Reflections from a fellow therapist

Telemed

Hi, I’m Moira, and I’m Speech and Language Therapist in a supporting role for the Airedale telemedicine pilot. Steph invited me to sit in on some sessions recently. Firstly my thanks to Steph and her clients for letting me sit in, and now here are some my reflections of the day.

Seeing clients on their own turf made for a more relaxed and less formal session, and allowed a window into their everyday lives.  Our first client logged in from work and was very soon telling us about her talking challenges there, and her hopes and dreams for her future career. She and Steph could work with what mattered in the here and now. There was a great sense of immediacy and relevance in the session. I was also impressed with this lady’s openness and ability to reflect on her skills and progress after just a handful of sessions.

Another client logged in from his car. Again, in his own space, he could talk about his talking at home, work and hopes for the future. The discussions that followed seemed better aligned to the client’s everyday life. This gentleman seemed curious about and to take comfort from hearing about others’ experiences of stammering.

What surprised me about the Telemedicine day were the many advantages of seeing people in their own environment, both for the client and the therapist. What might have been regarded as a compromise to get around geography and other issues might well come into its own!

Otherwise, but still important, a message to any tentative clients out there, it was a very positive and at many times, a fun day. Yes, sessions can occasionally be challenging, but there is laughter in-between.

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“Everything you want is on the other side of fear.” Jack Canfield

Overcoming-Social-Anxiety

It’s proving to be a great week for the project!

One of the best moments of the project so far has been watching a video of one of our participants give a wonderfully moving speech at her local Toastmasters club. Laura got great feedback from her audience and was awarded best speaker. She has kindly agreed to share the video, so you can watch it here. It’s a great example of the rewards that come from being brave.Taking a leap

From a personal point of view, I am delighted that we have found a better platform to deliver the sessions – appear.in.  It’s free to use, the video and sound quality are excellent with no lagging, and it’s really easy to use. There’s no software or apps to be installed, and no wrestling with the audio and video functions – you just share a link and it works straight away! And importantly for us as an NHS Trust, it’s secure and encrypted, with no data being stored on their server. Thank goodness I can now focus on the therapy and not waste the first ten minutes of every session trying to sort out the technology!

When we first proposed this project, we said we would aim to see between forty and sixty participants over the course of the year, but we were slightly concerned that we would not be able to get that many referrals. We needn’t have worried – less than three months in, we are already up to thirty-two, with four new referrals in the last two days! One of the things our wonderful project manager, Jody, is working hard on at the moment is looking into how we can continue this service after the life of the project, as there is clearly a demand. Watch this space….

 

Argh….help please!

So the project has been live for over 2 months now. We have 15 current clients who are actively undertaking therapy and another 6 who are at the beginning of the referral process.

This is fantastic as we had an initial aim of 40-60 clients throughout the whole year of the project so we’re nearly half way there, only 2 months in…

The client feedback we have had has been great, everybody seems to really benefit from the therapy and appreciate being able to access it in areas where there has been previously been no therapy provision for adults who stammer.

The one issue we do seem to be having time and time again is the technology. We are using a web-based platform called WebEx. This seems to be fantastic for B2B users. It is an industry leader in online conferencing but it doesn’t seem to have the stability or reliability for our usage.

We often find that either the video or the audio, or sometimes both, stops working. This can be despite having good internet connection, and even if the users have previously had no problems and the settings are the same.

We had some quick testing of another web-based platform (appear.in) last week and this did seem to be a lot easier to use and didn’t seem to have any of the stability issues from our limited testing.

We now need to speak to our Information Security department to ensure it meets the NHS’s strict security guidelines.

So, my question for you all is; have you got any recommendations of a system/platform/website we can conduct our therapy over? It needs to be free, easily accessible and secure, offering both video and audio capabilities.

I’m hoping we can get some good ideas of things to try to ensure we’re getting the very best out of this project.

Thanks,

Jody

Why does therapy work?

