You can read the piece in its entirety by clicking this link routing you to the current ASHA Leader issue. But it's also pasted into the body of this post below.
Calling on—and Grateful for—Counseling SkillsWhen a client revealed a suicide attempt, this SLP used techniques she never anticipated she’d actually need.
The ASHA Leader, May 2016, Vol. 21, 80. doi:10.1044/leader.FPLP.21052016.80
Alan, an Army veteran in his mid-20s, had been coming to my cognitive-communication clinic for nearly a year. His chart noted a 2010 deployment to Afghanistan, where he sustained a concussion. He also had a childhood history of attention-deficit hyperactivity disorder and anxiety, disordered sleep, and chronic pain. His case manager referred him to the clinic because Alan’s attention, learning and executive-function difficulties affected his ability to make and keep medical appointments, apply for a disability claim and succeed in community college.
He was truly a pleasure to work with. When I first met him, I was endeared to his childlike qualities. Despite his imposing height, he had excellent posture, profusely apologized for (always) being late, and regularly called me “Ma’am”—even though I am less than a decade older. He was engaged in treatment and motivated to employ strategies.
During one visit, rather than working on strategies to support writing, he impulsively confessed that he tried to kill himself that weekend. In the throes of ever-increasing panic attacks, he had hastily held a loaded gun in his mouth. “I was ready to pull the trigger,” he told me, staring at his shoes. “To make it all stop.”
My heart broke for him. But I felt out of my element. I’m a speech-language pathologist specializing in cognitive rehabilitation—thinking is my area of expertise, not feeling.
With Alan that day, I drew on the less-natural techniques: silence, mirrored body language and reflection of feelings.
Though I was uncomfortable, I was able to draw on the counseling techniques I learned in graduate school just a few years prior. I recalled thinking the Counseling for Communication Disorders course was more or less common sense—that a person either had or didn’t have the skill set. I now understand this is not true, not in times of crisis. I’d had plenty of practice with asking open-ended questions, active listening and paraphrasing information. But with Alan that day, I drew on the less-natural techniques: silence, mirrored body language and reflection of feelings.
Although I was grateful for my graduate training, I was also glad to work on an interdisciplinary team. With Alan’s permission, the psychologist met with him immediately to create a “safety plan.” She helped him schedule an appointment with his mental health provider for the following day, and with his primary care doctor for a medication evaluation.
As for me, I try not to picture Alan with that loaded handgun pointed in his mouth, desperate for relief. I feel for him and can only hope that with the right tools, support and preparation he can learn to manage his demons. Because with the right tools—the ones I learned in my graduate counseling course—and the support of my skilled colleagues, I was able to manage a critical situation that I would otherwise have been unprepared for.
- Joanna Close, MS, CCC-SLP, specializes in working with veterans with a history of brain injury in Portland, Oregon. She also co-owns Full Circle Speech, providing community-based cognitive-communication services, and works for a private practice, Parkwood Clinic. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. johartmanclose@gmail.com
- © 2016 American Speech-Language-Hearing Association
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