In speech pathology there is frequently “non-compliance” with what the therapist recommends. Patients report back to the SLP that they can’t find a way to integrate the information they have been given into their daily lives easily, so the guidance falls away, and after a while, the person goes back to speaking the way they did before. Two famous people who had vocal intervention that did not stick are Rachel Ray and Bill Clinton. Right back to their old speech ways, it seems to me.
Why would compliance be so hard, when having vocal problems is so debilitating? Wouldn’t people who were motivated to seek out help be very eager to follow the suggestions they were given by the experts they have consulted?
Well, maybe, just maybe, the fault lies not with the patient but with the therapy.
I heard tonight yet again at a hospital presentation about the use of “diaphragmatic” breath support and “resonating the cavities of the head” by two different Speech Language Pathologists. In both cases, the patients had problems that did not go away and in at least one case, the person was looking to shift her job to something else in order to prevent herself from getting worse. She had a history of vocal problems.
What if the therapy worked with words that the patient did not have to “interpret” at all. How about not using the word resonance in relationship to voice use except when it is necessary (as in an unamplified operatic performarnce). Resonance therapy (bone conduction, placement of tone, etc.) is a very validated, very common approach to vocal production, and it is taught to many people as the standard of clinical care. But what, I ask, does “vocal resonance” mean to the average person? Is it something they can see? How do they know if they have it, when all sound carries some kind of resonance, (or we couldn’t hear it)? Why is one kind of sound “special” and how do you get it to show up all the time after just four or five sessions if you have been speaking or singing a certain way for decades? The answer is, of course, you do not. But for this, you get blamed, just like in singing. Does no one ever think to evaluate the language of clinical care and its usefulness to the lay person who has no idea of what the jargon means?
Further, does anyone really watch the therapy with the idea that maybe the idea of the therapy is good but the transferance of the information to the patient is lousy. Happens every day.
Maybe I understand how to bake a chocolate cake. Maybe I know several ways to make one. Maybe you would like to learn how to bake a chocolate cake that tastes good and that you don’t over cook, so you come to me because you were told I am a good baker and know what I’m doing. Maybe I learned to bake this cake studying with a very famous TV chef, who taught me step by step how to do it. Maybe I tweaked the recipe she gave me and now I have my own. But maybe, also, I talk in circles. Maybe I contradict myself. Maybe I wander in my instruction and don’t bother to ask you if you understand me or can remember to do any of the things I have asked you to do. There are a thousand maybes.
If you give people what they want, they will come back. If you satisfy their needs, they will recommend others. If you put them back into the driver’s seat of their own lives they will praise you for a long time. If you fail them, they will be reluctant to return to you, lest you be disappointed and lest you chastise them. Rather than put themselves through that kind of experience, they don’t go back.
“Resonance” Therapy is as meaningful or meaningless as the person using it. The words used to explain it may or may not make a difference to someone with a speaking voice issue. It has little to do with the patient and a lot to do with the therapist.