Handing over control of communication seems to be the most difficult of all the skills we need to have when we are taking part in communicative exchanges. Just how difficult this is, even for skilled communicators, can be clearly seen when people are using Talking Mats. Handing over control of communication is one of the fundamental principles of the talking mats framework. If the person has the physical skills, the facilitator physically hands over this control by handing the person the symbol (and of course other approaches are used when the person does not have the physical skills). The ‘thinker’ (the person who is doing the Talking Mat) then places the symbol on the Talking Mat, under one of the points on the pre-agreed top-scale, having been asked an open question e.g. how do you feel about …….?
When facilitators are learning about this approach, they seem to find it easier to ask open questions, slightly harder to stick to the agreed top scale but really difficult to hand over all of that control. As part of the training, participants film themselves using Talking Mats with someone. We use that clip to reflect on the facilitators’ skills, by taking about things that we liked and then reflecting on ‘it would have been good if…….’
The video clips work really well as participants can see themselves making the errors of retaining control in small (but nonetheless significant ways) e.g.
• Having the mat facing themselves rather than the ‘thinker’
• Moving the symbols after they have been placed by the ‘thinker’ to tidy them up/to make it easier for facilitator to see them
• Forgetting to give a neutral response where ever the symbols are placed (even if the facilitator thinks that the symbol has been ‘misplaced’)
• Telling people that they must place the symbols in rows underneath one another
• Not letting people use the top-scale creatively e.g. by placing the symbols at specific points between the top-scale e.g. to represent unsure but I am more happy with it than not.

The great thing about the Talking Mats training is that participants noticed these things that they were doing and will be working hard at noticing and doing them less in future.

We find it hard to give up control and find it hard to notice the things we do to retain this control, even when we are working within the talking mats framework. This is a framework where we are ‘symbolically’ handing over that control in the form of giving someone a symbol and so have a very obvious reminder of whose turn it is. How many ways then must we do it in everyday conversations and never notice? After all, in every day conversations, there are typically much less obvious reminders of whose turn it is and who should be in control.

Many thanks to Dr Jill Bradshaw, Lecturer in Learning Disabilities/Consultancy Development Manager, Tizard Centre, University of Kent for this thoughtful blog.

We are grateful to Nicola King SLT, who describes how she and colleagues use Talking Mats not only to gain feedback from parents about the therapy process, but also about the parent’s understanding of the child’s diagnosis and its impact.
The options to start the discussion are included in the mind map below. Click on image to enlarge.

Issues raised by one parent were
1) Information given to me –unsure . The mum went on to say ‘I’m worried/ frightened. I don’t want to ask too much as I’m frightened as to t he answers
2) My child’s progress –unsure. The mum offered ‘I’m inpatient’

Nicola commented –‘These were huge issues and each response gave me a chance to explore what she was thinking and meaning. For the first time this mum offered her fears about ASD and ADHD. She enjoyed the Talking Mats process and after the interaction agreed for the first time to an onward referral which ensured support was in place for her son starting school.
The Talking Mats format was a brilliant way to have that ‘difficult conversation’ ‘

Whilst developing the eating and drinking resource, we tried it out with people with a range of eating and drinking difficulties. I talked to Ellie, who had swallowing difficulties following a stroke. She found it really helpful to use the mats to think about different aspects of meals (mealtimes, where you eat and the process of eating). Ellie had very good insight into her eating and drinking difficulties and had developed clear strategies to help manage them. She found breakfast and snacks the most difficult meals to manage. She was also very clear that pureed and soft moist foods were the safest and easiest for her. After we had done the mat, Ellie reflected on her eating and drinking, saying that it was limiting but that she could see that things had improved. One of the most difficult things for her was the impact of her swallowing difficulties on some of the social aspects of eating. She really misses going out for a meal with family and friends, something that we often take for granted.

