Episode #74 - The Whys and The Hows of the Clinical Doing: A Conversation with Rochelle Cohen-Schneider

Dr. Katie Strong, Assistant Professor in the Department of Communication Sciences and Disorders at Central Michigan University, talks with Rochelle Cohen-Schneider from the Aphasia Institute about the importance of developing and attending to our clinical selves. Rochelle Cohen-Schneider is the Director of Clinical and Educational Services at the Aphasia Institute in Toronto, Canada. She has worked in the field of aphasia (across the continuum of care) for most of her career spanning 38 years. She studied Speech and Hearing Therapy in South Africa and completed a master’s degree in Adult Education in Toronto. In addition to her interests in clinical education, continuing education and working within a social model of aphasia Rochelle is passionate about understanding ‘how clinicians think, and why they do what they do.' In this episode you will:  Hear stories about clinicians connect the dots in the things you can’t see as a clinician but have a critical role in the work you do. Understand the difference between reflective and reflexive work, and why both are essential to developing our clinical selves. Learn a few tips and some resources to broaden and deepen your clinical lens. KS: Rochelle, welcome to this episode of the Aphasia Access Conversations Podcast. I'm so excited for you to be here today, and to have this conversation and for our listeners to really hear about your work and perspectives. RCS: Thank you very much for this invitation, Katie, I'm really looking forward to digging into this topic with you. Thank you. KS: Oh, me too. I'm just so excited. And as we get started, Rochelle, I'd love for our listeners to hear a bit about your story and how you became interested in this area of the ‘clinical self’. That's powerful, that's powerful Rochelle. I mean I Wow. RCS: So, Katie, it became clear to me that the therapeutic encounter was a multi-dimensional endeavor requiring multiple skill sets, right from the days of being a student in, as you said earlier, in Johannesburg, South Africa. So, the physical structure of what was known as the Speech and Hearing Therapy Department housed both lecture halls, and small clinic rooms, where we, the student clinicians, carried out our therapy activities under the watchful eyes of our clinical tutors. These tutors watched from behind one-way mirrors and spent a lot of time debriefing with us about the session, our goals, the treatment methods, we chose, why we chose them, how we performed, and also how we enacted our clinical selves. In other words, how we related to our patients, where we sat, why we sat where we set, and we will often put through the paces to have us begin to understand how we positioned ourselves as clinicians. And it was really important in the clinical setting and how we learned to be, the relationship and relating to the clients was really, really important. And in fact, when we wrote our reports for our tutors, the first goal, regardless of age, or communication disorder, had to be establishing rapport. And actually, as the literature tells us rapport is actually only one small element within the clinical relationship. Maybe it's a gateway. It's a fairly static notion, because the relationship is much more dynamic, you know, interactive and an unscripted interaction. So because of the way this physical physically was set up, our academic and our clinical learning took place under the same roof, allowing for a very dynamic and stimulating learning environment, which focused both on rigorous academic growth and clinical development. So as a clinician stepping into the role of a clinician. And I think I might be able to say that this environment really helped us student clinicians “think with theory”, as Felicity Bright calls it. And we were trained to understand both the objective and subjective aspects of being a clinician and that fully engaging in a therapeutic encounter is really important. Another little aspect of this was in our third year of training in a four-year Honors Program, the clinical load was divided over four years and kind of matched what we were learning in those lecture halls. In the third year, we were observed by one of the professors from the psychology department. We had a couple of observations, and his job was simply to observe our therapeutic interactions, and how we engaged with the clients. And he obviously was not able to comment on the content of the therapy session because he had no idea. But he again, like our tutors, but even more rigorously asked us lots of questions around our positionality, both the physical and conceptual positionality, and all kinds of really very difficult and grueling questions. When I interviewed for the job at the Aphasia Institute, and I was interviewed by my boss, Dr. Aura Kagan, she asked me to tell her a little bit about what my day involved. That was one of the interview questions. I told her about the fact that I had to go, unlike the other professions, the physiotherapists who seem to have their own porter, me as a speech pathologist, had to porter my own patients or clients and I brought my clients into my room, and I started therapy. And she said, “Okay, no, no. Go one step down. Tell me more. What did you talk about when you were bringing the patient down?” Now, obviously, the patient was forward facing, and I was behind. But she was interested in the topics that I would think to talk about. And so, you know, we talked about what happened last night? Did you have any visitors? Did you watch TV? How's the food?  