The R sound can be one of the most challenging therapy experiences. Have you struggled to get consistent elicitations? Tried everything you can think of and you still have these cases that won’t progress? You’re not alone! Denise walks you through an overview of the three pillars of R therapy. This episode is a must-listen if you have R clients.

— Show links
Impossible R Made Possible Video Course

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 back to The Mindful SLP podcast. Hey, this week, we’re going to talk about in episode three, vanquishing the imposter syndrome. Impossible Rs are possible. So Denise, tell me a little bit about some of the most difficult things that you’ve faced as a speech therapist.

Denise: Well, one of them is definitely teaching the R phoneme,

I think I’ve lost more sleep in my career over kids that I just couldn’t seem to figure out how to teach R I might add, I don’t lose sleep anymore, which is what this podcast is all about. But let me tell you about two kiddos that I was working with that brought this all to a head. So when I was still working in the school district, I had two fourth graders and I’d had them since third grade.

So that had been on my kids a little more than a year, working on R, no progress. So you’re sitting in front of them. They’re losing faith in you. You’re losing faith in yourself. You know, you’re going to ask them to do something. And they’re going to fail and you can’t tell them that it was good and you don’t want to depress them and tell them they couldn’t say it.

And it just, their R’s just sound weird. They just sound bad. And you just go on from week to week, and then there’s the IEP meeting and the parents are looking at you. Like, what progress did you make? And you’re like, I got nothing and it doesn’t feel good. So I might say that I did research. And I went to conferences and I tried to figure this problem out.

So I wasn’t being negligent. And there’s a lot of research out there. There’s a lot of literature and art, but I have something unique to bring to the field. It has helped me with R more than any other thing I’ve found

Dan: Well tell me, is this something that other therapists have had a problem with?

Denise: When I go to conferences with my product, SLPs come to my booth and tell me about those one or two R clients that are really challenging for them.

It’s a common experience with pediatric speech therapists, uh, having trouble.

Dan: But why is R such a problem then?

Denise: Well, it requires integration, fine motor control integration on three different planes of movement. It’s not easy to see how the tongue moves and it’s not even easy to feel how the tongue is moving.

If you think about what you’re doing when you say R, can you describe that to someone else very easily? But mainly, I mean, because as therapists, we don’t know how to look at all the components that go into R we know some of them, but we’ve only got part of the puzzle. And so we don’t really know how to assess where our client’s deficits are.

And we go into correct R without the information we need to build a good foundation. So now kids who don’t have a severe issue with R they’re going to get it with what most of us know. But the kids who have severe or moderately severe problems with R they flounder and when they flounder, I mean, they can flounder for years.

One of the therapists I talked to, he said they stagnate in the system.

Dan: Oh, that must be horrible. Both for both of you, right?

Denise: Yeah. It’s not great. So. So, yeah. Before I discovered how to correct our, I felt the imposter syndrome every time I sat down with those two clients I was telling you about and others, and every time I thought about them.

Dan: So tell me, what is the imposter syndrome?

Denise: It’s a feeling you’re supposed to know what to do. But in actuality, you don’t, you have the degree that says you should know. So you feel like an imposter in your own profession. As speech therapists, we are not strangers to puzzling cases, but with autism or learning disabilities, there’s a whole team of specialists on board with you and you have vast quantities of resources.

Dan: And with that team of specialists, can they help out with R?

Denise: No, with our therapy, you’re the lone expert and maybe you don’t feel so expert. I looked for answers. I read books, I took extra training and none of the material helped me understand what to do to elicit a correct R sound. Most of the existing resources for teaching R don’t address the underlying issues.

There are issues that prevent someone from learning R, and that was why I wasn’t getting anywhere with the resources I had.

Dan: So what did you discover in your research? How did you solve it?

Denise: I discovered that clients who are struggling with learning R lacked oral motor skills that would allow them to place their tongue correctly and coordinate the integrated movements.

So over time, I created a method for R therapy that is centered around three foundational principles or pillars as I like to call them.

Dan: And what are those pillars?

Denise: They are stability and mobility, precise placement, and relaxed production.

Dan: Give me a little description about what is stability and mobility?

Denise: There are three ideas wrapped up in stability and mobility.

One, it’s moving a part of your body to where it needs to be and keeping it there to do whatever you need to do. Two, it’s having the range of motion to move your body part to the degree it needs to. And three, it’s been able to move body parts independently of each other. So to look at this from a speech perspective, a client might slide their lower jaw forward when they try to say R. That shows they can’t keep, they’re jaw stable in the place it needs to be. They might lack the ability to open their mouth to the degree it needs to be. Their jaw movement is too small or is opening too wide and they lack control of that range of motion. Finally, they might move their jaw, tongue, and even head as one unit.

