Aware is one of those words we see everywhere.

• In the city: Be aware of your surroundings.
• In the woods: Are you bear aware?
• In June: It’s Aphasia Awareness Month!

Awareness means recognizing, knowing, and understanding something. The kind of awareness that matters most in speech therapy is called self-awareness.

Self-awareness is a critical part of the therapeutic process. If a person can’t detect that there’s a problem with the way they communicate or think, then there won’t be any internal motivation to change it. Even if they know there’s a problem, they must be able to recognize it as it’s happening to be able to compensate or use strategies they’ve learned.

Too often in therapy, a client will say something and the therapist will immediately say if it was correct or not. This is all well and good in the clinic, but it doesn’t help the client when they leave the therapy session and there’s nobody around to give them feedback.

The goal of therapy should be to turn the client into their own feedback loop. They must learn to say something, listen to themselves, determine if it was correct, and attempt to fix it if it was wrong.

• A person with dysarthria will only try to speak more clearly if they can hear the slurred sounds themselves.
• A person with aphasia will only correct a mistaken word if they heard themself say it incorrectly.
• A person with a cognitive impairment will only use a strategy if they know they’re more reliable with structure or supports.
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How can we encourage self-awareness?

While it’s tempting to correct someone when they’ve made an error, try to resist. Try this sequence instead:

1. PAUSE: After an error, pause to give the person a chance to recognize it for themselves.
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2. PROMPT: If they don’t see it, provide a general prompt like, “Does that look right to you?” or “Did that sound right?” and give them time to self-reflect. If they still aren’t aware of their mistake, you can give a more specific prompt to direct their attention to it. For example, if someone made an error while filling their pill sorter, you might say, “Does the Sunday slot look right?”
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3. PRAISE: Adding positivity can help the person feel less defensive about their performance. You might say “Good job checking your work and fixing it on your own.”

You can also:

• Use a recording device to record and play back a person’s speech. Video can be especially helpful, and there’s audio recording functionality built into the top bar of most Tactus Therapy apps for this purpose.
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• Take advantage of dictation on a smartphone or tablet. Let the device listen and print what it hears, then read it back to see where it got things wrong.
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• Predict how things will go before an event or activity, and reflect back on it afterwards. This can help the person identify when strategies may have helped or what to do differently next time. Predictions should get more accurate over time.
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• As speech pathologists, we can ask our clients to self-score their responses for naming or speaking tasks. Resist hitting the scoring buttons on Naming Therapy and teach your client to do it on their own.
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Troubleshooting self-awareness

While self-awareness is essential for making progress, there are a few things that can go wrong.

1. The person is all too self-aware and resists speaking entirely for fear of embarrassment. In this case, you’ll want to focus less on the details and more on the overall achievements. It’s nearly impossible to get better at something you never do, so focus on increasing overall time spent speaking – even if imperfect – before fine-tuning the details.
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2. There is no awareness of any problem whatsoever. Anosognosia, or lack of awareness of a problem, is common in right-hemisphere strokes and brain injuries. There are many assessments of awareness (SAMAS, HIBS, PCRS-NR, SADI, etc.) to help determine the type and level of awareness impairment. Targeted treatments such as experiential learning, motivational interviewing, metacognitive techniques, or video feedback can be used.
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3. The person is aware of a problem but doesn’t know how to fix it. Therapy can focus on teaching repair strategies and other techniques to overcome this gap. The Apraxia Therapy app asks users to decide what to do next based on their self-rating.

Like all things, becoming self-aware of a communication or cognitive impairment takes practice and time. Don’t expect the person to be able to identify all errors immediately. Slowly build awareness activities into the treatment regime to build this skill like any other. It will pay out dividends in generalization and carry-over of skills into everyday life when the patient can become their own personal “speech therapist.”

All the best,

Megan
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P. S. Are you aware of the recording features inside the Language, Advanced Language, Number, Apraxia, Speech FlipBook, and Conversation Therapy apps? These are meant to encourage building self-awareness by recording and playing back speech during therapy exercises.