Doing the ‘meals’ mat helped Ellie to see that although she still has many difficulties, mealtimes have become less stressful. For example, although eating and drinking is still a long, slow process, Ellie and her family have adapted to this and now manage ok, especially if they plan ahead. Some useful action points were also identified for the professionals working with Ellie –  it would be good for her to have suggestions about a greater range of breakfast options as well as a variety of snacks which she could eat between meals.

Using the mats really helped to clarify the progress that Ellie has made with her eating and drinking since her stroke.

View  the images used in the resource by downloading this short selection

To order your copy of the resource click here  The resource will be available on our digital Talking Mat shortly

Thanks to Lauren Pettit for this thought provoking blog about using Talking Mats in a rehabilitation setting in South Africa to compare goals of adults with aphasia, their Speech and Language Therapists and their significant others.
I am a Speech-Language Therapist in Johannesburg, South Africa and I work in neuro rehabilitation for people who have had a stroke or head injury. Over the past few years, I have been inspired to learn more about implementing communication modes to assist people to participate effectively in various communication interactions.
Talking Mats™ is such a wonderful tool that enables people to communicate so many things, from their needs and desires, to engaging in higher level conversations. I have seen the benefits of this tool used in a rehabilitative setting. I recently completed my dissertation with the Centre for Augmentative and Alternative Communication (CAAC) at the University of Pretoria, in South Africa.
The study included adults with aphasia who were still attending therapy at least 6 months after their stroke and were working on activities and tasks in various therapies, for example: Occupational Therapy, Physiotherapy, Speech-Language Therapy, therapies. I wanted to understand what was important for them to work on in rehabilitation to improve in various areas of life. Some of the adults with aphasia had very little or no speech, others had difficulty expressing themselves and finding the appropriate words to use in a phrase or sentence. Talking Mats™ was therefore used to assist them to rate important life areas. The life areas (activities and participation domains) were identified by the International Classification of Functioning, Health and Disability (ICF). This classification system was created by the World Health Organisation (WHO) and may guide therapy assessment and management. The areas were depicted as symbols with a supplemented written word on each card. These nine cards were: Domestic Life, Relationships, Work and Education, Leisure or Spare time, Self Care, Learning and Thinking, Coping, Communication, and Mobility. The adults with aphasia were asked what was important to them to work on in rehabilitation. The adult with aphasia could place the card under Yes, Maybe or No on the velcro mat and provide a comment if he/she wished or was able to. The Speech-Language Therapists who worked with the adults with aphasia and their significant others (a family member/friend or carer, who knew the person well) were also included in the study. They were asked to identify which areas they thought were important for the adult with aphasia to still work on in therapy.

(Click on graphs to see clearly)

It was very interesting to see varied opinions in the results. Six of the areas received similar ratings from all the participants and Communication was highlighted as an important area to work on by all. There were statistical differences found for the following domains: Work and Education, Leisure or spare time and Self Care. The adults with aphasia wanted to work on Leisure or Spare time and Self Care, however, Work and Education was not important to them to work on in rehabilitation, whereas the Speech-Language Therapists rated Work and Education as important for the adults with aphasia to work on. Significant others did not rate these domains as important.
This study gave a glimpse into how some rehabilitation teams are currently communicating and working together and that very often, the people who have difficulties expressing themselves are perhaps not always given the time and space to understand the therapy plan and identify and communicate their individual therapy needs. This needs to be explored further. Talking Mats™ provided a structure and gave the adults with aphasia a ‘voice’ and the opportunity to engage in this complex communicative interaction. I am in the process of sharing the results from the study with the participants. I have encouraged them to sit together in their teams and identify areas that could currently be focussed on in their therapy. Many participants were eager to discuss the results after the interviews were conducted and were interested in the concept of prioritising their rehabilitation needs. I hope they see their participation in this study as the opportunity to further engage in their rehabilitation needs and that it gives them the confidence to participate more fully in many other areas of their lives that they identified as important.
I would so appreciate your thoughts and input. Please respond to Lauren lolpettit@gmail.com

We are delighted with the response to our new Talking Mats symbols. They created a real buzz at the ISAAC (International Society  of Augmentative and Alternative Communication) Conference in Lisbon last week.” Its so good to see something fresh and engaging” , “These are awesome”

