We hear about mindfulness all over now. What role does mindfulness play in speech therapy? Is it possible to get a wiggly child to practice mindful techniques in therapy? Instead of getting wrapped up in complex methods and tools, develop your super powers of observation and listening. Simple tools provide optimal outcomes. This episode is the beginning of your journey to becoming a Mindful SLP. 

— Links from the show
PROMPT   https://promptinstitute.com/page/WIPforClincian

Music: Simple Gifts performed by Ted Yoder, used with permission

Transcript

Dan: Welcome to the Mindful SLP, the podcast for SLPs, looking for simple tools and optimal outcomes. Your host is Denise, experienced speech therapist specializing in all things pediatric and Dan, business manager for her private clinic.

Welcome to the Mindful SLP. Thanks for joining us this week. Today, we’re going to do just a little bit of a background on Denise and, uh, the mindfulness idea of speech therapy. So first off, Denise is a speech therapist. She has over 25 years background in schools and in private practice, where all have you worked, Denise?

Denise: I have worked in public schools, I’ve worked for child development centers and I’ve been in private practice for about five years now.

Dan: So what’s your favorite people to work with

Denise: The kiddos? I love working with the kiddos and most of my career has been spent working with little kids, the pediatric population.

And when I say a little, I also worked with, I do work with junior high kids. Love them too. So that’s pretty much the range.

Dan: Kinda hard to love Junior high kids. Sometimes

Denise: it can be kind of hard to love some of those three-year-olds too. I got some stories, but anyway, no, I do love them all. And my philosophy has changed over the years and I find it find I’m a much more effective therapist now because of this mindfulness technique. If you want to call it a technique, it’s a mindset, the mindfulness mindset that I use now when I come to working with a client.

Dan: So what is your mindfulness? What is that philosophy?

Denise: It’s a lot of observation, a lot of stepping back and looking at the whole child, which we are told.

I mean, I was told that in school, But I didn’t really understand how to do it. I don’t know if I was instructed how to do it and I that’s why I’m doing this podcast so I can give you some ideas of how to really observe. Sometimes we think we’re being observant and we are not really being observant.

Dan: So let’s start there. Why do a podcast?

Denise: Well, I just wanted to share what I’ve learned. Um, okay. So when I first looked into becoming a speech therapist, I interviewed a speech therapist at college I went to, and one thing she told me that as much as she loved it, she said, it’s very stressful. It’s a very stressful profession.

Well, that didn’t put me off and I was glad it didn’t put me off.

Dan: So what would be stressful about it?

Denise: You have the weight and the burden of helping these kids progress through life. Communication is so important. It’s so vital to. Being a functioning member of society. And you can see that as a speech therapist, you can see the gap between where the child is now and where they could be.

And that can be really huge. I can just weigh down on you.

Dan: So it was a lot of pressure to try and make sure that the kids actually do the progression, that they actually can reach everything they can, that they don’t. You take that stress onto yourself.

Denise: You do.

Dan: So tell me about that a little bit more then.

So what do you do about that? I mean, tell in your earlier years, how did you handle that stress?

Denise: Well, I’ve got a story about that. So when I was working in a school district and I had a special needs preschool as part of my caseload, I had two preschoolers. They both had down syndrome and I saw them on the same day.

And it just so happened that both of them, they were really low in language and they were fairly passive communicators, so it was hard to get them engaged. And my philosophy back then was, uh, I don’t know if you’ve heard what fires together, wires together. So if you get someone really engaged, you get those neurons going.

The, the clients really engage that fires together. And the activity you’re doing with that will wire together. Those neurons. So you’re creating a learning pathway. So a client needs to be engaged to do that. So, and my thinking is to get them out of this passive state, there were in by doing, being really physically active.

Uh, so we kicked balls and me threw balls and we ran after them or used words like in and out. And we would throw them in a basket. We even physically crawled through those tubes because you know, they have those tubes in the preschool and swings. All of that kind of stuff, just to get them to say some words.

So I’m thinking, okay, if they say in, and if they’re really engaged in the throwing the ball in the basket, that’s going to fire together that word in.

So you’re thinking that the fires together or yeah. What fires together is an active type fire.

Yeah. Well, well, it’s been engaged and that’s the only way I can think of to get them really engaged was to do lots of physical activity and they did have fun.

How’d that work out though for it to speech therapy.

So I was really tired.

Dan: They have you out numbered on years.

