Empathy: the most important clinical tool
There is no such thing as a communication disorder; there are only people trying to communicate. There is no such thing as speech and language pathology, just the pathologization of language practices." -- Betty Yu
As a clinical fellow, I have regular supervisory meetings to discuss my caseload and work through any challenges I’m having. In one of my meetings with my supervisor recently, I shared two cases with her in which I was feeling stuck. The way she responded to these scenarios illuminated something very important that I hadn’t acknowledged before: when working as a speech therapist. empathy is an essential clinical tool.
While it may seem obvious to approach clients with empathy, I hadn’t thought of empathy before as an actual tool to inform the evaluation and treatment process. Here is how this concept became clear to me.
The first case I shared with my supervisor was that of a teen with a nonverbal learning disability and slow auditory processing, who does not engage much with others socially. There are long periods of silence between when I ask a question and when they answer, and they only respond in one-to-three word utterances most of the time. They are able to produce longer utterances, and grasp fairly complex concepts, but most of the time, they don't. Their parents are concerned, because this teen spends a lot of time alone and doesn't have close friendships. I had reached a standstill with this client because I kept introducing topics and questions to them and being met with a minimal response.
When I described this situation to my supervisor, she thought for a moment. “Well,” she said, “If it took me a long time to process auditory information, I would probably not want to ask a lot of questions, because I would know that then I would have to listen to the response.”
She suggested that instead of conducting our sessions as verbal conversations, I could incorporate visuals that we could look at together, and give the client the option of using the chat feature instead of talking.
The second case I shared with my supervisor was that of a client who was born without hearing, and who had a hearing device implanted as a toddler. This client’s speech is currently about 60% intelligible to an unfamiliar listener due to their way of articulating sounds. This client’s way of speaking was unlike anything I had heard before, and I was having trouble understanding the ways that they were producing speech sounds. My supervisor asked me to consider the question, “What would it feel like to make speech sounds if you couldn’t hear yourself? Where would you feel the sounds in your mouth and throat?” After I considered this, she shared with me that often, people with hearing loss make sounds further back in the throat because they can feel the vibrations of them more strongly there than they can when the sound is being made further up towards the front of the oral cavity. Because of this, part of my work with this client would be teaching them to deepen their tactile awareness of how sounds feel when they are produced further forward in the oral cavity.
In both of these instances, my supervisor used empathy in order to understand what was impacting the client’s method of communication, and how to proceed with treatment. This lesson has greatly impacted the way I approach my clients, and it led me to create the following empathy-based process for how to approach my work:
Step 1: Gather information about the person. Do any relevant formal or informal testing, and find out relevant details about their physical, mental, and emotional history. Find answers to questions like: How do they currently communicate? What is their day to day environment like? What demands are being placed on them by work, school, and community? What diagnoses do they have? What interactions with the medical system have they had?
Step 2: Do your research. Learn whatever you can about the diagnoses and conditions that they have, and the meaning of their test results. This is the part that graduate school prepared you for, so nerd out with confidence!
Step 3: Empathize. Given all the information you have collected about the person, imagine that you are them. Let yourself sit in that space, without rushing to come up with any answers. Once you have settled in, start to ask yourself questions like: How would I spend my time? What would I want to avoid? What might I believe is bad or shameful about me? How might I hide or try to compensate for things that I’ve been told are wrong about me? How might I advocate for myself? What are my needs? How would I seek to get my needs met?
We can never truly know what it is like to be another person, but by doing our best to empathize with our clients, we can treat them as human beings who are trying to communicate, rather than as something to pathologize.