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Speech and Language Therapist, Hospital

A narrative of change in speech and language therapy

'I am working with a young woman in hospital who has had a stroke and now uses a wheelchair. She worked full-time before being admitted to hospital.  In her mind she was thinking about life as a disabled person, unemployed, and having to rely on other people to do everything for her.  She was raw and every time she spoke about her future, she cried.  I was seeing her for a communication assessment, but she was more concerned about coping with her emotions than her communication.  When I asked about her goals, she found this hard to deal with and was crying all the time.  She wanted support with managing her emotions so I made a referral to the neuro psychologist.

'She asked if I could carry on seeing her. Using the techniques I have learned here, I felt I could offer her assistance to help her to be more positive.  She agreed and we made a contract.  She said she was fed up crying and was drained by all her tears. She specifically said, "I don't want to do that again".  We agreed that I could distract her if she cried, by reflecting what she said back to her. When I asked her to tell me about herself, her strengths, she said initially she couldn't do anything and had nothing. I used the ‘What's been better?’ question, and she said she had no confidence, no self-esteem. 

'I persevered and the turning point came when she talked about when she was 16, left school and had gone to get a job.  I said so you were a "tough, independent wee girl".  She agreed that she was independent.  She said ‘I showed my mum’ and I got in touch with that.  She was a private, independent person and didn't like the ward. She felt that being in hospital people were telling her what to do and she wanted to be very independent and in control.

'She started to say positive things. It was a positive story, although a lot was negative about how she saw herself and her future.  She would find it difficult when she got a package of care and had people coming into her home.  I was trying to flip that to get the positive.  Her body language changed, she gave more eye contact, she was smiling, and they were far fewer tears. Her face lifted, she used to look out of the window and now looks at my face.  There's more expression on her face.

'I see her once a week, as she has had to stay in hospital for a bit longer. Now I am asking what I could do differently to move her forward. Reflecting back on what she spoke about last week and see where it goes from there.  How she's doing in the physio, what's been better and what’s good for independence. The next signs of change would be that she continues to think about positive things herself. 

'It was lovely as I was never really sure I was saying the right thing but the changes over three to four weeks and the positive things she was saying and her giving evidence of her confidence, for example in the jobs she had whereas before she said she never had any confidence.

'I can see it can work. I did have concern about my remit, skills, and could I cause damage. I had confidence from the person wants me to do it.

'I have learned not to be so rigid. The person can manage emotion and what she wants support with.  I could have withdrawn after the referral to the neuro psychologist. My biggest learning is that just using these questions can really make a difference and that lots of silence is okay.'

Speech and Language Therapist, Hospital

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