Counseling and coaching in adult neurogenic communication disorders. Audrey L. Holland, Ph.D. Regents Professor Emerita University of Arizona

Transcription

1 Counseling and coaching in adult neurogenic communication disorders Audrey L. Holland, Ph.D. Regents Professor Emerita University of Arizona

2 Acknowledgments ASHA fpr inviting this presentation Marshall Goldsmith, who doesn t know me but got me into this anyhow Martin E.P. Seligman & Christopher Peterson, whose work is integral to my thinking Karen Reivich,and the ongoing Pod, my fearless leaders in this work

3

4 Assumptions of this Workshop Clients will refer to adults who have a variety of neurogenic communication disorders, AS WELL AS their partners, spouses, & other family members Emphasis here in stroke & aphasia, ALS Counseling/Coaching in relation to communication disabilities is within the scope of practice, as defined by ASHA. Counseling is the most underspecified of our clinical skills.

5 A Wellness perspective on Counseling/Counseling Some underlying themes Living the full catastrophe The importance of stories Sharing the expertise--a collaborative model Positive Psychology - principles and relevance Putting the themes into coaching/counseling practice For yourself For your clients The concept of counseling moments Agenda

6 Why a wellness perspective? The people who come to our attention differ from those who typically seek psychological or psychiatric counseling. They have a high likelihood of previous normalcy Something has happened, accident, chronic disease, etc.) that results in a fundamental change for them Getting on with life is a fundamental goal These features should significantly influence the nature of our counseling

7 The Full Catastrophe It is not a disaster to be alive just because we feel fear and we suffer.we must understand that there is joy as well as suffering, hope as well as despair, calm as well as agitation, love as well as hatred, health as well as illness» Katazanzakis, Zorba the Greek quoted in Kabat-Zinn, Wherever You Go, There You Are

8 Counseling Implications of the Full Catastrophe Underscores the importance of helping clients gain perspective on the bad things that happen(ed) to them Provides a firm and realistic basis for building resilience and optimism Foreshadows the role of growth and change in meeting challenges

9 My barn having burned down, I can now see the moon anonymous

10 A little story.. A retirement A decision.. An enlightenment.

11 In the words of Marshall Goldsmith. Don't cling to the past, everything that happened in the past is past, every time you take a breath, it's a new you, and the whole focus is on looking to the future, and figuring out where you'd like to go. It's creating a positive mental set that is focused on this future life.' Other aspects of Buddhist philosophy include taking responsibility for yourself, and not blaming others. When you're over 50, blaming Mom and Dad for your behavioral traits is weak. Can you imagine a CEO sitting down with people and saying,'you know, I make too many destructive comments, and I analyzed why. It's because of my father.' Forget it. You're an adult. Grow up. Take responsibility for your own behavior.

12 The Positive Introduction Compose a brief, serious story about yourself The story is called Me at my very best Showcase one of your strengths Choose someone sitting near you and swap your stories Then we ll talk about it briefly

13 Domino at her best

14 Importance of stories Telling one s story is not the same thing as being interviewed about one s stroke or diagnosis of ALS Work in illness narrative has emphasized the healing power of one s stories The aphasia group experience Cynthia, Jordan and BAND OF ANGELS

15 Stories and counseling Our counseling must provide time for listening to the stories of one s catastrophe--the bad and good parts Group sharing of the stories (including our own) Importance of disclosure Stories hold healing power, magic, lessons to be learned from others, inspiration

16 An aside.. I also think that stories are central to direct aphasia treatment that is oriented toward consequences Discourse involving telling one s life stories Conversation and the role of stories Life scripts

17 Who are the experts? Those who experience a disorder? I.e., live IN it? Families and close others? I.e., live WITH it? Those who study it and work with it? I.e., those whose expertise is BREADTH? US??