Anything else you want to say? And then I would get my office, I would wheel the client in, and then I had a ritual. I didn't realize it was a ritual. But I leaned over, and I put my white coat on. And that signaled to me, the clinician, that the personal self is out the door, and now I am the professional, I am the clinician.  KS: That’s powerful, Rochelle. I mean, wow! RCS: And she said to me, “Okay, so what's the difference?” and she probed, and I started having the beginnings of the understanding of pulling together the personal self and the professional self, that maybe then becomes the clinical self. And this very clear demarcation fell away completely when I joined the Aphasia Institute, where there were no white coats, and there were almost no doors. And so, we worked in open spaces. And obviously, there of course, were times when doors and private spaces were called for. But I suddenly had this dawning realization that, you know, a couple of years, seven, eight years into my career, I had never, ever watched another clinician work. And here I was suddenly watching these brilliant clinicians work, and I wanted what they had. And so that set me on my journey. And, and just being very, very interested in how to develop that part of myself, that would engage our clients in a life participation model. KS: That is such a journey and I so appreciate you sharing that with us. You know some big ‘aha moments’ about who we are as clinicians and how that changes or doesn't change based on who we're interacting with. I'm so excited to talk more about this. I'd like to first talk about an article that you co-authored a clinical focus article in the 2020 ASHA perspectives journal titled Spotlight on the Clinician in the Life Participation Approach to Aphasia, Balancing Relationship-Centered Care and Professionalism. Could you tell us a little bit about how this article came to be? RCS: Katie, before I tell you that I just want to...thinking about and talking with you, I've kind of connected many, many dots. And the dots are some are visual dots, some are auditory, some have cognitive, some are emotional dots. And so, one of the things that dawned on me, when I used to read to my children, there is a well-known book here in Canada called Something from Nothing. And it tells a story of a little boy whose grandfather is a tailor. And the grandfather makes the grandson a jacket. And of course, with each passing year, as the boy grows, the grandfather has to refashion the garment. It becomes a vest, then a tie and finally, the fabric simply covers the button. As the grandfather is snipping away, pieces of the fabric are falling through the floorboards. And unbeknownst to them, there is a little family of mice who live under the floorboards. And they're getting all these pieces of fabric. And they are designing and furnishing their house with this with this fabric. The minute I saw this image, I said to myself, that is what interests me. It's everything that we don't see. The mouses house was about one eighth of the page, (of the book). It was a fairly big book. And to me, that was the clinical encounter underneath. And when working with social workers for many, many years, I thought that that's where they worked, in the things that you can't see. And again, I wanted to go there.  KS: Wow! RCS: After the over many years of working together with Aura, we had spoken so much about the value of working with social workers and our learnings and how we really feel so privileged to have social workers by our side for so many different reasons. And one year at an Aphasia Access Summit, Aura heard Denise McCall and Ann Abrahamson, SLP and social worker respectively, from SCALE, The Snyder Center for Aphasia Life Enhancement in Baltimore. And she heard them give a talk about what they call ‘the dance’, how they learned to work together, despite having such disparate perspectives. Denise actually bravely talked about what got in the way and how the speech pathology lens got in the way of the in the way of a satisfactory client encounter. And Aura came back to me and she said, “You know what, you've got to reach out to Denise and Ann because they think like you think.” And so that’s kind of where it started. But also, in my quest to understand the nuts and bolts of how we do our job, I have also explored how my colleagues work and what they know about how they work. What I understand as their deep tacit knowledge. KS: What they know about how they work, that's deep.  