Becoming a Speech Therapist

The Why and the How

Why do I want to be a speech therapist?

“Vivid in my memories are the days when my younger brother with autism was nonverbal and every interaction was a yelling match. Because my family didn’t understand him or know how to help him understand us, every decision was made for him, sometimes forcibly. Over time, I witnessed how speech therapy helped my brother’s language grow, which helped our family eliminate many of the frustrations we faced with communicating with each other. However, I also witnessed how being restricted to only learning English prevented my brother from communicating with our grandmothers and left him out of family conversations, something that saddens my mother to this day. My brother’s gains from becoming verbal and his losses from becoming monolingual are what inspire me to be a speech language pathologist (SLP): I want to be an SLP to help individuals like my brother be active participants in all their communities — to find their voice while staying connected to their cultural identities.”

That was my introduction for my personal statements, but it’s not quite the truth.

How I actually realized I wanted to be a speech therapist:

You’re a freshman in high school, and you’re sitting on a too-small plastic chair to supervise your autistic brother in his speech therapy session. This is the first time you’ve sat in on a session. You really don’t know why your brother is seeing a speech therapist: he’s never had trouble pronouncing words.
In front of you you’re watching a speech therapist work with your brother on having a conversation. “How was your weekend?”, she asks him.
He’s looking past her, repeating a string of non-meaningful sounds to himself. “[jau ə jau] I’m fine.” he replies.
The speech therapist scrunches her face. She calls his name. “Look at my face.” Your brother doesn’t look. The therapist tries calling his name again. “I’m confused. What are you supposed to say when someone looks confused?”
It’s very intriguing for you to watch the therapist try to teach your brother social skills most people don’t need to be taught. You wonder how you would teach someone those skills. “This would a be fun puzzle to solve!” you think.

You’re a sophomore in college, and you’re sitting in the front row of your brain disorders lecture. Today’s topic is aphasia, brain damage that affects language. The professor explains that there are two types of aphasia: speech aphasia and language aphasia. “Isn’t speech and language the same?” the students wonder.
The professor reads our minds. Or more likely, he’s all too familiar with this misconception. “Contrary to popular belief,” he explains, “speech and language are NOT the same. Speech refers to the production, moving our mouths to talk. In contrast, language refers to comprehension of that speech, understanding what people say.”
Suddenly, you remember that day you supervised your brother’s speech therapy session. You gasp as a light bulb goes off: “Oh my god! He went to speech therapy to work on language!”

You remember the puzzle the speech therapist was trying to solve: How do I help this boy read my facial expression? How do I help this individual know what I know? How do I get them to see what I see?

You have a puzzle you want to solve too: How come my brother doesn’t know how to read facial expressions? Why doesn’t the individual know what I know? How can I see what they see, so I can help them see what I see?

On that day, I knew that was the question I wanted to answer. On that day, I knew I wanted to be a speech therapist.

What do you see yourself doing in 5 years?

If I’m at a school…
It’s 2020, and schools have gone online because of a dangerous pandemic. An 11-year old immigrant Chinese boy is sobbing because his teacher called and told him and his parents he was failing all his subjects at school. “I want to die!” he cries to his teacher.
His teacher, extremely alarmed, tells his parents. “I don’t even care about his missing work. Right now, we need to make sure he’s okay.”
I know the boy and his family: I worked on English with him a couple years ago. At the time, he could only read letters, and he refused to even try writing. “He’s just very self conscious”, some would say. “He won’t try unless he can give the right answer.”
“He’s just lazy”, others would say. “He refuses to read books and never practices his spelling.”
His parents ask me to help him, and I tell them I’d like to watch him in a zoom class. I watch him stare at a word problem… for 20 minutes.
“Do you want to message the teacher for help?” I ask him.
“I don’t know how to write.” he says.

