Article 8: Graduate Clinicians Leading Aphasia Conversation Groups

Lee, J.B. and Azios, J.H. (2020). Facilitator behaviors leading to engagement and disengagement in aphasia conversation groups. American Journal of Speech-Language Pathology, 29: 393-411. 

This article was sent to me by a researcher and one of my former professors and clinical supervisors at California State University, Northridge, Ms. Sarah Cathcart. An expert in conversation facilitation for groups of varying degrees of aphasia and apraxia of speech, Ms. Cathcart is someone I continue to turn to for to talk shop. 

Purpose: To know more about what graduate student facilitators of aphasia conversation groups do to, well, facilitate conversation. What do they do right? What mistakes do they make? How could they and their supervisors learn from those successes and failures?

Method: Researchers analyzed recordings of 4 aphasia conversation groups led by graduate student clinicians at 2 universities, one in the southern US and one in the eastern US. Graduate clinicians were given training and practiced their facilitation techniques over two sessions prior to the sessions that were analyzed. Researchers applied sociolinguistic discourse analysis to transcripts of group sessions.

       Note: Sociolinguistic discourse analysis: "...unlike conversation analysis, sociolinguistic discourse analysis places an importance on interpreting the nonlocal context, especially participants' social roles and background knowledge, and how these factors influence participation in conversation" through focusing on sequences of turns in conversation, how each turn influences future discourse (both positively in encouraging connection and a feeling of successful communication, and negatively, resulting in disengagement), and how people understand their roles in conversation within one conversation and over several conversations (p. 395).

Patterns/Findings/Results: Researchers found the following patterns in graduate student facilitator behaviors that led to either engagement or disengagement (i.e. turning away from conversation, hindrance to a natural flow of conversation). 

     Note: Patterns are categorized below as "engaging" or "disengaging".

1) The Power of Turns

• Engaging: "Turn sequences following facilitator's acknowledgement of tokens and assessment often led to topicalization and engagement in conversation by all group members" (p. 399). 
• Group members responded well to being acknowledged for their contributions to conversation and would continue trying to get their message across if they had word-finding difficulties, paraphasias, etc. 
• "Mhmm" "Yeah" "That's good!"
• Engaging or Disengaging: News inquiries and news announcements "as a means of mutually and interactionally establishing a topic...includes a speaker's request to be informed about activities or circumstances that have recently happened.
• Engaging: Use once at the beginning of a session or to introduce a topic
• "How are you feeling?" or "What's been going on?" 
• Disengaging: "Recycled" news inquiries or announcements that put specific people on the spot after the question has already been asked to the group.
• "How are you feeling, Chad? How are you feeling, Darla? Tell me what you did this weekend, Chad"--If the person didn't participate, there could be a number of reasons why. Often better to not force unless you see a signal that they want to contribute. 
• Engaging or Disengaging: Restricted discourse behaviors "such as closed or forced-choice questions".
• Engaging: At certain moments when a group member might not have a word they want to say. 
• "May I try to help?" "Yes" "Is it about horses?" "Yes, horses!"
• Disengaging: Repeating closed questions to the group in a "round robin" style (similar to recycled news inquiries)
• "Do you like Billy Joel?" "Yes" "Do you like Billy Joel?" "Yes." "Do you like Billy Joel?" "No"
• We may think we're engaging everyone in the group, but really we're stalling out the conversation. The other group members are sitting there while we go around in a circle, and then they might wonder, "So what?"
• Disengaging: Closed questions that don't allow for elaboration or move the conversation forward
• Main Takeaway: Don't over-rely on turn-taking and learn when to use different inquiry types with the aim of helping move the conversation along rather than stalling it out. Not everyone needs to speak every time in order to have a successful conversation.

2) Purpose and Value System

• Engaging: Equalizing the power differential between facilitator and group member
• Emphasize facilitator's "naivete or limited knowledge of worldly topics (e.g., fine wine, international travel)" (p. 401) and let group members be the ones to show the knowledge
• Use "self-deprecating humor, teasing, and joking to highlight" facilitator's inadequacies, which will often result "in shared laughter and other signs of affiliation between group members" (p. 401)
• "Word-finding celebrations": When the entire group has supported the person experiencing the word-finding difficulty to find the word. Facilitators play "a key role in these sequences and often provide(d) targeted guesses that directed all group members' suggestions" (p. 402).
• State values or "ground rules" at the beginning of sessions
• Examples: reminding "members that the purpose of the group [is] for everyone to laugh and enjoy conversation" or that group members can stop the facilitator if they are "speaking too fast and that it [is] okay to ask people in the group to repeat themselves if something was not understood" (p. 402).
• Disengaging: Encouraging a power differential 
• Test questions or using a teacher-student style of conversation that makes group members feel like there's a right answer to questions
• Exposing errors of the persons with aphasia, such as pointedly correcting or emphasizing incorrect words; allow members to "save face"

3) Managing Competing Needs

• Every group member has strengths and deficits
• Graduate student clinicians often focused too much on group members with more severe aphasia and/or AOS, which made them miss the contributions of group members with milder forms
• Engaging: Use multimodal communication so that all can participate themselves rather than the facilitator have to always help the same person/people
• Drawings, writing key words, visuals, etc.
• Shift your attention between group members; avoid getting locked in to helping just one person as you would in a 1:1 session

My heart rate sped up when I thought about being one of the graduate student clinicians in this study. But then I laughed because I made and still make many of the mistakes that they make (hence First Year Speechie--and probably will be the case for my 2nd, 3rd, etc years :)); they're not alone and neither was I! It's an article I learned a lot from and helped me to think about and analyze my own facilitation in new ways to make conversations better for my clients.