Therapy in the age of COVID-19

Sam Grant and Melanie Moses talk about their work, how it has changed in recent months, and why staying connected matters.

smiling woman working on a laptop in a wheelchair
Sam is a clinical psychologist who works with many people in Lifetime Care and Workers Care and supports those with a brain or spinal cord injury. Sam sees her role as providing the skills and knowledge to increase the skills of everyone around the person with the injury, because that person will need ongoing support due to the effects of the injury. She also provides education and training to family members, other therapists and support workers who themselves are supporting individuals with a brain injury.

Melanie is a speech pathologist who works with people who have acquired communication and swallowing disorders. She is passionate about helping those who have communication challenges following a brain injury. 

Communication is everything 

Melanie considers communication to cut across everything we do. It's our ability to make friends, to stand up for ourselves, to express our wishes and choices. She works with other therapists in the team to help clients achieve goals that really matter to them. 

"Many of my clients find it hard to express their goals, particularly about their thinking or communication skills. In contrast, if someone can't walk, they can more easily see the problem, and other people can see the problem so they can focus on recovery. They often aren't as aware of their communication difficulties or how these may impact on them. It’s a lot more complex," says Melanie.

Adapting to needs 

The needs of each client change over time and the different stages of recovery. Sam and Melanie both work with one Lifetime Care participant, Jon, who volunteers his time at a breakfast club at the local school in Griffith. They focus on the skills Jon needs to engage effectively. Recently they've been helping him work out how to buy a puppy, how to ask the right questions, helping him self-advocate.

"Communication is about regaining control over your world after you've had a severe injury and are extremely vulnerable. We help our clients work out how to seek information, making sure they’re understood and making sure their own needs are being met," says Melanie. 

A family affair 

Training up family members is always dependent on the journey someone is on, and the timing. In the initial stage family members will be so grateful that the person is alive. They are more tolerant, and they want to engage and learn.

That changes and family members start the grieving process. They start to think, for example, 'this person is not the person I knew before the accident.' Then they start to see barriers. 'You don’t really know them,' 'You don’t live with them.' That becomes more challenging and requires more time and strategies to work differently.

Working in the time of COVID-19

Sam and Melanie have both used telehealth before the lockdown commenced. They have clients in regional or remote parts of the state who they would visit on a scheduled basis and then do follow-up sessions by phone or video. But now, nearly all face-to-face support work has had to move online.

For many people with a brain injury it can be difficult to stay focused and they can easily become distracted, so having to focus on one thing like a computer screen is often helpful. 

"But as a psychologist, the general disadvantage of telehealth is that you can miss a lot of cues you'd normally pick up. Also, in most regular therapy sessions you sit side-on to the client, and it’s very unusual to do therapy face-on as you do on a screen. There's evidence that the left side of your brain talks to the left side of the listener's brain, and you don’t get that via a computer screen. On the other hand, telehealth can work well for problem solving and for education," says Sam.

The importance of connections

Connecting participants to each other is something that both have been able to do a lot more of during the lockdown. Both have had success pairing up a few participants online, chatting to each other one-on-one. Many of them have tablets and we have trained them to use Zoom, so just connecting them—with them in the background works well.

From a speech pathology point of view it provides a valuable and empowering opportunity for people who are isolated to chat and offer each other advice while practising important communication skills. Participants are now accessing specialist services online that they couldn't before when they had to go in person. 

While COVID-19 has opened lots of doors like this and been really positive, there are also downsides. It's important for people to spend time in different environments, since transferring skills from one environment to another is often hard for them. It can be frustrating being in the one environment for too long.

Telehealth does lose something in that area. This whole period has given therapists opportunities to think outside the square. Many therapists will, in some capacity, keep using some of these resources long-term because many clients will benefit—even when COVID-19 is behind us.

"It’s also been strangely empowering," adds Sam. "Social isolation, which is the normal life for many people living with a brain injury, has become the default life for everyone else during this lockdown—'Hey, look, I’m doing what everyone else is doing!'"