Counseling practices of speech-language pathologists working with aphasia: “I did not have adequate training in actual counseling strategies.”

Abstract

ABSTRACT Background Counseling is a part of the scope of practice for speech-language pathologists (SLPs), however training has been inconsistent across programs. Students, clinical fellows, and practicing SLPs alike report feeling under-prepared to address the counseling needs of clients and their families. Research evidence about counseling training and practices specific to addressing the psychological well-being of individuals with aphasia and their families is even more limited. While practicing SLPs feel confident and prepared to address communication-specific interventions for aphasia, they feel ill prepared to address the counseling needs that arise on a regular basis. Aims The present investigation was part of a two-part investigation that included an online survey to practicing SLPs throughout the United States (US) and follow-up interviews with a subgroup of those participants. This paper addresses the counseling practice interview portion and addresses two research questions: How confident do SLPs feel using counseling with individuals with aphasia? To what extent are SLPs implementing counseling in practice with individuals with aphasia and their family members? Methods & Procedures Eight practicing SLPs who participated in the part 1 counseling practices survey agreed to participate in the part 2 counseling practices intervention. They varied by years of practice, region of practice, and practice setting (acute, subacute, and chronic). Participants engaged in the Counseling Practices Interview (CPI) via the BlueJeans video conferencing application. Interviews were transcribed and coded qualitatively using open and axial coding methods. Multiple rounds of iterative coding were conducted to ensure rigor and coding stability. Outcomes & Results Multiple rounds of coding resulted in the following overarching themes: confidence in aphasia-specific skills/techniques, SLPs encounter emotional and psychosocial discussions regularly, confidence with educational counseling, not prepared for psychosocial adjustment counseling, taking the perspective of individuals with aphasia and their family, referrals/interprofessional practices and scope of practice issues, and SLP self-care. SLPs reported a clear difference between knowledge and skills for which they feel prepared and confident, versus addressing psychological well-being of individuals with aphasia and understanding practice boundaries. Conclusions SLPs recognize the importance of counseling skills for working with individuals with aphasia because counseling moments arise regularly. They use a variety of techniques but lack intentionality and specialised training. Academic training was deemed to be inadequate in scope and instructional methods. Post-academic training was identified as hard to access but useful. SLPs reported a lack of clarify on scope of practice, practice boundaries, and referrals.