What I Want to Do

“Experimental Psycholinguistics” was the course, during my life as an SLP doctoral student, that separated girl from woman – man from boy. Three hours of grind on a Monday afternoon almost always began with the professor standing pensively at his podium, saying “What I want to do….”. There were no rows of laptops  or tablets, all radiating readiness at that cue. The coffee was cheap and not the robust blends from far-flung corners of the world, but spat out instead by the one vending machine for one square block. Though we digested tons of theory and argued reams of hypotheses, it was that professor’s invocation to the class I remember most vividly. 

Flashback to the middle of that decade: I had begun graduate school on what was a non-traditional track. I didn’t feel I knew what therapy was all about. I had done well in methods courses. I had assisted other clinicians with their cases. My core communication sciences and disorders (CSD) courses were stimulating and making me want more. Sprinting around a child-sized table to refocus a child who suddenly bolted from the table, panting and flush with mortification – no, that was not great assisting! Stimuli presentation?  I could do that. Data collection? I did that after some practice. Maintaining focus and flow of the session?  Most of the time I crashed and burned badly while trying that.  I wished I had had, amongst the clinic supervisors and faculty, somewhere in my group of peers – someone to be Linus to my Charlie Brown and say,” I can tell you what therapy is all about. “

A few years had elapsed when, one day at my first job after the master’s degree, a copy of Elizabeth Bates’ Language and Context: the Acquisition of Pragmatics arrived in the mail. It took a few days to skim the book’s chapters, but then – I heard the voice exiting the stage… “That’s what therapy is all about, Charlie Brown”. Pragmatics, a hybrid born of philosophy, sociology and linguistics, led me to discover that for me, the object of therapy was establishing then following the rules of your context. You do good therapy by constructing and nurturing the environment that best grows your client’s skills. The focus of my treatment plans became – “in here, you do this”. How do I apply these concepts to daily operations of a clinical CSD program?  

 

In the present-day clinical environment, when I have to confront an inattentive or resistant client I say in essence: “This is not your house. You are here to (play/work on your goals/learn to speak [swallow] better.)”  You reinforce clients who show they agree with you. When you begin training generalization of target behaviors: “You are here for only 1-2% of the entire time you are awake. How can you build a strong new habit by just using 2% of your week?” If a client expresses reluctance to generalize a skill e.g. drinking thickened liquids at home, my answer might be: “When you leave here, I won’t know what you do. All this work is not for me but for you. You’ve seen this has worked. We’ll do our best to get you back to regular liquids”. I learned how to say “What I Want to Do….” I learned how to help my patient focus in the moment, to respect the therapeutic environment and use it as intended, and to bring the most energy possible to each time we meet. That’s what it’s all about.

(originally submitted in different form to ASHAsphere, the blog of the American Speech-Language-Hearing Association)