Enhancing social identity

5.21 Aphasia rehabilitation can include focus on enhancing social identity.

References:  Brumfitt, 1993: Theoretical review; Corsten et al., 2014: Before and after design; Corsten et al., 2015: Before and after design + qualitative study; Shadden, 2005: Theoretical review; Shadden & Agan, 2004: Theoretical review; Shadden & Koski, 2007: Theoretical review; Simmons-Mackie & Elman, 2011: Qualitative study; Steffens et al., 2019: Systematic review and meta-analysis of 27 studies (not restricted to aphasia); Taubner et al., 2020: Qualitative study. 

NHMRC Level of Evidence: IV & Qual

Rationale: Language is important for constructing and presenting one’s sense of self and identity when interacting with others (i.e. “who” and “what” are you in a social context – one’s roles, values, and beliefs; Shadden & Agan, 2004; Shadden & Koski, 2007). Aphasia reduces the ability to do this and risks the person with aphasia being viewed as having less agency or autonomy than their conversation partners (Shadden & Koski, 2007), an experience that is very disempowering. This feeling of being “less competent” than conversation partners may also be present in clinical settings and is something that speech pathologists and other clinicians need to be aware of and try to take steps to prevent (Simmons-Mackie & Elman, 2011).

Aphasia may also leave people feeling a general “loss” of their previous identity due to their changed circumstances (Shadden, 2005). Many people with aphasia therefore need to reconstruct their identity and find a new sense of self in the face of living with a language disability (Shadden, 2005; Simmons-Mackie & Elman, 2011), which is particularly challenging given that language is an important tool for identity construction (Brumfitt, 1993; Shadden, 2005; Taubner et al., 2020). 

There is emerging evidence suggesting that clinicians can help in this process by recognising, facilitating, and validating reconstructed identities. This can be achieved by, for example (Shadden, 2005; Shadden & Agan, 2004; Simmons-Mackie & Elman, 2011): 

·        seeing the “person”, rather than the “patient”,
·        focusing on personal strengths, skills, knowledge, values, and competence rather than on incompetence or disability,
·        prioritising communicative content rather than language performance, and
·       guiding the person to clarify their personal values and helping them engage in new activities in line with those values, to facilitate the identity reconstruction and adjustment processes.

Speech pathologists can also facilitate interventions that help people construct their identity and share their life stories. Community aphasia groups may promote this by providing a social context and safe space for constructing and presenting one’s self without a sole focus language performance, as well as a sense of belonging with other people who have similar challenges (Shadden & Agan, 2004; Shadden & Koski, 2007; Simmons-Mackie & Elman, 2011 – see also statements 5.22 and 8.7). Such social identification-building interventions have the potential to improve overall health, mood, physical health, psychosocial wellbeing, and quality of life for people with a range of health problems, including aphasia (Corsten et al., 2014; Corsten et al., 2015; Steffens et al., 2019). 

References:  

1. Brumfitt, S. (1993). Losing your sense of self: What aphasia can do. Aphasiology, 7(6), 569-591. DOI:10.1080/02687039308248631
2.  Corsten, S., Konradi, J., Schimpf, E.J., Hardering, F., & Keilmann, A. (2014). Improving quality of life in aphasia: Evidence for the effectiveness of the biographic-narrative approach. Aphasiology, 28(4) 440-452. DOI: 10.1080/02687038.2013.843154
3. Corsten, S., Schimpf, E.J., Konradi, J., Keilmann, A., & Hardering, F. (2015). The participants’ perspective: How biographic-narrative intervention influences identity negotiation and quality of life in aphasia. International Journal of Language and Communication Disorders, 50(6), 788-800. DOI: 10.1111/1460-6984.12173
4. Shadden, B. (2005). Aphasia as identity theft: Theory and practice. Aphasiology, 19(3-5), 211-223. DOI: 10.1080/02687930444000697
5.  Shadden, B.B., & Koski, P.R. (2007). Social construction of self for persons with aphasia: When language as a cultural tool is impaired. Journal of Medical Speech-Language Pathology, 15(2), 99-105
6.  Simmons-Mackie, N. & Elman, R.J. (2011). Negotiation of identity in group therapy for aphasia: The Aphasia Café. International Journal of Language and Communication Disorders, 46(3), 312-323, DOI: 10.3109/13682822.2010.507616
7. Steffens, N.K., LaRue, C.J., Haslam, C., Walter, Z.C., Cruwys, T., Munt, K.A., Haslam, A., Jetten, J., & Tarrant, M. (2019). Social identification-building interventions to improve health: A systematic review and meta-analysis. Health Psychology Review, 15(1), 85-112, DOI: 10.1080/17437199.2019.1669481
8. Taubner, H., Hallén, M., & Wengelin, Å. (2020). Still the same? – Self identity dilemmas when living with post-stroke aphasia in a digitalised society, Aphasiology, 34(3), 300-318, DOI: 10.1080/02687038.2019.1594151