finding out more.
  • Dr Allan McGroarty’s reflections on ‘Dr Quack and his stammer cure: quick fixes, bogus treatments and charlatans’. An amusing and informative review on how to spot a ‘Quack’ following the growth of the Internet and social media. Allan concluded by reflecting on the important role that the stammering and professional communities need to play in questioning and challenging false claims about stammering therapy in the public domain.
  • RSM Jimmy Lang’s motivational speech on ‘Reaching the Top’. The sheer grit, determination and resilience that Jimmy has applied to progressing his career in the army are truly impressive. Furthermore, his willingness and commitment to using his experience and influence to benefit others has resulted in the Defence College of Health Education & Training (DCHET) joining the ESN and developing clearer systems and support processes for other military personnel who stammer. Jimmy’s personal story offered a direct and powerful challenge to the ‘why try?’ effect often reported in the research (Corrigan et al., 2009; Boyle, 2013) due to the internalisation of public stigma. Exposure to Jimmy’s encouraging and constructive ‘can do’ attitude was particularly timely for the student I sat next to, who was contemplating a career in speech and language therapy and questioning the implications having a stammer would have.
  • Convincing reports on the BSA impact at the AGM, with a persuasive video testimonial on the successful Facebook page, underscored the need for greater involvement in fundraising in order to safeguard the future of the BSA: “Ask not what the BSA can do for you, ask what you can do for the BSA!”
  • The Gala dinner at the spectacular Science Centre followed by a highly entertaining impromptu exploration of Glasgow’s nightlife.
  • Bob Adam’s and Trev Bradley’s dynamic, engaging and practical workshop on ‘staying safe on the streets’ – a salient reminder given the unfortunate mugging of one of the conference delegates in the early hours of Sunday morning.
  • The infamous ‘Open Mike’ session where delegates queued for the entire 90-minute session to speak out in front of the bigger group – many for the first time, some to share their conference reflections, others to signpost a helpful resource (e.g. the Opening Doors employment course run jointly by City Lit and the BSA) and one person to get some practice in before his daughter’s wedding later this year!

A heartfelt thank you to everyone who made the 2014 conference possible, especially David Lilburn and John Mann, and to everyone who came and contributed to such a lively and memorable weekend.

In the online feedback, I was set the task of capturing the essence of the conference in four words. They would have to be: inspiration, connection, courage and community.

The next BSA conference is scheduled for 2016 – I’d highly recommend making a note in your diary now!

Sam

Boyle, M. (2013) Assessment of stigma associated with stuttering: Development and evaluation of the Self-Stigma of Stuttering Scale (4S). Journal of Speech, Language, and Hearing Research, 56, 1517-1529.

Corrigan P., Larson J. & Rusch N. (2009) Self-stigma and the “why-try” effect: impact on life goals and evidence-based practices. World Psychiatry, 8, 75-81.