My Approach To Speech Therapy

Written by: Nimra Khan / Treatment / June 19, 2023 / 8 minutes read

After working with adults full-time with Well Said, I’ve had the opportunity to help with many speech and language concerns, as well as learn from my clients the issues and obstacles they face in their professional and daily lives. This has allowed me to shape my approach to speech therapy and build my own ‘speech therapist superpower’; the key to my personal style of working with clients. Each SLP has their own strengths, and for myself that ‘superpower’ is personalization. I strive to create client-centered goals and practice geared towards my client’s daily activities for any area that we are working on. 

Client-centered care can mean being creative and out-of-the-box in how we practice, as well as being flexible enough to change plans when a client tells me a situation has come up that would be better to address.

Working towards conversation level

The long-term goal for many adults is to reach the use of skills we practice in daily conversations without effort. Of course, this is the aim so that goals are achieved with less effort in daily situations. However, the time for this long-term goal can be longer than just a couple of weeks. As with many skills we want to gain, practice makes perfect. That practice, at first, will be mostly within the one-to-one therapy appointment. This allows clients to improve their skills with the benefit of having more time to give feedback and provide corrections, especially without a high-pressure situation. 

This ladder towards conversation-level requires making many bridges and practice to be personalized. It should be noted the amount of time it takes to move up that ladder depends on each person – some clients may move up within one appointment, while others might require practice for a few weeks. Here are some examples based on goal areas that I have supported:

Goal area: confident speech for presentations

With this goal, I want to help a client become increasingly more independent with each attempt. For instance, we can try at the first level with a presentation script and work on how to have a confident voice with good use of pausing, articulation and downward intonation. After use of a script becomes easy, we work up to using a PowerPoint presentation so that the client has to fill-in certain areas with their own words (not completely scripted). As confidence in this increases, we step up to a completely non-scripted presentation, based on a chosen topic. This topic could also be something the client will have to speak about coming up in their own lives, or ones we make as hypothetical situations. 

Goal area: active listening for social skills

For clients with active listening as a social communication goal, there are some limitations in that I have to rely on the client’s assessment of conversations in their daily life. This means that it can be a little more subjective, because it’s hard to know exactly how their conversation partner felt about the conversation. However, this is working on the one aspect of conversation that we can control – how you respond. If you’d like to learn more about my methods for working on social communication, you can read more about it here. 

We would start by discussing at least one area that is most difficult in this skill area. For instance, this could be a skill such as ‘paraphrasing’. By discussing the definition and examples, we then use a scripted method to take a hypothetical conversation and brainstorm together the most likely positive paraphrasing responses to it. Once the client is able to do this independently, we step up to role-playing. This could be with me, the SLP, acting as someone the client has to speak to daily (i.e. a boss, co-worker, teacher, etc.). We can also practice previously difficult conversations the client describes, or upcoming ones. This could be scenarios such as upcoming work dinners, speaking to a boss in a meeting, and more. 

I’ve found that by practicing in a low-pressure situation and receiving constructive feedback, clients can improve their confidence so that they have to put less effort in-the-moment to try it. Expecting that speech and language skills will just happen in the moment is similar to thinking that you can enter a weight-lifting championship just by thinking about it. As with most skills, practice, practice, practice beforehand to see results. Read more about recognizing areas of need in conversational skills here.

Each SLP has their own strengths, and for myself that ‘superpower’ is personalization. I strive to create client-centered goals and practice geared towards my client’s daily activities for any area that we are working on. 

Goal area: voice feminization

For clients who would like to work towards voice feminization, it’s expected that there is a long road to using a consistently different, but more congruent voice, through the day. Many clients begin speech therapy with this expectation, so the challenge is usually in increasing the client’s own control of various qualities of voice and subsequent use in conversation. It’s a rewarding area to work in, because each result is unique and personal to each client. The voice practice is developed as we practice. 

In my approach to this, once again I am very flexible in catering my practice to the client’s strengths and weaknesses. For example, if a client does not enjoy a brighter resonance, we focus on making use of healthy pitch changes and breath support. A part of this therapy is also helping clients to work up their use of carryover of voice within the therapy sessions. We slowly increase the use of congruent voice with gradually longer conversations. By doing this within the therapy session itself, it allows the opportunity to give feedback and make use of many voice recordings to find qualities to tweak and improve. 

The use of voice recordings, as much as no one enjoys listening to recordings of their own voice, is very important in this goal area because it allows clients to not just have to remember everything in-the-moment and gain a more objective view of their voice. Read more about how the voice works.

Goal area: speech sounds

There are many reasons that clients will need to work on speech sounds. Most commonly, it could be due to accent modification or lisps. These goals do take a few months at least to make consistent, of course considering variation between clients. However, I use a structured approach so that each step of the way is clear, and enough practice can be added to help make the speech sounds consistent. 

The speech sound hierarchy is one method to work on speech sounds, which pictures acquiring new sounds from auditory discrimination (being able to perceive the different between target sounds), sound in isolation, words, sentences, paragraphs and all the way to use in conversation. As each level of this hierarchy becomes easier, more difficult practice can be added in. 

Another method is to use “cycles”. This is most helpful for client with multiple difficult speech sounds. By grouping together a few sounds, each group is targeted for a couple of weeks at a time, before cycling to another group for a couple of weeks. It is not expected that the goals will be achieved immediately in those two weeks, but more to allow time for retention and reduce frustration when there are many areas to target. 

I use this as the foundation and then add on personalization by the use of words that are most common or useful for the client. For example, the most common vocabulary for a teacher will be different from a software engineer. This helps practice be something that can be used in daily situations as well. 

Conclusion

Although the areas discussed today are not exhaustive, I hope that it provides an overview of areas of strength in my work, as well as explain to you a little bit about my approach using my speech ‘superpower’ to personalize each therapy method to the clients that I am working with. At the end of the day, making each goal functional will help make goals more achievable too. 

If you are interested in working on areas of communication on your own, it would also be worthwhile to see our Communication Wellness Masterclass.

To speak with one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.