Those therapists who have learned to accept and appreciate individual differences in their patients rather than change or reject them have the most positive rapport.

By Barbara A. Ellicott, PhD, CCC-SLP

Language equals power. The more adept people are in language, the more efficient they may become in the areas of understanding, persuasion and verbal self-defense. As speech-language pathologists, it is imperative that we understand our patients. This is essential in the rapport process as well as in the therapeutic process. A concomitant part of this process of understanding is becoming familiar with their temperament, character and intelligence—so much of which may be learned through their language.

Other ways to acquire this information are temperament/ personality sorters or methodologies, such as those devised by Watson (behavior); Freud (lust instinct theory); Rogers and Maslow (self-actualization theory); Jung (extroversion/introversion, thinking, feeling, sensation, intuition types); Miller (ethnology); Murray (personology); and Briggs and Myers (Myers-Briggs type indicator).

It is imperative that we understand both our own temperament and that of our patients. By comparing the two, we may come to learn and appreciate their values and differences.

In my experience as both a speech-language pathologist and a psychologist listening to colleagues' successes and failures, I have come to realize that those speech-language pathologists/psychologists who have learned to accept and appreciate individual differences rather than change or reject them have the most positive rapport with their patients. An inordinate number of patients in my caseloads over the years have related negative experiences with other therapists. Upon analysis of these experiences, I've discovered that most problems had much more to do with rapport issues than with therapeutic techniques.¹

Therapists with various personality types may become effective in understanding their patients and establishing a positive rapport with them. However, research, professional feedback and personal experience all lead me to believe that the "idealist" personality type has an exceptional ability to introject or empathize—to see the world through another's eyes. They are the true masters of the art of intimacy.² For idealists, understanding their patients may feel natural and spontaneous, qualities that give way to positive patient-therapist rapport and intimacy. Such understanding is advantageous in motivating patients and negotiators through the therapeutic strategies.

Understanding patients' personalities and needs can play a significant role in persuading them. Learning persuasive techniques of language can greatly enhance one's therapeutic success as well. Roger Dawson discusses a multitude of persuasive methodologies that may be particularly effective during the therapeutic process.³

One of the keys to success in understanding a patient is bonding, a term used here to get the person to commit to a position. Projecting your beliefs onto your patients' ability to change or modify their behavior can have a powerful impact on their motivational level and commitment. These are of critical importance in the therapeutic process. Positive reinforcement given by the therapist is of equal importance in the persuasive process for commitment.

When treating preschoolers, praise and accolades in the form of dancing and cheering often are all that is necessary to keep them motivated. When working with teens and adults, however, it sometimes is necessary to spell out the benefits of therapeutic intervention, e.g., elimination of the need for surgery if nodules shrink, increased opportunities for job promotion with improved articulation and/or accent reduction, and increased confidence with improved fluency.

It is imperative that clinicians maintain consistency in the therapeutic environment and in their expectations and positive feedback. Why? Because our need for consistency is an awesome force and conditions the other person to trust you.³ When patients sense that trust, they may be persuaded more easily to modify their behavior, speech or language.

In addition to learning persuasive techniques in the therapeutic process, it sometimes becomes necessary to arm ourselves with verbal self-defense strategies. While many of us are fortunate enough to experience positive relationships with our patients, there may be occasions when we are faced with disgruntled individuals who, usually by no fault of our own, may manifest abusive verbal behavior. The vast majority of these individuals come to therapy sessions with a good deal of accumulated baggage from various aspects of their lives.

When exposed to abusive behavior, we need to recognize it and utilize strategies to combat it. Naive and inexperienced therapists often assume that their hurt feelings are the result of being oversensitive, paranoid or childlike.⁴ Consequently, they become a vulnerable target of verbal abuse.

Recognition of the abuse and the types of abusers is the first step in the defense process. The gentle art of verbal self-defense is a way to prevent violence.⁴

One type of abuser is the placater, an individual who is frightened that others will become angry. When asked what they expect to achieve in therapy, placaters say, "Whatever you think." The therapist needs to inform these patients that therapy is a two-way process and they have to assume responsibility for what they hope to achieve or correct in therapy.

Another type of abuser is the blamer. This individual frequently avoids taking responsibility for the lack of progress in therapy and continually blames the therapist for such things as not providing enough attention.

Passive aggressive patients avoid demonstrating anger overtly. They do so in a passive and indirect manner, such as coming late to sessions or missing them entirely without notifying the therapist.⁵ These patients may procrastinate persistently in doing their practice assignments and sometimes are insulting and/or overbearing.⁶ They may attempt to sabotage their therapist's efforts by distracting or putting forth their own agenda.

As a rule of thumb, if clinicians feel uncomfortable in the therapeutic relationship, some antagonism is involved in more cases than not. They then must begin detective work to determine what abuse undercurrents may be at work.⁷

To be forewarned is to be forearmed. Therapists must not allow themselves to be victimized. Once problem behavior is recognized, they need to confront the patient and re-establish rules that need to be adhered to in the therapeutic process. Language may help us to become more effective as therapists as we progress in our ability to understand, persuade and defend in our therapeutic relationships.

References

1. Fisher, R., Ury, W. (1981). Getting to Yes: Negotiating Agreement Without Giving In. London: Penguin Press.

2. Keirsey, D. (1998). Please Understand Me II: Temperament, Character, Intelligence. Del Mar, CA: Prometheus Nemesis Book Company.

3. Dawson, R. (1992). Secrets of Power Persuasion. Upper Saddle River, NJ: Prentice Hall.

4. Elgin, S. (1980). The Gentle Art of Verbal Self-Defense. Prentice Hall.

5. Langs, R. (1993). Unconscious Communication in Everyday Life. Northvale, NJ: Jason Aronson Inc.

6. Wetzler, S. (1992). Living with the Passive Aggressive Man. New York: Fireside/Simon & Schuster.

7. Stenack, R. (2001). Stop Controlling Me. Oakland, CA: New Harbinger Publications.

Barbara Ellicott, PhD, is a speech-language pathologist, learning consultant and school psychologist at Comprehensive Therapeutic Services in Madison, NJ.