Counseling in Communication Sciences and Disorders with Dr. David Luterman

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Kate Grandbois (00:13):

Welcome to SLP Nerdcast. I'm Kate.

Amy Wonkka (00:16):

And I'm Amy, and we appreciate you tuning in. In our podcast, we will review and provide commentary on resources, literature, and we'll discuss issues related to the field of speech language pathology. You can use this podcast for ASHA professional development. For more information about us and certification maintenance hours, go to our website, www.slpnerdcast.com. SLP Nerdcast is brought to you in part by listeners like you. You can support our work by going to our website or social media pages and contributing.

Kate Grandbois (00:46):

You can also find permanent products, notes and other handouts. Some items are free, others are not, but everything is affordable. You can go to our website to submit a call for papers to come on the show and present with us. Contact us anytime on Facebook, Instagram or at info@slpnerdcast.com. We love hearing from our listeners and we can't wait to learn what you have to teach us.

Amy Wonkka (01:06):

Just a quick disclaimer, the contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are not PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it's always likely that there is an article that we've missed or another perspective that we haven't shared. If you have something to add to the conversation, please email us, we would love to hear from you.

Kate Grandbois (01:40):

We just had such a great experience. We had the pleasure of welcoming Dr. David Luterman here with us to have a conversation about counseling and communication sciences and disorders. I had the pleasure of having Dr. Luterman as my professor in graduate school. He is a well known teacher, researcher, author, consultant, and lecturer and he specializes in counseling, in our field.

Kate Grandbois (02:10):

He was clinically trained as an audiologist, and he is a specialist in the hearing impaired and in counseling. He has written in a handful of books including Counseling the Communicatively Disordered and Their Families, Deafness and Perspective, Deafness in the Family. When your Child is Deaf, In the Shadows, Living and Coping With a Loved One's Chronic Illness, The Young Deaf Child and Early Childhood Deafness.

Kate Grandbois (02:41):

He presents at lectures frequently and he presents at symposia around the world. He's a fellow of the American Speech and Hearing Association, and also the recipient of the Frank Kleffner Clinical Achievement Award in 2011. He's famous, and we got to talk to him for a whole hour, and we're so excited to share it with all of you. I left feeling sort of speechless and inspired and also full of thoughts that I need to sit on for a while.

Amy Wonkka (03:14):

I feel like it was a really interesting conversation. I think that it was a very thought provoking conversation, and I think our listeners probably might find the same thing. His perspective on counseling is different from perhaps not what we learned in school, but perhaps what we're doing in practice. I agree, it was a really informative and pleasurable-

Kate Grandbois (03:53):

He's awesome. There's really just no other way to say it.

Amy Wonkka (03:56):

Yeah, he's pretty awesome.

Kate Grandbois (03:57):

He's completely awesome, and I cannot wait to share this with everyone. It's funny, I took his course when I was in graduate school, so I was probably 23 years old. Now that I'm medium old, and I have more than 10 years of experience in the field, I re-learned so much information, and I think my takeaways are completely different than what they were at a different phase of my life.

Kate Grandbois (04:26):

I also wanted to make sure our listeners knew that this course is available for free on our website. Well, everybody is listening for free on a podcast player, but if you would like to use this for ASHA Professional Development, this course is listed as free on our website and will be forever and today, just because everybody needs this information, everybody needs this content.

Kate Grandbois (04:47):

Before we get started, we do need to read our financial and non-financial disclosures and go over our learning objectives. Financial disclosures, Dr. Luterman is a Professor Emeritus at Emerson College in Boston, Massachusetts. Kate is the owner, founder of Grandbois Therapy and Consulting LLC and co-founder of SLP Nerdcast. Amy Wonkka is an employee of a public school system and co-founder of SLP Nerdcast.

Kate Grandbois (05:11):

Non-financial disclosures, Dr. Luterman is a certified member of ASHA and an audiologist and an ASHA fellow. He is also the author of numerous books on counseling listed on our website. Kate and Amy are both members of ASHA SIG 12, and both serve on the AAC Advisory Group for Massachusetts Advocates for Children. Kate is a member of the Berkshire Association for Behavior Analysis and Therapy, [inaudible 00:05:35] the Association for Behavior Analysis International and the corresponding Speech Pathology and Applied Behavior Analysis Special Interest Group.

Amy Wonkka (05:43):

What are our learning objectives for today, Kate?