RCS: That's what I'm constantly trying to understand. We don't spend a lot of time articulating what it is we know and why we do what we do. We spend a lot of time talking about the evidence-based approaches and absolutely we should. We should totally give as much time and attention to that as possible. But there's this whole, rich, rich source of information and rich source of data that we're all generating every single day as we interact with clients. And the literature tells us that these kinds of things are really, really important in understanding and dealing with because it makes us more effective. Clinicians offering evidence-based models, treatment services, assessments, etc.  KS: We are an ingredient to the therapeutic interaction.  RCS: Absolutely, absolutely. Many years ago, I read a research article, and I cannot remember exactly what it wasn't it, I think it was possibly not even our field. But the title of the research article was Hardening the Soft Data, which I think those of us and those of you who are involved in qualitative research are totally engaged with. But to me that really spoke to trying to take this whole, the subjective part of the relationship and trying to see exactly what it is. And so that sort of set me on the path with this article.  KS: That's great. So, the focus of the article is about relationship-centered care, and you co-authored it with colleagues, Denise from SCALE and social workers and speech pathologists.  It's really about relationship-centered care. I was hoping you could talk with our listeners about this approach to care and why it really is essential for our work as clinicians who embrace the Life Participation Approach to Aphasia. RCS: Yeah. In the article, the first vignette that I bring forward is the contribution of Denise, and Ann where they tell this story of a session, where they were working collaboratively with a client. The session by their account, did not go well. And as I mentioned earlier, Denise very bravely explains why in her opinion, it didn't go well. And she says, the speech language pathologist changed the subject, and ignored the social workers cues to continue the conversation. And so, a key opportunity was missed. And I thought so much about all of our missed opportunities, where we just don't have the lens to catch things that we don't see. So, they continue their story and tell us that they debriefed and obviously have a trusting relationship with each other. The interprofessional collaboration was enriched by that discussion. They go back and they resolve the issue. And it was a serious issue. It was a family secret that the client was carrying. And so of course, made me think about all the secrets that our clients carry. And what if you don't have a social worker to work with you? And so those of us who do are really, really, really fortunate. I think the contribution of social workers is significant. I think they inherently and as part of the learning, are engaged with learning about the therapeutic relationship, and also the tensions that arise from that, around professionalism and boundaries. And of course, their scope of practice naturally includes gathering information about goals, roles and interactions among family members and within social network. They are also interested in learning about clients and families before the health incident that caused the aphasia and of course, the impacts. So social workers de facto have always had a broader clinical gaze than we have. But of course, now with the Life Participation Approach, the model and the model of the A-FROM (Framework for Outcome Measurement in Aphasia), the model that Aura Kagan and a bunch of her colleagues have created. So, I think with these models we are catching up. And we are broadening our gaze and considering many, many more domains for our intervention. I think as we continue to understand the impact of aphasia, on all aspects of the client’s life, we have no choice but to go there. And I think also in terms of the Life Participation Approach to Aphasia, which clearly puts the client at the center of the clinical endeavor, we've had to do our own dance, I guess. This again makes me think about Felicity Bright, drawing from sociology. She talks about our positionality in the therapeutic encounter and so we are no longer the expert. We are the expert guide, but the client is the expert of themselves. I'm not in a university setting, so I don't exactly know how students are being taught. I would imagine is such a tension between trying to teach the scope of our professional responsibilities