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Exploring hopes for therapy and establishing goals
Published on August 31, 2017 21 min
Other Talks in the Series: Speech Dysfluency
Teenagers and stuttering management: are they ready?
- Prof. Patricia Zebrowski
- University of Iowa, USA
Speak more fluently and stutter more fluently approaches - their principles, strengths and limitations
- Mrs. Ali Berquez
- Michael Palin Centre, UK
Hello. My name is Sharon Millard, and I am a speech and language therapist and the research lead at The Michael Palin Centre in London, and I'm also a lecturer at City, University of London. I'm going to be talking about why and how we might work out with our clients what the aims of our therapy might be. I'm going to talk about why we need to establish goals collaboratively with our clients, suggest one way in which we might approach this process and then talk about how to formulate those objectives in a way that we can then evaluate our effectiveness. We will consider long term goals, short term goals and then how we might develop individual session goals and build a program of therapy.
Let's start with the EBP triangle. Straus and colleagues proposed that evidence based practice requires us to use our clinical expertise to evaluate and appraise the empirical evidence, to explore our current unique values, priorities and circumstances and then to apply the evidence based on those. What we are thinking about during this session is how we can work together with our clients to establish some goals that will make a difference to them.
By exploring the client's preferences and priorities, we are able to incorporate their expertise into the decision-making process. Acknowledging and appreciating the client's knowledge and expertise about themselves and their stuttering, not only helps us as clinicians to identify outcomes that are meaningful, functional and important to the individual client, but also helps facilitate the client-therapist relationship and shifts the balance of expertise from the therapist to the client. According to Locke and Latham, the key moderators of goal setting are feedback, commitment to the goal, task complexity and situational constraints. Understanding these, in relation to the individual, requires us to explore the client's perspective of the complexity of the task for them and their knowledge of the situational constraints that might get in the way for them. This will directly affect their commitment to the goal. Importantly, there is evidence from the medical literature, for instance, in asthma, that when people are involved in decision-making, there is better adherence to medication and management and better outcomes. Patients are more confident in decisions. They're more motivated and actively involved. Decisions made are better understood based on more accurate expectations and more consistent with personal preferences. And we know from our own field, particularly with parents, that when they are not involved in the decision-making process, parents expressed dissatisfaction with therapy.