Kate Grandbois (05:45):

Learning objectives. Okay, number one, identify and define at least two features of successful counseling. Number two, identify at least two common mistakes made by clinicians that are barriers to an effective counseling relationship, and three, identify and describe the importance of support groups. I think there is nothing else we can say to better highlight what is about to happen. So, enjoy, everyone.

Amy Wonkka (06:13):

Welcome, welcome, welcome, Dr. Luterman. Thank you so, so much for joining us. We are so excited to learn from you.

Dr. David Luterman (06:24):

Well, good, I'm glad to be here. Let me tell you a bit about myself and then we'll open it up for some discussion among the three of us. I am a clinical audiologist, or at least I was trained as a clinical audiologist and I started in 1960, that's 60 years ago.

Dr. David Luterman (06:44):

I was doing what I was taught to do in my training program, which is essentially the medical model. A client would come in and I would take a careful case history. I would then do my testing, and then I would counsel and counseling was seen as a separate entity at the end of the interview and the testing. The counseling was always information based. It was an explanation of the audiogram, and if appropriate, it was a discussion about hearing aids and what the next step was for them, and what might be the cause.

Dr. David Luterman (07:28):

It was in terms of causation, in terms of habilitation or rehabilitation, but there was no dealing with the feeling aspect of it. In fact, I remember my grad school, the injunction I had was, if there's feelings around refer to those social worker which we had associated with the clinic.

Dr. David Luterman (07:53):

I had that notion about counseling, as counseling as information giving. Then I proceeded to start my clinical career, and I followed through on that. After about two or three years, I began to find that clients just weren't absorbing anything that I had said. After a while, it becomes almost routine, the information giving at the end of the testing.

Dr. David Luterman (08:36):

They would come back, they would be asking me questions about stuff that I knew I had covered, and I'd covered sometimes two and three times to be really clear with them. They seemed to be listening. But apparently they heard almost nothing that I had said. Then I found that there was, way back then in the '60s and '70s, a fair amount of clinical research indicating how little clients retain of the content that is given in an interview.

Dr. David Luterman (09:17):

This was true for me as well. I began to explore that a bit. What I discovered, looking at the literature further, is that when people are emotionally upset, they can't retain content. Your brain goes into a fight or flight mode and you're not in your left brain, you're in your right brain. I think we've all experienced this. When you're emotionally upset, you just can't read. You try to read something and you read the words and they don't connect in the brain. There's like a disconnect. It's a phenomenon that occurs normally.

Dr. David Luterman (10:10):

When we're emotionally upset, we go into fight or flight mode. But cognitively, we shut down. This is a survival characteristic that we have that's built into our neurological system. It doesn't matter how prepared a client is, but when you make a diagnosis, and this would be true if you tell them that their kid is on the spectrum, or he has an articulation disorder, certainly, if he's developmentally delayed, you're going to have that shock response, that fight or flight response, and cognitively, they shut off.

Dr. David Luterman (10:51):

I used to think, well, okay, I was wasting my time maybe giving content, but it's not benign, because what happens is when you give content early on, and the client is not ready for it, not emotionally ready for it, or physiologically ready for it, it contributes to their feeling overwhelmed, and scared, and inadequate, and all that are very negative things for a positive outcome with a client.

Dr. David Luterman (11:27):

I found that in order for me to be effective as a clinician, I needed to deal with the emotional realm. ASHA, way back when defined counseling as both cognitively and personal adjustment counseling as aspects of it, that we as clinicians in the speech and hearing field should be comfortable with. There was that personal adjustment piece. But what I realized is you really can't do one without the other, or you shouldn't do one without the other.

Dr. David Luterman (12:12):

In other words, the content has to be intertwined with working with the emotional state of the client. We can't ignore it. If we do, we're not going to be effective. I think that's what happens, I think right now, in looking at the research that's out there, the predominant way of counseling, at least for audiologists has been this medical model. We've inherited it, it's comfortable, it's self-protective, and a lot of people in our field are very uncomfortable when we're dealing with the emotional aspects of it. But the emotional component is there. We are dealing with people who have lost the life they thought they were going to have, and we're really doing grief work.

Dr. David Luterman (13:04):

What we must do is we must become comfortable with that feeling component in order to be effective clinicians. We can't do one without the other. I have built my career on trying to help people in our field, clinicians in our field become more comfortable with that emotional aspect of it.