and expertise, that I don't know exactly what's being taught. We need to shift these positions and to be open to partnering more with a client. I think we have to really follow and pay attention to the relay, a relationship-centered care framework. And Linda Worrell talks about this incredibly eloquently. She bases the work on the model that was developed for physicians. And, you know, talking about the fact that we as therapists, and our patients bring full dimensions of ourselves as people into the relationship. Thinking backward Aura challenged me, “You know, you can't leave yourself out the door, you came with yourself, even if you had to mark that moment when you transitioned, you came with yourself.” And so, as we are delving into clients lives and our position of power is changing, and we're opening ourselves to interrogating ourselves in a sense, based on how the clinical encounter proceeds. KS: Yeah. I love the thought of the broadening of the gaze. And your point to training clinicians, I think it's something that we really need to start paying attention to, early in the development. Just like you were sharing about your story with your own training and having someone be able to help you talk about, “Why are you sitting where you're sitting? Or  Why are you sharing with this? Or when this happened, by saying this, you shut, you shut the door or shut someone down about something that was very important to them.” I think it's, you know, really essential. I feel like, historically, we've ignored it or just expected that to happen after you get your knowledge about evidence-based practice knowledge. And I really feel like we need to be better at helping our students that were training into the field, to do such beautiful work to be able to develop themselves early on, so that they're able to better serve their clients and themselves really.  RCS: Yeah, yeah, absolutely. You know, one year I was at ASHA, and I went to a really powerful presentation, by the late Shirley Morganstein. And I looked around the hall. It was such a brilliant presentation. And I saw just older clinicians there. To your point, Katie, of, you know, you first learned this, and then you learn that. After the presentation, I went up to Shirley and we chatted, and there were a couple of other people standing around and just to your point of trying to get this in as early as possible. Kind of braiding it together the subjective and the objective. And just building that awareness, because the subjective enables the stronger version of the objective. KS: Absolutely. I think we've got work to do in that. I know you've been a guest speaker in the course that I teach. I've been fortunate to develop an elective called The Engaged Clinician: Our Behavior Matters. I think I've taught it for three or four years now. It's kind of viewed as a special time to be able to focus on that. And I think what's sad is that it shouldn't be special. It should be an integral part of how we train our workforce, our clinicians.  RCS: Yeah. And I think we're lucky that we are seeing a not a resurgence, but an emergence of interest. And we're seeing it from people who are thought leaders in our field and, you know, sort of narrower area. And so I think, it'll roll around. There's some really, there's some really amazing and powerful work being done right at the moment, which is exciting. KS: Absolutely. You mentioned earlier one of the vignettes. The article that you co-authored has six vignettes that provide examples of how SLPs navigated clinician-client boundaries. It's a fabulous article, it really is. I was wondering if you could pick one more to walk us through another vignette just to give us a flavor for the article. RCS: Sure, thank you. One of the exciting things is, some of these vignettes have been floating around in my brain for a while because I've, as I mentioned earlier, kind of after some of my colleagues. Each time I come back to them, I see something else, which is really enriching for me. And again, thinking about this talk today has given me some additional perspective. So. I will take you through one, and it's been Vignette #5. I titled all the vignettes, together with my second co-author, Melody Chan. We titled them to sort of give some clues. So, this is called Recognition as Relating. I'll just quickly read a small segment of this.  The SLP says, “the client was quite reserved, and he began telling me about his job. I could see that he took a lot of pride in it. And when I reflected that back to him, I said to him, ‘You’re, quite a perfectionist.’ He broke down and he cried. It was quite a moment because it was just one word.”  