Personal expression

The third person in the room

READ THIS IF YOU ARE INTERESTED IN ENABLING CLIENTS TO AIR THEIR VIEWS OPENING UP SENSITIVE ISSUES FOR DISCUSSION PRACTICE BASED RESEARCH

Following a Symposium to celebrate 10 years of the low tech communication framework Talking Mats, editor Avril Nicoll reflects on its wide-ranging applications.

The Talking Mats Team

n 1998, Joan Murphy wrote an article for Speech & Language Therapy in Practice about her newly released Talking Mats package. Already the low tech communication framework that had been developed to help adult AAC users express their views during a research project was showing its potential to benefit a wide range of people in different situations. Ten years down the line, Talking Mats enthusiasts from a variety of backgrounds gathered in Stirling on 7 November to celebrate the achievements and disseminate good practice. As Joans service manager and Royal College of Speech & Language Therapists Chair Mary Turnbull said, Talking Mats has had a profound impact, not just in the UK, but across the
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world. It has raised awareness that successful communication is everyones business. The mat is simply a textured doormat. The talking is facilitated by sets of Boardmaker symbols or other pictorial or written material. The symbols can be placed or, if necessary, attached to the mat with Velcro, then moved around as the client works towards a complete picture that accurately represents their views. The issue for discussion is placed centrally. Symbols depicting a choice of positive / unsure / negative response are across the top. The client then considers, one at a time, things which may have a bearing on the issue, and chooses how they feel about them. Completed mats can be photographed and shared as appropriate as evidence of the clients

view at that time. Joan explained how Talking Mats can be used for: Getting to know someone Reflecting on your own life and experiences Planning for the future / setting goals Establishing consent Making difficult decisions Comparing views over time. Symposium participants were invited to indulge in Speed Matting to get to know each others film preferences. A Know your Mat quiz showed the research teams expertise in matching mats to the store they were purchased from and the cost (frequently under 1). Tongue firmly in cheek, Joan claimed a history for Talking Mats as far back as the Garden of Eden. The humour, changes of pace and mix of prac-

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tical presentations and hands-on resources demonstrated why the team is so successful at providing training to a range of professionals and service users. Joan had prepared a mat to reflect on her experience over the past 10 years. Although the work takes a lot of energy she says she has much to be grateful for in addition to the feedback from training courses the people she has met, the research opportunities, the chance to travel and her team. Its interesting that she has had great success in obtaining funding and spreading the approach so widely when the aspects of her work she doesnt like are the university financial system and committees.

Open questions

Joans colleague Lois Cameron read a message from Jane Higham and Jill Eddlestone, who had been due to present but were unable to attend. Jane is the first person with a learning disability to become an

the most important thing is learning to ask open questions

accredited Talking Mats co-trainer. Both work as part of the Clear Team based in Leicestershire, which employs people with learning disabilities as well as speech and language therapists. They said of the training that the most important thing is learning to ask open questions. They use Talking Mats to find out peoples interests and what they are good at, for supervision and for meetings. Charmaine Gordon, an Inclusion Teacher with Stirling Council, uses Talking Mats to consult children with Additional Support Needs prior to their termly review. She aims
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to gauge how they feel they are getting on with meeting their short-term targets for the term and their longer-term targets for the year. Once the child is happy Laura Coakes with their mat, Charmaine photographs it for documentation and the children like to take it into the meeting as a way of ensuring their views are taken into account. As the expectation of Additional Support Needs legislation in Scotland is that children will be consulted, staff welcome Talking Mats as a tool in line with that requirement. After viewing a video of Charmaine and a child building up a mat, a participant suggested that it might be useful to make two mats in such situations. One would represent the childs view of their progress towards targets and the other the teachers view - seeing them side by side could promote discussion. Another participant noted how the physicality of the Talking Mats process the satisfaction in moving, banging, patting, stroking or turning over the symbols seems to help with ordering thinking. Alex Gillespie, a psychology lecturer at the University of Stirling, agrees that the movement is crucial, as it shows change is possible. One of his criticisms of attitude research is that it seems to assume attitude is fixed. Alex is therefore using Talking Mats as a dynamic way of studying the care relationship and divergences in perspective between a person with aphasia and their carer in essence, looking at how aphasia changes how

people think about themselves and their partner. He pointed out that, within a care relationship, there is a double problem. Firstly, roles and identity change and secondly there is difficulty communicating about these changes.