Dr. David Luterman (13:38):

I recently wrote a paper on teaching counseling, and the reviewers asked me to write a definition of counseling. Now, I've been teaching counseling for 40 years, and I've written a number of books about it. But nobody had ever really asked me to write a definition of counseling. So, I sat down and wrote it. It's a bit of a mouthful, but let me give it to you in pieces, and then I'm going to just open it up for discussion. Counseling are the components of the clinician-client relationship, that promotes self-enhancing behavior in the client. That's one piece of it.

Dr. David Luterman (14:28):

What happens is when clients have a lot of feelings, they behave in ways that are not self-enhancing. A lot of anger gets displaced around, they're feeling overwhelmed and scared, so they go to seek somebody to solve their problems for them, and so on. We need to deal with that behavior which is not self-enhancing. We can promote self-enhancing behavior in the client through the judicious provision of information, while also allowing for the expression of painful feelings in an emotionally safe context.

Dr. David Luterman (15:13):

That's what we need to do, we need to be able to build in to the relationship, where they feel emotionally safe, to begin to talk about how they're feeling, to experience their feelings, to cry. Because, what happens to our clients is they're not given permission to feel bad. Everybody conspires, including people in our field, to try to make them feel better, and that's probably the worst thing you can do for somebody who's in pain.

Dr. David Luterman (15:53):

It seems counterintuitive, but what you do when you try to make them feel better is you invalidate their pain. I remember one parent, as she was sitting down in a support group, she looked me square in the face. She looked at me and she said, "You're going to make me cry." I looked back at her, and I said, "No, I'm just going to give you permission to cry." And she started to cry.

Dr. David Luterman (16:25):

See, when we try to make them feel better, we invalidate the feelings. We tell them they have no right to feel pain. Yet, they're in a very painful situation. It's that safe context that we need to provide, where parents or clients can feel and experience their painful feelings. If you're successful, successful counseling results in an empowered client, who has the information he needs, and who is emotionally grounded. By emotionally grounded, I remember one parent said to me once, she said to me, "I have the same feelings I used to have, but they don't control me anymore."

Dr. David Luterman (17:14):

We're not going to try to do away with the feelings, we're going to just let them not control their behavior. Then successful counseling is also transformative. People should come out of that growing, they should be better off. There's one thing I've learned over the years, I never feel sorry for our clients. They're in a painful situation, none of their own making very often. I know that if I hang in there with them, that they are going to grow and learn from this. These disorders are powerful teachers. So, they can be transformed into a more grounded human being.

Dr. David Luterman (18:11):

Kate and Amy, what would you like to know?

Amy Wonkka (18:14):

I feel that you've touched on so many wells of information. I think what I'd like to start with is the concepts of... It's really twofold. The first is deep listening, which is something that you reference a lot in your writing, and the second is self-care, which is something that you touched on briefly about being grounded, and I know that there's a relationship there, but can you tell us a little bit more about the importance of deep listening and self-care?

Dr. David Luterman (18:47):

Okay. Well, yes. Let's do listening first. Listening is I think one of the most important tools. It's not always seen as a tool. Because students are trained and clinicians are trained to perform, to be doing, to be showing you how smart they are, to be helping and, and yet sometimes, or most of the time, actually, the most helpful thing you can do is listen to the client, because nobody's bothering to listen, they're all busy telling them what they should do and how to feel better. Instead of listening carefully.

Dr. David Luterman (19:29):

What I mean by that is listening and listening selflessly without having any agenda. Then being able to listen to what Carl Rogers calls the faint knocking. See, the language we use is really a map of a territory, and underneath the territory, is very often how we're feeling or what the feelings are.

Dr. David Luterman (19:59):

We need to listen to the map very carefully, to see what the territory is described. Let me give you an example of this. A question you're going to get almost invariably is an etiology, what caused my child to be autistic, or what caused my child to be deaf or my husband to have a stroke or any of those questions about causation. On the surface, you can just look at that question, and you can see it as content based question, and you can give them the content from your courses.

Dr. David Luterman (20:53):

But I can tell you right now, that that's going to be unsatisfactory. Because most of the time, people already have an idea of what autism is, or deafness is. Before they come in, they've been on the internet, people have told them all kinds of things. When they answer that question, they're really not asking that question. The underlying feeling there is probably guilt. They're really asking is, did I do something to cause my child to be deaf, or autistic, or my husband to have that stroke? They're really dealing with guilt.

