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Breakin’ the Law

4 Sep

Something that has been on my mind lately is following the rules.

As an undergrad when I was first introduced to testing protocol it was hammered into our heads, “DO WHAT THE MANUAL SAYS.” No extra prompting, no coloring outside the lines, just do what you are supposed to do or the test is invalidated and you suck.

And I’m okay with this, but only in the case of eligibility. You give a test to determine eligibility for services, then you want the results to be reliable and valid. So follow the rules.

However, tests have a lot of purposes. You can use a test to probe a specific area of concern, to screen, to compare to previous results. As an SLP I am certainly curious about my clients’ problem areas and I want them to qualify for skilled services. But I also want to know how they perform with prompts and cues. I want to alter protocols to explore my clients’ strengths and weaknesses. I want to make goals that truly suit their needs. And in these cases I say, go ahead and break the rules! (Do it, I dare you.)

The same goes for specific therapy techniques. There are a lot of programs out there that you must attend the workshop, obtain a certification, and follow the rules! This program won’t work unless you follow those rules! And you know what – some of these programs genuinely work, have excellent evidence backing them up, and are truly wonderful for our clients.

But by suggesting that “the rules” work for every single client is unrealistic. Our clients are individuals and between them, their needs are so different. I say take those rules and stick with the main basis and the main theory, but alter them as needed! I want my clients to experience success and I’ll change up things if I determine that it is appropriate to do so.

You’ll often hear “You aren’t doing X-program if you aren’t following the rules outlined by said program.” And to that I say, “So be it.” I don’t particularly care if I’m following the rules so long as I’m making therapy beneficial to my client. Obviously you should NOT run around saying you’re a provider of a specific kind of therapy or program if you haven’t actually been certified (that’s a quick way to get yourself sued), but if you have and you want to make some changes I think you should be able to. I understand and respect companies’ desire to charge money to certify and educate SLPs in their specific program, but I also think it is a little backwards that companies have resources and ideas that WORK that aren’t open sourced to all clinicians. We should all have equal access to important research and programs.

As CSD professionals we are lucky enough to have an incredible amount of resources at hand. Tests and tools and strategies that are becoming more and more evidence based. With the #slpeeps on Twitter we can discuss what we like and don’t like, and explore what really works. It is really wonderful. I think we should use each other’s skills, expertise, and ideas for adapting protocols even more than we do now, and really encourage the concept of open-source therapy. Share the adaptations that work, so we can all help our clients benefit!

NP: The Cure – Pictures of You


take a deep breath everyone

19 Oct

This post is about breathing. Not involuntary-subcortical-breathing. But taking a second to close your eyes and purposefully breathe. In your nose, out your mouth, fill up your lungs (inspiratory checking everyone!) and let it out like you’re blowing out candles on a birthday cake.

Last week I got a blog-hit from someone struggling with SLP grad school. Common sense tells us that graduate school is going to be hard. Duh. This semester has been my toughest (aside from the second block of my first summer when I had a nervous breakdown*). Everyone has high and low points and it isn’t just about grades. Really, the grades are the least of your troubles. Study. Go to class. Talk to your peers and professors. If you got into a Master’s program then you likely know how to get good grades so keep it up. When was the last time you failed? Like, FAILED? I got a 37% on a stats test sophomore year. That was my last F. You know how to be a student. Being a student isn’t the hard part. If being a student is suddenly hard you need to step back and think about how badly you really want to be in a Master’s program for speech-path. Where has your motivation gone? Is this what you really want?

The hard part is keeping your head above water. The hard part is getting up every morning and saying “I can do this” even when every fiber of your being feels like it can’t do this another day.

So let’s talk about how to keep your head above water.

1. Stay positive. I know this is corny and cliche but it is so true. I am a naturally dark type of person. I can get dragged down into the abyss of crankiness real quick. Use the fake-it-til-you-make-it mentality. Smile a lot. Call your grandma. Listen to happy music. Eat something legitimate at least once a week.

2. Get out of the clinic. Listen, I get to work everyday at 8 AM and this week I’ve been in the clinic until 9 PM every night. It has to happen. I’ve got a lot going on and I know you do too. But when you finally get out don’t just go home and get in bed. Go get a drink with the girls. Go watch a Disney movie. Buy a sandwich. Take a little time to do something outside of sleeping and clinic-ing.

3. Use your damn planner. I suppose if you aren’t very busy this doesn’t apply but if you don’t write what you’re doing down it is going to just float around in your brain and make you nutso. This week I’ve got data collection and analysis, meetings, a thousand emails to catch up on, planning for Pathways, ASHA-SOFAC paperwork, clinic, work, a workshop to attend, hearing screenings, class, homework, legislative committee conference call, THE WORLD SERIES WHICH I MUST WATCH —the list goes on. If I didn’t write this crap down I’d never know what was going on.

4. Talk. Talk to your friends. Talk to your professors. Talk to your family. Talk to your guinea pig. Doesn’t matter who you talk to but you’ll feel better after you do it. Everyone (but maybe your guinea pig) has confidence in you, has advice to dispense, and may be going through/have gone through what you’re going through right now. Take what they have to say and use it to your advantage.

* Finally I want to say that if you’re genuinely having trouble with mental health you need to see someone. When I say I had a nervous breakdown I am being completely honest. I’ve struggled with hereditary panic disorder for a very long time and I thought I could deal with it on my own but I couldn’t. Everyone has stress and everyone hits a low, but if you’re consistently in a dark place then please get help. Every school has counseling programs which are generally free to students and confidential. I went to mine and it was great.

Speaking from experience, if you’re scared of your own kitchen because there are knives in there, can’t take a shower because you’re scared of being near a razor, sleep all day (or don’t sleep at all), shake all day, cry all day – maybe it is time to give your doctor a call (my doctor’s office offered to come pick me up from my apartment at 7:30 in the morning). Give your mom a call. Call me. Call anyone. Call the National Suicide Prevention Lifeline – 1-800-273-8255.

There is so much help out there and so much support. Graduate school is scary and tough but it isn’t worth your life – we need you to stick around so you can change lives and help people communicate!

NP: Ingrid Michaelson – Keep Breathing