Many discussions start with the question "What have you been up to?" Quite often we get the "Nothing much" or "You know, the usual" as the first reply. But then, the magic happens. The question triggers stories about meeting old friends at the grocery store, finally fixing the broken lawnmower, relatives who visited on Sunday or a good movie on TV the other night.
However, in speech therapy, even with our high functioning, fluent patients the “nothing much” is often the end of the story. The question does not trigger the spontaneous ideas behind the stories that could be. The overlearned phrases are enough to get us through the exchange and that is where the exchange ends.
However, sometimes this can be a great achievement for a person who has difficulties with speech! Being able to react, respond and engage. The overlearned, automatic responses are there to establish a connection between individuals, and as such, they are great. I encourage my patients to use these automatic phrases as much as the next guy!
But being an SLP, I want more. I want these phrases to be a starting point, not the whole deal. I want the phrases to buy time for making that connection between the time since I last saw the person I’m talking to and what I could tell them. This is why I generally begin our session like this:
Me: Hi, how are you? (Pause)
Me: Good to hear. What have you been up to? (Pause)
P: Nothing much.
Me: Really? Now, I don’t believe you. It’s been a week since I last saw you. What have you been doing? (Pause)
P: The same.
Me: Ok, tell me about your “the same.” What does that include? (Pause)
If you want, I can help you think about things you might have done during the week. Would that be good?
I offer ideas that might relate to that person (for example, have you talked to your neighbor?). Write down different options—everyday things and unusual activities (remember to include crazy ones like “went bungee-jumping” to prompt reactions) and so forth.
I tell my patients that we will be doing this every time we meet, so “come prepared”. And usually about the third time I meet with them, they get the idea and the discussions go something like this:
T: Hi, how are you? (Pause)
T: Good to hear. What have you been up to? (Pause)
P: Nothing much. (Long pause) But in physio, it was not the same girl.
T: Really? You have a new physiotherapist?
T: Tell me about her. (Pause)
And Voilà - we have a story. Something the patient came up with by themselves, something important to them. And they know I’m there to hear that story, I have time to wait for it to unfold. A step closer to a real conversation which I always see as “The Ultimate Goal in Speech Therapy.”