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! ;)


Marla said...

Very interesting to think about. We have never had the experience where we get all emotional over a diagnosis. Usually, we have searched for so long that it does not hit us for some time when we have finally found one.

There are different types of parents and different reactions for sure. I think I have often been judged because I don't get overly emotional with doctors or other professionals. I act more like a professional advocate and save my emotions for later when I am at home alone. So, don't be alarmed if you have some parents that are all business.

Trish said...

Our original evaluators at Early Intervention were very hesitant to even mention the word autism but did finally recommend that we see a developmental pediatrician. It is hard but I think it is good for parents to have some idea of the possible diagnosis before going in, so they can look up more information before going in.