49 / 64
Supporting social, emotional and mental health and well-being: Roles of speech-language pathologists
www.speechpathologyaustralia.org.auJCPSLP
Volume 19, Number 3 2017
163
Mary Woodward
(top) and Kirsten
McCosker
Talking Mats® approach which provides a non-verbal
means of expressing opinion and choice and has been
used with a wide range of individuals including those with
intellectual disability (Cameron & Murphy, 2002), mental
health difficulties (Macer & Fox, 2010), dementia (Murphy,
Gray, van Achterberg, Wyke, & Cox, 2010) or those in
custody (Boardman, Crichton & Butterworth, 2016). Talking
Mats® has also been widely used to enable individuals
with communication difficulties to engage in goal-setting
(Bornman & Murphy, 2006; Murphy & Boa, 2012).
Lucy and Ellie discuss what is known about the
communication skills and deficits of those with
schizophrenia, including considering published research
papers they have already read. They know that it is well-
established in mental health literature that communication
impairment is a core diagnostic feature of schizophrenia
and other psychotic disorders (Boudewyn et al., 2017;
Colle, Angeleri, Vallana, Sacco, Bara, & Bosco, 2013;
Marini et al., 2008). Much of the literature related to
this topic aims to identify the neurological mechanisms
underlying what is often described as the semantically and
syntactically “disorganised” verbal output of people with
schizophrenia. This communication disturbance suggests
a verbal manifestation of formal thought disorder (Ayer et
al., 2016); however, it is unclear whether this is caused by
higher level semantic processing deficits (Dwyer, 2014),
linguistic sequencing deficits (Docherty, 2005) or is related
to social cognitive impairment (Docherty, McCleery,
Divilbliss,Schumann, Moe & Shakeel, 2013).
Lucy and Ellie discuss the fact that, in addition to
language difficulties, people with schizophrenia, as in
Mark’s case, overwhelmingly present with significant
pragmatic deficits i.e., difficulties with the social and
contextual use of interpersonal communication. This
may include difficulties with conversational turn-
taking, understanding or using appropriate non-verbal
communication, relevant and appropriate topic choice and
maintenance, use of appropriate social register, extent of
verbal elaboration in conversation and difficulty considering
and estimating a listener’s level of prior knowledge. Mazza,
Di Michele, Pollice, Roncone, and Casacchia (2008) and
Langdon, Coltheart, Ward, and Catts (2002) refer to deficits
in theory of mind (ToM) as the ultimate cause of pragmatic
language deficits in people with schizophrenia. Whatever
the cause, communication difficulties undoubtedly impact
significantly on the functionality and quality of life of people
with schizophrenia (Bambini et al., 2016; Tan, Thomas, &
Rossell, 2014).
Clinical scenario
Ellie has been working as a speech-language pathologist
(SLP) for three years, and has just taken her first position in
an adult psychiatric hospital. She has received a referral to
assist with communication with a patient, Mark, a 29-year-
old man with schizophrenia. Mark has had multiple hospital
admissions and has been in his current hospital for seven
months. Ellie has met Mark and observed that when trying
to have a conversation he stands very close to the other
person, makes minimal eye contact and facial expression,
and talks at length about topics which are difficult to follow.
He is easily distracted and often does not answer questions
accurately but he seems to focus better when looking at
pictures. He often mumbles or shouts even when there is
no-one in the room with him, and laughs at unknown
stimuli. Nursing staff are finding it extremely difficult to
communicate effectively with him.
Response
Ellie takes Mark’s case to supervision with Lucy, who has
been working as a SLP in mental health for over 10 years.
Ellie wonders what impact speech-language pathology
might have for Mark and his treating team, and what aspect
of his communication she might prioritise for intervention.
Ellie and Lucy discuss the three components of evidence-
based practice (research evidence, clinical experience/data,
and informed client choice/preferences). Ellie poses the
following clinical questions:
•
can speech-language pathology intervention improve
the social communication skills of people with
schizophrenia?
•
if so, what are the recommended methods of
intervention?
Lucy discusses her own experiences and outcomes with
patients with similar presentations. She tells Ellie about the
successful outcomes she has seen in social communication
groups she has run previously in several of the mental
health wards, with individualised treatment targets for each
patient, as well as the 1:1 therapy she has offered to those
who were unable to benefit fully from group intervention.
She explains that in her clinical experience, she has seen
a positive impact for many of her patients, and for their
families/carers, but that progress is more modest when a
patient has had limited insight into their difficulties and/or
motivation to modify their communication. Lucy suggests
that Ellie attempt to obtain Mark’s views about his own
communication and possible treatment goals using the
What’s the evidence?
Speech-language pathology intervention to improve
the social communication skills of individuals with
schizophrenia
Mary Woodward and Kirsten McCosker