Yeah. Um, they were having fun. I would have fun. I could keep it going while I was with them and be engaged. But at the end of the day, when I was done, I was just exhausted. But. The amount of energy used to get them to say anything was exhausting and they weren’t really making significant progress.

So these words that they were using and they were saying words were more like happy accidents in something.

What do you mean by happy accidents?

Denise: Okay. So a happy accident is like, suppose you are not a great soprano and you’re singing the Star Spangled Banner. And there’s that note that’s way up there, but you’re okay. But you’re in a group or whatever, and you hit it because maybe you’ve got a strong soprano standing next to you and you say, And you do that, have you really mastered that note?

Dan: Of course.

Denise: Well, maybe you have, by the way, Dan is a great singer. So he probably, he does have all these notes mastered, but I don’t. So I can, um, I’ve been, had the experience of lots of times having happy accidents with notes and not ever not being able to replicate it because it wasn’t really mastered. I don’t really understand how it even got there.

It just happened. Um, it was a one-off.

Dan: So that’s what a happy accident is. It’s just, just the, the accidental,

Denise: Well, it shows you the potential, which is great. The potential is there, but the benefit of mindfulness is focusing on what really needs to change so that can be mastered.

Dan: So focusing on what is around that to build on it. So, you know, putting the foundations together so that it can happen again and again, cause you know, actually being a singer and knowing that note and the Star Spangled Banner, you have to practice a lot, but you have to actually practice up, uh, get your voice warmed up low before you can go high with any kind of support.

You got to make sure you have enough air support, all those same things that happen in speech. Right.

Denise: Well, I love that you said air support because air support is a fundamental speech mechanism that often as speech therapists, we haven’t been taught enough about, uh, many of these little clients have really, um, complex communication disorders such as down syndrome.

They lack the air support to consistently produce sound or to, to have sound mastered. Um, they lack control of their jaw. To produce consistent vowel sounds control their jaw and their lips to make really clear distinct vowel sounds. And that is the foundation that is missing and why they weren’t getting mastery.

Dan: Well, is that something that’s taught in schools? The, all those pieces that go into it?

Denise: I didn’t really learn it in a way that connected in my mind. So when I was in school and we took the anatomy of. speech, it was kind of boring, but, and I love anatomy, but it was not really connected to what would actually see in the clinic.

I was like, you’re going to memorize these cranial nerves, you know, and there’s little cranial nerves. This is what you’re going to memorize where the nerves come in and where they come out, the muscles. Um,

Dan: So all the technical technical stuff.

Denise: And we did learn that speech was an overlaid function and the professor kept emphasizing that, but it didn’t connect to my mind. Speech isn’t an overlaid function of the mechanism we use to eat and breathe. But until we really look at and know how to see can do they have breath support, do they have control of their jaw? Are they using the muscles of their face, their lips and their cheeks to shape the vocal tract?

Dan: So, when did you learn that something needed to change? And how did you go about realizing that you could do something different?

Denise: Well, I got trained in Prompt.

Dan: What’s Prompt?

Denise: Prompt is a way of looking at the client’s speech subsystem. So you look at how the muscles move. You look at how the client’s bodies, even you look at their posture, but sometimes their posture is not conducive to speech, not conducive for breath support, things like that.

Dan: Wiggling around the chair hopping on, down on one foot

Denise: Or being, uh, having a hypotonus or hypertonus. So having too much muscle contraction or not enough muscle conduction be low tone or high tone is how you might think of it.

Even looking

Dan: You can sound and hear that.

Denise: Yes, you can hear all that wasn’t very clear speech. So you need to look at all of those things. You need to look at what, uh, okay. So my orchestra teacher always said, the orchestra is no better than the weakest player. She didn’t want any of us to slack off and let, the more skilled players carry the orchestra.

Right? So your, your speech subsystem, your speech system is no stronger than your weakest function. So these little kids I was working with after I was Prompt trained, I came back and I was like, oh, They don’t have good breath support. They don’t have a good jaw control. They can’t round the lips and say, oh, with consistency, there were the one-offs, but not consistently.

So of course these words aren’t getting mastered.

Dan: Right. Cause they don’t even realize that when they do say it, what went into it because it was just like sort of happy accident. And it was like, oh, but what did you do? Well, I don’t know, but if you don’t stop and work on it and then point it out, then they don’t learn what that is,

Denise: It can’t be replicated.

Dan: So what does it look like then? How do you help these kiddos figure that out?

Denise: It was great. Cause I sat them on the floor face to face with me. We were sitting not running and not jumping, face-to-face doing really simple activities that they thought was just as much fun as throwing balls. I mean, blowing bubbles, really simple cause and effect toys.