Dr. David Luterman (21:38):

It can be much more helpful when you're listening carefully to the client, to be able to indicate, in some kind of way in which you respond. You can say, sometimes it's very easy to feel guilty, that you may have done something to cause your child to be deaf. Is that true for you? It might be a way to respond to that, rather than to the content level. That's what I mean about deep listening, being able to hear that faint knocking that Carl Rogers talked about, which is related to the emotional state of the client. What is the emotional state of the client there?

Dr. David Luterman (22:32):

That's the listening piece of it. I think there is no single more important aspect of counseling skill than that ability to listen, to allow the client to come to you, and then to be able to respond to the territory. Then the second question you had was about care, or self-care. This is something I find, especially with women in general. I don't like to generalize this way, but women are acculturated to be taking care of everybody else, and to take care of themselves, usually involves a certain amount of guilt.

Dr. David Luterman (23:23):

But yet, we are the most important tool in the clinical interaction. By self care, what I mean is that we have to be sure that we're comfortable with ourselves, and then we're able to listen. If we're running on empty because we've had so many clients that day, we're not going to be able to listen, and we're not going to be effective.

Dr. David Luterman (23:55):

I always tell my students, one of the most important things you can do for your clients is to have lunch, and they always laugh at that. But no, you need time out, you need time to just get yourself together, to get yourself what I call centered. I teach the students very often to meditate for a few minutes, just go back and sit and be comfortable with their feelings. Then when you're centered, you can be much more effective.

Dr. David Luterman (24:32):

Is that enough, Amy?

Amy Wonkka (24:38):

I feel like when I listen to you speak and when I read the writing since you also wrote my counseling textbook for grad school. But I think that it's such a big topic, and I guess I appreciate the examples that you give in your writing about how to learn to be a listener, and what types of questions to ask. Because I think, you're making the point that it's a skill just like, for a speech pathologist transcribing an IPA is a skill. It's a skill that has features that can be learned.

Amy Wonkka (25:21):

But I think it's hard to know how to do that, and we don't get a lot of training in it, necessarily. Which is another thing we wanted to ask you about in terms of, for our listeners out there, who maybe didn't have the pleasure of having you as a professor, or one of your books, do you have recommendations for how clinicians can acquire these skills, no matter where they are in their career?

Dr. David Luterman (25:54):

Well, I have a confession to make. I have never had a counseling course. They weren't in existence then, and I've never taken a counseling course, formal ones in school either, in the psych department. My learning has been all self-taught by looking and reading books. But it was also by doing a lot of personal growth experiences. As I get more comfortable with myself, then the counseling skills get added on. A textbook helps, like the counseling textbook, when I wrote, but there's several others. There's one by Holland and one by [inaudible 00:26:45] that are pretty good, too.

Dr. David Luterman (26:48):

Reading about counseling in our field, and then counseling beyond our field into the psych literature is helpful. But I think the most helpful thing for me has been keeping myself grounded, that self-care that I talked about. Because when I do that, then you can listen better, and you somehow hear better. But what I can do is, I can talk about two ways, there's two ways of going at this. One is we can talk about what you should be doing. But I think there's another way to go, which is let me talk a few minutes here about some of the mistakes we make, what I call counselor caveats, things you shouldn't do.

Dr. David Luterman (27:44):

If we strip away a lot of the things that get in the way, what's left is the good stuff of relationship. We're really talking about relationship here, and what makes a relationship work. What gets in the way of our relationship, if we can strip that away. One of the things that's a real problem in our field is what I call over helping. It's when we do more than we should be doing, and we tend to create a dependent client so that they're not empowered, and gets in the way of empowering.

Dr. David Luterman (28:21):

Clients want us to solve their problem. They want us to be a fixer, and to fix the problem. If we take that on, which is very tempting for people who have a strong need to be needed, and there are a lot of people in our field who have that need to be needed, then we create dependent clients who are just looking to us for the next answer.

Dr. David Luterman (28:46):

I had a poster in my office and it said, give me a fish, and I eat for a day, and teach me to fish and I eat for the rest of my life. That's what counseling is about. We're there to teach fishing. Not to over help, to the point where we would create a dependent client. Because that would be giving them fish. We have to trust that the client themselves is going to be able to solve that problem, eventually. If we give them enough support and enough information, they'll make good decisions for themselves.

Dr. David Luterman (29:26):

We need to understand denial. Denial is a coping mechanism. It's something that the client goes into, right away. It's the way in which we self-protect ourselves. We may admit that our child is deaf, where it becomes very hard for us to put hearing aids on the child, because looking at the hearing aids means that he's deaf. Very often, you have parents who are just remiss about putting hearing aids on.

