Make It Work: How to Check Your Emotions in Treatment Beating yourself up after a tough session? Stop it. Instead, ask yourself these five questions and see what you can learn. Make It Work
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Make It Work  |   March 01, 2014
Make It Work: How to Check Your Emotions in Treatment
Author Notes
  • Irene Gilbert Torres, MS, CCC-SLP, chair of ASHA’s Multicultural Issues Board, is a clinician in New York City. This article was adapted from one of her posts on ASHA’s blog, ASHAsphere. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations; 16, School-Based Issues; and 17, Global Issues in Communication Sciences and Related Disorders. ■irenetorres@optonline.com
    Irene Gilbert Torres, MS, CCC-SLP, chair of ASHA’s Multicultural Issues Board, is a clinician in New York City. This article was adapted from one of her posts on ASHA’s blog, ASHAsphere. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations; 16, School-Based Issues; and 17, Global Issues in Communication Sciences and Related Disorders. ■irenetorres@optonline.com×
Article Information
Special Populations / Autism Spectrum / Practice Management / Professional Issues & Training / Make It Work
Make It Work   |   March 01, 2014
Make It Work: How to Check Your Emotions in Treatment
The ASHA Leader, March 2014, Vol. 19, 34-35. doi:10.1044/leader.MIW.19032014.34
The ASHA Leader, March 2014, Vol. 19, 34-35. doi:10.1044/leader.MIW.19032014.34
As a more … ahem … shall we say “senior” speech-language pathologist, I relish the chance to help early-career colleagues with problems I’ve tackled during my career. And problems involving our clients and our emotions are often the trickiest. When the going gets tough in treatment, how do we keep our emotions in check?
I know of a recent situation encountered by a clinical fellow I supervise—whom we’ll call Karen—that well illustrates the type of emotionally charged treatment challenges we can face. I hope the rules of thumb I offered her can help you through similar situations.
Here’s what happened: Karen was just starting her second week treating 8-year-old Eli (not his real name), who has autism spectrum disorder and no real verbal language and displayed serious negative behaviors—some of them hostile and aggressive, like biting. Such behaviors had spurred intervention from a crisis-management team, but his previous SLP recorded some very positive sessions with him.
Karen had conducted five successful sessions with him and as they began their sixth, she felt confident that she could have him request food items using his communication book. That is, she felt confident until, out of the blue and with no provocation, Eli grabbed her arm and bit down hard. She pulled her arm away before he broke the skin, but not before he bruised and hurt her. And not before he bit his own lip and bled all over the materials Karen had spent considerable time making for him.
Well, there went her confidence. Needless to say, Karen was extremely upset. But she managed to hold it together long enough to get Eli and herself to the nurse, get him and her materials cleaned up, get an ice pack for her arm, and get herself to my office to decompress.
When I noticed the ice pack, she lost it and began to cry. I saw that this was a good time to discuss the issue of “not being emotionally involved” with a client.
We’ve all heard about this concept, but I remember finding it very strange when I was a new SLP. Of course I was emotionally involved! I was invested in the client’s success. I cared about the client. What were people talking about—this not being emotionally involved?
Over the years I have come to understand that it is about not having your ego caught up in the client’s performance, but having it grounded in your own performance. I have developed a few questions that a CF (or an extern, or any SLP) can ask herself or himself when feeling bad about a session. Let’s take a look at each one, as applied to Karen’s situation:
  • How do I really feel? I asked Karen if she was hurt. Was that why she was crying? Was she just upset about being bitten? As she examined her feelings, she determined that she felt she had done something wrong. Why did the child bite her? She said that she did not want to have the child taken off her caseload but that the bite made her feel that she wasn’t doing a good job. So she identified that she felt like a failure.

  • Why do I feel this way? Well, the other CF never reported being bitten by Eli, so Karen felt she must have done something wrong.

  • Could I have done something differently to change the outcome of the session? Aside from staying far enough away from the child that he couldn’t grab her (not always therapeutically appropriate), she concluded that she could not have done much differently.

  • What precipitated the client’s behavior? Karen could not really identify anything.

  • Did I do the best I know how to do? Karen she said she thought she had.

In your own situations, your answers to these questions will reveal that either you did all you could do, and you did it properly, or you did not. Either way, the client’s behavior is not your behavior. Your emotions should be based on your behavior. And even if you think you could have improved things, you did not fail. You learned. If you think you could not have done anything differently, you learned that you cannot always avoid a negative outcome, no matter what you do.
No matter what, you must not allow your emotions to get the better of you. You must be intellectually involved in your treatment and in your outcomes. Your sense of success and failure must come from knowing that you know what to do—or from knowing that you know how to improve, or how to seek the help you need to improve. When you are present in your sessions and aware of your behavior and can assess your behavior after a negative outcome, you are remaining objective and not being overly “emotionally involved.”
2 Comments
March 24, 2014
Margaret Simpson
Thank you
I'm not an "ahem" unseasoned Therapist, more of a mid-lifer, but it helps to remind yourself of these things, and check yourself every now and then. The work we do can often be very emotionally and psychologically demanding, and it's important that we are in tune with ourselves. Some of my early intervention work causes me to feel powerless, and that can create some overwhelming emotions. Do you have any words of wisdom for those of us working with vulnerable children and families? There are no established clinical supervision practices in our profession to provide an opportunity for reflection and review of difficult situations. Social Work and Psychology professionals have certainly engaged in clinical supervision for a long time, and acknowledge its critical role in maintaining healthy therapists.
March 26, 2014
Priya Gole
Agree on some. ... not all...
Being working with children for last 12 years, I think it is very difficult not to get emotionally involved. I can't speak for others but here in India we are not just SLP s but also counsellors to parents and at times be their friend too. I think emotional evolution is a learning process which gets strengthened with experience. All said and done, I think it is this involvement which makes our profession stand out! !! Just before I end, I think in cases like above the sensory integration specialist may help him better to settle down in order for the SLP to work better. My two cents. ....
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