You blow up a balloon and you let the balloon. But you don’t have to run around. I mean, okay. I have a stock of balloons and we let a bunch go and then we’d gather them up at the end. So we’re not easier. And more time, more time efficient, keep, keep focused and we can get many more repetitions than same in when you throw a ball in and then you have to go retrieve the ball.

If it didn’t go in or get out of wherever it is and do it again, not that physical activity can’t be good, cause it can be good, it depends on where you are at. And how many repetitions you can get. Um, so I’m not totally dismissing physical activity cause I do do it, incorporate it when it’s needed for these little guys, it was just really the simple focus of sitting face-to-face with them.

So eye contact and an engaging activity that equals engagement. You don’t have to expend all this energy. And for me, I could say, oh, my one focus today is my one focus is for them to have breath support. And maybe we’re only trying a couple of words or vowel sounds that we are modifying to be a word like off or on something like that or a for up, maybe they’re not even ready for the P.

Dan: So yeah, you’re just working on focusing on one aspect until they can repeat that and then you start adding onto it. Do you need to be Prompt, trained to be able to do this mindful activities?

Denise: No, you don’t. It was just a way for me to see how I could be more effective, a way to kind of wake me up to what I was doing. If I wouldn’t be doing this podcast, if you have to be Prompt trained, trying to just say, go get Prompt trained and well I do love Prompt therapy. And I think it’s hugely beneficial, that’s not what this podcast is about. It’s about being mindful. It’s about stepping back, observing what foundational thing is your client missing that you can fill in because you won’t be able to build your house without a good foundation, that is going to be shaky.

You won’t make steady progress that really moves the needle without looking at these basic fundamental skills.

Dan: And that’s what you’re looking for with this podcast is to help speech therapists find simple activities to focus and be able to move the needle on everybody’s therapy.

Denise: Yes, because I have found that the activities don’t need to be really complex.

In fact, the complexity can take away from your ability to be effective. And I do have lots of toys, but they’re, they’re simple toys. They’re simple activities so we can focus on the communication on the back and forth on the relationship.

Dan: And so what is your plans for this podcast? Where do you see us going, why do people want to listen to it?

Denise: Well, we could all use less stress in our lives. So the therapy that is stress-free is wonderful. It’s freeing, it’s very freeing to be able to focus on just one thing, and that therapy session. And to really, and to know that it’s the right thing to focus on. I’d like to help other speech therapists determine what is that one thing I’m missing, because I’ve discovered a lot of those as I’ve been exploring mindfulness and just introduce them to ways and activities and things I’ve discovered so they help you progress. I mean, they help you help the client progress and they help lift that burden off your shoulders of, oh my goodness, are they progressing? ’cause you can see them progressing, but you’re not trying to build the walls. You’re not trying to put the windows on. You’re not trying to put the roof on or paint the house before you got the foundation built.

Dan: What does that look like? If I was going to start doing mindful therapy tomorrow, what would it kind of start looking like, what would I need to practice first? What’s the number one thing to start doing?

Denise: You need to practice helping the client be in the same space with you without being distracted by toys and activities.

When my clients first come in there, isn’t a toy on the table. We’ll usually do some personal engagement, mindfulness sort of activity where we’re looking at each other and that client to the point they are capable, they’re sitting next to me or they’re sitting across from me and we’re looking at each other and we’re paying attention to each other.

And our bodies are still, and the reward of that is, and it is rewarding is that we’re looking at each other and there’s a connection

Dan: So sitting still, you know, working directly with the client to become engaged, looking at them, getting the eye contact and really being in the moment with your clients.

Denise: And don’t be surprised if some clients who aren’t used to this are uncomfortable with that. Sorry, uncomfortable with that. Especially clients who are on the spectrum, uh, they have these anxiety levels and they feel like they need to. Be constantly engaged in something. So their bodies are always moving or their eyes are always looking around and some of the more severe clients can actually start to tantrum.

Just if you’re asking them to just be still with you in the moment, because something’s not going on to distract them from their own anxiety. So that’s a whole nother podcast about how to work with some of those clients to get them to be mindful because they can make progress that you never thought they could make, if you can get them into a mindful state.

Dan: Okay. All right. Well, we will link to the prompt in the show notes and we’ll, uh, come back next week with some more.

Denise: Remember to subscribe to the podcast.

Dan: That’s right. Thank you, and we’ll see you next week.