A speech therapist, sometimes known as a Speech and Language Therapist or a speech pathologist, is someone who’s qualified to help young people and adults with communications disorders. Most people think that speech therapists are only able to help with speech problems (such as stuttering or speech delay) but they actually deal with a much wider range of issues.
All speech therapists will have a three or four year university degree course behind them. Some may have done a post-graduate speech therapy course after a previous degree; generally these courses require three A-levels or equivalent qualifications to enter.
Speech therapy courses are universally intensive and contain both clinical placements as well as theoretical work. Speech therapy graduates will have experience helping treat a wide range of different communications disorders.
In the UK all practising speech therapists are required to register with both the HPC (Health Professions Council) and the RCSLT (Royal College of Speech and Language Therapists).
The Initial Assessment
Though speech therapists can work with adults, most of their patients tend to be children and young people. When they first see a patient, they start out by doing an assessment of the person’s speech comprehension (i.e. how well they understand language) and expressive language (i.e. how well they use language).
Comprehension covers both vocabulary and language structures. Some people have trouble with the correct use of verbs, nouns, and prepositions. This is a vocabulary issue. Others may have issues understanding language structures, such as the meaning of a phrase meant to give instructions.
Expressive language is what most people think of as “speech therapy.” This category is broken down into three different areas: speech sounds, articulation problems, and fluency.
Speech sounds, or phonology, happens when the person simply doesn’t have a certain speech sound in their vocabulary. Alternately, they might be using these sounds inappropriately. When someone pronounces “dog” as “dod,” this is called fronting, for example. Pronouncing “glove” as “glub” is called stopping.
Articulation difficulties mean the patient has difficulty producing speech sounds entirely. Perhaps they have a physical problem that hurts enunciation. Cleft lips and palates, poor dentition, and coordination issues (dyspraxia) can all negatively affect pronunciation.
If someone stammers or tends to hesitate in their speech, it’s considered a fluency issue.
Of course these are not all the areas a speech therapist may examine in their assessment. Since they focus on communication as a whole, they will look at the patient’s ability to listen, concentrate, play, imagine, communicate socially, use the appropriate system of communication, and their behaviour.
For example, a patient may hear the words as they’re spoken, but they might not be able to concentrate enough to process the information they hear. This would be an attention/concentration issue, even if others might assume it’s a hearing impairment.
Social communication, functional language use, and behaviour are also important. Speech therapists therefore look at how well the patient can interact with others, and how well they understand the mechanics of a conversation. Can they choose the appropriate system of communication? If they display challenging or agitated behaviour, is this the product of a frustrating inability to communicate?
It’s important to note that the assessment phase does not necessarily mean putting the patient through a battery of tests in a clinic or office. A speech therapist looks at all the areas where a person experiences trouble: they may observe or work with them in different settings, at home and at school. They will also consult with those who are regularly in contact with the patient — parents, carers, teachers, health professionals, etc.
Following therapy, the speech therapist will work out a plan of options and discuss them with the patient. Therapy usually involves some combination of direct and indirect therapy, as well as any necessary changes in the ‘communicative environment.’
Direct therapy is what most people think of as therapy. Here, the therapist and patient work on a one-to-one basis to deal with the issues identified during therapy. However since this is time consuming and expensive (the patient or therapist must travel) it’s also common to include indirect therapy in the programme.
With indirect therapy, a certain person (such as a teaching assistant or parent) carries out a specific work programme under the speech therapist’s guidance. The therapist still monitors progress of course.
If needed, the therapist may also suggest changes in the communicative environment. This may mean ensuring the classroom and home contain appropriate symbolic systems, or advising people in the patient’s environment on alternative communication methods.