A group including people with aphasia advised on which symbols to include

His recent research involved 25 people with aphasia and their partners. The researchers offered two home visits, one for using Talking Mats and one for a joint problemsolving task. Talking Mats was distinctive in that it was used both with the people with aphasia and with their partners. The research assessed three levels of perspective: what people think about themselves, what they think about their partners, and what they think their partners think about them. This was done for a variety of topics, including being corrected, starting a conversation, speaking for the other person and using gesture. For identity, the participants looked at traits and matched them on the mats with like me or not like me. Terms such as communicative, childlike and overprotective came from the literature of identity

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in aphasia. A group including people with aphasia advised on which symbols to include. Alex was surprised by the high amount of agreement, such as participants feeling their partners are kind and generally good at communication. However there were a number of clinically important divergences: 1. Partners overestimated how much the people with aphasia would like being spoken for. 2. The people with aphasia thought they were good at using gesture but their partners did not agree. 3. Partners thought they were very good at communicating but the people with aphasia didnt think they were as good as that. 4. The people with aphasia find it difficult to start a new topic, but their partners dont see this as a problem. 5. While the people with aphasia say they have difficulty at times with comprehension, their partners think it is better than that.

Tracey Oliver

Dynamic process

what you think other people think about you feeds into what you think about yourself
In terms of identity, the people with aphasia thought their partners were more overprotective than the partners felt they were, and they were also less embarrassed than their partners thought. The people with aphasia thought their partners were more confident than they actually felt, which is not surprising as people often appear confident in spite of self-doubt in order to manage a difficult situation. And, as Alex says, what you think other people think about you feeds into what you think about yourself.
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Alex recommends video recording of sessions as a way of getting to grips with the dynamic process of decision-making and the formation of attitudes which Talking Mats facilitates. With so much emphasis on the user involvement agenda, this is a timely reminder that questionnaires simply cant capture the way that answers shift depending on the frame at the time. The team is now undertaking a follow-up project with four couples in a once a week group. One of each couple has severe aphasia, and the group is based around strategies arising from the research. Dementia is another clinical field where Talking Mats is proving its worth in helping people express themselves (Murphy et al., 2007). In the early to moderate stage people can use Talking Mats effectively and in the late stage it is more effective than conversation. The benefits can include an increasing level of engagement and keeping on track, and a decrease in perseveration and distraction. Tracey Oliver reported on a current project looking at whether Talking Mats can help people with dementia and their carers feel more involved in care decisions. There are four topics personal care, getting around, housework and activi-

ties (indoor / outdoor). Compared with conversations, the carers felt Talking Mats opened up the opportunity to discuss sensitive topics. It also appears to be a visual way of finding strengths and boosting confidence. A poster from Mick Worthington, the first police officer accredited to train others in the use of Talking Mats, provides further evidence of the value of Talking Mats in helping people talk about difficult issues. He found that, compared with the standard police interview procedure, Talking Mats elicited more information from children with intellectual disabilities. He concluded that the findings were promising enough to make the method wor-

questionnaires simply can't capture the way that answers shift

thy of further consideration as a tool for investigative interviewers. Speech and language therapist Maria Venditozzi has used Talking Mats with people with learning disabilities in a range of sensitive cases including housing, childcare issues and sexual abuse. She presented the two case studies previously reported in the Royal College of Speech & Language Therapists Bulletin (2006; 2007). One established that abuse suspected by staff was not in fact occurring, while the other meant a client had his allegations of sexual abuse against a carer taking seriously by the police, the Procurator Fiscal and his care organisation. Maria paid tribute to her manager for recognising the importance of giving her the intensive time required at short notice to prepare these cases. Joan Murphy noted that Marias speech and