Peanuts

Some of our participants have now had several sessions and are approaching the end of their therapy journey with us, so it feels like a good time to reflect on how therapy can help people to make changes in their lives. It’s very easy to sit in our little comfort zones and never push ourselves outside of it, but every single one of the people I am seeing at the moment is being brave, pushing themselves to try new things and seeing the benefits that can result.

When I asked one participant what was helping him so far, he said, “You helping me to know I’m in control. I’m not scared any more.”  Most of our participants have said that understanding the mechanics of speech and being able to relate this to what happens when they are stammering has been really helpful . Others have said they’ve found it helpful having a technique to use, which can increase fluency, but which also provides a safety-net effect, helping to reduce the anxiety around stammering.  Talking to other people about stammering and about coming for therapy is also proving very useful for many of our participants, and helping to challenge some of their assumptions about what other people might be thinking.

thoughts feelings behaviour

I’ve had a few discussions this week about how to overcome fears and anxieties and about different psychological approaches.  The great thing about being a speech and language therapist is that I’m not tied into any one particular approach, and can cherry-pick the bits I feel would be useful for each individual. So I use elements of Cognitive Behavioural Therapy, Solution Focused Brief Therapy, Acceptance & Commitment Therapy and Mindfulness, to name a few!

There is no consensus about which therapeutic approaches work best, but various meta-analyses of scientific studies (e.g. Wampold et al, 1997, 2002) have concluded that no one approach is more effective than any other. There seem to be other factors which influence whether therapy is effective, e.g. the therapeutic alliance between therapist and client, the client and their situation, their readiness for change, other support systems, etc.  And then there are those things that the therapist brings. Wampold’s Qualities and Actions of Effective Therapists lists fourteen qualities of effective therapists. I’m not convinced I fulfil all of these, but I do constantly strive to improve, and what I learn from the amazing clients I work with helps me to do this. I particularly like number 10 – for me, hope and optimism are a huge part of therapeutic change. As far the rest, I’ll leave it to our participants to judge!

  1. Effective therapists have a sophisticated set of interpersonal skills.
  2. Clients of effective therapists feel understood, trust the therapist, and believe the therapist can help him or her.
  3. Effective therapists are able to form a working alliance with a broad range of clients.
  4. Effective therapists provide an acceptable and adaptive explanation for the client’s distress.
  5. The effective therapist provides a treatment plan that is consistent with the explanation provided to the client.
  6. The effective therapist is influential, persuasive, and convincing.
  7. The effective therapist continually monitors client progress in an authentic way.
  8. The effective therapist is flexible and will adjust therapy if resistance to the treatment is apparent or the client is not making adequate progress.
  9. The effective therapist does not avoid difficult material in therapy and uses such difficulties therapeutically
  10. The effective therapist communicates hope and optimism.
  11. Effective therapists are aware of the client’s characteristics and context.
  12. The effective therapist is aware of his or her own psychological process and does not inject his or her own material into the therapy process unless such actions are deliberate and therapeutic.
  13. The effective therapist is aware of the best research evidence related to the particular client, in terms of treatment, problems, social context, and so forth.
  14. The effective therapist seeks to continually improve.

 

 

 

 

One participant’s journey so far…

One participant’s journey so far…

“I started this telemedicine pilot with Steph just under a month ago and I have found that this method of delivering speech therapy has been highly effective. We have been through several different strategies of coping better with the stammer, in particular breathing techniques, which I have found really helpful. I have incorporated a subtle outbreath technique in to my daily life and I feel that the impact on my stammer and overall well-being has been quite profound.

We have also examined the mechanics of speech in to order to help me understand the origin of different sounds, practiced interview questions, and some reading out loud. I have found all of this really helpful. Going forward, I feel continuing with the same approach would be beneficial as I feel like I am generally on an positive upward curve in regards to getting to where I would like to be.

The WebEx app I use on my iPhone is generally very good, although the screen does go blank every now and again. On the whole verbal and visual communication is clear with no lagging.