Over the past few years we have been looking at symbols in a new way and have used our specialist skills from clinical practice, research and language structure to underpin their development. These skills, in partnership with a leading comic artist, www.adammurphy.com , have enabled us to design our symbols, making sure that they are:

• Unique
• Attractive and fun
• Simple but represent concepts clearly
• Distinguish between concrete and abstract concepts
• Show full body, not stick figures
• Acceptable in terms of  age and ethnicity
• Balanced between male and female
• Provide additional visual clues within topics to support understanding

Talking Mats does not require people to select and ‘name’ symbols – the important feature is that the symbols act as a support to hang meaning on. In this way people can understand and use the symbols to express their views .

To determine the size and colour of the symbols, we have used a pragmatic approach as follows:

A search of the literature showed that very little empirical research has been written about optimal symbol size and colour for different client groups. However several leading graphic and cartoon designers use yellow as this is easily recognisable, attractive and ethnically neutral e.g. Simpsons, Lego

• Our artist advised us that cool colours such as blue recede into the background visually whereas warm colours such as yellow stand out more
• We believe it is important to include text as this provides additional input for many people e.g. many people with dementia can read.
• From discussion with colleagues and reading learning disability literature we decided that  Arial, san serif point 14 would be the clearest font
• We experimented with various sizes, using very large symbols on one dementia project. However we found that very large symbols are too distracting and limit the number of symbols that can be used on a mat. Following piloting with older people in care homes we determined that the optimal size for using with Talking Mats is 5.5 square cm.
• We ran focus group discussions with speech and language therapists, people with learning disability, people with aphasia and people with dementia. The focus groups presented participants with symbols of different styles, size and colours. The resulting responses plus our literature search led us to the current symbols in terms of design, size and colour.
• We then piloted the symbols in several settings including a day centre with adults with complex physical and cognitive disabilities, a care home with people with dementia and a secondary school with children with additional support needs. In all of these setting almost all participants were able to see, recognise and use the symbols appropriately.
• We made a conscious decision not use photos because photos often have too much detail on the one hand or conversely can be too specific… but that’s a topic for another blog!

We are constantly extending the range of symbols and are currently working on a resource for helping people to consider their Eating and Drinking.  We are also working on providing additional visual clues within topics to help people understand concept more easily e.g. emotions are represented within a cloud border. e.g this poor guy is feeling guilty

We are really excited that our new symbols are now being used by 2 organisations outside the field of disability to help students and graduates reflect on their skills,strengths and weaknesses.

 For further information click here

Congratulations to our 5 new accredited trainers from Edinburgh City Council , Lothian NHS, Perth Kinross Council and SENSE Scotland

We had a great two days working together, exploring the Talking Mats framework and thinking about skills in terms of training and implementation of the Mats. Lots of chat but some key thoughts emerged that are worth sharing

• Keep calm with Talking Mats and have a blether
• Talking Mats gives the thinker the power to say ‘No’
• Open questions create open dialogue
• Children do but don’t get enough time to say
• Recap; Talking Mats provide a visual summary of the conversation
• It is easy to feel drowned out by other voices Talking Mats keeps the focus on the person
• It is good to have 1 to 1 time and not just when things go wrong
• The health and being resource is a perfect fit for the outcomes focused approach

There were lots of exciting ideas for future projects and further blogs which will expand on these ideas a bit more. So watch this space as the new trainers develop their ideas more.

If you are interested in becoming an accredited trainer click here

Talking Mats is fun! Whether you are sitting on the floor completing your mat or sitting at a small table, young children enjoy the fact that they can give information through multiple channels – Talking Mats is visual, auditory and tactile. It is an engaging tool to use when consulting children.They can express a view without words if they want to or they can have a conversation if they enjoy chatting. Watching a young child thinking and reflecting about where they place their symbol on the mat can be a humbling experience. Some adults still consider young children as incapable of expressing their views or opinions but in reality they can often express strong views about things and are very capable of grading their responses. Sometimes we just don’t take the time to ask them about the issues in their lives and free up some time to listen.

