IN BRIEF

In Brief...
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Brief items (up to 500 words) may include therapy or assessment tips or a description of a resource you have developed. It may also be a reflection on the best piece of advice I have been given, or the things I wish theyd told me at University. Alternatively, it offers an opportunity for you to get on your soapbox! Although what you write will be substantially your own work, please acknowledge any influences. E-mail your entries to avrilnicoll@speechmag.com. One lucky contributor in each issue will receive 50 in vouchers from Speechmark, a company which publishes a wide range of practical resources for health and education professionals working with people of all ages (visit www.speechmark.net for more information).

sense. Some clients feel that this is better conveyed by the term acknowledge. This may seem very obvious, and of course the use and meaning of words continues to evolve. But this example has brought home to me afresh the realisation that the actual words we use in the therapeutic process have powerful effects, and that they can sometimes be changed for the better. Winifred Ashmore is a specialist speech and language therapist in adult dysfluency in Oldham.
Reference van Riper, C. (1973) The Treatment of Stuttering. New Jersey: Prentice- Hall.

Hands-off hands-on
Sheina Stockton defends the place of direct therapy.

How liberating
Sian Owens makes a plea for information to be truly accessible magine to go abroad and understand, whatever the language. How liberating would that be? We all have moments when we dont understand. Words used are difficult, or unfamiliar acronyms are not understood in context, and were afraid to voice this because were scared of looking stupid and drawing attention to ourselves in a negative way. We dont feel confident or comfortable to speak out. If we experience this, then how much more do the individuals we work with who have some sort of communication difficulty? As speech and language therapists were familiar with simplifying sentences or thinking of alternative ways to present information, without being patronising. By considering a persons perspectives and abilities, we try to find ways to explain difficult concepts, and avoid unfamiliar vocabulary and long sentences. But I perceive that Total Communication and accessible information needs to go one step further. Everyone has a right to be involved and included at their own level of ability. Those of us who work with service users with learning disability aim to use basic language and vocabulary, and consistent signage, symbols and visuals. If we can achieve this, then these resources will carry over into other areas. They will then be of value to individuals who have had a stroke, or have a hearing impairment and associated communication difficulties, specific language impairment, or English as an additional language. Communication is important to everyone to prevent isolation. The ability and opportunity to understand is essential to this. Any system or method that enables people to do this has to be a positive thing. To contribute to this in some way is a privilege. Sian Owens is an advanced specialist speech and language therapist with the Learning Disability Team, Betsi Cadwaladr University Health Board.

Accept or acknowledge?
Win Ashmore reminds us of the powerful effect our choice of words can have on the therapy process. provide a community-based service to adults who stammer, mainly using the process model derived from van Riper (1973) of Identification, Desensitisation, Modification and Stabilisation (IDMAS). To begin changing a stammer, the person who stammers needs to accept not only that it exists, but also what it is like in detail. This can be extremely difficult and painful, because of complex behavioural, emotional and cognitive defences. Through working with clients I have come to question whether using the term acceptance creates an unnecessary further barrier. Some have said to me, But I cant accept my stammer! or I wont accept it! Thats obviously true, because otherwise they would not have come for therapy. Some clients have found that acknowledgement of the stammer is a more useful term than acceptance. Perhaps this is because the word acceptance has other meanings, for example a positive response to social, cultural, ethical and other differences, which we not only accept but even celebrate. People who come to speech and language therapy do not accept stammering in that sense, and they want to reduce its control over their lives. To do that, however, they need to engage with and accept it - but only in a neutral, factual

en years ago, I left the NHS. The primary feeling which provoked the move was that I am at heart a hands-on therapist who loves working with young people, untangling their problems and helping them to move forward. I can chair meetings, write policy documents, train others and write therapy programs. I still do all of this, but I trained to work with young people and that is what I wish to spend the majority of my time doing. I am lucky to have contracts with a number of state and independent schools, both within mainstream and special education. Most of my work is with teenagers who have complex difficulties linked to the autistic spectrum or long-term language disorders. I work with teaching and speech and language therapy assistants, carry out training with teaching staff and, where appropriate, leave programs of work to be carried out in school. However I spend most of my time doing hands-on therapy, week after week, mostly in small groups but also on an individual basis when appropriate. Even after 30 years in the business, I am still unable to carry out a one-off assessment on some of these complex youngsters and leave a useful program of work for someone else to do. I need to spend time working with them to untangle the underlying difficulties and focus therapy on the core problems. The teaching assistants have all had training from various sources, but still find it hard to know when to move a pupil on, how to react if they become stuck, and to spot clues which indicate a need to adapt the program. My concern with our profession at present is that we are in danger of talking ourselves out of direct work with children. We still train our new therapists in this role, but increasingly we seem to be adopting an assess-and-advise model of support rather than hands-on. It is very important to ensure a range of inputs, and to have a good skill mix. However, this is very different from adopting the attitude that hands-on therapy is wrong. I have been criticised for actually working with children, as if this was an archaic way of delivering a service. This is despite the fact that the schools who employ me have been profoundly dissatisfied with the advisory model and have found money to support direct therapy. If schools can see the benefits, I find it very hard to understand why some of my NHS speech and language therapy colleagues do not. I am very aware of the profound shortage of therapists in some services and therefore the need to avoid over-committing staff to provide direct input. However, being honest about the reasons for the input model is one thing. To move to a position of being convinced that this is the only acceptable model is a different ball game altogether, and one which I really hope will not prevail. Sheina Stockton is an independent speech and language therapist in the Worcester area.

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2010

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