Counseling and coaching in adult neurogenic communication disorders

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Counseling and coaching in adult neurogenic
communication disorders

• Audrey L. Holland, Ph.D.
• Regents Professor Emerita
• University of Arizona

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Acknowledgments

• ASHA fpr inviting this presentation
• Marshall Goldsmith, who doesnt 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

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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.

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Agenda

• 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

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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

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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

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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

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

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A little story..

• A retirement
• A decision..
• An enlightenment.

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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.

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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 well talk about it briefly

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Domino at her best
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Importance of stories

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

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Stories and counseling

• Our counseling must provide time for listening to
  the stories of ones 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

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An aside..

• I also think that stories are central to direct
  aphasia treatment that is oriented toward
  consequences
• Discourse involving telling ones life stories
• Conversation and the role of stories
• Life scripts

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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??

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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

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Interviewing, counseling, consulting, coaching
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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

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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

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Implications (contd)

• 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

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Counseling CoachingSimilarities
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

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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)

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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 clients
  life despite disability.

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Positive Psychology
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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

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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
• Whats wrong with you? vs
• Whats right with you?
• THIS DOESNT MAKE MUCH SENSE FOR DISORDERS OF
  COMMUNICATION

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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
• Whats RIGHT with people, despite chronic
  problems
• Parallel change in mental disease
• Mental HEALTH is finally getting its due

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Tenets of Positive Psychology

• 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

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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.

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

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

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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

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Pillar I Positive Emotion--The Pleasant Life

• Past life satisfaction and contentment
• Present pleasure
• Future optimism and hope

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Pillar II--Positive Character

• The Engaged Life
• Gratification
• Flow
• Csikszentmihlyi,
• Being there

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Pillar III--Positive Institutions

• The meaningful life
• Attachment to something beyond oneself
• The greater good

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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

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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

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Life Satisfaction ScaleEd Diener, U of Ill.

• Rate from 1strongly disagree to 7strongly 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

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Interpretation

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

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How do people get happier?Increase life
satisfaction?

• Many ways, including a number of the exercises
  and interventions described in Authentic
  Happiness and in Petersons 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

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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

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Lets 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

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Character Strengths Virtues

• Result of great study and scholarly cooperation
• Hinduism to Hogwarts--universal
• Manual of the Sanities

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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

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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

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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.

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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?

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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.

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Petersons list of American virtues

• Achievement, assertivenss autonomy, celebrity,
  competitiveness, fitness, happiness, looks and a
  whole lot of money, personal control, redemption,
  self-esteem, toughness uniqueness.

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My Candidate for Americas Most Virtuous
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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 self-improvement stuff?
• Do you care?
• Other insights?

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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 future-mindedness

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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.

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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 CANT 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.

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Lets 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? ?

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Lets try anotherThree 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

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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?

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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.

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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.

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Overarching counseling/coaching needs

• Support
• Information
• Hope

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The point is

• Much of this work can be applied
  straightforwardly
• Some requires adaptation, particularly the
  wordier exercises

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Family issues

• Time-sharing with disabled/non-disabled children
• Sharing responsibilities
• Behavior management

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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

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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

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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

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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 whats 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

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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

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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

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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

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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

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In closing.

• Our responsibilities involve providing
• INFORMATION
• SUPPORT
• OPTIMISM
• HOPE.

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Wanna talk more?

• http//www.autumnspring.com
• 1-800-854-9594
• aholland_at_u.arizona.edu
• 520-293-2926

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Relevant Websites

• http//www.authentichappiness.org
• For Authentic Happiness assessments--free
• http//www.CoachTrainingAlliance.com
• Website for on-phone coach training
• http//www.mentorcoach.com
• Website for on-phone coach training
• http//www.authentichappiness.com
• Website for Seligman Positive Psychology Course