By Janet Ronchetti
“There is an invisible cord around my throat, making talking feel like I push against tight rubber bands in order for words to emerge. I have to tell myself what it is I want to say and sometimes, if I’m weary, the combination of having to direct my thinker and having to work to get things spoken results in a bunch of blah. Or nothing.”
This is how Helen Harlan Wulf describes her struggle to regain speech following her own stroke in Aphasia, My World Alone. While stroke symptoms such as loss of mobility, numbness or weakness, facial droop, and loss of coordination can be corrected through physical and occupational therapy, survivors often find the journey of recovering their words exhausting and frustrating. Deep-seated emotions and feelings may go unexpressed due to the lack of words, and spiritual healing goes unaddressed.
To give voice to both the stroke survivor’s audible voice and inner world, chaplains and speech therapists of the Alexian Brothers Rehabilitation Hospital implemented a new Communications Support Group, co-facilitated by both a speech therapist and a chaplain. The typical group is restricted to six patients to ensure that everyone has an opportunity to share. Speech therapists identify patients who would benefit from group interaction or those who may be struggling with emotional issues. In this group setting, patients are encouraged to search for and use words expressing what their unique stroke feels like for them. They also share how having a stroke has impacted their life and what goals they are working toward.
The group explores feelings of sadness, anger, and guilt, and we discuss coping strategies. Reframing thoughts and feelings are introduced. For example, patients are invited to view themselves not as burdens to their loved ones — a common fear of many stroke survivors — and instead think of family members’ offers of assistance as demonstrations of love and caring. As patients share, the speech therapist offers helpful suggestions on speech mechanics and tips on pronunciation, enunciation, volume, and eye contact.
Pairing chaplaincy and speech therapy has resulted in many benefits. First, relationships between patients and their therapists and chaplains deepen, yielding enhanced trust and communication. Patients feel cared for, listened to, and are less hesitant to ask questions about their medical situation or care plan. Second, the one hour spent in the Communication Support Group counts toward the mandatory three hours of therapy required each day in the acute care rehabilitation hospital setting, and is billable time for the therapists. Attendance is indicated on each patient’s daily therapy schedule, and staff is scheduled to help get patients to and from the group. This benefits not only speech therapists, but also physical and occupational therapists who might be scheduled to meet with the patient immediately afterward. Third, observing one-on-one interactions between attendees helps chaplains identify which patients may need follow-up support visits to explore new areas of spiritual distress or to continue an important discussion point started in the group setting.
However, the greatest benefit of this new approach of chaplains and speech therapists working together lies in the freeing of stroke survivors’ suppressed feelings. I remember one 58-year-old professional woman who had a calm, reserved demeanor, was soft-spoken and could best be described as gracious. She presented as an individual who, while struggling with how a stroke had changed her life, seemed to be coping positively with the support of her family and friends. But her calm was shattered in group as she broke down with heaving sobs. She suddenly came in touch with all the anger she was harboring because of the stroke — anger that had gone unrealized and unacknowledged. With follow-up chaplain visits, she was finally able to experience, explore, and understand the source of her anger, which contributed significantly to her spiritual healing.
Janet Ronchetti, M.Div., BCC, is the chaplain manager at AMITA Health Alexian Brothers Rehabilitation Hospital in Elk Grove Village, IL.