And that shows lack of independence of movement. It’s common for me to see clients tilt their heads up when they attempt R because there’s some upward movement of the tongue involved in R, but they can’t separate their neck and tongue movement. So, these are just some examples of lack of stability and mobility.

Any of these issues can prevent a client from being able to produce R.

Dan: How about precise placement?

Denise: Oh, I love precise placement. So many times the R clients who’ve had previous therapy come to me and there R is in the neighborhood, but not good enough. So they’ve had years of therapy. They can kind of make an R or they can make an R in some words.

But when you really ask them, just give me your best R, it doesn’t sound good. It’s not precise. It’s like you’re always flat or you’re always sharp. If you’re a musician it’s not dead on and it will not generalize, they will not sound good. It’ll stagnate.

Dan: So it’s really about making sure that you are all set and ready to go, and that first attack is the correct one every time.

Denise: Yeah, that’s exactly it. And they need to know it. They need to know where that precise placement is. If they don’t know, then they’re always guessing and usually their guess is wrong.

Dan: And then how about relaxed production?

Denise: Okay. Love, love, love, relaxed production. It’s the same R with the same easiness and breath flow that they do for other sounds and that their peers do they can spend years in therapy and not generalized.

Because they have some tension associated with how they produce that R stops them, slows them down. And if they’re running along a conversation, they’re not going to slow down for that R, they will in the therapy room, but they won’t in everyday life. They don’t have it integrated fully into their, um, conversational stream.

Dan: So was there anything that surprised you as you learned about these?

Denise: Yes. I was so surprised at how little I needed to instruct the clients, what a little bit of minimal instruction that was really geared to what they actually needed, what a great effect it had. So one of the clients I told you about, we call him Casey, who was in the fourth grade, and I didn’t know what to do with him when I figured out what to do with him in two weeks.

Two weeks from the time he said his first good R sound, which is just a ‘ruh’, he was saying all beginning Rs. Wow. In conversation. I mean, and he had been in therapy for more than a year, so huge effect.

Dan: Once they understand it, then they really are able to generalize it quickly.

Denise: Many, many clients. Now, not all, there are lots of clients with underlying factors that you need to address.

But they always move faster with this approach. So even the ones with underlying factors that are going to slow them down are still going to go faster than they would without this approach, without stability and mobility and precise placement and relaxed production.

Dan: These things that you’ve learned are other therapist able to use them?

Denise: Absolutely. I have created an online video course that’s called Impossible R Made Possible, and I deliberately chose that word impossible because what seemed impossible to me when those clients were looking at me and I was looking at them and we were both losing faith in this whole process. It is so empowering to know, Hey, this is possible.

I know what to do. So you can take this online video course and learn what to do. I’ve got client videos that show me eliciting Rs from clients, that show how I do it. And a picture is worth a thousand words. And there’s also 60 worksheets that take you through every step of the process. So you don’t need to create materials.

Dan: So you can bring these materials right into your therapy.

Denise: Yes. And they are great for homework. Parents love it. Parents get how these materials are going to move their kids along.

Dan: Those pillars sound pretty simple and basic, but where lies the challenge?

Denise: The challenge lies in learning how to train yourself, to observe and hear what is really going on with your client.

Now, I would just love to describe those three pillars and maybe a little bit more detail, and then send you on your way, you’re R problems are solved, but that’s just not possible. That’s why I created a video course. It’s detailed there’s research involved in explaining. Uh, what these components are that go into creating R. And so the video course is two and a half hours.

Dan: What do you do in those two half hours?

Denise: I lay the groundwork saying, this is what you need to look at. I explained the static and dynamic assessment you need to go through. So looking at the client’s oral structures, looking at how things are moving from the very beginning, and maybe they do not have the ability to form an R.

And some clients that I work with, it might be a month or two before I asked them to even attempt an R. So you need to know what to look at. If you go in, ask them to say an R and they don’t have that ability, they’re going to be experiencing disappointment and failure for who knows how long.

So that’s one of the things I teach is, is where to begin. Maybe they need to do some things to prepare their system, to even produce an R.

Dan: So what are the big takeaways?

Denise: The big takeaway is you are not alone in this. If you are struggling with R well, welcome to the club of seasoned speech therapists, you see this question everywhere.

I’ve got this kid. We’ve been working on R, I just don’t know what to do, but this is totally solvable. This is doable. And that’s one of the takeaways. I want you to know that you’re not alone. There are resources out there. There are ways to solve this problem. I do know there are a lot of programs out there for R, I do believe that mine is unique and it’s the only one I’ve seen that has brought all these components together to help a client really master R from the beginning to the end.

Dan: And the second takeaway?

