When asked to work with patients who don’t speak, but use assistive technology to communicate, psychologist Amy Szarkowski said yes.
Szarkowski, of Harvard Medical School’s psychiatry department and Children’s Hospital Boston, works with many clients who are deaf and hard of hearing, so she had a lot of experience overcoming communication challenges to provide therapy.
“We know the communication language is not perfect, so let’s work around it,” she said while presenting her work at the American Psychological Association’s annual convention here earlier this month.
These new cases were a new challenge, however. (Other psychologists had already turned them down. And in one case, the insurance company was reluctant to cover therapy—because the patient couldn’t speak.) One was an adult with cerebral palsy, the other a teen with the same condition. Neither had cognitive disabilities. Both had extremely limited ability to move, which made using their text-to-speech devices slow-going. The adult used a tool attached to his head to tap the device. But would Szarkowski really be able to tell what these patients thought and felt through a piece of equipment?
Before meeting with the clients, Szarkowski met with a speech-language pathologist. She realized that she would have to guess, at least a little, at what her new patients were saying—the opposite of what psychologists are trained to do.
“You don’t want to put words in their mouths,” she said.
In between sessions, she emailed back and forth with the two, figuring out what they wanted to discuss in therapy so they wouldn’t have to take up time doing that when they met in person.
For one of the clients, she devised a system of leg movements, where one move meant she was on base with their feelings and four meant she was totally off.
In one case, she spent an entire session helping the younger client develop ways to tell his mother not to ruffle his hair. Styling it took a significant amount of time because of his cerebral palsy. But he didn’t want to offend his mother.
The leg-movement system she designed was later adopted by his parents to better understand their son.
For the adult, who lived in a household where swearing was a part of the vocabulary, she suggested adding those words to his communication device. “It makes him part of the group,” she said. He had also never had any sex education in school, and he wondered how his body worked. He wasn’t comfortable asking his caregiver for the details.
Perhaps these don’t sound like the things that traditional “talk” therapy might yield, Szarkowski said, but in these cases there was no other person in these people’s lives who could provide the information and guidance they sought. She sees applications for English-language learners, as well.
“We all experience emotions,” Szarkowski said, “even if we can’t talk.”
A version of this news article first appeared in the On Special Education blog.