Handle With Care Tips on delivering bad news from former ASHA president Tommie L. Robinson Jr. Overheard
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Overheard  |   July 01, 2015
Handle With Care
Author Notes
  • Tommie L. Robinson, Jr., PhD, CCC-SLP, is chief of hearing and speech and director of the Scottish Rite Center for Childhood Language Disorders at Children’s National Health System in Washington, D.C. He is also an associate professor of pediatrics at the George Washington University School of Medicine and Health Sciences. Robinson was the 2010 ASHA president and is an affiliate of ASHA Special Interest Groups 4, Fluency and Fluency Disorders; 11, Administration and Supervision; 14, Cultural and Linguistic Diversity; and 16, School-Based Issues. trobinso@childrensnational.org
    Tommie L. Robinson, Jr., PhD, CCC-SLP, is chief of hearing and speech and director of the Scottish Rite Center for Childhood Language Disorders at Children’s National Health System in Washington, D.C. He is also an associate professor of pediatrics at the George Washington University School of Medicine and Health Sciences. Robinson was the 2010 ASHA president and is an affiliate of ASHA Special Interest Groups 4, Fluency and Fluency Disorders; 11, Administration and Supervision; 14, Cultural and Linguistic Diversity; and 16, School-Based Issues. trobinso@childrensnational.org×
Article Information
ASHA News & Member Stories / Overheard
Overheard   |   July 01, 2015
Handle With Care
The ASHA Leader, July 2015, Vol. 20, 24-25. doi:10.1044/leader.OV.20072015.24
The ASHA Leader, July 2015, Vol. 20, 24-25. doi:10.1044/leader.OV.20072015.24
Counseling students and their parents during difficult situations is part of the school-based clinician’s job. In a recent online chat from an ASHA conference on language and literacy in elementary schools, former ASHA president Tommie L. Robinson Jr. shares tips on delivering bad news and cultivating empathy.
Lauren Kaps: Do you feel that speech-language pathology students are taught sufficiently about counseling students and their families in graduate school, or is it a skill that is gained once in the field? Or perhaps a little of both?
Tommie L. Robinson Jr.: This is one of the hardest clinical areas that we have. As a clinical administrator, I see this start to develop in new clinicians after two to three years of practice. I do know that more and more graduate programs are adding counseling courses to curriculum.
Catherine Windom: In my college days, we SLPs took a course based on the book “I’m OK, You’re OK” [by Thomas Harris]. Are such courses required today in SLP programs to help understand one’s own issues and to relate to those of others?
Robinson: I was fortunate enough to have a course in counseling, and that became the basis of my thinking about clinical service and how important counseling is to the entire clinical process. There are a number of programs that have a counseling course, but all the courses have some element of counseling. The major issue is, how do students practice their counseling skills and move into a more realistic clinical environment? It seems this needs to be front and center in clinical programs and in practical experiences at all times. This is a great opportunity for researchers and clinicians to get together and start studying counseling as it relates to best practices for teaching.
Pamela Wilkes: Can you please share some tips about how to go about delivering bad news?
Robinson: Delivering bad news is tough, and I think that our nonverbal behaviors are so important to the process. This goes back to the need for empathy—it’s key. I always position myself next to the parents when I am talking to them in team meetings; after I started doing it, the psychologist began to do the same thing. We shared the experience of listening, watching and supporting the parents as they had to deal with the bad news. The unfortunate thing for us is that most of what we deliver is bad news, because we see a skewed population, in that most of our students have some area of concern. We have to be in tune with the support that the parents and students need during this process. I sit next to them to open up my relationship with them and to literally remove the physical barrier of a table. I want them to feel as if they can really talk with and to me.

We have to be in tune with the support that the parents and students need during this process. I want them to feel as if they can really talk with and to me.