Dr. David Luterman (29:58):

It's very easy to start blaming the parents, or trying to rescue the kid from the parents, both of which are bad mistakes. We need to understand, and we need to put the parents in as our client, understand that denial is a crisis of confidence. That's the only way I can cope right now, by emotionally pretending that this is not there.

Dr. David Luterman (30:28):

Denial gets in the way so often, because it's just not understood well. There's implicit expectations that get in the way of relationships. This is when we assume something. The other person, and we haven't really checked it out. It's what's called contracting, being very explicit about what you want, and what you expect from the client. I always ask clients, what do you want from us? What are you hoping will happen here today? I do this with students in my class, always start off a class with, what do you need?

Dr. David Luterman (31:14):

We then see where there's a match. Very often, clients want you to be the Anne Sullivan, and solve their problem and take the good and be the fixer. If you've been listening carefully in here, you don't want that wrong, it's a bad roll, because you're not going to get a good result long term with that kid. Because you only have the kids for such a limited amount of time. We need to spend that empowering the parent and not diminishing the parent. But over helping diminishes the parent's self-esteem.

Dr. David Luterman (31:51):

The thing that we also have to avoid is stereotyping people. It's very easy to do it. To try to put them in a box. I had a prof who was really good about counseling, he had it intuitively. What he used to say is, "Remember, you have to see each client as a wonderful experiment of one." Once we can do that, set aside expectations, then we can hear clients and seek clients and just be present for the client.

Dr. David Luterman (32:35):

Then the last thing that gets in is what I've talked to before, and that's all about that cheerleading, thinking our job is to make the client feel better. That's going to invalidate their feelings of pain. They won't have that kind of honesty, the kind of openness in the relationship that I think it needs in order to be successful in promoting growth in the client. That's some of the things that get in the way of the relationship.

Dr. David Luterman (33:14):

We can get those out of the way, then technique flows from this. The best technique is, as I said, listening, and not always responding with content. Content is the easy thing to do. We do have a content mandate, as I've said at the outset. We do have get information, but it's the timing of that content. Very often when clients ask you a question, there's an underlying, as I talked about before about the feelings, but very often they want a confirmation. When people seem to be asking for advice, 95% of the time, even closer to 100% of the time, what they're really seeking is for you to confirm what they've really secretly known.

Dr. David Luterman (34:22):

If somebody asks you, "What do you think of my boyfriend?" Don't answer that with content, trust me. That isn't what they want or need. What they want is confirmation of some position they have. The way to respond to that is what I call a counter question, which is, "Well, it sounds to me, when you're asking me that question that you have some doubts. Could you tell me how you feel about your boyfriend?"

Dr. David Luterman (35:06):

That's a much safer way to do that. Now, to get back into our fields, if they ask you, "What do you think about cochlear implants, or is that School for the Deaf a good school for the deaf?" Or anything else where they seem to be asking for advice, they seldom are, they're asking for confirmation. What you want to do is throw them back on their own heels, on their own self so that they really answer the question for themselves. If they sometimes get angry at you for that, but it's the best teaching technique you have.

Amy Wonkka (35:51):

That brings me to one of the other questions I had going through your readings. You've framed it so well about these obstacles to relationships, in terms of denial. Then earlier, you mentioned misplaced anger. I'm wondering if you have, I don't know, wisdom. You have lots of wisdom about counseling parents are working with families where there is misplaced anger or denial, that is such a roadblock that the clinician might feel a little powerless in terms of either the family's asking for a treatment that is against our code of ethics or they're being butt up against our evidence based practice or there is misplaced anger, where there's name calling or inappropriate behavior on the side of the family. What tools would you recommend, given the realistic restrictions of our work environments, to navigate those spaces?

Dr. David Luterman (36:57):

What you need to understand, that's the non-productive behavior that I talked about, which really comes about because people haven't heard and listened to the client. Almost all of that is fear based, or that's what you need to understand. We're dealing with people who are grieving, and they're feeling overwhelmed. These are the two principal feelings that they have; they're in pain, and they're feeling overwhelmed, and they're scared to death.

Dr. David Luterman (37:28):

What we need to do is respond to the fear. Let me give you an example, which I saw from that prof, Jean McDonald, who was my mentor in graduate school, and what he taught me so well. I watched as he was counseling this family with a Down Syndrome kid. The father was this big, burly steel worker. He comes in to the meeting with his wife. He says, "If anybody tells me my kid's retarded, I'm going to punch him in the nose."

