Monday, June 16, 2008

The bottom line

As an SLP, I am not going to be qualified to diagnose conditions such as mental retardation (Is there a more politically correct term I should be using? I'm trying to be sensitive, but I honestly don't know.) or autism or Downs Syndrome or anything like that. If an individual has an undiagnosed condition pertaining solely to communication, then I can make a diagnosis, but other than that I can only make suggestions or referrals. For example, if I see a child who is flapping his hands, avoiding eye contact, and having lots of difficulties with expressive communication, I could suggest that the child see a developmental pediatrician or child psychologist. I could not diagnose the child as having autism.
Even so, communication impairment diagnoses can be devastating in and of themselves, and every family reacts so differently. One family may be thrilled to finally have a name for their child's difficulties. Another might want a diagnosis only to get more insurance money. Still another may completely deny that anything is wrong with their child, and another might be very angry at everything in general for a while.
I was thinking today about my professional and personal reactions to these various reactions of families with whom I will work. I do not envy those doctors who have to give the heavy diagnoses. You have to remain professional, and that means distancing yourself to some degree from the emotional impact of the diagnosis you give. Only a trained counselor/psychotherapist can deal with that aspect. Indeed, my Traumatic Brain Injury professor told us to always recommend family counseling with any TBI case we get, no exceptions. TBI can be especially devastating because sometimes the brain loses its capacity for higher functioning and will never regain it; there's just too much damage. Plus, personality changes are a common side-effect of TBI, and if you've known someone for twenty years and all of a sudden they seem like a completely different person, well...that's tough, to say the least! So as an SLP, I am not qualified to get into all of that. I have to keep some distance for my own mental health.
However, completely distancing myself from the family isn't the answer either. I need to be able to sympathize, commiserate, and celebrate with my families. If families think me callous or cold, I will not be a very effective therapist. I need to get to know the individual, what s/he likes and dislikes, favorite movies and TV shows and books, favorite subjects in school, etc. Why would the individual want to have a conversation about soccer if he's never played it in his life but tap-dances for 2 hours every day? It would make much more sense to talk about tap-dancing. (In my personal opinion, it ALWAYS makes sense to talk about tap-dancing. The only thing that makes more sense is actually tap-dancing. But that is just me ;) )
The bottom line is, I need to work out a healthy balance for myself. I need to be involved, but not too involved. This is going to be one of the hardest things for me to learn, and there is only so much help and advice I can get from other people because it is a personal emotional thing for each person. How much should I leave at the door of my clinic? How much should I take home with me every day?
For now, I need to shower and get to work. At least it's easy to leave office work at the door! ;)

Wednesday, June 4, 2008

Forgetting why I do this

As I may have mentioned before, I have not started to do actual therapy yet in the course of my education. I begin to have clients this fall, and am closely observed by a qualified SLP as well as videotaped during my sessions. When I talked to other students who had not had clients yet, they said they were terrified. I then feel like kind of a jerk for saying, "I can't wait!" I know that having clients is going to be difficult. When you are a student clinician you have to write out lesson plans for every therapy you do in a specific format, and then write up how the session went in a specific format. It's a lot of extra paperwork. We have to get 375 hours of therapy in, but the preparation and follow-up do not count as therapy hours because we are not actually with a client. Also, many children are unpredictable and inattentive by nature. I heard about a client last summer who would not listen to the student clinician at all. Her supervisor, who has two children and thus has developed a "Mom Voice," had to sit at the door of the therapy room to keep the child from running away.
Despite all of the extra stress and work that comes with clients, I find myself eagerly anticipating them. Why? Because they are the reason I am doing this. They are the reason that I am sitting through classes and making flashcards and reading never-ending chapters in textbooks and memorizing and forgetting the cranial nerves on a regular basis (don't judge, those buggers are slippery...ask any med student). You cannot learn to be an SLP sitting in a classroom, and sometimes when I'm sitting in a classroom I forget this fact and think that the book-learning is the most important part. Then I get depressed and overwhelmed. I cannot wait to be thrown into the fray, to make mistakes and learn from them, to watch children learn and grow. And it is good to remind myself of this when an afternoon of Morphology and Syntax homework and Traumatic Brain Injury studying stretches before me. Thus, I go to shower, and hopefully to conquer! :)