The current ASHA Leader closes with a column by Laura Deer ostensibly about motivation for a student with a tough /r/ to crack. While the format inherently results in a certain level of triteness or simplicity, the theme is universal for our field, and can sometimes be easy to lose sight of, especially for those of us who are still rather green as clinicians.
I have a patient that is really having difficulty with a number of his higher-order cognitive skills and executive function, but consistently attempts to gloss over them with jokes and diversions. He’s clearly unhappy about his current predicament, but has a hard time seeing the trees for the forest. On an average day, nearly half the session is spent in goal-related counseling, showing him where the problems are, why they are going to cause him trouble when he leaves if he doesn’t address them, and reaffirming his personal goals (“I know that this is what I need to do if I want to get out of here”).
“You know,” he began one day—usually a marker signifying “I intend to digress and bemoan everything I can’t do anymore”—”you have a tough job.”
“How so?” I asked.
“Well, you have to deal with all these people, with all these different personalities, and you have to make yourself into whoever they are so you can be on the same page.”
He and I aren’t always on the same page, but occasionally, when we are, this results in a level of determination and productivity that I rarely see from patients of his age. It can be a long, slow trudge through the morass of “Why am I doing this?” to get to that point. Progress is slow, but what progress we do make would never be made if I just jotted down “Patient not compliant with tasks” and left it at that.