Talking Mats has created a specific Early years resource to make consulting young children easier. The symbols have been graded according to their developmental stage. When using the picture symbols it is important to remember:

• Most of the symbols in the Early years pack are concrete and you can quickly identify the shared meaning for example – “drawing”
• Others are concrete but have a broader meaning. An example of this is when asking about “eyes”
• 

We have found that it is best to allow the child to interpret the meaning at their level so it maybe they have sore eyes; they don’t like their glasses or they have brown eyes. Try not to be too prescriptive when presenting the option to the child; a symbol can act as a jump off point capturing what fits for the child at the time. Just allow the meaning to emerge.

• The abstract symbols do need a bit more explanation because they ask about more complex concepts such as safety. The Early years pack asks about safety in relation to the road,  physical safety and safety around others.

Asking about daily routines will give insight into how nurtured and cared for they feel. Let the child lead the discussion as much as possible.

Using visual communication is a great way to have a conversation with children in the early years and a good tool to involve children in decision making. Listening to the child’s view is essential for the GIRFEC process in Scotland and for co-producing Education Health care plans in England and Wales. Talking Mats has created a unique resource which is based on the “International Classification of Functioning, Disability and Health – Children and Youth version” Talking Mats uses a framework which helps children to express themselves in a way they feel comfortable with. As adults we need to be able to facilitate the conversation.

We find that to realize the full potential of Talking Mats it is best to attend a Talking Mats course . The courses allow you to focus on your situation and how you can be creative and apply it in your own work,

In the Health and Well-being resource, we have provided four sets of symbols to help people consider how they feel about their communication. Because communication is  complex and often abstract, it can be particularly difficult for people to express their views about it, especially if they have existing communication difficulties. To make this easier, we have divided communication into four topics:

• Expression
• Understanding
• Learning and thinking
• Relationships.

In the following example, I show how each topic can be used to build up a picture of how someone feels about different aspects of their communication. I worked with Kate, a 42 year old woman who had a stroke which left her with severe expressive and receptive aphasia. She was able to communicate through vocalisations and gestures. She could sometimes draw or write down words and needed to point to ‘yes/no’ in order to reliably answer closed questions. Following discharge from hospital, I used Talking Mats with Kate to find out how she felt about her communication. I started with the ‘communication – expression’ topic and found that she felt that she was having lots of difficulties making herself understood, particularly on the phone and in group situations:

I then explored how Kate felt about understanding what people were saying to her. Kate was able to tell me that she found it easier to understand people on a one to one basis rather than in a group setting. She indicated that it really helped her if people used gestures or wrote things down. Her main difficulty was understanding people on the phone, and in fact she had stopped answering the phone altogether (see mat below).

We went on to do a mat about Kate’s learning and thinking. In this set, there are symbols which cover higher level language activities such as reading, problem solving and organisation. When we talked about these areas, Kate was able to tell me about the things she was finding most problematic, but could also identify some things that she felt she could still manage (such as calculations and reading newspapers).

I then asked Kate how she felt about communicating with different people in her life. This mat shows that Kate found talking to her husband and her parents (who lived quite far away) particularly difficult.

As a result of doing these mats, we were able to target the things that mattered most to Kate in relation to her communication, and came up with the following actions:
1. Kate felt that her husband needed support and information, so we spent time working with him, showing him the best ways to support Kate’s communication.
2. Because Kate’s parents lived quite far away, she could only contact them using the phone, which was very difficult. We worked on getting Skype set up so that Kate could communicate with her family using all the modes available to her.
By splitting communication into different sub mats, Kate was able to think about different aspects of her communication and identify the things that she found most challenging. Together we began to work out some ways to help her overcome her difficulties.
Use the communication symbols to find out what people want to work on and use a collaborative approach to establish some goals to work on in therapy. I used the original Talking Mats when I explored  Kate’s communication with her, but you could do the same with Digital Talking Mats. Find out more about it here.

