I had a couple of very lovely 'therapy moments' today. I am really enjoying my placement - working with adults with communication problems has been very rewarding.
Lovely moment 1. I see a patient with Multiple Sclerosis every day to work on improving her voice quality and self-monitoring of her understanding. She's about 60 and had MS for 40 years of her life. She is such a pleasure to work with - always engaged and motivated during therapy. No matter how tired she is or if she had a bad day, she would always want to do work with me. A dream patient! Well, today she reported that she has been feeling a lot more confident as a communicator and finds that her speech is getting clearer. She said she had a wonderful conversation with the other patients in her room yesterday and not once did any one of them asked her to speak louder or to repeat because she wasn't intelligible, which were frequently what her listeners had to do before we started our therapy. She said she felt good to be part of the conversation and was pleased that she remembered the strategies we've been working on and how well they've worked.
I am most certainly not saying that I'm a miracle worker here. This lady's progress is because she has been so 'switched on' throughout the therapy process, making the effort to work on her homework everyday. Such engagement and motivation are key factors for good prognosis during any therapy.
Lovely moment 2. With a lady with Vascular Dementia. She's 80 years old. Bless her. She also has a gamut of many other medical difficulties. I am currently doing assessments on her to find out what her swallowing and speech difficulties are. Saw her once before and we didn't hit off on a particularly great start. She was a bit agitated and didn't really want to do much with me.
But you need to understand that her behavioural difficulties are partly due to her medical conditions, and not completely due to her trying to be a 'difficult patient'. This is something that not many people comprehend. People who have brain lesions, injury or trauma at the cerebral frontal lobes or at the right hemisphere are likely to exhibit behavioural and cognitive impairments. This second time, I prepared myself that I might need to negotiate with her because I aimed to complete all my assessments. She was great in terms of agreeing to do them with me. During the assessments, she kept saying 'I can't do it' and pushed the booklet away. We had a very good chat at various times and talked about how she feels about her communication. Apparently she feels she can't communicate as she used to and people often say they "don't understand what she is saying". Her awareness that her condition is deteriorating has been eating her self-esteem and it was now clear to me why she was previously unwilling to engage. While she does have significant cognitive problems, affecting her ability to follow and participate in conversations, but if people can slow down or use more simple language, she can and is able to converse. All I did was to listen to her and told her to be patient and try to focus on the positives. I think when we get ill, it is only too easy to focus on the negatives. Sometimes, when people are feeling discouraged, what they really need is simply active listening. Well, I did just that and felt very nice that I managed to help make her day a little brighter today.
Doing what I do, I've come to realise that one's identity, self-perception and self-esteem can be so tightly intertwined with one's ability to communicate. I quite like this quote from Schiffin, a social psychologist, "Conversation is a vehicle through which selves, relationships and situations are talked into being."
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