Communicator Reality...where framing this in terms of a "medical issue" misses the boat big time!!!!7/19/2021 So you go to the hospital, or the doctor, or even a Speech-Language Pathologist (gasp!!!!!) and one of these lovely professionals tells you what it is that is wrong with you....what broke in terms of your communication or swallowing. This is the medical model in which we gather information, compare it to what we know, narrow down a diagnostic label, tell you what it is, and give you options about how to treat "it". My website is full of the influence of this medical model....it is literally everywhere. Your insurance then dictates that when you get "treatment", it is associated with a diagnostic label...and it is YOU that has the appointment and gets treated. This might work well for a broken leg, but communication, voice, and even swallowing are much more nuanced because they exist within a social context. The medical model says the burden of a change in communication falls squarely on YOU...YOU the person with a condition or illness. BUT, this challenge has happened to you, your family, your social network, your social roles and identities (employment, cultural, other). There is both a "medical model system set-up" and an understandable temptation (that probably exists even independently of the influence of the medical model) to FIX IT---IT being whatever the labeled problems are (word-finding, grammar, vocal pain or tension, etc.). To fix those pieces that are different inside of you and in YOUR messages. And certainly this can be a PART of the puzzle, but it would be terribly narrowly-focused and ultimately less helpful for us to ignore the other pieces. What are those pieces you ask? Brace yourself for a busy visual!!!! ![]() A change really means that expectations have not been met in some way.
We expected life to proceed in a certain way...and it didn't. We expected our communication to continue as it had always been...and it didn't. We have those communication expectations about ourselves and about others, and THEY have expectations about themselves and about you. Expectations when met make us feel safe because they are predictable---unpredictable things make us nervous. We use our senses to find out if expectations are being met or not. So let's assume that these two colorful people are interacting. They are using their senses to see if expectations are being met. This is all happening prior to and while an actual message is being communicated. Both of these people are constantly interpreting how the interaction is going: is it meeting expectations? how is the other one doing? how am I doing? If something seems to NOT meet expectations, this is where our thoughts come in. Our senses are on high alert and we start processing more...and this happens very quickly. The most efficient thoughts are the "broad-strokes" type thoughts that label and categorize, especially if you have no or limited personal experience with a certain reality...and stereotypes fall into this. So if you are speaking with someone, and they are struggling to find words, you recognize that this goes against your expectation, and now you have thoughts. These thoughts can be so varied, and they are hard to predict because we are all different. This is yet another level of unpredictability in this communication puzzle. We are not mind-readers, so we make guesses. These guesses may be: 1) maybe they don't know what they want to say, 2) maybe they don't know how to say it. Then we try to PLAN what we need to do about it: 1) do I need to help them in some way?, 2) how do I help them? Do I have TIME to help them? Then we might have some FEELINGS about it: 1) I'm really annoyed or maybe not annoyed but flustered because I don't know how to help. And then we actually DO something: 1) I roll my eyes, tap my feet, look around for someone you know to communicate FOR you. But this can go in another direction. The guess might be: 1) Oh, this person is having trouble communicating kind of like my grandpa. The FEELING might be: I love my grandpa. The PLAN might be: I have some ideas about how I can make this interaction better for both of us. The DO might be: I'll offer a pen and paper, offer verbal or written choices, etc. These are REACTIONS: the thoughts, feelings, the plans, and actions. Everyone in the interaction has them, everyone in the interaction makes ASSUMPTIONS and tries to INTERPRET what the OTHER'S INTERPRETATION and REACTIONS are, and these all influence our MESSAGES: what we share, when we share, where we share, and how we share it (stuttered, choppy, single words, use of drawings or pictures, etc). YES...successful communication is not equal to the mechanics of the message. In fact, successful communication can happen even if the mechanics of the message are not perfect, are not as expected, but because all of the other factors (the interpretations/thoughts, the feelings, the plans, and the do's) allow the communication to flow. IMPORTANTLY, a kink in any one of those cogs can make communication be interpreted as unsuccessful, AND a mechanically-changed message can still result in SUCCESSFUL COMMUNICATION (perceived by all involved as successful). What else do we bring to the table? It is more than just the interaction itself. Our experiences, including changes in communication, have an impact on our identity. We make decisions about whether or not a specific piece of our identity has relevance in a situation (for example, the fact that I have vocal cord nodules and need periodic voice breaks to have my voice serve me well during my day), and if we should share it or try to hide it. We analyze the type of situation we are in, what kind of talk is expected, what is our relationship with the other communicators in the interaction, how do we COMPARE to the other communicators in the room (usually we frame this in terms of better or worse, normal or changed---and we can explore together how these dichotomies are not very helpful). What risks and benefits are each of the communicators facing in 1) starting or continuing the interaction? or avoiding the interaction? This can be lots of things: humiliation, loss of job, access to healthcare, loss/access to participation in enjoyable activities, self-dignity. These all impact our communication interactions, and which interactions we choose to have or not have. It is helpful to try to take a step back and observe our own behavior here, with judgment. BOTTOM LINE: There are many pieces to the communication puzzle, and they are ALL impacted with a communication change. This does not exist solely within the individual, but within the social sphere. Communication and changes to communication are not just about the mechanics of the message delivery or the messages themselves.
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AuthorThese are my SLP-related musings. I will come up with topics that I think are interesting, but will be relying on you to make suggestions! Sometimes when you have gained more knowledge or "answers" on a topic you forget what the good "questions" are!!!! Archives
July 2021
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