Denise: Think big act small. I know this is true for almost all of our therapy goals, but especially true for R, so thinking big is, yeah, the goal is they’re going to say R in conversation and they’re going to sound just as great as their peers. But think small is looking at how they are trying to say R, and if they aren’t ready, not even going to a word, don’t even have them try, say, run around a rabbit if they can’t do it.

You got to think small, you got to think, how is their jaw moving? And what’s happening with their tongue. And these are all the things I get into my course that I can’t and go into depth. There’s time, wouldn’t allow. But you got to think small in that moment. And what am I doing today?

What tiny little step are we accomplishing today that will make that big goal possible. And as therapists working with R, we so often start too many rungs up the ladder. Here they are. Let’s see if you can say run today or you’re not ready

Dan: They start too far up the ladder and they’re missing two or three steps and they’ve got a huge leap to get from the ground to that level, and that can be demoralizing.

Denise: If they do manage to have some success there, they will fail later on. I see this again and again, so many preteens coming to my clinic. Um, some even dismissed from speech therapy. Hey, they said they were ready to go, but the parents say, hey, I’m not hearing that R, or I’m not hearing it all the time.

Um, usually I take them back, ask them to say just an, R syllable like ‘ruh’.

Dan: Oh, so they might have ran, but they might not have run. You know, it’s a different, slightly different R. So if you don’t get those basics downs for all the, R sounds, then it’s really hard to put them all together.

Denise: If you don’t have that nice placement.

And if you can’t hear when you’re wrong or right. It’s not going to fly at the end.

Dan: Well, let’s face it. You see a lot of different disabilities in your practice, you know, some severe ones like autism and just, you know, some really challenging ones. But why work so hard on R?

Denise: I’ve got to share a story with you. And this is just one of many, this young man’s grandfather shared this story with me.

He can’t say R, he’s in junior high, incidentally R is in his name. He actually thought that school would be easier for him. If he enrolled in a sort of military like school, an alternate school, where kids with discipline problems usually go and, you know, he didn’t have discipline problems. But he thought that would be easier for him because of the social pressures of not being able to say R well, he got there.

It was not a good situation for him and the other kids picked on him, but he was the one who got in trouble because they understood how to work it. And he didn’t.

Dan: Right. So the second person was the one who always gets caught.

Denise: So this kiddo, no problem, other than he can’t say R in junior high, ends up getting in disciplinary trouble at the military school when he didn’t even need to be there.

Fortunately, you know, he left his back, got his junior high school, but he’s still gonna say R, and his grandfather is looking at me and saying, what can you do? And this is why it’s so important. I mean, that is a tragedy that leaves a mark on that child forever. And it’s totally treatable as unnecessary.

So now I’m getting all teared up. Sorry.

Dan: But it’s true. I mean, you see it and I see it.

Denise: Yes. And it’s a huge self-esteem factor for most kids, even the ones who hide it and I’ve seen some who hide it pretty well and think it doesn’t bother them, but when you dig down, it does bother them. Cause you can see that come out when you really start to get to the nitty gritty of correcting it.

So yeah, it’s important. Every client is important and we just need a method that works.

Dan: Okay. So if someone is looking for help with there are kiddos, you know that you’ve heard the question before I’ve got this, this client. I can’t seem to make them move forward. What should they do?

Denise: You can visit our website, SLP proadvisor.com.

Take a look the course. See if you’d like to take it. I promise you. I promise you that will help. You know, whenever I look at taking a course and I look at the cost, I have learned to say to myself, how much would I pay to make this problem go away. How much would I pay to be able to solve this? And I’m actually paying for the imposter syndrome to go away sometimes.

And that puts it in a light for me. I can compare the cost to my motivation to solve the problem, make it go away. I do promise you that it will help if you are struggling with R ever since I have started this journey, I have had phenomenal success with R, I want other therapists to experience the same success, vanquish that imposter syndrome, help children, like the one I just described, that tragedy that happened with the military school enrollment. This is a problem that we can solve. And as speech therapists, we see a lot of problems that we can help with or mitigate not totally solve. This is one I see as totally treatable. So why not?

Dan: Thank you very much for listening today.

Again, the website to go check out is SLP pro-advisor dot com. The course name is Impossible R Made Possible, hoping to see you there. And if you have questions, there is a forum in there. Please go ahead. Choose [email protected]. And we’ll talk to you again soon with our next podcast.

Thank you for listening to The Mindful SLP. We hope you found some simple tools that will have optimal outcomes in your practice. This podcast is sponsored by SLP pro-advisor visit SLP pro-advisor dot com for more tools, including Impossible R Made Possible. Denise’s highly effective course for treating those troublesome Rs.

A link is in the show notes. If you enjoyed this podcast, please give us a five-star rating and tell your fellow SLPs. And please let us know what you think. Join the conversation at SLP pro-advisor dot com.