In honor of BETTER Speech & Hearing Month, I am tackling some answers for BETTER questions we can be asking each other as a profession. Imagine if we started asking some of these thoughtful questions that could elevate and inform how we practice, in contrast with questions that oversimplify what we do such as “What’s your favorite game to play for memory?” Let’s crowd-source our knowledge here! I’d LOVE to hear your thoughts in a comment below or email me: [email protected].

This Week: What If Someone Has No Speech Therapy Goals?

This is a common question when we start getting into a Person-Centered Care approach. After all, if we aren’t simply basing our therapy goals on how someone does on standardized testing, then what our own patients think about their need for speech therapy starts playing into things. And of course, that can get a bit messy. We are working with populations that have had brain changes, so it can get complicated if they don’t think they need therapy (but we can see that they would benefit.) So how do we handle this?

Although this is a nuanced issue, here are the main ideas that I usually think about.

• Move to Family-Centered or Care-Centered treatment. What I mean is that if your client is unable to adequately or reliably express what needs they may have, expand your circle to THEIR circle. Ask their family / nursing staff / communication partners / whoever they interact with regularly what the needs are that they are noticing. Your cognitively-challenged patient may not be able to express a functional need to you, but when you talk to the facility staff you understand that almost daily they are dealing with outbursts centered around bathroom issues. Here, you’ve found a communication need! Work within the need to develop supports and an intervention that can improve how the patient and staff communicate in order to decrease outbursts. This could go any number of directions – safety, enjoyment, behavior, choice-making– but the bottom line is that their circle of people will better inform you how you could improve functioning in speech therapy.
• Are you asking the right questions? In order to understand client needs, we should be using a counseling technique that supports autonomy in decision-making. I suggest looking into Motivational Interviewing and how phrasing your questions appropriately can reveal functional needs with the conversations you are having.
• Just because you can, doesn’t mean you have to. Have you ever noticed that you might KNOW you should choose to eat more green leafy foods…. or exercise more frequently…. but you don’t choose to do it? In the same way, we can educate our clients in the ways that we may help them address a need in speech therapy, but they may not want to address it. It may not bother them that they forget where they put their keys… or call their family the wrong name … or get distracted when grocery shopping. Ultimately, it is their choice if they want to partner with you in speech therapy. Before I knew about person-centered care, I would dare call people who chose not to participate in speech therapy as “noncompliant.” Now, I view my work as complete if I have educated them as a partner in care, and even if they choose not to complete speech therapy, I know that I’ve planted the seed for a relationship that they may dare to approach me in the future if they do feel like they are ready to address the need. I find this approach far more beneficial than forcing therapy on someone who does not yet want to participate, even if they could benefit.

I’d love to know your thoughts on this issue! How do YOU handle things if someone doesn’t have any real goals for speech therapy?