How to reach your Speech Therapy Goals

Breaking goals down into specific, achievable steps.

stepping stones arcross wide river The trick to crossing a river is to use stepping stones. The same is true for any big challenge: figuring out how to break it into manageable steps.

I’ve had my fair share of Physical Therapy. Most of it’s pretty minor stuff, luckily. (Bear with me. This really is about speech therapy goals. )
As my PT was teaching my how to do the exercises I realized that we naturally recognize that PT has steps. You don't just go to the PT and in 1 hour you're completely "cured".

Therapy has several steps:

Observe how to do the exercise.
Learn to judge when you do it correctly (or not), with assistance from the PT.
Practice the exercise, self-correcting when you judge you've done it wrong.
Learn to judge when you did it correctly (on your own).
Practice independently as you recover.

Break Speech Therapy Goals into Manageable Steps

I'm a parent coach of my daughter's robotics team. One of the things our fantastic head coach teaches the kids is that you have to break the goal into small steps. His example is you can't plan like this:

Plan for trip to the Moon:

Build Rocket
Fly to Moon
Land
Fly Home

You need to break the goal down into simpler steps than above.

Image result for cutting steak into pieces with fork and knife My analogy is that you can't eat a steak in one bite. You literally cut it into pieces. So, we have to break speech therapy goals down into pieces as well. And the first steps are critical. If you get them wrong, the rest of therapy is frustrating and, worse, less effective.

Speech & language treatment can have a similar progression to PT, but I think most people only think about the last step (am I 100% yet?). That’s like spending the entire drive to Disney World asking Are we There yet?

Read the rest: how break your speech therapy into easier steps...

When I provide coaching on the Bungalow Software for speech & language, I often find it very helpful to approach speech practice as this progression of steps:

Observe the proper way to say the word or compensatory strategies, like these for word retrieval)
Learn to judge when you have said it correctly by comparing your voice to the model. Or, for compensatory strategies, be aware of whether you are using them correctly.
Important: If the patient judges their effort as incorrect that is success for this step.

This can apply to conversations as well, but in a conversation the feedback is that the person you are speaking to understands (or seems confused.)
I’ve found that some always think they’ve said it wrong. For them, it’s even more important to recognize when they said it correctly. It’ll give them some well earned confidence and pride. And for everyone, it lets them know what worked. (“Oh, my tongue should be against the roof of my mouth”, etc.
Learn to self-correct themselves with feedback ( a model sound or video).
They may be able to participate in conversations with people who can accommodate their difficulties. I call this a therapeutic conversation. This accommodation might be include: patiently giving them time to communicate (or processes what they've heard), after waiting, give them gentle feedback that you (or they) did not understand the communication. Read more tips for gently helping the survivor.
Learn to judge (independently) when they have done it correctly.
This is essentially Step #2, done independently (without assistance or feedback)
I.e., they say the word and realize they said it correctly, or not. Even recognizing that they said it incorrectly is success. Remember, the goal is knowing whether you got it right.
Learn to recognize and self correct independently, without feedback or assistance.
This is step 3 done without any help.
At this point, they should be ready to practice in conversation.
They are now now ready to for a "normal" conversation. They may stumble a bit but they should be able to dust themselves off and get back horse on their own.

Note that with all of these, it’s less important how many retries it takes to get it correct, it’s more important that they are completing that level successfully, whether that’s just recognizing that they said it right that time, and incorrectly this time (after comparing it to a model.)

Once they master step 2 they should be able to use the program independently.

Remember: The end goal is to be able to self correct on their own. They don’t need to have perfect speech to have a conversation. If you can self correct, then every conversation becomes practice, just like every day I made my bed in the Navy was practice once I knew what “correctly made bed” looked like.

Read Tips for Caregivers on breaking therapy into easier steps

Help for Caregivers

Communicate the goal clear for each step (for the survivor). For Example, in step 1, Observe. They can try to get the right answer but it's enough for them to carefully observe. And in step 2 (Judge, with feedback) : it's enough for them to simply judge whether they got it correct or not. If they realize (accurately) that they got it wrong, that's success for that level. Congratulate them on recognizing the difference. That really is an accomplishment on it’s own.
When working with one of the Bungalow Software speech programs (Sights’n Sounds 1, 2, Speech Pacer or Numbers’n Sounds or Speech Sounds On Cue) work with the survivor until they are accurate at Level 2 (Judging when they got it correct or not, by listening to their voice and the model sound).
1. Tell them they can retry each exercise as many times as they like.
2. If it’s too hard, they can skip to the next exercise (and indicate they are skipping, not that they thought they got it right). Or ask for help. (It’s easiest for them to indicate this non verbally, perhaps shaking their head or thumbs down)
3. The should advance to the next word/exercise (without indicating it’s too hard) only if they felt like they got it correct.
4. Assess their assessment
  If they got it incorrect, but continued as if they felt like they were correct, ask them :
  Do you think you said that correctly?
  
  If they answer yes: gently let them know that you don’t think it was clear enough and ask if they’d like to try again.
  FYI: they may figure out that you’re only asking this when they got it wrong, so you may need to mix it up a bit and ask that even when they got it right. If you do that and they did get it right, let them know (big smile is good) that they were right, they did get it correct.
  
  See how the initial goal is just to teach them to recognize when they got it right?

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Clay Nichols
Co-founder of MoreSpeech and Bungalow Software for unlimited speech therapy at home and in the clinic.

Clay For 3 decades, Clay has helped patients, caregivers and speech pathologists with speech & language software. He is not a speech-language pathologist.