And the imposter syndrome goes on – diary of a PhD student


I must confess that I had this small, idealistic and slightly odd idea that I would get towards the end of my PhD and it would all be different. I would be more sure of myself, in fact I would be certain. In this scenario I imagined my brain would be calm and clear and constantly bathed in a warm glow (like a suntan) of knowing. I would just write my thesis because, you know, I had done the work so I just knew the words. I also envisioned that I would have great ideas, and know they were great, and these ideas would enable me to keep applying for further funding as a post-doc.


Well hmmm let’s stand back for a minute and re-evaluate this scenario. In actual fact I am not more sure of myself at all. I have been studying for nearly four wonderful years and am no brainier than previously. I am due to return to part time clinical work and am feeling a little rusty. I have previously taken two lots of maternity leave (in the dim and distant years prior to doing a PhD) and went back to work feeling jittery. I recognise that internal dialogue now; “Is it this time – will they realise I am just an imposter?!” I can deal with this dialogue now. I let it have a moment and then I pop it back in its box. After all, I embarked on this journey into clinical academia because I wanted to find a way to help more people. And I do so love seeing client- I am actually rather excited about being abck.


Then there is the thesis. I do actually have to write it. And then two (TWO) examiners are going to read it. I write some stuff, then I re-write it. Then I decide not to look at it any further so as not to risk getting completely bogged down and stuck in the one sentence. Then I am reminded that two people  are going to read it so I do re-read it and some of it is awful (delete) and other bits are pretty good (did I actually write this?). I do so enjoy this writing though. I feel like I am using a muscle I have never previously used, and using it to its full range. It is a great pleasure for me. And one I won’t really get to experience in the same way again. Thus I plan to spend the next few months really reminding myself of how lucky I am.


Since I don’t really want this PhD to end, I am also planning to apply for further funding. I have lots of ideas. But I am no more confident in my ideas than prior to embarking on this PhD journey. I do hope to apply for funding to continue the programme of work I am currently doing (a post-doc!!) but only if the results of my current work suggest I should. And I haven’t completely collected the results and analysed them yet. So I’m not sure what they say. In the meantime it’ll be good to have some back up idea right? The lack of certainty is a little disconcerting. There may be a bridge across the abyss to the next pot of funding, or there may not be one. I may need to walk down to the next bridge… so to speak) and that could take some time. But it is so incredibly exciting. I am feeling so lucky to be in this position. What a great opportunity. I have a fair bit of planning to do, but that makes it all the more exciting! The start of another project feels like opening up a brand new book and reading the first page and knowing that you’re going to love it.


In my originally imagined scenario I envisioned myself being on top of all my life chores too- paying for bills in advance, getting children’s packed lunches ready without panicking about stale bread and a lack on anything resembling fruit in the fridge. I would be fitter, younger and more adept at life. Just to be clear this is not true. I am older and feel even less organised. But yes it’s true I ammmmm happier for choosing to undertake this PhD. So go away imposter syndrome, take a nap!

The more the merrier: more speechies joining dementia care please!


When I posted the wonderful blog written by the SLT, Georgia Bowker-Brady, I was overwhelmed by the response. The twitter discussion on the topic of speech and language therapy for dementia was really valuable. In response a wonderful colleague, a Neuro-psychologist and researcher here at UCL; Dr Aida Suárez-González got in touch with a really inspiring blog she wanted me to share here. A call to arms to all speech and language therapists. Aida is a massive advocate for speech and language therapy and an all round wonderful human being. Thank you for the support Aida- we really appreciate it!

The first SLTs in my life were my friends from the School of Speech and Language at the Universidad Pontificia of Salamanca. I met them in 2003 while studying my masters after completing my undergraduate degree. I spent a lot of time surrounded by SLTs over the next couple of years. I learned about their role in managing voice conditions, dysphagia, dysarthria, administering orofacial myofunctional therapy, supporting kids with learning disabilities and  deafness etcetera. Clinical discussions over dinner, the challenges in teaching and training, the lack of appreciation of SLT in the health care system and related topics filled many conversations over drinks, dinners and Sunday afternoon gatherings. I remember reflecting on how practical their discipline was. I found it very varied and hands-on and was intrigued to see that even recently graduated SLTs were already able to use many techniques, solve many problems and be very useful.


Then I qualified and moved to pretty Seville to join the Cognitive Disorders Unit of the Neurology Department at Virgen del Rocio University Hospital as a junior neuropsychologist. I must say that my 9 years there have never been exceeded by any other experience in any other place in which I have worked since. Apart from the exceptionally high clinical services delivered and my overwhelmingly experienced colleagues in the department, I had the opportunity to be completely immersed in a clinical culture that celebrated excellence, mentorship, integrity, knowledge and most importantly: collaboration. For instance in the 90s the team on the Stroke Unit had pioneered the carotid artery stenting in Spain. They did this through a bold collaboration between neurologists, radiologists and nurses. The neurologists in the Cognitive Disorders Unit (my Unit!) really appreciated the role of the neuropsychologist, in spite of being highly knowledgeable and well versed in cognition and neuropsychology themselves (or maybe because of that!). Other allied professionals were also very respected and everybody knew everybody in the hospital, after years of inter-professional collegiality.


I was however very surprised when I learned that the SLTs in the hospital refused to see our patients with PPA, either because they did not accept referrals for people with dementia (they were prioritizing people with chronic conditions such as stroke related aphasia) or because those who did accept referrals, did not know how to handle PPA. The neurologists had been trying to refer patients with PPA for years and referrals always bounced back to us. I then learned that in other places the problem was the other way around: there were SLTs eager to help people living with dementia but referrals never arrived, or they arrived only when the person was in the severe stages of the disease, or presenting with swallowing difficulties. Five years ago, I moved to the UK and found that the situation was similar here. The problem in both countries is not only that the role of SLT is not properly understood by many people. The crucial problem is the historically nihilistic and reductionist approach to dementia across our society, which considers that people with degenerative cognitive conditions do not have the same rights as others, and do not deserve the same level of rehabilitation and positive support and investment as people with chronic conditions such as stroke related aphasia. In my mind this is discrimination. it is unfair, unethical and it is a violation of human rights.


50 million people are currently living with dementia worldwide. This figure will increase to 82 million in 2030 (11 years from now). And to 115 in 2050 (31 years from now). Some pharmaceutical companies have now simply discontinued the fight to find a cure. Altogether this depicts one of the most challenging global health crises of our time. It is estimated that by 2050 there will be no person in the developed world untouched by dementia, either because they have dementia themselves or have a close relative or friend living with dementia. This is why we need as many hands on deck to join in the work we are doing in the area of dementia care. SLTs have a crucial role to play here. In my 14 years of experience working with people with dementia, I have seen many families shattered by two of the main consequences of the disease: the neuropsychiatric symptoms and the communication breakdown. And SLTs can actually help with the second issue. So, this is a call for action. For SLTs to take a prominent role at the front-line in this challenge, to join forces with the rest of the professionals up here and help to create a world where we can live together with the symptoms of dementia and still be the owners of our own lives.


A life working in dementia is a life well spent, a huge legacy for future generations. And you will probably meet very inspiring colleagues, friends, families and patients on your way. I hope more of you will join us on this journey.