18 The concept of shared expertise Good clinical work in general involves collaboration Crucial to the counseling process Honoring the expertise of the others is a key to good counseling/coaching & getting other participants to buy in. Without shared expertise, there is no counseling, only handing out information

19 Interviewing, counseling, consulting, coaching

20 Life Coaching: a Special Type of Counseling Geared to increasing job or life satisfaction in individuals who are relatively free from psychopathology Fits well with goals of counseling individuals with communication disorders and their families Focuses on change Can incorporate principles of positive psychology. A collaborative partnership

21 Why a coaching perspective? Coaching emphasizes wellness and developing behavioral solutions and alternatives Thus, appropriate to our goals Increasing understanding of the disorder Coping with loss Learning to live with a disorder or a disability--developing resilience Dealing with changes in societal roles Managing changed responsibilities Dealing with anger and frustration

22 Implications (cont d) Getting through? Getting over? Getting on! There is life after stroke and aphasia; There is life still to be lived with deteriorating conditions Playing the cards you are dealt

23 Counseling & Coaching Similarities Differences Both provide information, guidance & support Both depend on active listening skills Both can guide persons to choose their own goals and ways to meet them Both honor and understand the importance of grieving Counseling focus is on Why?--Coaching focus is on What next? Coaching more feet to the fire -- Coaching centered in problem solving Coaching believes individuals hold key to solutions

24 Coaching also differs from consulting Does not set the agenda or provide solutions Persons being coached are considered to be among the experts Coaches listen support clarify, elaborate, reframe, guide Coaches might share their expertise, but they Also request changes Request that actions be taken Hold clients accountable for taking actions Provide opportunities to experience a fuller life (especially important in disability coaching)

25 Summary: Coaching Coaching is oriented to action and to change Coaches collaborate with clients to develop doable plans of action related to reaching goals and achieving success Coaches hold individuals accountable for completing their action plans. Coaches assist individuals to maximize the meaning in their lives. Approach is geared to CHANGING What Is, not to understanding WHY What Is Coaches are not distant from the process. They use disclosure to catalyze and challenge their clients Coaching has as its goal to enhance a client s life despite disability.

26 Positive Psychology

27 Goals of this section Get a taste of Positive Psychology Learn about your signature strengths Begin to consider ways to apply positive psychology to communication counseling and to your life

28 Costs of a disease model in psychology Victimizers and Pathologizers Little concern for improving normal lives,or nurturing and fostering talents Therapy model was adopted, rather than a coaching model What s wrong with you? vs What s right with you? THIS DOESN T MAKE MUCH SENSE FOR DISORDERS OF COMMUNICATION

29 Nor for psychology either!! ENTER POSITIVE PSYCHOLOGY Medical models are losing their foothold in many health professions Progressive abandonment in rehabilitation and thereafter for an emphasis on wellness and re-establishing societal roles What s RIGHT with people, despite chronic problems Parallel change in mental disease Mental HEALTH is finally getting its due

30 Tenets of Positive As concerned with strength as with weakness As interested in building the best things in life as in repairing the worst As concerned with making the lives of normal people fulfilling as with healing pathology Psychology

31 Translating the tenets to neurogenic communication disorders---- To maximize recovery or to make remaining life fulfilling, it is important to focus on personal strengths, in both individuals and partners.

32 The proper focus of our coaching & counseling is maximizing the quality of life post illness

33 Most people with communication problems have little or no psychopathology Therefore, we can focus on fulfilling lives, not on healing psychopathology

34 The three pillars of Positive psychology Positive Emotion--The Pleasant Life -- Past life satisfaction & contentment Future optimism and hope Present pleasure Positive Character--the Engaged Life-- Gratification and flow Positive Institutions--The meaningful life The greater good

35 Pillar I Positive Emotion-- The Pleasant Life Past life satisfaction and contentment Present pleasure Future optimism and hope

36 Pillar II--Positive Character The Engaged Life Gratification Flow Csikszentmihlyi, Being there

37 Pillar III--Positive Institutions The meaningful life Attachment to something beyond oneself The greater good

38 A Quick Trip through Positive Psychology: What We Know Most people are happy Happiness is causal, not epiphenomenal Most people are resilient Happiness, strengths of character and good social relationships are buffers Crisis reveals character Other people matter Work matters Money is important, but only to a point Happiness trumps pleasure The heart matters more than the mind The good life can be taught/learned

