SHLD 530 Counseling

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SHLD 530 Counseling Communication Disorders

• Class 7
• February 27, 2009

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Working with Challenging and Difficult Emotional
States

• What is our role? To address emotional states
  only when they interfere with progress in
  treatment of communication disorders.
• Diagnosing emotional states is not in our scope
  of practice, but we can provide behavioral
  descriptions of our observations.
• When emotional states greatly interfere with
  treatment, we need to make a professional
  referral to a psychologist/counselor.

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Grief and Communication Disorders

• Grief is a natural reaction to loss (of a loved
  one, loss of hearing, speech, language,
  swallowing, loss of a healthy child)
• Stages of Grief - Elisabeth Kubler-Ross (1969)
  discussed the grieving process in her book On
  Death and Dying.

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Stages of Grief

• Denial- This isnt happening to me
• Anger-Why is this happening to me
• Bargaining-I promise Ill be a better person if
• Depression-I dont care anymore
• Acceptance- Im ready for whatever comes
• Grieving is a dynamic process that each
  individual experiences differently. Stages of
  grief are not clear-cut and individuals may show
  signs of being in more than one stage at a time.
  Stages may also reoccur.

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Yale Bereavement Study. Prigerson (Feb 2007)
Journal of American Medical Association.

• Three-yr study of 233 individuals.
• Yearning is more pronounced than sadness, peaking
  at 4 mos
• Disbelief peaked 1 month after loss
• Anger peaked at 5 mos
• Depression peaked at 6 mos
• Acceptance is present from the beginning, but
  became more dominant as time passed.
• Grieving is reportedly easier and faster when the
  death was anticipated
• Most stages peaked before 6 mos
• Studied only American culture.

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Anxiety and Communication Disorders

• Anxiety is a feeling of uneasiness, apprehension
  or dread.
• All people experience some anxiety at points in
  their life.
• Anxiety can sometimes serve to provide just
  enough tension to motivate an individual.
• Acute anxiety- sudden onset
• Chronic anxiety - a prolonged course
• Kinds of anxiety (situational, free-floating)
• Difference between anxiety and fear

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Anxiety and Communication Disorders

• Psychological Symptoms- irritability, poor
  concentration, tension, fear of losing control,
  fear of impending disaster, and worrying.
  Depression often goes hand-in-hand with anxiety.
• Physiological symptoms-tightness in the chest and
  throat, changes in respiration, shaky or
  tremulous voice, queasiness, dizziness, dry
  mouth, difficulty swallowing, increased pulse
  rate, muscle tension, headaches, sweating,
  flushing/chills, exaggerated startle response,
  disturbed sleep.
• Behavioral symptoms- strained-looking face,
  furrowed brow, tense posture, clenched fists,
  restlessness, rapid speaking rate, volume often
  decreased or erratic, pitch unusually high
  because of tense vocal folds, strained or hoarse
  vocal quality.

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Kinds of anxiety- Social Anxiety

• Social Anxiety - fear of embarrassment or
  humiliation in certain situations. Sometimes an
  individual avoids work or social activities.
• Children and adults who stutter, have
  articulation disorders, repaired
  clefts/hypernasality, and those with neurological
  impairments frequently have high levels of social
  anxiety when talking in front of others.

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Approaches to Help Social Anxiety

• Hierarchy Analysis - Individual lists anxiety
  producing situations from least to most
  threatening. The individual is then taught to
  relax using a systematic desensitization approach
  for each situation.
• Relaxation Training - Individuals are taught to
  change their responses to stress through
  relaxation.
• Cognitive Therapy - Individuals identify
  maladaptive negative thought patterns and work to
  use more productive thinking patterns.
• Group Therapy - Individuals meet in groups to
  learn and share common experiences.

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Kinds of Anxiety - Acute Stress Response

• Acute Stress Response - Developing anxiety in
  response to a life threatening event.
• May lead to a diagnosis of Acute Stress Disorder
  or Post traumatic Stress Disorder.
• In our field we may see individuals with this
  disorder who have had sudden loss of hearing or
  abrupt onset of communication disorders.

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Kinds of Anxiety - Panic Attacks

• A panic attack is a severe alarm reaction in
  response to a perceived threat. Sometimes
  emerging without provocation or apparent reason.
  
• Involuntary nervous system mobilizes several
  different bodily reactions rapidly and intensely
  (large amount of adrenaline are released, heart
  rate increases, shallow rapid respiration occurs,
  profuse sweating, trembling /shaking, cold hands
  feet).
• In our field we can co-treat individuals with
  communication disorders and panic attacks.

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Kinds of Anxiety- Related to places and situations

• Examples- fear of being home alone, being in a
  crowd of people, traveling in car/plane.
• Often synonymous with agoraphobia.
• Individuals may not only fear panic attacks, but
  also fear what others think of them if they have
  panic attacks.

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Depression and Communication Disorders

• Depression is a common response to life events
  (grieving after a significant loss.)
• Those who suffer more severe symptoms may have a
  clinically diagnosed disorder.
• Our role is not to diagnose depression.
• Symptoms may include - feelings of sadness,
  hopelessness, discouragement, anger, loss of
  interest in activities that were previously
  enjoyable, sleep problems, loss of appetite,
  difficulty concentrating or making decisions.

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Approaches to Helping Individuals with Depression

• Although we cannot diagnose or treat depression
  it is within our scope of practice to incorporate
  ways to improve our clients coping abilities in
  order to enhance communication therapy.
• Cognitive-Behavioral Approach - Helping
  individuals identify coping strategies such as
  listening to music or seeking supportive
  family/friends.
• Humanistic Approach - Focus on unconditional
  positive regard. Occasionally reflect feelings.
  
• Interpersonal Approach - Responding in a
  supportive and encouraging manner with voice and
  body language.