Christa Pryce: I find the most difficult part of counseling is to not emotionally react to the issues the person we are counseling faces.
Robinson: Absolutely correct. A major key to counseling is not being judgmental in any form or fashion. You absolutely must keep the emotions under control. But this does not mean that you sit there like a lump on log—it means you might follow up with a “wh” question to make sure the decision the student/family member has made is the one he or she wants. Here, again, the nonverbals say a lot, so please be mindful of the message that your body is giving.
Jennifer Mojica: What do you do when you are counseling the student or the family during IEP meetings and the school psychologists or other team members do not agree with your plan of action? How do you manage this type of scenario?
Robinson: One of the best ways to handle situations like this is to talk offline—I think it would be a big mistake to have a disagreement in front of the parents or students, for that matter. I would try and do some consensus building with the other team members before the meeting or after the meeting. If you see that you are all in a different place, you might want to send a signal to the chair that you would like to have another meeting with the parents in the very near future after you all have discussed things in more depth.
Denise Dawn Guthrie: I would like to explore the idea of “changing a person’s communication skill means changing who they are.” I have seen this demonstrated so many times in my work with students—even articulation students sometimes reject correction because they think that their “new production” sounds odd. Can you discuss strategies you have used to counsel students to believe new skills or different skills are better?
Robinson: This is a very interesting question. As a person who works with individuals who stutter, I see this all the time. One of the things I do along the lines of counseling is have my students/patients journal. In the journal, I have them talk about the reactions of others as they use their new voice. This helps them to see that while the speech sounds “funny” to them, others don’t see it that way.
The other thing I do is have them acclimate to the new behavior by doing “in-therapy” work with someone else in the building. This person reacts positively to the new way of speaking, and all of a sudden the students seem to like what they are hearing and feeling. I just saw this this month with my 18-year-old student/patient. I still see the smile on her face—it was a hurdle she had to jump. I could tell her all day, but she had to see and witness the reactions from others and feel the positive nature of it.
Mary Goode Kleinberg: I could really use some tips on helping parents of children with significant disabilities come to terms with their child’s prognosis without sounding like a complete “Debbie Downer.” I feel horrible when I talk about regression or lack of progress and the tears start flowing. No matter how much of a positive spin I put on things, I still come out sounding so negative.
Robinson: I know what you mean. One of the things that you have to think about is timing. Please be sure that you are giving the information at the right time—that is, when they are ready to accept it. Also, you might want to let them arrive at the conclusion themselves, rather than you giving it to them. If you have a relationship with them, it helps a lot: “Now I have someone that I know, love and trust who is giving me this information, and not a stranger.” This truly opens them up for the information. By the same token, you don’t want to be too close, because that becomes a problem as well.

A major key to counseling is not being judgmental in any form or fashion. You absolutely must keep emotions under control.

Paige Martin: As far as counseling, when a child has low self-esteem due to communication issues, how much should we, as the SLPs, attempt to counsel on our own before we refer to a different professional (e.g., if the issue continues)?
Robinson: My answer to your question is a very simple one. As much as you can, especially if the low self-esteem is from the communication disorder—we understand this better than anyone. If it is extreme, then I would probably work with the parents, classroom teacher, school counselor and/or psychologist as well to develop a team approach to the process.
Lauren Morrison: How might we deal with parents who are resistant to labeling? Specifically, I have had several parents who do not want their child to be told they have autism, even when the “child” is in high school and is very emotional because they recognize their communicative and learning differences.
Robinson: This is a very sensitive issue. I would probably spend a great deal of time talking with the parents and helping them understand that this student is old enough to know what is going on with him/her and should be a part of his/her treatment process. When they are involved, they understand what is going on with them and there is more buy-in. The other thing that needs to be done is education of the student body so they understand how each of us is different in a variety of ways. I think that this combo would get parents, students and others involved to maximize these potential situations and get ahead of bullying and so forth.
Anne Current: I’d like some input about how to prepare parents for their first IEP meeting. Entering a room full of “experts” all telling them what is wrong with their child is so overwhelming to parents—and sometimes teachers.
Robinson: You are so right. One of the things you might do is [alert] parents ahead of the meeting to its purpose, who will be present and the process; I would suggest that this be done in writing and with a phone call ahead of time so you can answer any questions they might have. The other thing that comes to mind is to have the parents “buddy” with the professional of the primary concern. For example, if it is the SLP, then she/he can sit next to the parents and help them understand what is going on. I also think that the chair of the IEP meeting should make clear throughout the meeting [with open dialogue], “We are going to be talking about [your child’s issue(s)], and I hope you don’t feel as if we are beating up on him/her. We are just trying to put all the options on the table so we can design the best learning process for him/her.”
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July 2015
Volume 20, Issue 7