Dr. David Luterman (38:09):

McDonald, without missing a beat, looks him square in the face, and he says, "You must love this child very much." The guy started crying. He just blubbered. It's the feeling underneath there. A response that helps me a lot with parents, well, not just parents, I've worked a lot with parents of deaf kids. That's where I went on after I left clinical audiology. I always tend to refer to them in that way.

Dr. David Luterman (38:51):

The response that I find very helpful is, this must be so hard for you. I don't respond to the anger, I respond to the pain that's there, Or I respond to the fear. "It's pretty scary right now for you, isn't it?" and mean it. if you say it that way, and mean it, it sets the parent back, I don't get defensive. The worst thing you can do is get defensive, and then it's hard not to. But to hear the pain, hear the fear and respond to it.

Amy Wonkka (39:32):

I think in part that, for me, when I listen to you speak and in reading the content you had sent to us, I think part of it is also about just shifting though and shifting from that role of being the fixer and if you as the clinician give yourself permission, that that's not your job, I think it's a little easier to step outside and have a more human relationship with the person, because you're no longer having all the weight of all of these responsibilities, that actually aren't that productive in the first place.

Kate Grandbois (40:09):

I was actually thinking something somewhat related. But having been in situations like this before, it really makes me think about how grounded you need to be. Because when someone is yelling at you, or threatening to punch you in the nose, or calling you names, as a clinician, as a human, I have a fight or flight response. Then, being really able to ground yourself and separate yourself from and not take it personally, I think that those two things combined are just of utmost importance. That's something that we talk about a lot as a field.

Amy Wonkka (40:48):

I have one more question, also, which I think Kate and I talk about this a lot on our show, and the fact that-

Kate Grandbois (40:55):

I know what you're going to say.

Amy Wonkka (40:56):

The fact that we're a reimbursement driven model, and all of the negative repercussions that that can have on our continuum of service, overall. But I think a real challenge with forming genuine relationships with people is this pressure of time. Whether you're in an outpatient setting, or you're in a school, we have such limited time with the families, and I didn't know if you had any tips about how to operate in the treatment model that many of are operating under?

Dr. David Luterman (41:34):

It's what I've talked about really, is embedding that information with the emotional responses. That's how you're going to be effective. If you're going to just try to deal with the content and information aspects, again, it's a waste of time. In fact, you're damaging your client when you do that. You need to realize that and hopefully reimbursement can.

Dr. David Luterman (42:05):

Somebody asked Carl Rogers that, because what I'm talking about is the non-directive counseling that he [inaudible 00:42:12] He said, "What do you do if you have 20 minutes only with a client?" Rogers looked him square in the face and said you do 20 minutes worth." It's a question of how to be effective with your client, and we have to recognize this as a profession, that the most productive way we can spend our time sometimes is just selflessly listening to the client.

Dr. David Luterman (42:44):

It pays huge dividends later on. The pay off may not be right away, but what happens is you get an empowered client, so then you can start really dealing with content a little bit later. But you embed the content there too. It's a matter of being effective. I hope we just don't get pushed around by insurance people. I know the pressures are there.

Amy Wonkka (43:23):

I remember working in a hospital setting where, I had to see X number of patients a week. To your point earlier, the best thing you could do is eat lunch, I barely had time to eat lunch, and it wasn't necessarily... I think that burnout is high. I know, you've mentioned that a lot in your writing about burnout. I can't help but feel that the funding model and lack of funding for indirect service, frankly, is really a contributing factor there.

Dr. David Luterman (43:56):

I think we have to change it. We have to work at that. We have to create environments that make it possible for us to be effective in our job.

Kate Grandbois (44:12):

Such a good point.

Dr. David Luterman (44:12):

If you have lunch, you can be more effective. If you go outside and take a little walk and get some air and give yourself a break, you'll be more efficient to use your time better.

Amy Wonkka (44:30):

I was wondering about the role of support groups. You mentioned a lot in your writing about the power and importance of support groups. Can you tell us a little bit more about that?

Dr. David Luterman (44:46):

I am such a fan of support groups. I got disaffected. I just didn't like clinical audiology. I decided that I'm going to transition myself out of clinical audiology, and I'd start nursery school for parents of young deaf kids. I did this in 1965, it became one of the first early intervention programs around. I didn't have any of this vocabulary at the time.