And as I think about this tiny little window into a clinical encounter, there is so much richness here. The client she was talking about an assessment encounter. She had just met the client for the very first time. It was not a long-standing relationship, and she recounts this piece that what had happened sort of at the beginning of the session is he had walked into the room, and he'd noted that the picture. There was a picture that was crooked. And so, he either commented, or he kind of adjusted it, I can't remember. And so, she was starting to form a picture in her mind. So, I think what happened was, it wasn't just one word. It was the fact that she's saw into this man. She saw into his identity, and she recognized who he thought he is. Who he is, his essential self. And I think what a moment for a person with aphasia, was had their whole life quickly, suddenly up ended by a very traumatic event. And his identity has sort of been shattered as well and stolen and all the words that that we use when we talk about identity. And here is somebody who he has never met. And she says, “I see you”. And that is incredibly powerful. And I think that my new reflection on this is that at that moment, the clinician must have been golden for him. Of course, I wasn't there. But I imagined that the level of engagement and connectivity must have spiked significantly. And so, I really have learned a huge amount from the work of Felicity Bright, and I'll talk about that in a little bit. But co-constructing engagement between a client and clinician is a relational act, it's happening with you pay attention to it or not, it's happening. The fabric is falling under the ground, it's happening. You're not seeing it. We're not seeing it. And so ultimately, the more engaged and connected a clinical encounter feels for the patient, the more positive the patient experience is, which leads to all kinds of positive foundational elements that allow a clinical encounter to be successful, and a therapy session to be successful, and a treatment approach to be successful. And so, for me in this vignette in this anecdote, the clinician is primed to look for identity. She knows how important this is. It didn't take any time. It took no time whatsoever. She still completed the assessment in the required amount of time. But that one thing, just hit the ball out of the park. It's such a powerful story to me. KS: It is what it is to me too. I'm a little teary and I've read the article before. But it you know, that's, you know what we're talking about. And not every session has to have that amount of power, but those little instances where they happen, weave together this stronger relationship where you're more willing and able to work collaboratively together, because there's this respect and trust.  RCS: Yeah.  KS: Thank you. Well, thinking about the critical incidents like the one you just walked us through with that vignette is really an integral part of developing who we are as clinicians or our clinical selves. And I know you've read a lot and examined this quite a bit in your experience, and particularly in your expertise in adult education. And I was hoping you could share a few tips for our listeners, who might be ready to expand their reflective practice. RCS: Absolutely, Katie. So, I think that the Master's in Adult Education was a direction that I really never thought that I would go. I had always thought that I would be interested in going back for either social work or psychology. I always had a deep interest in counseling. I think many of us who've ended up in this particular subset of a subset of a subset or subfield, many of us have this interest. But I was asked many years ago by a one different social work and speech pathology team to videotape a session that they were running with two couples were both in both instances, it was the husband who had had aphasia, they were doing a counseling, training kind of session. And so, sitting behind the camera, it became clear to me that I wanted to pursue what I'd always thought about, you know, you've heard that the seed from the very beginning, the whys and the hows of the clinical doing. It was clear, I didn't want to be the social worker, but I wanted to know what the social worker was thinking. And so somehow, I found my way to adult ed, and I think it served me really well. There was a lot of learning in something outside of our field, but certainly the, the field of teaching and learning, and education and pedagogy and teachers, and nurses really do a lot of self-examination. And so, there's been a lot of kind of building of theoretical models and thinking around what can help teachers and various other professionals look into this whole endeavor, or whether it be a clinical endeavor or a pedagogic endeavor. And so, I think one of the key things that I learned that I had to sort of sum up. There were two main areas, but I'll talk about what you've just raised, the reflective, is kind of thinking a little bit about both the reflective and the reflexive ideas. So reflective, to me is something that we tend to do afterwards. We reflect on how the session