I always wanted to work in health, but I’ve also always loved language. In my final year of studying modern languages at Bristol, I met a young man on a train who had had a stroke, and now presented with aphasia: a problem with understanding or expressing language, or both. This was a pivotal moment in my life, when I realised that there was a career that encompassed my love of language with my desire to be a health professional.
Now, I teach postgraduate SLT [speech and language therapy] students at AECC University College, Bournemouth, and love seeing the students transform into competent, confident practitioners. Because this is a Master’s course, we have students straight from their first degree at 21, and others changing careers in their forties and fifties.
SLT is a wonderful amalgam of science and art: phonetics, linguistics, audiology, psychology, sociology, research methods, counselling skills, and working with communication disorders. More than that, students have to transform into therapists, which demands lots of self-awareness and reflection. We can’t be good at everything, but putting the client at the centre of all we do is the most important aspect.
Any therapy works best when it’s person-centred; so we use materials that are meaningful to patients — about Arsenal, if they support Arsenal. But we often reach into spirituality and faith when it’s those things that touch them deeply, and it’s really important to bring that into the therapy room. When I’ve practised clinically, I’ve always brought my empathy to patients, wanting what’s best for them, seeing potential in them — a Christian ethos.
There’s a lot of joint work we can do with chaplains. They’re experts in spirituality and ministry, and we’re experts in communication disorders. As SLTs, we have the privilege of having time and space to talk and listen to people deeply. I’d never say I’m a spiritual expert — I understand my remit as a therapist — but people will open up to us as we offer them time and space.
My colleague and co-editor Kath Mumby is an SLT and licensed lay minister in the Church of England. She has a long-standing interest in enabling people to communicate, particularly those with aphasia. She’s combined a clinical career with academic research, and has taught at several universities, and tells part of her story in our book.
Life experiences, such as suffering illness and grief myself, certainly foster empathy and understanding. Patients taught me huge life-lessons about connection and the resilience of the human spirit, especially those with locked-in syndrome after a brain-stem stroke. They’re able to think and formulate language mentally, but can’t move or speak. I remember every locked-in patient I ever worked with.
I’d only just started my job, and found myself working with a man who was adept at using an alphabet frame, [where you] look at letters while you follow their gaze to spell out what they want to say. He was really adept, and I was amazed at the power he had over the conversation. We forged a relationship, because the essence of him still came out.
Another locked-in patient, who had five children, was being filmed by a television crew, and someone asked him if he was glad he was still here. He blinked “yes”. That’s quite humbling, when everything been had taken away from him.
Awareness of SLT as a profession has increased, because people with Covid and long Covid can suffer from voice, swallowing, and cognitive issues, all of which fall into the SLT’s remit.
There’s such a thing as selective mutism: a child never speaks at school, perhaps, but speaks at home. That comes within our remit, and those issues have a psychological overlay; so we might work in tandem with an educational psychologist. Some adults have voice problems caused by over-use — teachers’ and singers’ nodules — or for no organic reason, related to stress.
Voice, speech, and language all help to express our identity. This is why it’s so important for transgender clients to work with an SLT on their voice so that it aligns with their gender identity more fully.
Some stroke patients with mild speech-slurring really struggle with their identity if they experience “foreign-language syndrome”: when they don’t recognise their voice as their own, or it sounds French or Australian. Therapy-wise, it’s difficult to change; so it’s about helping them to come to terms with the change and making their new voice as valid as the old one.
As a clinician, I specialised in working with adults with neurological conditions, such as stroke, head injury, and dementia, assessing and managing speech, language, and swallowing problems. In 2012, I started my Ph.D., exploring the spiritual issues and needs of people with aphasia, post-stroke.
Kath and I co-edited Perspectives on Spirituality in Speech and Language Therapy — all done over Zoom during Covid, and a firm friendship has developed, despite the fact that we still haven’t met in real life.
The book has a chapter written by people with aphasia about their spirituality. Other chapters give the chaplain’s and SLT’s perspective of spirituality within their work, and SLTs’ working within different cultures, and the significance of spirituality in educating therapists.
Speech enables us to connect and grow — with each other and with God — but all this can be done with no words. Connection, love, prayer can all be communicated by touch, gesture, or mere presence. People who have no speech, such as someone with a significant learning disability, or people who have lost their speech, such as someone with end-stage dementia, in my mind haven’t lost any of their humanity. In fact, Clark Power argues that, in that non-verbal world, they may have a privileged access to the Divine. If God reveals his true nature via the Word — the logos — yet he doesn’t have speech as we know it, perhaps people with no speech, changed speech, or a different way of communicating altogether can also reveal the essence of themselves.
After a stroke, head injury, or diagnosis of a neurodegenerative disease, patients may ask existential questions such as: What have I done to deserve this? Where is God in all this? Patients with aphasia and other communication disorders have the added complication of having difficulties verbalising these. Part of our role as therapists is facilitating that re-engagement in these questions, and in activities that give our lives meaning.
SLT patients may not be able to express their spiritual needs verbally. Some may also not be able to engage in religious or spiritual rituals, such as saying liturgy or confession. Some religions are very text-based, and we need to think about how people can still participate. I love that verse in Romans when we are told the Spirit intercedes for us with wordless groans. Some people express their spirituality non-verbally, anyway — through delighting in nature, for example.
Communication can be impacted by deterioration in hearing, and sometimes unclear articulation because of muscle weakness as we age. We can all help facilitate communication in older people by being patient and by continuing to acknowledge their communicative competence.
I’m the youngest of three girls, born and brought up south of London. Church was always a part of my life, growing up, but I moved away from Christianity while at university. When my future husband and I went to hear our banns being read in 1991, we enjoyed our local church so much we carried on attending. My then bank-manager husband felt called to ministry in 2002, and we moved to Bristol for him to train. He was ordained in 2004, and held posts in Kent and London. Jobs for me always became available wherever we went.
In the early ’90s, we were steeped in Evangelicalism and the idea of revival — stories of being slain in the Spirit and speaking in tongues. The death of my sister in 1995, and also a number of ectopic pregnancies, challenged that very black-and-white faith, particularly faith in healing. I’ve no doubt that God has been with me throughout, but now my faith is more nuanced. I don’t believe we can demand gifts from God, but I do believe in his deep, complete, and unshakeable love.
Lack of inclusion makes me angry. Life in its fullest should be accessible to all.
Knowing that my family is safe, happy, and fulfilled makes me happiest.
My son, Jacob, and his contemporaries give me hope for the future. They care so much about sustainability and care of the planet. I pray most for the world, for reconciliation, for my family and the planet.
I’d like to be locked in a church with P. D. James’s Commander Adam Dalgliesh. Not only do I have a penchant for maverick police detectives, but he could also keep me entertained with his poetry. If Phyllis could join us, so much the better.
Sophie MacKenzie was talking to Terence Handley MacMath.
Perspectives on Spirituality in Speech and Language Therapy is published by J & R Press (22 Third Avenue, Havant, PO9 2QS) at £24.99; 978-1-907826-49-8.