Dr. David Luterman (45:25):

But what I knew what needed to happen was, you needed to focus on parents. It's very frustrating to me, because everybody agrees in early childhood deafness, and notice how important parents are, and nobody's ever going to argue with you about the importance of parents. They seldom do it though. What you need to do and it causes a paradigmatic shift of saying, the parent is the most important piece here, and I'll get to this [inaudible 00:46:09] in a minute, but I just went a long way around here for a minute.

Dr. David Luterman (46:14):

Its causes a paradigmatic shift when you put the parent in the center. I remember talking to a group of itinerant teachers of the deaf, and this was in England. I said, "How many of you think the parent is the most important person?" Everybody raises their hand. Then I said, "How many of you go into the house with a toy?" Everybody raise their hand?" I said, "So, why are you bringing a toy to the parent? They don't need it."

Dr. David Luterman (46:55):

It's just the reflective of how we go about things, that people say their parent centered, but they're not really, because our training is all geared towards the identified patient, the kid or the adult with the stroke and so on.

Dr. David Luterman (47:17):

I started a parent centered program, and we had a nursery school and we had the parents observing, and then we had two parents doing therapy. But I knew something else, too, at that time, although I couldn't have articulated it. I took the parents upstairs, left the kids down in the nursery, and had a support group. I can still remember, this is in October 1965, I can still remember it vividly, because it made such an impression on me. I didn't quite know what I was doing, and I didn't have the vocabulary. But intuitively, I knew that they needed to be together.

Dr. David Luterman (48:01):

That group was so powerful. We just went around the room, and I had everybody introduce themselves. I had these short speeches, as an audiologist, content. But here I was committing myself to a whole semester worth. I was scared to death. I said, "Well, I just think we need to just use this space as you need to use this space." And I shut up. Then the torrents started, the parents just started to talk.

Dr. David Luterman (48:39):

What I realized right then, that what happens when you have a catastrophic event in your life, it's emotionally isolating. It sets you apart from all your ordinary places of being. You're now different than anybody else, and people don't understand. They all, again, what I was talking about, conspired to make you feel better, which just tends to isolate you and invalidate your feelings.

Dr. David Luterman (49:20):

When you can get into a room with a bunch of people that are experiencing the same thing you're experiencing, you get validation for your feelings, and for your experiences. No other place can you do that. Every time I do a support group, particularly an initial one, it's the same thing. There's a palpable whoosh in the room when people recognize that/ Here's a place I can be safe, here's a place that I can talk and people will understand.

Dr. David Luterman (50:02):

Now, I have taken this model, this support group model, and I have used it in all kinds of contexts, including people giving up smoking, and smoking cessation groups and caregiver groups of one kind or another, experiences is always the same, is always is that validation of my experience. The only place I can really get that is this support group. I can't imagine any program without it. It's the most valuable tool that we have, and it's a great gift that we can give our clients.

Dr. David Luterman (50:48):

First of all, you got to see the parent or the caregiver as your client, and two, you got to give them that kind of safe environment where they can talk to each other. It's a wonderful experience for yourself. I've learned so much, these parents have taught me so much. I'm a big fan of support groups. I couldn't imagine a program without it.

Kate Grandbois (51:13):

When you said that before, as you're describing it, it sounds incredible. Yet, I don't know of a single program that has one, which is, obviously, we're unearthing a lot of deficits in the normal day-to-day of our field. I'm sure or hoping that a lot of our listeners will leave this conversation and try and advocate for a support group.

Kate Grandbois (51:37):

I think a lot of speech pathologists and possibly audiologists, but I'm not an audiologist, may not feel that running a support group or starting a support group is within their scope of competence or something. For example, in one of my settings, we're consistently advocating for a social worker, because the social worker is the role that will initiate these kinds of endeavors. Do you feel that a speech pathologist and/or an audiologist has it within their scope to spearhead these kinds of projects and start support groups?

Dr. David Luterman (52:14):

You bet I do. In fact, I don't want the social worker in there-

Kate Grandbois (52:19):

That's the answer I wanted.

Dr. David Luterman (52:22):

Well, the social worker comes from a pathology point of view, we're not dealing with pathology here at all. We're dealing with us, we're dealing with people who were in a catastrophic situation, not of their own choosing. Their life is turned upside down, all of a sudden, once they find their kid is deaf or autistic, or whatever.

Dr. David Luterman (52:50):

It's grief work. Grief is endemic to our humanity, and it needs to be within our scope of practice, and makes it so much easier. This is not pathology. These are people who are emotionally upset, not emotionally disturbed. It's much more relaxing for them, to be with a speech pathologist or an audiologist than with a social worker.