went. We pull things apart. And it's extremely valuable because it builds all kinds of muscles and lenses. But I think what became really clear to me, and what was really interesting was thinking about being reflexive, which would be in the moment of things happening, being able to identify it. And we don't always talk about that in our field. In in nursing there's a nurse educator called Patricia Benner and she talks about going from novice to expert. And I think that probably for those of us in the academy, that those are concepts that are well known to you. But we don't always talk about it out in the field. And so, reflexive is being able to make those tweaks as you go along. And, of course, that is what, whether you in the academy, or we're whether you're a field supervisor as I have been, it's what we're teaching our students. You know, make the adjustments as you go. Sometimes you can, and sometimes you can't, but look for them and see them. And then under being reflexive is critical reflexivity, which is understanding all about yourself, and how that impacts your environment. And so I think those were really, really key learning issues. And I just want to, I want to just take advantage of your question, Katie, if I may, and just go through one of the other vignettes that sort of demonstrates kind of reflexivity.  So, the clinician says, “I was scheduled for an assessment. And when I prepped and read the chart, I saw the client was a gentleman in his late 70s, early 80s. And I had an oh moment as I realized that this client was born in Germany, and that my own grandmother had survived the Holocaust. I did have a bit of a personal reaction to his potential life situation at that time, so I had to check myself in the moment, aka do a little moment of reflexivity. And I had to make sure that I wasn't showing the reaction to the client.” And the clinician realizes that having been attuned to her critical reflexivity, she says, “I guess in that moment, it was a point of growth. Because I didn't think that early on in my career, I would have been able to have that self-talk in my head, and still be able to carry on with the assessment.” So, I think, you know, she caught herself, she had that little conversation with yourself in that moment. It was a real moment of reflexivity. And I would imagine, I never have asked her that she's added that to her toolbox of critical reflexivity. And she now knows that about yourself a) what triggers her and b) what she can do about it. So, I think that was the big learning from adult age.  KS: And you know, that's just so important because, you know, we haven't really talked about this at all today and didn't really plan on it, but the aspect of stress levels and burnout and you know, taking care of ourselves as clinicians and, this work of reflection and reflexivity is helpful in helping us to navigate the really intense experiences that happen when you're living a clinical life. RCS: Yeah. Yeah. And there is I won't read the vignette, but the last vignette in the article is about is a clinician telling a story of how negative how negatively a client impacted her, because he embodied all the things that ran counter to her values of how she lived her life. And this tension of, you know, duty of care and intense dislike of somebody. And I think what we drew as a collective as our team from that, is there has to be a safe place. Back to your point about stress and burnout, there has to be a safe place that a clinician can come and say, I cannot work with this gentleman. Who does he not trigger? And if he does not trigger you, could you please be the one? And that's actually what we did. So, this is making time for reflection and reflexive talk, and is really important butt it has to be in a safe environment for clinicians. Yeah.  KS: Well, so, you know, I think most of us think about things like journaling or talking with colleagues. Not complaining with colleagues, but debriefing and really sharing about, where you were, where you were at, and what you were thinking and how you're feeling currently, you know, are really vital parts of our job. What are some of your top resources that you would recommend for someone who wanted to explore into this area? RCS: Yeah. Yeah, absolutely. So, I'll break him down into two major categories. The first one, I will just run off a couple of names within our field, whose work is so inspirational and so groundbreaking and continues to break ground, even if they've been saying and talking these thoughts for many, many years. So, I'm going to start there. I do have to talk about the impact that my boss Aura Kagan has had on me, and Nina Simmons-Mackie, Audrey Holland's work from being a student in South Africa was absolutely (inspiring). Discovering and falling upon this work, and this reading was just, you know, an absolute godsend. It felt like an oasis in a desert sometimes. So Audrey Highland, Jackie Hinckley's work, and Linda Worrall’s work. Felicity Bright’s’ work. And Martha Taylor Sarno’s work. I don't know if people have read and if it even possible to get hold of a lecture she once did called the James Hemphill Lecture or award or something that. These works just helped to open up an additional lens and an additional dimension. So those are people in our field. And Katie, classes like yours are also groundbreaking for clinicians to, as you said, to be learning early on. So those are really, really inspiring.  