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language therapy background was clearly important in enabling her to hone the Talking Mats and ensure the procedure was robust. One thing Talking Mats really does is open up a tool designed for people with recognised communication impairments for use in any situation where communication may be awkward or inadequate. Pam Crawford and Elaine Watson are careers guidance officers at Stirling University. Discovering that both undergraduate and postgraduate students can find it difficult to articulate their thoughts, particularly around selfawareness, they introduced Talking Mats to some individual consultations. They have devised cards on employability skills and find that Talking Mats functions as the third person in the room. It introduces a neutral, systematic and objective element that takes the pressure off and leads to greater disclosure than would otherwise have happened. Although it isnt necessary or suitable for every student, it is now an established part

of the careers guidance toolbox that is enjoyed by staff and students. Pam and Elaine are planning to pilot its use in class and group settings.

Social closeness

Speech and language therapist Laura Coakes also demonstrated how Talking Mats has lots of applications as long as it is adapted to the cultural context. We saw a video from Sweden on Samtalsmata and heard about Talking Mats at a Finnish wedding, but Laura has exported the approach to the land of daggy men who eat Vegemite and dont give a XXXX. Laura began her career in Stirling as Talking Mats was being developed but is now in rural Australia where therapists have to be inventive in sharing information and resources such as videos due to a lack of organised training. It was interesting to see in her videos how the process encouraged clients to initiate communication as well as to respond, and how skilfully Laura picked up on this. As with any

communication tool, users need to understand that it is as important to focus on the quality of the interaction (what Lois Cameron calls social closeness) as it is to complete the task in hand. The Symposium was funded by Forth Valley R&D Committee to reflect where Talking Mats had come in 10 years and to disseminate good practice. Lois, who was the main organiser of the event, said she was delighted that in addition it had been the tribute to Joan I wanted it SLTP to be.

REFLECTIONS DO I UNDERSTAND THAT ATTITUDE IS DYNAMIC RATHER THAN FIXED? DO I PROMOTE SUCCESSFUL COMMUNICATION AS EVERYONES BUSINESS? DO I MAKE TIME TO CELEBRATE MY ACHIEVEMENTS AND THOSE OF OTHERS?

Murphy, J., Gray, C.M. & Cox, S. (2007) Communication and dementia. How Talking Mats can help people with dementia to express themselves. York: Joseph Rowntree Foundation. Available at http://www.jrf.org.uk/bookshop/details. asp?pubID=931 (Accessed 27 November 2008). Venditozzi, M. (2006) Defining sexual relationships using Talking Mats, RCSLT Bulletin September, pp.10-11. Venditozzi, M. (2007) Total Communication, RCSLT Bulletin July, p.8.

References

What is your experience with Talking Mats? What other methods help clients to express their views? Let us know via the Winter 08 forum, http://members. speechmag.com/forum/.

Talking Mats articles in Speech & Language Therapy in Practice

Boa, S. (2005) How I set goals (3) You will know when it feels right, Speech & Language Therapy in Practice Autumn, pp.27-28. Crighton, E., Forsyth, I. & Cameron, L. (2008) Are you Listening?, Speech & Language Therapy in Practice Summer, pp.1416. Hunter, A. (2004) Inspections and Talking Mats: a more powerful say, www.speechmag.com/Resources/Originals. Murphy, J. (1998) Taking Mats: speech and language research in practice, Speech & Language Therapy in Practice Autumn, pp.11-14. Murphy, J. & Cameron, L. (2002) Let your mats do the talking, Speech & Language Therapy in Practice Spring, pp.18-20.
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