In summary, my experiences of receiving speech therapy via Telemedicine with Steph has been excellent. From a personal point of view, I believe it is an effective method achieving it’s objectives in delivering high quality speech therapy using technology.”

Five weeks in!

stammer

Well, I feel like we’re getting into our stride now with this project. We’ve got about a dozen people receiving ongoing therapy, several more booked in waiting to be seen and others signing up all the time.  It’s great to see how people are getting on and the difference that having therapy is already making.  Here are some of the positive comments I’ve heard in the last week or two:

“The world suddenly seems full of possibilities.”

“It’s up to me now to go away and do these things.”

“I feel I’m on an upward curve.”

One of the great things about the project is being able to work in partnership with the British Stammering  Association. They are a fantastic source of support, and I regularly signpost clients to information on their website.  As an organisation it’s free to join, so if you want to receive regular updates about what is happening in the world of stammering, be able to access expert advice, read the latest research and be inspired by people’s stories, what are you waiting for? You’ll also be helping them to continue their fantastic work as the UK’s national charity supporting people who stammer. Click here to join right now!

And now I’m off to enjoy the sunshine. Hope you all enjoy a nice long weekend!

BSA Chair Tim Fell visits the project

Tim & Steph

Three weeks into the teletherapy trial to deliver speech therapy for adults and there are signs that Airedale NHS Foundation Trust is on to something big.

I called Steph last week to find out how things were going, and to ask if I could sit in with her during some therapy sessions.  A few days later, having got the necessary permissions, there I was sitting in her office while she talked to one of the early participants in the trial.  What’s different is that the chap she was talking to was in his living room at home.

But what struck me was how natural the conversation was.  Therapist and client were talking away as if they were sitting right next to each other.  I guess we’ve got used to talking to friends and family on the screen using platforms like Messenger and Facetime.  OK, there’s not quite the same intimacy, but needs must.

And the fact is that Steph’s first client of the day at 9am lives in an area where there is no provision for stammering therapy on the NHS.  At the age of 47, he had never had therapy before, and it appeared unlikely that he would be having therapy now had it not been for Airedale.  He had heard about the teletherapy programme via the BSA website.  This was his third meeting with Steph and the first part of the session explored progress over the previous week.  A particular difficulty for him was saying his name, and Steph suggested using a technique for sliding in to the first syllable.

The second client had also come to the programme via the BSA website.  Again, NHS speech therapy was not an option for her.  Now a graduate, she had flirted with speech therapy at University and was now looking for help at a pretty stressful time in her life.

From a technical point of view, the picture on Steph’s screen was very clear and the sound quality was good.  And once Steph learnt how to expand the screen we got a full picture 😊.  There was no delay in sound, but one small criticism was that the software didn’t allow both participants to speak at once.  So, for example, you couldn’t hear any comments made by the client before Steph stopped speaking.

This is a pilot programme.  Its purpose is to test the viability of delivering speech therapy online in terms of efficacy and practicality.  At all stages, it’s worth reviewing progress to try to identify any improvements that could be made.  So, for example, the software being used is Webex, but are there other platforms available that provide an improved experience without compromising privacy and security?  Feedback from the clients is crucial to try and match their expectations.  What other technologies can we add on to exceed their expectations?  Do speech therapists need to develop different skills to make the most of these technologies?

Teletherapy is a way of reaching people who stammer who find it difficult to access traditional therapy for whatever reason. That could be because there is no NHS provision in your area.  It could be because your employer won’t allow you time off work.  It could be because getting there is too much of a hassle.  It could be because you find face-to-face meetings intimidating.  Making speech therapy more accessible must be a good thing.

It was a privilege for me to sit with Steph as she talked to her clients.  It was a window into other people’s lives that mirrored many of my own experiences.  The job of a therapist is highly skilled and, I suspect, emotionally draining.  But seeing the difference you can make must be very rewarding.

Thanks Steph!