Think about a time when you’ve been fully immersed in what you’re doing. You’re engrossed in the task and time seems to fly by. All those thoughts that weigh heavy on your mind disappear, at least for a while. Well-known positive psychologist Mihalyi Csikszentmihalyi calls this experience “flow,” referring to that wonderful feeling of engagement and control that occurs when skill and challenge are optimally balanced. You may have heard about flow relating to exercise and running, or relating to learning theory and motivation. Millions have watched his popular TED talk on flow.

When a task is challenging, but not to the point of being impossible, and when you possess a set of skills that allow you to meet the challenge and improve, you can find flow. If either the skill or challenge of a task is too high or too low, then you may experience boredom (low challenge, high skill), anxiety (high challenge, low skill), or apathy (low challenge, low skill). However, you can adjust the challenge or increase your skill to achieve flow. This relationship is illustrated in Figure 1.

Finding Flow

Figure 1: Quadrant Model – Csikszentmihalyi & Lefevre, 1989; Moneta, 2012

Finding Flow at Work

Studies of flow have found that people find flow more often in work settings than in leisure settings, even though we do not always enjoy our work. Given the amount of time we all spend at our jobs, it is both understandable and encouraging that flow experiences abound while we work.

At work, I’ve used the construct of flow as a barometer of my own engagement. When I am frustrated or feeling overwhelmed at work, I go back to the axes of flow: skill and challenge. My anxiety is happening because the challenge is too high – perhaps because of an overly heavy caseload or a particularly perplexing client. To better align the balance of skill and challenge, I may need to enhance my own skills or make the environment less challenging.

This model is also helpful when I find myself feeling bored when doing a task I’ve done hundreds or thousands of times before. During such times, such as a during a routine bedside swallow evaluation, if I find myself tuning out or “going through the motions,” I try to re-align the balance of skill and challenge. Perhaps there are aspects of the procedure I am under-utilizing. Making a collective effort to increase the challenge, and increase my skill level to meet that challenge, often results in an increase in my own engagement. I can increase my focus on a more thorough cranial nerve assessment, or focus my attention on the subtle nuances of the patient’s hyolaryngeal excursion during swallows.

By doing so, I not only find myself increasingly engaged, but also find my skill sets improve as part of the positive momentum, change, and growth identified within the concept of flow. Achieving flow – that state of being immersed in the task such that time passes differently, and you feel a distinct sense of control in the task at hand – can indeed be a driver for clinical improvement.

Finding Flow for Our Clients

While I’ve identified with this construct personally, I’ve become more intrigued with not only how it impacts me on a personal and professional level, but also with what the concept of flow may hold for the individuals with whom we work – our patients, clients, and their families. Does having a communication or cognitive disorder influence the ability to be in flow, and is there value in thinking about flow?

I’d argue there is indeed value. Noted aphasiologists Jon Lyon and Audrey Holland have written about the concept of flow and aphasia. I’m intrigued by the idea of potentially “forgetting about aphasia.” Dunn and Brody (2008) postulate that “variables such as social class, gender, culture, age – and we might add disability – have no impact on its [flow] occurrence.” However, they identify that “a particular challenge for some people with disabilities is that those activities that once induced flow pre-injury may no longer be accessible” (p. 420).

So if people with disabilities can achieve flow, but perhaps not in the same ways as before, how can we help them? If we look to the Environmental Factors of the WHO-ICF, we can try to create an environment that is supportive, yet challenging. Environments that are carefully planned and structured to facilitate maximal participation, such as aphasia camps, can provide the right amount of support to balance challenge with ability.

In therapy, we are always looking to provide the right amount of challenge in a task so that our clients do not become too frustrated or too bored. This is a moving target, since their skill increases as they recover. Therapy is the new “work” of our clients, so the more we can help them to achieve flow in their work, the longer they will stay with it, enjoy it, and benefit from it.

Tactus Therapy aphasia apps like Language Therapy, Apraxia Therapy, and Number Therapy provide many levels and settings to adjust difficulty, so you’re always able to work with just the right amount of challenge to match your skill.

Researching Flow

For my dissertation work, I investigated flow experiences among individuals with aphasia. In preliminary studies, I found that people with aphasia do report experiencing flow, and they report similarities in their flow experiences compared to those without aphasia. Comments from some participants with aphasia show a degree of perceived value in the concept and the experiences of flow as well. While some talked about forgetting about aphasia for periods of time, others indicated they did not forget about aphasia. How the individual characteristics impact flow experience, as well as how certain environments may optimize flow, are just two of the many areas needing further investigation.

I hope you find value in considering the construct of flow, and the increased engagement that can result from an optimal balance of skill and challenge, within your own personal and professional life, as well as within the services you provide to your clients.

Thomas Sather

Guest Blogger Bio

Tom Sather, PhD, CCC-SLP  is an assistant professor in the Communication Sciences and Disorders department at the University of Wisconsin – Eau Claire, and on staff at Mayo Clinic Health System – Eau Claire.  He received his PhD at Western Michigan University and studied flow experiences among individuals with aphasia for his dissertation.  Tom is a board member with the Chippewa Valley Aphasia Group, and a founding staff member of the Chippewa Valley Aphasia Camp.  He is on Twitter (@TomSatherSLP) and the UW – Eau Claire CSD podcast. He lives in Eau Claire with his wife and three boys, and enjoys finding flow experiences on the trout streams of western Wisconsin.