Wednesday, May 8, 2013

Always striving to be....BETTER!

So it is MAY!  FINALLY...nice weather, colorful flowers and...


Figure 1, adapted from

I currently teach an undergraduate course on Language Disorders and this past week, as we near the end of the semester, our focus has been on intervention.  I truly enjoy teaching; I get an intense satisfaction from my interactions with the students and sharing with them therapeutic technique(s).  When students come to my practice to observe, I become more conscious of my techniques and the materials I have chosen to facilitate the current goal(s).  Sometimes in therapy, I notice I go into "auto pilot", and this increased consciousness is important.  This is also how I feel about teaching.  It keeps me current. It is nice revisiting theories that are logged in my brain and don't necessarily come out for air much--but definitely guide my assessment and intervention approaches.  It is also nice to take another look at old (and new) research as an "older" or shall I say "seasoned" clinician.  I enjoy reading this literature with the students as well, who are digesting it for the first time. 

The past week we have talked a lot about the continuum of "naturalness" in therapy, which Fey introduces in his 1986 book Language Intervention with Young Children.  We focused on how each approach is distinct and uniquely important.  But we also talked about how these approaches can exist in harmony within an SLP's therapeutic practice.
Fey identified three basic approaches to intervention:
1. The Clinician Directed Approach,
2. The Child Centered Approach,
3. The Hybrid Approach. 

Most Natural                                                                                                              Least Natural
Child Centered                                          Hybrid                                               Clinician Directed
Daily Activities                                          Milieu Therapy                                             Drill
Facilitated Play                                         Focused Stimulation                                      Drill Play
                                                                Script Therapy                                              CD Modeling

Figure 2, The continuum of naturalness.  (Adapted from Fey, M. [1986] Language Intervention with young children.  San Diego, CA: College-Hill Press.)

My assumption is many of the therapists practicing right now rarely think about these approaches--rather we just adjust to the needs of our clients.  After observing a session of mine through a two-way mirror, a wise parent once exclaimed, " There is a lot of "art" to the science of pediatric speech therapy!" YES...there certainly is! I remember here is a parent who really gets it!  A big part of this "art" is understanding how to approach our clients.  As we have been discussing this continuum, I find myself thinking a lot about how I approach intervention and, generally, where my sessions fit in the above paradigm.  As it is BETTER HEARING and SPEECH month--I have been reflecting on my practice and how I can be better.  How can my sessions be better?  

Assessment and goal planning, although challenging, are many times easier than execution (although, not always).  When a session doesn't go as fabulous as I had planned, I have learned to re-think how I could of executed my goals better.  Was I too rigid (clinician directed)?  Did my kiddie over-run the session (Child Centered)?  Should I have swayed a little to the right or left of the above paradigm in an effort to actively engage my client while simultaneously targeting my goals?  I used to pride myself on being a "tough" clinician; keeping my sessions very structured and rigid and expecting a lot of trials on part of my clients.  And, although this can be a very productive way to do therapy, I came to realize it was more about my need to feel "in control" and less about what my clients' needs were.  Now, I see there is a certain fluidity that my sessions must have to keep my clients working optimally.  Maybe that means I fluctuate between all three of the above mentioned approaches within one session, because that is what my client requires.  It certainly goes, without saying (although, I am saying it aren't I????) different activities lend themselves to different approaches and we must adjust accordingly. can my sessions be better?  I like the idea of bringing to the forefront of thought--goal execution and this continuum of naturalness.  I think for many of us, therapy feels intuitive (which it MOST CERTAINLY is), but like a conversation with a good friend, thinking about this paradigm and our interplay between ourselves, our clients and the items with which we have chosen to address our targets (Pop Up Pirate anyone?) can only strengthen our sessions, not hinder them.  I will now always include a comment in my notes indicating where on the above continuum my client seemed to fare the best and how I responded.  Was I comfortable?  If not, why? And lastly, how can I make myself comfortable in the approach which seems to really fit my client.  A little bit of self-reflection always goes a far way!  

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