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[box]Changing into something different is not always the best thing to do. Especially, if you give up the best things about you. This article was written for speech-language pathologists S. Goldberg (2003), ASHA Leader[/box]

In Tibetan Buddhism the word “bardo” refers to a transition or a gap between the completion of one situation and the beginning of another. That gap can occur between life and death, ignorance and understanding, or in the case of speech-language pathology, between who we were and what we are becoming.

Transition and change are not things to be feared. On the contrary, change is the basis of vitality for most professions. Blacksmiths became steel-makers, carriage makers became automobile designers, and witchdoctors became psychiatrists. The questions we need to ask ourselves as a profession are: what is it that we are becoming and is that what we want to be? There are three roads we are currently taking, with each one acting as an escape route from a current problem: 1) expansion of services; 2) specialty certification; and 3) more objective forms of therapy. I believe each of these paths will pull us in a new direction without addressing the reasons why that path was chosen.

EXPANSION OF SERVICES

We live in a professional age when “best practice” is often dictated by economics. We look at a competitive landscape and justify economic decisions in the cloak of professional concerns: speech-language pathologists should do dysphasia therapy since they are more qualified than occupational therapists or nurses. School speech-language clinicians should do general language stimulation because they are more qualified than classroom teachers. Child language specialists should work with children who have written language problems since they are as qualified as reading specialists.

The question we need to ask ourselves is: are we engaging in activities because of economic reasons, or are they part of the mission we as a discipline aspire to? During the period of business expansion in the 1990’s, many companies believed that “bigger was better” in an economically competitive environment. It almost didn’t make any difference what kind of business was taken over. The most extreme case was when a company specializing in Mexican food bought a major software firm. Throughout this period of reckless expansion, the energies of the acquiring companies became diverted from their core business to the newly acquired ones. After a period of time, bankruptcies became rampant.

Expanded companies that failed were those that allowed their core holdings to wither in order to give attention to new areas of interest. What they didn’t understand was their recent acquisitions were the core holdings for other companies. A food company that attempts to enter the software world becomes only a pesky insect to a company like Microsoft. I believe that we are heading in the same direction.  We need to ask ourselves two questions: 1) have we been so successful in the treatment of oral speech-language disorders that we have the extra time to engage in new areas, ones often that have been treated for decades by other disciplines? and 2) when other disciplines reciprocate and believe they have the right to expand into our traditional areas, how will we react?

SPECIALTY CERTIFICATION AND CONTINUING EDUCATION REQUIREMENTS

We are in an era where many of our colleagues have successfully pushed for “specialty certification” in areas such as child language disorders, stuttering, voice, and aphasia. The purpose of specialization is to provide the consumer with some assurances that the person dispensing the service is qualified. Unfortunately, most certifying groups add experience to knowledge and believe it equals competency. Experience and knowledge when added together equal experience and knowledge. Competency is how the two variables are applied in ways that can successfully take our clients from A to B; from where they are to where they want to go. We have been marvelous in documenting each of the steps we need to take to go from A to B, from single word productions to complete sentences, from stuttering to controlled fluency. But how we move someone along in that direction receives scant attention in the research literature. Unlike many of our sister disciplines in the clinical sciences, we have spent an insignificant amount of time on investigating how to deliver effective services. We are long on the what’s of therapy, but short on the how’s.

How is it possible to certify the competency of a “stuttering specialist” or an “aphasiologist” when we have ignored what makes a speech-language pathologist competent? Documenting experiences will do little to enhance competency. Is 100 hours of incompetent stuttering therapy more valuable the two hours of competent stuttering therapy? Will 30 hours of forced continuing education produce as much competency as one hour of insight into what a client needs to change? Who benefits most from continuing education credits; the clinician who often takes a workshop of little interest, because it’s approved and a really useful one isn’t? The workshop presenter and sponsoring agency who receive a handsome fee? Or the treasury of ASHA, which will receive money for the units its 106,000 members will be required to take? As we travel down the road of specialty certification and continuing education requirements, many of us will confuse professional aspirations with realty. The problem of clinical competency will still remain, but we will have so effectively hidden the problem in a morass of formal documents, we will fail to realize the problem is still there, though our clients won’t.

COMPASSION

As a discipline, we have always encouraged research in understanding the nature of communicative disorders, yet all but ignore the importance of compassion in treatment. In the 1930’s, some of the most important foundations of our field were developed by individuals who themselves had communicative disorders. The writings of these pioneers had an empirical basis and showed a deep understanding of human suffering. In hindsight, we can fault their science, but not their compassion. Today, our science is impeccable, but the level of our understanding of what our clients need outside of the specific communicative behaviors is questionable. Someone once said that therapists in all areas have a unique responsibility. Clients allow therapists to take them to places of incredible vulnerability. It’s incumbent upon the therapist to walk the client, hand-in-hand through that place, and bring them back to the world in which they live. As I see the de-emphasis upon this supportive aspect in our field, I wonder if the precise, objective methodology of our practice is an appropriate substitute for that warm handholding experience our clients desperately need, yet are often denied.

Our actions today will have consequences on future professional practices and the lives of our clients. It seems to me, as we continue to branch out into areas that some believe are peripheral to speech and language disorders, we are traveling down a path that may lead us, in hindsight, to a place we never intended to go. It appears that we are in the process of running away from what we have been and moving into areas that may have more of a financial justification than a sound academic foundation.  The problems of providing effective therapy to people who have speech and language disorders won’t go away by expanding our scope of practice. Nor will we necessarily produce more competent clinicians by requiring continuing education hours where the vested interest may be more financial than professional. I fear that, just like the Mexican food company, we are venturing into areas that will do little to strengthen our core; our reason for being.

copyright 2010 Stan Goldberg, stangoldbergwriter.com

This article can be reproduced and distributed without charge for any non-commercial project if the source is provided.

2 Responses

  1. Bob Ferguson

    Hey,
    I am sitting with a messed up back in Ottawa Ontario contemplating a career change. I am a disillusioned SLP working at the local school board and a Buddhist. I thought why not goolge SLP and Buddhism to see what karma comes back and there you were with a fascinating article on change. The very thing that I am struggling with. When I read more about you I laughed aloud because you now work around death which is what I fear most. I would love to know how and why you made the jump as well as any direction on where to find answers about what I should do next. My work brings helps others but brings me stress not joy which makes it tough to leave.

    Reply

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