I shared my story of being admitted to hospital with anorexia nervosa in a previous blog. At that time, my life was balancing on a knife-edge. My experience in the emergency department was poor, and no one communicated with respect. Today, I want to share a positive story about how a therapist was able to communicate with me when I had a loss of speech.
Perhaps the biggest barrier to communication in healthcare is the loss of direct verbal speech. This could be due to learning or physical disabilities, and/or a range of mental health issues. I guess, it can be hard for health care professionals to have to think outside the box when communicating with patients who have special needs. But my psychotherapist did a great job.
I was a patient of Child and Adolescent Mental Health Services (CAMHS), following my diagnosis of anorexia nervosa. I was 14 years old and I also had anxiety and depression. My parents had insisted I needed help when they discovered I had been self-harming. My psychotherapist and team leader wanted to discuss this with me in an emergency session. However, due to the extreme social anxiety, I had been experiencing as a result of my eating disorder, I had become selectively mute.
This meant that even though I had the means to talk, I rarely spoke and had a loss of speech. It was too much of an effort to talk if you like. Within most of my CAMHS sessions, I let my parents talk for me. This was despite the fact they weren’t always quite right. My psychotherapist, during one particular session, highlighted a major cause for concern about my self-harming. She requested to see me alone, without my parents, even though I rarely spoke for myself.
I remember, pretending to myself and others that my issues were not real and refused to believe what I had done to myself. You know, this was despite the physical pain I was in. I look back on this time with embarrassment. The thought of sharing such personal information and insight with someone I barely knew was to me humiliating.
Enabling me to communicate
Initially, my psychotherapist tried to encourage me to talk to them. But it became apparent very quickly, that I could not communicate in this way. My loss of speech prohibited this. A bit of creativity was required if they were to get me to open up and that is exactly what happened.
My psychotherapist enabled me to communicate by expressing my emotions through non-verbal communication. They opened a door for me to open up myself. She asked me to draw how I felt before and after I hurt myself. I drew many different pictures in response to the questions she asked me. The physical visualisation while drawing helped me to process and understand my emotions in a different way. I couldn’t have explained myself through words alone.
On occasions, I would write notes to answer queries which didn’t need much explanation. Throughout these activities, (believe it or not) we were able to have informative discussions on the risks of self-harm and alternative approaches I could use to help me feel better. I was really surprised by how empowering and beneficial these sessions were to me.
What would I like healthcare professionals to learn from my story?
As a healthcare professional it is crucial to understand your patients communication needs, to be able to fully provide a beneficial and therapeutic service/experience. For those of us that struggle to communicate verbally, please consider using creative ways to help us overcome our barriers and offer solutions which may suit individual needs. You could try British sign language, makaton or using signs and symbols to support communication. Drawing created a real breakthrough for me. Just by making a simple adaptation to the way you communicate to gather and share information can make a huge difference. We know we are in safe hands, and can feel empowered, which is an amazing feeling when you are anxious and very vulnerable.
Communicating with my therapist through drawings and writing made me feel safe and less intimated or defensive. I grew to trust her. As I opened up to her our therapeutic relationship flourished. I so value her giving me this opportunity. Otherwise, I think I would have felt unheard and unimportant. By selecting other options to aid our communication, it showed me she cared and was willing to invest time in me. If she hadn’t done this, it could have made my unstable mental health even worse.
What would I like other patients to learn from my experience?
I would like anyone reading my story, to take away the message, that no matter what your communication preference is, don’t feel pressured to communicate in a way that you are not comfortable with. It is the responsibility of the professional to recognise what barriers you may be facing and be able to make reasonable adjustments to the method they use to communicate with you. If you can explain your preference through words, then I guess that will help greatly, but if not you may be able to explore what method suits you best – like drawing or writing. If you choose drawing, please know you don’t have to draw like Picasso, some of my drawings were terrible! but they did the trick.
The healthcare professional should adapt to you, whether this means getting someone to translate https://healthcarecommunicationmatters.co.uk/translation-a-language-barrier/ or interpret sign language, or even just offering a pen and paper so you can write your own thoughts down. I don’t think, you should never have to adapt to the preference of the professional if this isn’t right for you.