Speech and language therapy Art or Science?

1. Speech and language therapyArt or Science? Jane Stokes Senior Lecturer Speech and Language Therapy University of Greenwich

2. What exactly is it? • The therapeutic relationship • The measurement of change in communication • The negotiation with the client, the family, the keyworkers • Drawing on evidence from research to deliver the most effective practice Some of this is art – some of this is science

3. Tacit and explicit knowledge • Some knowledge and skills are explicit – how to carry out an assessment of the muscles and nerves of the mouth • Some are tacit – difficult to describe and measure rapport, partnership with clients, values based work, impact of communication difficulties, empathy, personality factors in success of therapy, motivation to change • Tension between practice wisdom, intuition, common sense and knowledge based on research

4. The term therapy • Comes from a biomedical frame of reference – usually signifies an attempt at remediation, following diagnosis • Phrases like packages of care, treatment programmes, diagnosis, intervention all derive from a medical model • Imply person-fixing, rather than context-changing (Martin 2009 ) • But much of what we do is not health related but more akin to education and this terminology is inappropriate • Also does not fit clearly with concepts of quality of life Martin D (2009) Language disabilities in cultural and linguistic diversity

5. Professional artistry • This term recognises the uniqueness of decision making • The complex and messy challenges common in what Schön called the “swampy lowlands of practice” (1987) • The nuances of how people make sense of their world are often expressed through artistic expression rather than through objective, scientific methods Schön (1987) Educating the reflective practitioner

6. Scars of battle? “Speech language pathology as a profession has fought many battles over many years to have its practice recognised as scientific at the same time as internally debating the legitimacy of the scientific paradigm –the battle has left its scars in the language we use to describe what we do”(p 109) Ferguson (2009) The discourse of speech-language pathology in Journal of Speech-Language Pathology 11(2) 104-112

7. If we view it as purely science we lose the art

8. If we view it as purely art we lose the science

9. What is therapy? • Difficult to sum up an entire profession in tidy little statements • Hard to stand outside the act of therapy because of the relational aspects of therapy where the therapist becomes a part of the very process he or she is trying to observe ( Stedmon and Dallos 2009) • But it contains the following elements – some are more artistic than scientific.. Stedmon and Dallos (2009) Reflective practice in therapy and counselling

10. Therapy comprises the following.. Theoretical knowledge Observation skills Measurement skills Monitoring change Connection between people Art of communication Practice wisdom

11. Therapy is.. C ommunication between people O bservation skills M easurement skills M onitoring change T heoretical knowledge A rt of communication P ractice wisdom

12. Communication, observation, measurement, monitoring, theoretical knowledge, art, practice C O M M T A P

13. References Ferguson, A. (2009) The discourse of speech-language pathology. Journal of Speech-Language Pathology 11(2) 104-112 Martin, D. M.( 2009) Language Disabilities in Cultural and Linguistic Diversity. Bristol: Multilingual Matters Schön, D. (1987) Educating the Reflective Practitioner: Toward a New Design for Teaching and Learning in the Professions. San Francisco: Jossey-Bass Stedmon, J., and Dallos, R. (2009) Reflective practice in therapy and counselling. McGraw-Hill.