39 Some consequences of being happy (Lyubomirsky, King & Diener, 2005)o, More success at school & work Better social relationships Better health and longer life Why? Happiness broadens and builds Happiness can be a buffer Happiness opens doors

40 Life Satisfaction Scale Ed Diener, U of Ill. Rate from 1=strongly disagree to 7=strongly agree In most ways my life is close to my ideal. The conditions of my life are excellent. I am satisfied with my life. So far I have gotten the important things I want in life. If I could live my life over, I would change almost nothing. Sum your ratings

41 Interpretation 31-35=extremely satisfied 26-30= satisfied 21-25=slightly satisfied 20=neutral 15-19= slightly dissatisfied 10-14= dissatisfied 5-9= extremely dissatisfied

42 How do people get happier? Increase life satisfaction? Many ways, including a number of the exercises and interventions described in Authentic Happiness and in Peterson s Primer, and on the authentic happiness websites (see handout) Including the Positive Introduction we started with Many come with efficacy data Too many to talk about, too little time

43 Building the best things in life In this, and other, ways, PP recognizes its debt to CBT. Some examples of assessments: VIA Life Satisfaction Scale Grit General Happiness Some examples of exercises Gratitude visit Forgiveness letter Savoring activities 3 Pillars exercise 3 Good things

44 Let s play around with one Knowing and using your strengths Capitalizing on strength rather working to overcome weakness Learning how to count on strengths and use them in new ways Recognizing others strengths and respecting them

45 Character Strengths & Result of great study and scholarly cooperation Hinduism to Hogwarts -- universal Manual of the Sanities Virtues

46 Character strengths and virtues Strengths of Wisdom & Knowledge Creativity Curiosity Open-Mindedness Love of Learning Perspective Strengths of Courage Bravery Persistence Integrity Vitality Strengths of Humanity Love Kindness Social Intelligence Strengths of justice Citizenship Fairness Leadership

47 Character Strengths and Virtues Strengths of Temperance Forgiveness and Mercy Humility and Modesty Prudence Self-regulation Strengths of Transcendence Appreciation of Excellence & Beauty Gratitude Hope Humor Spirituality

48 Get out your strengths list Read the list Work down the list, checking one of the three boxes Me,not me,??? NOW, identify those most like you, and pick 5 that REALLY resonate with you.

49

50 Values in Action (VIA) This is the quick and dirty VIA, The real one is available on the websites, but this is a reasonable approximation. Look back to your Positive Introduction. What strengths can you identify that relate to this exercise?

51 The VIA: Some further considerations It is a work in progress. Flexible, open to change Given the universality of its goals, there is little consideration of culture specific virtues.

52 Peterson s list of American virtues Achievement, assertivenss autonomy, celebrity, competitiveness, fitness, happiness, looks and a whole lot of money, personal control, redemption, selfesteem, toughness uniqueness.

53 My Candidate for America s Most Virtuous:

54 Lots of ways to go with this.. Was this easy or hard to do? Did you surprise yourself? Did your strengths reflect the same core value (ie, all the same color)or were they spread out? Does it matter? WHY? What about the not-like me? Is this where you go for selfimprovement stuff? Do you care? Other insights?

55 Top five strengths most closely associated with personal happiness Curiosity and interest in the world Zest, enthusiasm, and energy Capacity to love and be loved Gratitude Hope, optimism, and futuremindedness

56 What can the workplace teach us about working from strength? : Speed and Simplicity People operating from strengths learn the role faster, adapt to more variance in the role faster, and need less complicated systems to do so. Productivity and Precision People operating from strengths produce significantly more at higher quality. Longevity and Attendance People operating from strengths stay longer, miss less work, and build stronger client relationships.

