Sunday, 22 February 2015

Aphasia Therapy Works

I have worked with people who have dysphasia for years and in the early 90’s I was a Tutor at the City University’s Dysphasic Group set up by Bob and Maggie Fawcus. An amazing therapeutic and research facility sadly disbanded some years ago. Tragically at a time when we were making real headway in advancing our understanding of the linguistic forces that lay behind the work with our clients.
Sadly the prominence of this work has been lost in the last 20 years and as a result direct therapy is largely been swept into insignificance. Little and none of it is offered within the NHS and I’d say that there are very few of us who practice it. In fact in some quarters it is falsely derided as ineffective.
I really struggle to understand how we lost our way as a profession in this arena of our work. Although I think it happened at least in part, when in 1990’s we threw our lot in with the materialistic scientific model and with that our complete capitulation to the idea that statistical methodologies are the purest form of research.
In our attempt to gain credibility and ‘be in with’ the hard hitters we aped the practices of our medical and scientific colleagues and kicked into touch anything that represented the human aspects of our work. In doing so we sealed the door closed on the very essence of our intervention, ‘the therapeutic relationship’. Many of us were uneasy with this abandonment of this crucial aspect of our work because we knew this was the heartbeat of the therapeutic transformation. But the tide was turning, and as a young profession we had not had time to develop a sufficiently robust narrative through which we could fight our corner. The weight of opposition was too great and many of us felt pushed into silence and those of us who wanted to persist with working within the remit of the ‘therapeutic alliance’ felt they had to do so quietly and without drawing attention to themselves.
Sadly the sense of hopelessness in the face of the devastation caused by neurological damage can leave people believing that recovery of their linguistic functioning is impossible. Nothing could however be further from the truth. Therapy works and people can making amazing recoveries despite their initial prognosis but it takes a lot of time, great skill and of course money. Institutionalised dogmatism and financial imperatives are I believe the main driving forces for keeping the lid on a therapeutic revisionism, despite evidence of the success of the work and the increasing costs of supporting people who remain long term disabled.
There’s none as blind as them that don’t see
I believe we must return our focus towards the efficacy of direct therapy. In doing so we can identify the elements that contribute to successful outcomes, including the impact of the therapeutic relationship. Given the exciting and burgeoning evidence as to the brains plasticity never has there been a better time for us to achieve fresh prospectives that would shine a more revealing light on the underlying reasons for the successes many of us experience with our clients. And with this greater understanding, our interventions could be refined, to the point where we could reasonably expect to see a speeding up of what is at present a lengthy process.
This would however require those in the field to develop new and creative methods and protocols to explore and advance these ideas. And it would also need those in this field to be brave enough to stand their ground when speaking up for such new and possibly out there ideas.

Unfortunately fundamentalism is not restricted to aspects of Middle Eastern politics, it is alive and kicking within the very fabric of our scientific community. Consequently those of us who advance the notion of an alternative thesis, often struggle to be heard. In the worst case scenarios we face the ever growing threat of being restricted in our work practices and ‘the fear’ of being struck off, where it is deemed these practices and methodologies fall outside those sanctioned by the proponents of Evidenced Based Practice.

Despite the sometimes aggressive and unreasonable nature of the opposition we potentially encounter, I believe that those of us in the field ultimately have little to fear. As long as our rationale and debate is founded within our clinical experiences and we are able to articulate the outcomes as a result, in my experience the opposition melts in the light of robust evidence, no matter how it is presented.

It is worth remembering that the success of the status quo is hugely dependant on our compliance and more importantly our fear, but as long as we remain loyal to our clients and to the integrity of our work, we will ultimately find that all we are up against is ‘just another person’ with a different point of view. 

Which is where it should be - Je suis Charlie.