Amy Wonkka (53:17):

Such a good point.

Dr. David Luterman (53:17):

But that gets sent to the pathology piece of it. In fact, I get some blow back from psychologists and social workers sometimes, because they also say, "No, I never refer any of our clients to social workers or psychologists." They always look at me, I say, it's not their problem, it's my problem. I just identify it as such.

Dr. David Luterman (53:52):

There are clients who really do need professional help. But I don't make that referral, I just tell clients, this is as far as I can go, and I want to go. These are parents who are having a lot of problems with their marriage, for example. I don't go there, I just say, "I want to go, this is beyond my scope of practices," is what I always say. But I leave it there. I don't say you should go and see a marriage counselor. Because it may not be within their value system at all. That's the same way I just don't bring a social worker in to work with them, because then that may not be their value system either.

Dr. David Luterman (54:43):

The discussion will go on, then where do I go and then we can talk about that. I'm always looking for them to make a self-referral. When it's a self-referral it has a much greater chance of being successful, than if they're going to the social worker, because I sent them there. It's not necessarily their problem, it's my problem, certainly, because I didn't want to go there.

Kate Grandbois (55:14):

That makes a lot of sense. I am hoping that all of the people who are listening to this course, take a nugget from that and advocate with their administrations. Gosh, after hearing this whole conversation, I hope we all do a lot of things. I hope we all do a lot of things differently.

Dr. David Luterman (55:37):

That's my goal. My goal is to make you upset. My goal is to make you upset, and upset people will make changes. Happy people bliss out, they have no investment in making some changes. I love the book, way back when. I love the title of the book, it's also good content called Teaching As a Subversive Activity. They talked about that, that the teacher's job is to undercut the learner to a certain extent, and make the learner uncomfortable.

Kate Grandbois (56:18):

Good job. You did a really good job.

Dr. David Luterman (56:22):

Good, so I succeeded?

Kate Grandbois (56:24):

You did. Oh, my gosh. We're uncomfortable, but I'm not that uncomfortable. I think it's really refreshing, and I say this to my mentees a lot, you're never going to learn until you're operating in some moment of discomfort. Even just thinking in reflecting back on ourselves, as new graduates, that first time you're sitting with a client, you're being looked at through the mirror, you're sweating, you're nervous. These moments of feeling nervous are so important.

Kate Grandbois (56:57):

I think all of the things that you've just touched on, highlights so many deficits that... I can only speak for myself, I have not embraced as deeply as I could have or should have, but will and I feel pretty comfortable saying that as a field, we don't have an emphasis on these areas. I'm so grateful for you pushing us to a place of discomfort so that we can share all of these things with our listeners.

Dr. David Luterman (57:30):

Yeah, you should always be operating on the fringes of your competency. If you're comfortable about what you're doing, you're not learning anything. I have a whole list of aphorisms, clinical aphorisms. Did I send those on to you?

Kate Grandbois (57:42):

You did.

Amy Wonkka (57:44):

Yes, they were so good.

Dr. David Luterman (57:44):

Good. All right. I think those, you might find them helpful too. If somehow you could share it with your listeners, it would be anything helpful.

Kate Grandbois (57:54):

We will. We can list them on our website that will correspond to this episode. We will put them up there for everyone.

Dr. David Luterman (58:04):

Oh, good.

Kate Grandbois (58:05):

Thank you so much for joining us. This was an unbelievable pleasure. Before we close the episode out, do you have any advice or closing remarks or more words of wisdom than you've already given us?

Dr. David Luterman (58:19):

I think you got enough. It sounds like you got enough. You got to go digest it for a bit, and come back, we'll talk some more.

Kate Grandbois (58:29):

I think digesting is a good idea. We're so grateful for your time. Thank you so, so much for joining us.

Dr. David Luterman (58:37):

You're very welcome. Do take care.

Amy Wonkka (58:39):

Thank you. You too.

Dr. David Luterman (58:40):

Good luck to you.

Kate Grandbois (58:42):

Thank you so much.

Dr. David Luterman (58:43):

Bye-bye.

Amy Wonkka (58:43):

Bye-bye.

Kate Grandbois (58:44):

Thank you so much for joining. As I'm sure I hope all of you are walking away from this conversation feeling like you have things to digest and feeling empowered to effectively make change in our fields. If you have any questions, please email us anytime, info@slpnerdcast.com. We really, really enjoyed this episode and we are so excited to have been able to share it with all of you.