Counseling in Language Intervention: Building Effective Relationships

The primary task of speech-language pathologists (SLPs) is to help their clients learn the skills necessary to establish more effective communication skills, transfer these new behaviors from treatment sessions to the natural environment, and maintain them over time. Consciously or not, speech-language pathologists frequently use a range of methods which have their roots in counseling and psychotherapy to accomplish these goals. The applicability of these techniques cut across virtually all classifications of communicative disorders--voice, hearing, neurogenic pathologies, stuttering, and, as we will discuss in this article, language (Shipley & Roseberry-McKibbin, 2006). After all, SLPs do not treat a communication disorder--they work with people who happen to have a disorder related to communication! Consequently, although some SLPs profess to be uncomfortable entering the realm of human values, feelings, and beliefs, we cannot hope to bring about lasting change if we ignore the personal aspects of a communication problem (English, 2002; Flasher & Fogle, 2004; Luterman, 2001; Shipley & Roseberry-McKibbin, 2006).

This viewpoint is consistent with the American Speech-Language-Hearing Association's (ASHA) most recent Scope of Practice (2001) document which includes "educating and counseling individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decision making about communication, swallowing, or other upper aerodigestive concerns." Counseling has been variously described as building rapport, providing information, and lending the proverbial "sympathetic ear." While counseling skills are used naturally by many SLPs, the skills and strategies that contribute to building an effective counseling relationship can be learned and incorporated into treatment in all professional settings.

There are a number of theoretical models that have been proposed over the years, such as cognitive-behavioral, rational-emotive, informational-educational, family systems, and client-centered (Flasher & Fogel, 2004). While there are many differences among them, all have in common the basic fundamental concepts of facilitating changes in behavior. While the strategies presented in this paper are generally oriented toward the client-centered approach, as first proposed by Carl Rogers (1942), tenets of other theories that support the overall goal of helping clients make positive changes in their communicative skills and behaviors are blended in as appropriate.

The Nature of Counseling Individuals with Communicative Disorders

Counseling has been described by Rollin (2000) as "the establishment of an effective interpersonal relationship within which client growth and change are fostered." Understanding the characteristics and scope of counseling relationships relevant to the clinical management of communicative disorders is an important first step toward actively incorporating counseling activities into intervention. To alleviate potential concern of some SLPs regarding the possibility of crossing professional boundaries, it is helpful to review characteristics of counseling as it relates to a communicative disorder.

First, counseling in communicative disorders is person-centered rather than disorder-centered. That is, we do not design and implement intervention for a language disorder, but rather to meet the unique needs of a particular child. This is not a new concept. The recent emphasis on using person-first language (e.g., "child with a language disorder" rather than "language-disordered child") when describing our clients reflects our belief in the primary importance of the person over the disorder. Thus, counseling is not employed to "fix" the communicative disorder, per se, but as a means to help clients determine how they can most effectively manage the personal challenges that are posed by the disorder.