57 Capitalizing on strengths (lessons from the workplace) You will truly excel much more by maximizing your strengths, seldom by fixing your weaknesses. You do not have to have strength in every aspect of your role to be successful. (Myth: Excellent performers must be well-rounded.) You CAN T have all the VIA strengths. Some are even opposites. Consider those out of the range of 1-8 to be non-strengths NOT weaknesses. Five creative strategies Get a little better at it. Design a support system. Use one of your strengths to overwhelm your weakness. Find a partner. Just stop doing it.

58 Let s think about this one simple exercise. Can it translate to you? Can it translate to persons with ALS aphasia, to spouses? How could it influence their lives??

59 Let s try another Three good things Think of three good things that happened to you today Practice daily for a week Write them down every night before you sleep. Adapt it to Spouse Use it as a discussion exercise

60 And another--- The Gratitude Visit Think of someone who has very positively influenced your life, but whom you have never properly thanked (ie, to your satisfaction) Write a 2 page (max) letter thanking him or her Schedule a time to visit with that person, or if too difficult, to have a long phone call. Read the letter to the person WHAT DO YOU THINK HAPPENS?

61 Adapting the gratitude visit For a spouse: Think of someone who has helped you a lot in getting through this stroke. Write the letter. Make the visit. For someone with ALS Think of someone who has been helpful to you in dealing with it. Write the letter, make the visit or the phone call. Or even send it.

62 Depression: Caveats Few of us are trained psychotherapists Dilemma of the talking therapies for communication impairments We lack skills in most effective methods of treatment CBT, CBT+ antidepressants Critical to know when to refer and to whom But a growing awareness that principles of positive psychology, applied to SOME depressive conditions can be helpful.

63 Overarching counseling/coaching needs Support Information Hope

64 The point is Much of this work can be applied straightforwardly Some requires adaptation, particularly the wordier exercises

65 Family issues Time-sharing with disabled/non-disabled children Sharing responsibilities Behavior management

66 Some more examples Subtle, but debilitating problems that follow mild TBI or mild stroke. Getting back to work issues Interpersonal interaction issues Re-establishing focus Developing new goals for a changed life Learning to know and like who you have become Feeling safe, feeling well again--dumping your invalid

67 After moderate stroke and aphasia Retirement and family issues Family roles Unplanned-for changes in income Developing a wellness (as opposed to illness) focus to the rest of your life The move from PT(physical therapy) to PT(personal trainer) Dumping your invalid Living positively and successfully and resiliently despite chronic problems

68 More examples Preventing problems that occur in the wake of a diagnosis of progressive disease. Adapting to changing skills, deteriorating abilities Living as fully as possible Being well despite illness Planning for a different future Developing patterns and rationales for coping Getting your ducks in a row Reaching out to friends Asking for what you want

69 Still more. Assisting grown children of ailing parents Getting local supports in place Dealing with issues of long-term placement Knowing the resources Finding out what s best Learning to live with it (the children, that is) Giving yourself permission to feel good about yourself Defining and refining the concept of the dutiful child

70 Summary Unique problems facing counselors of individuals and communication problems Overlay of problems on mostly previously okay lives Problems result from potentially catastrophic change Confusion about the counseling responsibility Difficulties that many psychotherapists/social workers may have in communicating with our population--thus, we are frequently counselors/coaches despite ourselves

71 But when do we have TIME?? The Concept of Counseling Moments Few of us have TIME for an hour or so of counseling, even sporadically. We are stuck with fitting counseling in around our more direct clinical activities

72 One suggested way Be on the alert for family/client counseling needs These are COUNSELING MOMENTS, The times to put on your counseling hat These typically occur at the beginnings or at the ends of clinical sessions

73 Summary Unique problems facing counselors of individuals and communication problems Overlay of problems on mostly previously okay lives Problems result from potentially catastrophic change Confusion about the counseling responsibility Difficulties that many psychotherapists/social workers may have in communicating with our population--thus, we are frequently counselors/coaches despite ourselves

74 In closing. Our responsibilities involve providing INFORMATION SUPPORT OPTIMISM HOPE.

75 Wanna talk more?

76 Relevant Websites For Authentic Happiness assessments--free Website for on-phone coach training Website for on-phone coach training Website for Seligman Positive Psychology Course