Secrets of Change

Inspiring Students to Want to Improve

By Barbara A. Ellicott, EdD, CCC-SLP

Does it take a miracle worker to change the will of a depressed, frustrated or resistant client? Does it take a magician to motivate an adolescent to improve? Does it take a genius to convince a student that he needs help and to hold him in therapy for a prescribed amount of time?

In my professional opinion, the answer to every one of the above questions is no.

Success in dealing with these requires genuine caring and sincerity, empathetic and analytical listening, insightful thinking and selective therapeutic strategies.

I have found a number of dynamics to be most successful in the thera-peutic process. I will describe the "secrets" of luring the patient/student to therapy, establishing and maintaining rapport, breaking down patient/student resistance in the therapeutic process, and creating and sustaining a high motivation level in both yourself and your patient.

The "bait" refers to attraction and motivation. As a therapist, it is imperative that you remain ready to respond to the patient's question, "What's in it for me?" This is particularly challenging with the adolescent population.

I have found the pragmatic approach to be most effective in the attraction process. For example, if a middle school student is having difficulty socializing because of extreme self-consciousness and awkward conversational skills, she is more likely to appreciate an activity such as role-playing in a safe therapeutic environment than she would playing a board game.

A high school student with a lisp might better appreciate employing his newly acquired speech skills in a pragmatic context, i.e., role-playing for a job interview, than using isolated words in sentences from a drill book.

Many students, especially adolescents, have a need to feel independent and in control of their lives. The adult-to-adult approach, which is student directed, is most effective.

For example, when working with one of my students who has special needs, I try to instill in him a feeling of independence. He not only tends to feel out of control but fears being "trapped" in therapy forever.

I reinforce the idea that he is the boss and speech is a service offered to him. However, if he feels he is not getting anything out of it after three sessions, he has the option of taking a "leave of absence."

"What?" you might interject. "You can't do that. What about the complexity of the school schedule and the mandated requirements on his IEP (Individualized Educational Plan) or the equivalent, which is a legal document?"

My experience has taught me that forced therapy doesn't work. Usually, if you are careful to match the activities to the students' interests and needs, you will succeed in motivating them to stay. Should they, out of a need to feel in control, elect to take a "leave of absence," nine times out of 10 they will return, especially if they discover that their friends are enrolled in the speech program.

The latter is a concomitant part of the luring process. I go out of my way to "match" kids, that is, to schedule "awesome buddies" for speech at the same time whenever possible.

I also make a concerted effort, when appropriate, to schedule them at a time of their preference. For example, I would not want to take them out of a major subject area--unless we were to follow a rotating schedule--or special support subjects, ones that have been prescribed in their IEPs. The latter would not only be an example of "robbing Peter to pay Paul," it would be illegal.

In sum, it is essential that we help students gain a sense of feeling in control of the captain's wheel, while we therapists actually remain at the helm, guiding our "sailors" in the growing process.

We also must be excellent persuaders, demonstrating to our students how improved speech and language will benefit them personally, now as well as in the future. The more secure we are as therapists--both personally and professionally--the easier it will feel to be flexible in our delivery of services.

The more emotionally secure we feel, the easier it will be for us to establish and maintain rapport with our students/patients. I have discovered the most satisfying and lasting rapport comes from a willingness to risk being emotionally intimate. Intimacy permits a therapeutic bonding that escalates the motivational level which, in turn, fosters internalization of newly learned speech and language skills.

Patients/students, especially those who feel the most vulnerable, are often perceptive enough to spot insincerity and superficiality. We must avoid condescension and projections of superiority. Such behavioral flaws will stir negative feelings and cancel out our therapeutic expertise.

To establish and maintain rapport, we must be one with each of our students to feel with them and for them. It is important that we start with the heart and move to the head (Hour of Power TV broadcast, Feb. 25).

We must listen deeply to our students/patients and observe them in an environment that makes them feel safe--an environment that fosters feelings of trust.

It is also imperative that we believe in our students/patients--believe in their ability to change, to improve, and to grow.

Above all it's imperative that we respect confidentiality. Make it known to them early on that there are only two situations that necessitate our breaking confidentiality: if they are a danger to themselves, or if they are a danger to others.

We must tell them this prior to establishing intimacy, so they will be less likely to feel betrayed should the need for divulging such material be necessary at a later time.

Sometimes students/patients tend to be resistant to developing an intimate relationship and to participating in the therapeutic process in general. When faced with such a reality, it is important that we have a strategy already developed for dealing with resistance so as not to be caught by surprise. This strategy will help us to remain in control of the situation and enable us to prevent therapy dropouts.

The most important thing to remember is never be pushy or forceful. We must be patient, listen to the student, and observe body language cues for verbalizations of resistance. In more cases than not, you may discover the tendency to avoid and/or sabotage the therapeutic process stems from extraneous circumstances rather than from our insufficiencies.

For example, the patient may have had negative therapeutic experiences in the past, may have been betrayed or abused by authority figures, and may feel insecure and extremely vulnerable. It also is likely that he or she may have assumed a "victim" posture for most of his or her life, may enjoy the attention derived from negativity, or may be afraid to change.

Sometimes we will encounter resistive patients who have been negatively programmed. They may feel a sense of hopelessness and/or may be afraid to risk trying.

By sincerely believing in them--in their ability to improve and grow--we may empower them as they emulate our faith in them. In short we must not be afraid to sensitively confront the resistance.

Once the resistance is overcome, it is important to hold the patient in therapy until the appropriate time for dismissal.

In addition to the maintenance of a pragmatic approach, essential ingredients in the holding process are maintaining faith in the patient, maintaining an atmosphere of trust, accepting him or her unconditionally, and recognizing that everyone has good days and not-so-good days.

It is especially important for the neophyte therapist to bear in mind the fact that the therapeutic process is often like going up and down mountains. This realization will help us accept our humanness and that of our patients. We all have good days and less positive ones.

I refrain from saying "bad" days because I have come to realize the power of positive thinking, as well as the extraordinary consequences of having the ability to convert negatives to positives. In my professional opinion, at least 50 percent of therapeutic success is determined by our modeling. Our outlook affects our attitudes toward our patients, and this positivism is then internalized by them.

We continually need to remind ourselves of the power of positive thinking. We must be patient with our patients' progress. Through our example, they may be helped to be patient with themselves. Delayed gratification is a concomitant part of the therapeutic process.

Remember to praise and encourage, and always seek out and emphasize the positive, no matter how minimal that positive may be. My wish is that you find the therapeutic process as exciting and inspiring as I do.

REFERENCES

Armstrong, T. (1987). In Their Own Way. California: Jemey P. Tarcher, Inc.

Canfield, J. & Wells, H.C. (1976). 100 Ways to Enhance Self-Concept in the Classroom. New Jersey: Prentice-Hall.

Friedmann, B. and Brooks, C. (1990). On Base. Missouri: Base Systems.

Gil, E. (1991). The Healing Power of Play. New York: Gilford Press.

McDaniel, S. & Bielen, P. (1986). Project Self-Esteem. California: B.L. Winch and Associates.

Myers, D.G. (1989). Psychology. New York: Worth Publishing Inc.

Rollin, W.J. (1987). The Psychology of Communication Disorders in Individuals and Their Families. New Jersey: Prentice-Hall.

Strean, H.S. (1985). Resolving Resistances in Psychotherapy. New York: John Wiley.

* About the author: Dr. Ellicott is a speech-language pathologist, learning consultant, child development specialist and state-certified school psychologist in New Jersey.