In terms of stepping out of our field, an area that has been extremely important and influential for me, is the area of Narrative Medicine, in all of its forms. And a lot of medical schools are starting to adopt the principles. Narrative Medicine comes out of the medical humanities. It involves using the arts to help clinicians see and think and develop what's called narrative competence. I'll give a shout out to a group of clinicians in Toronto who are using a Narrative Medicine framework for some student training. And we at the Aphasia Institute have jumped on board as they've allowed us into join them. This is very, very powerful in helping students write and tell stories from the perspective of the client. Very, very important. There so there are Narrative Medicine courses. The Narrative Medicine, Columbia, runs an incredible Narrative Medicine course and Jackie Hinkley will back meet up. We found each other at the course many, many years ago.  KS: Oh, that’s fabulous! RCS: So, that that would be a strong recommendation, then on Twitter. And I do see sometimes speech pathologists, and whatever we do with Twitter. It's the handle the hashtag is #medhumchat. And it's sometimes worth just scrolling through there to get just great thoughts and ideas. I omitted to mention all of the clinicians who are part of that original Life Participation Approach to Aphasia core group, any of them and their work is really instrumental in in moving us forward in this domain. And finally, looking outside of the field into the field of maybe social work for courses. I was very fortunate to be able to take a two-year externship in family therapy. And the clinician is, well there's no way to hide in that field. And so, there's a lot of things that I learned and I'm thinking about it from there. And so, again, encouraging people to look outside of the field for any education.  KS: Thank you. I know you sent a list of some favorite reads and so we will have reference citations and some links in the show notes. We'll make sure to put the med hum chats hashtag in there also. So be sure to check out the show notes if you're listening and you're wanting to dig a little bit deeper into this. Rochelle, any thoughts that you'd like to share as we start to wrap up this conversation today? RCS: Yes, I'd like to just share just two final thoughts. The one is what you actually had said, Katie, you know, they are all these great resources out there, but there are a lot of things that clinicians maybe can do locally, in their own departments. And so, you know, not complaining, you said by talking about, both for the purpose of de-stressing, and for the purpose of deepening, and building lenses and muscles. One of my biggest learning opportunities, and I mentioned it early, has been to see and watch and hear and feel my colleagues working. I don't know if that's possible for people to do. You don’t have to do it often, just once asked if you would be permitted to sit in and watch a session where you work, you know. You both see the same thing. And ideally, of course, like we do with students, sometimes if you can record it, but I know there are issues of time and privacy, those do get in the way. But at least looking for sort of things that are in place already, that you can just think about different topics. So, if there is a journal club, or case discussions, once in a while just shifting the focus onto some of these. Remembering the image of the mice underneath just to the tiny little piece, the liminal space underneath there, I think it could be really helpful. And I just am going to end off with a story. And a resource that I did not mention, Cheryl Mattingly, who is an anthropologist, who has watched occupational therapists, and I am not exactly sure how that came to be. But there's an incredible vignette that she tells, and I don't have the book because it's sitting in my office, and we're not yet back on site. But it's the story goes something like she observed a young occupational therapist, doing a session with a group of older gentlemen, possibly in a Veterans Hospital. And when she walked in, the gentlemen were, you know, they were in wheelchairs, they were hunched over, they were drooling, listing to one side. And the girl, the occupational therapist came in the clinician came in, and she sort of sat down. It took her a