Allied Health Professionals Maximising Psychological Wellbeing

Confident Conversations

Here are two of my favourite things – having a great conversation and observing people reach their potential. As a speech and language therapist, I’m lucky that I have the opportunity to do two of my favourite things for a living.  I’ve always been involved in communication groups for a variety of people.   I’ve been running post-stroke conversation groups for years.  I love the camaraderie of the shared experience as well as the stories, humour and courage.  I decided to offer the same experience to a small group of men who had recently been diagnosed with Alzheimer’s disease.  I’d been working with them individually for some weeks and had heard their struggles to manage everyday conversations.  Their specific strain of Alzheimer’s meant that speech and language was the primary presenting symptom – they could remember the story but were unable to find the words to provide the detail.  They admitted that they frequently ‘gave up’ or looked to others to speak for them.  For this reason, they were a little reluctant initially to accept my invitation to join a conversation group.  I heard the phrase ‘I don’t do groups’ a number of times when introducing the topic.

However, on a wet Monday morning in October, every person I had invited made the effort to come along and see for themselves what group speech and language therapy might offer. We developed some aims for the group;

• To develop communication strategies within a supportive environment
• To share experiences
• To develop confidence in conversations.

Each session targeted word-finding strategies through identical activities using different materials.  Current affairs were discussed through the departmental ‘Words of the Week’ material. This encouraged group members to find out about each other and led to animated story-telling and debating!    The mantra for the group was ‘don’t be stuck’ and group members were encouraged to provide descriptions (‘tell me more’), gesture, write or draw (‘show me’) – anything that would keep the conversation going.   Throughout the sessions, we began to notice increased communication confidence – group members were taking more turns and starting the conversations.  We actually became redundant group leaders as the group developed its autonomy.  Over the course of the sessions, the men were helping each other by offering supportive feedback, demonstrating active listening and using humour to reduce tension.

After 10 sessions together the group ended for the Christmas break. I invited each member to consider how they felt about coming along every Monday.  We used a tool called ‘Emotional Touchpoints’ to help the men to select key emotions from a selection of written words.

When asked how they felt about conversations before the group, members selected words  such as ‘insecure’, ‘frustrated’, ‘held back’ and ‘unsure’  .

To describe how they felt during the group, they selected words such as ‘encouraged’, ‘supported’, ‘respected’, ‘confident’, ‘involved’ and ‘hopeful’.

They were asked how they felt in conversations outside the group and they all selected ‘confident’ – one member described feeling ‘a lot more confident’.

Relatives and carers were invited along to the final session and spent time individually with the speech and language therapist before joining in with the group. The consensus from relatives was that their family member had enjoyed and looked forward to each Monday morning session.  They commented on confidence generally and attempts to use strategies.  Two relatives noted their partner’s increased conversation skills outside the group, for example ‘He used to sit back and just listen but now he’s really getting involved again.  Our friends have noticed a difference and commented on it’.

Each group member admitted that they did not know what to expect prior to the group and that they felt nervous about it.   They were unclear the role a speech and language therapist played in dementia.  By the final session, they were recorded as saying ‘I think it was really the best thing’, ‘It was even better than I thought’, ‘we all got a lot out of it’, ‘I enjoyed it better each week – lots of free chat and laughter’. One member described the ‘camaraderie’ of the experience helping him to adjust and accept that he can live well with dementia and he said ‘when I got this diagnosis, I was just going to lie down to it. Give up.  But coming here every week – I realise I want to fight it’

You can hear more about my work at the Alzheimer Scotland conference on the 3^rd June where I will be talking about the “confident conversations” during my ten minute “soap box” session, describing how some of the men in the group have got involved in their local Alzheimer Scotland reminiscence group and the Scottish Dementia Working Group.

Thank you for reading my blog and I wander what you would answer if I asked you

‘What can you achieve when you are feeling confident?’

Jenny Keir

Specialist Speech & Language Therapist, NHS Tayside

@jenny_keir

I am based within the Medicine for Elderly SLT team in Dundee.  We are involved in communication and swallowing assessments across a wide range of conditions both in hospital and in the community.  I’m developing our SLT dementia service.  This involves training, establishing links in new teams, assessment/ therapy and promoting SLT role.