| General |
Empathize and reassure patient about speech limitations and EMDR Establish safe and non-judgmental setting regarding speech limitations Build rapport by normalizing common feelings associated with aphasia Emphasize collaborative process to problem solve and communicate Encourage/praise verbalizing but reassure/move on when unable to verbalize Use closed-ended questions to speculate and deduce patient’s thoughts Supply likely emotions and cognitions based on formulation and assessment Guess by following the affect, and looking for themes or incongruences Expect a slow process and take all the time that is necessary
|
| History taking |
Determine communication capabilities, and factors that may help or worsen Determine memory, attention or other deficits that may impact treatment Determine realistic prognosis of stroke-related deficit recovery Obtain collateral history from trusted friends/family with patient permission Utilize validated questionnaires to illicit unapparent symptoms/history Develop a coherent formulation of symptoms and underlying factors
|
| Preparation |
Educate about nature of change and self-assessment of change Agree upon verbal and non-verbal signals for change Determine if motor/sensory deficits could impede bilateral stimulation Consider use of communication devices, pictures or symbols
|
| Assessment |
Educate the difference between emotions, cognitions, sensations and images Utilize lists of emotions and cognitions to improve guessing Agree upon cue words/phrases for thoughts that cannot be verbalized Use visual scales for SUD and VOC
|
Desensitization/
Installation/
Body Scan |
Empower patient-centered setting Patient may require slower or faster passes depending on deficits Check-in about level of arousal since affect may be masked by motor deficits Continuously educate about nature of change and self-assessment of change Utilize lists to help deduce blocking beliefs Utilize formulation to target cognitive interweaves Use closed-ended Socratic questions Consider stroke-related ecological validity (e.g., realistic expectations about full neurological recovery, body sensations that are unlikely to resolve)
|
| Closure |
Summarize changes Debrief about patient experience using closed-ended questions Validate/affirm/reinforce strengths and gains Consider ending with safe place (which requires no verbalization)
|
| Reevaluation |
|
