Addressing Emotions and Beliefs in Therapy

Question

Answer

When a patient’s emotions and beliefs interact directly with a deficit in one of the target domains, the relationship needs to be addressed in order for treatment to be effective.  We are not going to get the outcomes we want if they are not addressed.  They need to be addressed, but maybe not just by us.  How do you decide if this is something that can be part of the services you are providing versus something that you should seek additional help?  Below is a set of litmus questions to make that determination. 

• How much of the patient’s emotional difficulties relate directly to the targeted cognitive-linguistic deficits?  Is it a response to a change in their functioning versus having a diagnosis of schizophrenia, for example? 
• As you are getting a better understanding of this person, do the emotional difficulties have a contributing role or a causative role?
• Do the affective concerns overshadow your scope of practice concerns? 
• Given my ability to provide some counseling and do it in the framework that is centered on my scope of practice, when I am working with the patient, do I feel comfortable with the content of my sessions?  Do I think I am doing the thing that I was referred for?  Do I think my medical notes reflect that?  If not, would a referral be appropriate?

​William S. Evans, MS, CCC-SLP, is a Ph.D. candidate at Boston University and a speech-language pathologist at Massachusetts General Hospital. His doctoral work focuses on the role of executive control in aphasia following stroke, and his interest in Cognitive Behavioral Therapy stems from his clinical experience providing cognitive rehabilitation for patients with acquired brain injuries.