Category Archives: Reflective practice

Putting Yourself First

We present a guest post by Cathy Sparkes and Sam Simpson, SLTs who work together as intandem. Here are Cathy and Sam’s reflections on supervision. 

Ask yourself this question: Am I looking after myself enough in these challenging times? If your answer is ‘no’ or ‘not sure’ then read on!

The service you work in is probably being exposed to job cuts, a reduction in CPD funding and the demand to maintain clinical standards with ever-shrinking resources. In the midst of this you still need to put yourself first by making sure you’re receiving the quantity and quality of supervision you need. Over the past decade we have been supporting SLTs to access and provide good quality supervision. However, we often find that people don’t know what supervision is, have never experienced it or think they haven’t got time for it.

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Invest in Yourself: Learn Essential SLT Skills for the Next Decade

Open Road

When I remember the therapy package I offered “Freddy”, I wince. Over 18 months, I gave him four six-week blocks of therapy: 24 sessions in all. When I eventually discharged Freddy, he still couldn’t consistently produce velars—and worse, he still didn’t care. Even though his parents realised that I didn’t have a magic wand, they didn’t practise with him at home. So I didn’t achieve my objective and I wasted several precious days—days I could’ve used working with other clients. I had clients on a waiting list who were ready to engage with therapy and work towards realistic targets. What a waste.

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Attachment to our clients makes diagnosis more difficult

There’s nothing like getting a huge hug from a 3-year-old speech therapy client: what a way to tell me he enjoys therapy!

The affection goes both ways: we grow attached to our clients. We notice progress, point it out to families, and celebrate with them. When we work with families for long enough, we meet new siblings, hear about first days at school, and get invited home to birthday parties and for tea!

Clouding my judgement

But is it possible for therapists to get too attached? I’m trying to make a tricky differential diagnosis and reflecting on whether my affection for this little chap is muddling me up. Am I observing his skills through rose tinted glasses? Placing more of an emphasis on things he can do while skimming over things he can’t?

I’m trying to clarify my thinking by making objective observations: noting down what I see without interpretation. I’m comparing these observations to what I expect from a child his age, as well as his clinical presentation from a year ago. I’m reviewing how he responded to different types of therapy and attempting Dynamic Assessment. I’m also planning to observe him at nursery, to see how he responds to other adults. I’ll figure it out!

Do you form close bonds with particular clients? Do you think it supports therapy outcomes? Or do you have to focus on being impartial?

Video as a tool for teaching adult-child interaction strategies

I visit nurseries to train staff as part of my job; we aim to support the language development of all the children by improving the communication environment. I observe the staff and complete a check-list about the communication environment; it covers areas like adult-child interaction, the listening environment, snack time, and story time. I discuss my observations with the nursery manager and we decide what to focus on.

I’ve recently trained several practitioners in adult-child interaction, with varying degrees of success!

Training package

The training package I offer is still evolving. I usually:

  • give the practitioners some written information about adult-child interaction from Elkan Early Language Builders;
  • discuss the dual strategies of following a child’s lead and commenting rather than questioning;
  • model these strategies; and
  • make a brief video of the practitioner interacting with a child, and give feedback.

Effectiveness

I have used this package with five practitioners over the last month. Three of them responded really well: they asked thoughtful questions, reflected on their skills as they watched the video, and were able to adapt their interaction styles to become better communication partners. Result!

What about the other two? Well, one was able to identify that she asked a lot of questions; with support she began to think about how she could use comments instead. However, at the end of the session she still seemed unaware that she was being directive. The other practitioner felt she was already using both strategies, but didn’t notice herself asking questions when we watched the video. Hmm.

Reflecting on the sessions that didn’t go so well, could I achieve more by fine-tuning how I use the video? There’s lots of useful information on this topic in the Hanen “It Takes Two To Talk” programme. After reviewing it, I’ve found three ideas to try:

  • considering the adult’s stage of learning,
  • using coaching methods, and
  • asking rather than telling.

Stages of learning

The Hanen programme describes three stages of learning: pre-aware, aware, and active. A pre-aware learner might be able to explain the strategies, but doesn’t realise that she’s not applying them. An aware learner knows the strategies and knows that she’s not yet applying them. An active learner has applied her knowledge and changed her behaviour.

So the practitioner who thought she was using the strategies but didn’t notice that she asked questions was at the pre-aware stage of learning. I should try to move her on to the next stage: to increase her awareness of her own behaviour. The Hanen information suggests making tentative statements about what you see and then “letting the tape do the talking.” I’ll try it.

Coaching

Hanen suggests coaching as another way to support an adult’s learning process, by improving the specific interaction. You can do this while the camera is running, during a brief break in filming, or by demonstrating the strategy.

So for the practitioner who was unaware of how directive she was, I could try some coaching: while the camera is running I could say something like, “don’t suggest what to play with: wait for him to show you what he wants to do.” Something else for me to try out.

Feedback: ask, don’t tell

Reflecting on the feedback I gave, I think it started well, but could be improved. I asked what the practitioner thought about the interaction, and then offered a specific focus; for example, “let’s look at when you made comments.” So far so good. But then I told them my own observations, rather than asking for theirs! By asking rather than telling, I could provide a more active learning experience, to increase the chances of learning new skills. Looks like I’ve got lots to practise!

Any ideas?

Do you use video as a teaching tool? What techniques have you found work well with pre-aware learners?