In a previous Blog, Joan talked about the four purposes of communication (Light 1988):
1. Expression of needs and wants
2. Information transfer
3. Social closeness
4. Social etiquette
Social closeness can often be overlooked when we support people with communication difficulties, as there can be a temptation to focus on what some see as the ‘important things’ – helping people to express their needs and wants or to transfer information. Social closeness is the glue which binds us together and helps us to form and maintain relationships. It’s really important that we establish this before we start exploring some of the difficult issues that many of the people we are working with face. In my work with people with severe aphasia, I spend time getting to know what matters to them and finding out what their interests are. This is a crucial part of building a relationship with the person and their family. It also provides a much more concrete starting point for beginning to explore rehabilitation goals, as this example shows:
When working with Jack (a man with severe receptive and expressive aphasia), I started by using Talking Mats to ask him how he felt about leisure activities. This was a great way to get to know Jack as a person and to find out his interests. During our conversation, Jack told me that he enjoyed going out for a drink but hated shopping and bingo – and we all had a laugh as he told me this. Jack also told me that he used to like ten pin bowling. He pointed to his leg to indicate that this was something he could no longer participate in as he was now in a wheelchair. I could see that this was important to Jack, so we talked about possible ways round his physical difficulties. Jack agreed that this was something he could work on with the help of his family and the rehabilitation team.

Given that Jack had severe receptive aphasia, if I had started by using Talking Mats to identify specific problems (using a top scale of ‘managing’ and ‘not managing’) as part of the goal setting process, it is highly likely that Jack would have found this too abstract and difficult to engage in. By using the more concrete topic of leisure (with a top scale of ‘like’/’dislike’), Jack was able to reflect on his life since his stroke and tell me how he felt about his restricted physical abilities. I was also able to build up a picture of him as a person and we had fun at the same time.

When using the Health and well-being resource, think about the person you are working with in relation to the ideas and concepts that they can cope with. Exploring leisure activities is a great way to start as it means you can establish rapport by finding out what matters to them.

Have a look at this Blog to see how other people have used a topic such as leisure to build social closeness.

For those of us who work or live with people with communication difficulties it’s important that we consider the purposes of human communication. As long ago as 1988 Janice Light suggested that there were 4 main purposes and we believe this is still a good model to bear in mind.
(Light, J. (1988) “Interaction involving individuals using augmentative and alternative communication systems: state of the art and future directions”, AAC, 4, 2, 66-82)

She described these purposes as:
1. Expression of needs and want – to regulate the behaviour of another person to get something
2. Information transfer – to convey information from person A to person B
3. Social closeness – to establish and maintain relationships with others
4. Social etiquette – to conform to the social conventions of politeness

We believe that there is a tendency to concentrate too much on 1 and 2 and not enough on 3 and 4. If we dwell on needs and wants, which is very often the focus of communication aids, there is a danger that the person with the communication difficulty will find it hard to establish and/or maintain relationships.

In 1998 John Locke wrote that ‘small talk’ is crucial for the construction and enjoyment of relationships with others and that by revealing thoughts we elicit reactions from others. This is what we regard as social closeness or engagement. ‘Small talk’ or ‘social closeness’ may sound irrelevant but it is one of the most important purposes of human communication.
(Locke, J. L. (1998) “Where did all the gossip go? Casual conversation in the Information Age”, American Speech Language Hearing Association, 40, 3, 26-31)

Talking Mats, which uses attractive and motivating communication symbols, is one way to help people to express their thoughts and achieve ‘social closeness’, whether they are a 4 year old boy with Downs Syndrome or a 95 year old woman with dementia.
Talking Mats is one of the few resources that is versatile enough to be used as a stroke communication resource, for consulting children and young people or to help with communication difficulties and dementia, to name but three.
It allows people to express their thoughts in a visual way which in turn can elicit a response from their communication partner. Moreover, solid research has shown that Talking Mats increases engagement in people with different communication difficulties.

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