minute, and then she looked out the window, and she said, “isn't it you know a glorious day? “And then she said, “Oh, I'm really excited about my vegetable garden or something.” And I sort of get goose bumps. Katie, you had tears. And I've read this a million times. But suddenly, Cheryl Mattingly says these gentlemen sat up, stop drooling, paid attention, looked at the clinician, and she could imagine them in the gardens with a bottle of beer, leaning over digging into the beds, and it became a very animated discussion. And then she says, and then something happened, and the occupational therapist said, “Okay, now let's get to our task.” And whatever the task was, it was the most boring, soul-destroying task. And these men, that she had enlivened, and awakened, suddenly just became, like they were in the beginning. It's a beautifully rendered piece that she writes, and she said, she was just heartbroken. She was heartbroken for the men, but she was also heartbroken for the clinician, because she missed such an opportunity. And so, I would just encourage us to, you know, look for the opportunity look for the buddy, the buddy colleague who might have the same lens as you and build on that together and hopefully impact everybody around you.  KS: Thank you, Rochelle, this has really been a delightful conversation. So much to think about. And you inspired me, and I know our listeners will be thinking more about the important role that we have as clinicians as people as persons as in contributing to this thing we call therapy. So, thank you so much. It's been great to have you on the show.  RCS: Thank you so much, Katie. And thank you for your work.   On behalf of Aphasia Access, we thank you for listening to this episode of the Aphasia Access Conversations Podcast. For more information on Aphasia Access and to access our growing library of materials go to www.aphasiaaccess.org If you have an idea for a future podcast topic email us at [email protected]. Thanks again for your ongoing support of Aphasia Access.   Websites and Social Media Aphasia Institute  https://www.aphasia.ca/   Aphasia Institute on Twitter @Aphasia_Inst    Links Mentioned in Episode Boundaries and Clinical Self Readings Cohen-Schneider, R., Chan, M. T., McCall, D., Tedesco, A. M., & Abramson, A. P. (2020). Spotlight on the clinician in the Life Participation Approach to Aphasia: Balancing relationship-centered care and professionalism. Perspectives of the ASHA Special Interest Groups, 5, 414-424. https://doi.org/10.1044/2019_PERSP-19-00025  Duchan, J. F., & Byng, S. (Eds.). (2004). Challenging aphasia therapies: broadening the discourse and extending the boundaries. Hove, East Sussex: Psychology Press. Penn, C. (2004). Context, culture, and conversation. In Challenging Aphasia Therapies (pp. 83-100). New York, NY: Psychology Press. Sherratt, S., & Hersh, D. (2010). “You feel like family…”: Professional boundaries and social model aphasia groups. International Journal of Speech-Language Pathology, 12(2), 152-161. doi:10.3109/17549500903521806 Walters, H. B. (2008, Fall). An Introduction to the Use of Self in Field Placement. In The New Social Worker: The Social Work Careers Magazine. Retrieved July 26, 2019 from https://www.socialworker.com/feature-articles/field-placement/An_Introduction_to_Use_of_Self_in_Field_Placement/  Kagan, A. (2011). A-FROM in action at the Aphasia Institute. Seminars in Speech and Language, 32(3), 216-228. doi:10.1055/s-0031-1286176   Clinical Engagement Readings Bright, F. A., Kayes, N. M., Cummins, C., Worrall, L. M., & McPherson, K. M. (2017). Co-constructing engagement in stroke rehabilitation: a qualitative study exploring how practitioner engagement can influence patient engagement. Clinical rehabilitation, 31(10), 1396-1405. doi: 10.1177/0269215517694678 Bright, F. A., Kayes, N. M., Worrall, L., & McPherson, K. M. (2015). A conceptual review of engagement in healthcare and rehabilitation. Disability and Rehabilitation, 37(8), 643-654. doi:10.3109/09638288.2014.933899   Kayes, N.M., Mudge, S., Bright, F.A.S., McPherson, K. (2015). Whose behavior matters? Rethinking practitioner behavior and its influence on rehabilitation outcomes. In K. McPherson, B.E. Gibson, & A. Leplege (Eds.), Rethinking Rehabilitation Theory and Practice (pp.249-271). Boca Raton: CRC Press, Taylor & Francis. Worrall, L., Davidson, B., Hersh, D., Howe, T., Sherratt, S., & Ferguson, A. (2010). The evidence for relationship-centred practice in aphasia rehabilitation. Journal of Interactional Research in Communication Disorders,1(2), 277-300. doi:10.1558/jircd.v1i2.277 Narrative Medicine Readings Charon, R. (2008) Honoring the Stories of Illness Oxford University Press. New York Hinckley, J. H. (2008). Narrative-based practice in speech-language pathology: Stories of a clinical life. San Diego, CA: Plural Publishing Inc. Medical Humanities Chat on Twitter @MedHumChat   #medhumchat