Read on for information on counseling within our scope, best practices, and practical techniques for effective communication.

As SLPs, we frequently work with individuals who experience both communication challenges and mental health difficulties. We also support caregivers who have to navigate the complexities of communication disorders while managing their own emotional well-being. While we strive to empower our clients and enhance their ability to communicate, addressing these challenges often requires recognizing the intersection of mental health and communication. At the same time, we are not mental health professionals, and it is important to understand the boundaries of our counseling role and when referrals are necessary.

So, how can we as SLPs address mental health and provide counseling while not veering out of our scope of practice? First, let’s understand what we can provide in terms of counseling. 

Understanding Our Role: Counseling Within Scope

What Counseling Includes in Speech-Language Pathology 

While SLPs are not mental health professionals, counseling is a recognized component of our scope of practice. According to the American Speech-Language-Hearing Association (ASHA), counseling in speech-language pathology involves two primary areas: informational counseling and personal adjustment counseling.

  • Informational Counseling: This aspect of counseling focuses on education. It includes explaining diagnoses, evaluations, and treatment options to clients and caregivers. Informational counseling also involves providing community resources, describing therapy techniques, and discussing general prognoses (when applicable).
  • Personal Adjustment Counseling: This involves addressing the feelings, emotions, thoughts, and beliefs of clients and caregivers as they relate to communication differences and disorders.

Both types of counseling often occur together. For example, when working with a child who has recently completed an evaluation for stuttering, an SLP may provide education about stuttering characteristics and therapy techniques. The SLP may also discuss myths about stuttering and address emotions related to the communication disorder.

Similarly, for an individual who has experienced a stroke and presents with aphasia, informational counseling may involve the client and caregiver and include providing strategies for communication, discussing treatment options, and recommending aphasia support groups. Personal adjustment counseling may involve supporting the client and their caregivers as they navigate the emotional impact of communication changes. SLPs can acknowledge emotions such as anxiety, frustration, and confusion while also recognizing when a referral to a mental health professional may be beneficial.

Practical Techniques for Counseling in Speech Therapy

1. Employ Active Listening

Active listening involves paying full attention, asking clarifying questions, avoiding interruptions, and summarizing key points to demonstrate understanding. Providing validation and space for clients and caregivers to express themselves may increase rapport, engagement, and buy-in for therapy services.

2. Use Strength-Based Approaches

A strength-based approach focuses on what a client can do rather than emphasizing what they cannot do. This method can enhance confidence and self-efficacy (the belief they can do something), which can lead to stronger coping strategies and problem-solving skills. For example, instead of emphasizing a client's difficulty with spoken language, the SLP can highlight their effective use of gestures and a speech-generating device for communication.

3. Collaborate with Mental Health Professionals

Collaboration with other related professionals can be key. When clients present with mental health concerns beyond the scope of speech-language pathology, such as clinical depression, post-traumatic stress disorder (PTSD), or severe anxiety, referrals to psychologists, counselors, or social workers are necessary. A multidisciplinary approach allows professionals to address both communication and mental health needs effectively.

In school settings, school psychologists and counselors are often available to provide mental health services. SLPs can collaborate (and even co-treat sometimes) with these professionals to ensure a comprehensive approach for students experiencing both communication and mental health challenges.

For SLPs in private practice or medical settings, maintaining a list of available psychiatrists, psychologists, and mental health professionals in the area can be helpful for making referrals.

4. Incorporate Mindfulness and Self-Regulation Strategies

Strategies that include mindfulness and self-regulation can be effective for managing stress related to communication or that impact communication. This may include starting sessions with self-reflection activities, grounding exercises, or a review of the session schedule. 

5. Provide Family and Caregiver Education

Educating caregivers on how to support communication outside of therapy sessions may reduce stress for both the client and their family. By providing strategies that encourage successful interactions, caregivers can create a more supportive communication environment. These strategies may include ways to model AAC or different cues for successfully producing speech sounds and encouraging generalization. They will vary based on the client’s needs !  

Counseling in Speech Therapy: Key Takeaways

SLPs play an essential role in supporting the emotional well-being of clients as they navigate communication challenges. By providing informational and personal adjustment counseling within their scope of practice, we as SLPs can support both clients and caregivers in a meaningful way. However, when emotional or psychological concerns extend beyond communication-related issues, referrals to mental health professionals are necessary.

For more information about counseling in speech-language pathology, check out the references below. Additional materials, including problem-solving tasks and self-advocacy tools, are available in the Premium Community.

References

American Speech-Language-Hearing Association. (n.d.). Counseling in audiology and speech-language pathology. ASHA Practice Portal. Retrieved February 20, 2025, from https://www.asha.org/practice-portal/professional-issues/counseling-in-audiology-and-speech-language-pathology/

Cherry, K. (2023, July 17). What is active listening? Verywell Mind. Retrieved February 20, 2025, from https://www.verywellmind.com/what-is-active-listening-3024343

Luterman, D. (2008). Counseling in communication disorders: A wellness perspective. Contemporary Issues in Communication Science and Disorders, 29(S), 6–16. https://pubs.asha.org/doi/pdf/10.1044/cicsd_29_S_6