As speech and language therapists we are highly attuned to interaction. We recognise the link between communication competence and how people feel about themselves. Many of our interventions encourage ‘significant others’ to make changes to their communication. This gives our client (the spouse with aphasia, the child with language delay, the parent with dementia or the young person with a stammer) the chance to express themselves more effectively and be a more equal partner in the exchange.
Much of healthcare is relational and ‘poor communication’ is recognised as an ongoing problem. The experience of speech and language therapists and their clients therefore has wider relevance for interactions between healthcare staff and users of services.
Video Interaction Guidance, Non-Directive Therapy and Solution Focused Brief Therapy approaches have found favour in speech and language therapy and across the helping professions, while Talking Mats and Parent-Child Interaction Therapy originated in speech and language therapy and have been widely applied. Now Ray Wilkinson, a speech and language therapy researcher behind the hugely influential SPPARC (Supporting Partners of People with Aphasia in Relationships and Conversation), is looking to extend his conversation analysis expertise to the broader training of healthcare workers.
Ray was invited to present last week at a multidisciplinary symposium on ‘Communication and Interaction: Applications for Healthcare’. The common bond between most of those attending was an interest in using conversation analysis as a research tool. The diverse backgrounds – such as sports, sociolinguistics, management and health – made for lively and thought-provoking discussion. For some, Ray’s before-and-after video examples were the first time they had really thought about what it might be like to live with – and to live with someone with – a communication impairment such as aphasia or dysarthria. It was also an opportunity for them to see how transformative speech and language therapy intervention can be.
Ray is clear that we don’t get a true picture of everyday talk from what we see in a clinic. Analysis of more natural interaction shows that, in their effort to adapt to and cope with a communication disability, families can get stuck in a particular interaction style such as a pedagogic (teacher/pupil) pattern. Importantly, he stressed that intervention is not so much a result of judging how ‘good’ or ‘bad’ the interaction is, as raising awareness that there are other options. These may produce different benefits such as greater participation in spite of a persisting impairment.
Although Ray says there has been a lot of work done on improving the communication skills of healthcare workers, this tends to concentrate only on the professional. In contrast, his Interaction-Focused Analysis and Intervention recognises that communication depends on at least two people. What matters is what happens in the space between them, and how they experience it. As much of the way we communicate is below our level of consciousness, video and natural settings provide an effective and generally acceptable way of raising awareness of interaction and the potential impact of adjusting it.
Later during the symposium we split into groups to discuss a transcript of an interaction between a community nurse and a client. This was a stark reminder for me that, however 'good' or 'bad' anyone judges the particular interaction to be, we should be mindful of the context in which the communication is occurring. Health professionals and the system they are constrained by hold a great deal of power. As with communication much of this is below the level of consciousness but, in raising awareness, we should find there are other options.
Speech & Language Therapy in Practice editor Avril Nicoll attended the University of Stirling sponsored 'Communication and Interaction: Applications for Healthcare' event on 27 January 2012 as a student on the MRes (Health).