It’s 2022, and I’m observing a speech therapy session at a middle school for observation hours. At that moment, the speech therapist was working with a Hispanic middle school girl. “Would you like to work on your homework?” the speech therapist asks.
The girl takes out some blank binder paper and some printed worksheets with the title “Japan”. “I’m supposed to write a paragraph about this.” she says.
I watch the speech therapist work with her to read the passages about Japan. The girl struggles with every other word. “In…age.” she stammers.
“Ancient”, the therapist corrects.
“In ancient… Japan?”, the girl guesses, unsure of herself.
The speech therapist nods. Several minutes go by before the first sentence is decoded: In ancient Japan, there were many kinds of craftsmen. After an herculean effort with the first sentence. the speech therapist reads the rest of the paragraph. “What was the main idea of this passage?”, she asks.
“I don’t know,” replies the girl.

I come home that day very inspired by the work I saw at the middle school: I’d love to help kids learn the literacy skills they need for academic success. I’m talking about what I saw in speech therapy with my father when my mother interrupts our conversation: The high school tutor the immigrant Chinese boy was supposed to work with said they were quitting: they just couldn’t help someone who couldn’t read and write. A sinking feeling hits me: It’s been 2 years since the boy had failed his classes. By now, it should have been obvious to the school he needed academic support. Why hadn’t he gotten speech therapy?

It’s not unusual for English second-language (L2) learners to be delayed in getting much needed speech-language services. In the beginning, it’s not clear to clinicians and educators whether the inability to speak, read, or write is due to a lack of English knowledge, or an underlying speech-language disorder.

The now 13-year old immigrant Chinese boy still can’t read and write at the 3rd grade level. There’s no denying that he has some sort of learning, likely literacy, disability. But because everyone thought he was just an L2 learner who needed time to catch up, he missed out on years of academic support, which led to him falling extremely behind, just as he’s about to start high school. He shuts down when anyone tries to talk about school with him; it’s going to be much harder to help him now, especially since he’s STILL not getting academic support.

Did you know that many prisoners have a speech-language disability? Did you know kids will misbehave or not pay attention in class if they have trouble hearing? In addition to external stressors like poverty and racism, a kid may act like a troublemaker because they can’t speak or understand speech as well as they need to. Did you know that kids who struggled with language don’t usually outgrow their disability? If anything, their struggles then get misdiagnosed as a learning disability. Even if a language-disabled student succeeds in learning to speak, read, and write, they usually find themselves struggling when homework shifts from paragraphs to pages of text. Unfortunately, most teachers don’t know this either. I want to make sure no child slips through the crack like that immigrant Chinese boy did. I want teachers to reconsider any assumptions they have about students who are failing: they’re just self-conscious, lazy, going to be behind because English isn’t their first language. If in 5 years I find myself at a school setting, I will make it my goal to ensure speech-language disorders are correctly identified in every student so that every one of them gets the support they deserve.

If I’m at a hospital…
On average, it takes at least 1000 repetitions for a person to experience some lasting improvement, NOT full recovery, but in the movement of a single muscle. In therapy, there is enough time for about 30 repetitions per 30-minute session. Let’s suppose someone is lucky enough to get 2 sessions every day: That’s still less than 500 repetitions, under half of what is needed for SOME change. In addition to time constraints, the healthcare system only continues services for people who pass certain tests. The problem is, they’re measuring people’s ability to perform functional tasks, such as being able to pronounce the “sh” sound, while dismissing subtle changes like greater range of motion in the tongue that might be necessary to eventually make the “sh” sound. As a consequence, patients are frequently dismissed from therapy too early. I’d love to work in the hospital setting and help people learn or relearn to speak. But because of limitations in time and how progress is measured, I plan to ensure folks have the support system and intrinsic motivation they’ll need to make progress on speech and language skills on their own.

I am extremely certain I do not want to run or participate in private practice, but given my disdain for prescriptive ways of doing things, I have a feeling that if I want to develop a forward-thinking practice that’s not measured by antiquated measures of success and service, and not at the mercy of insurance, I will need to be my own practitioner.

Additionally, while I think it’s important for students to get 1-on-1 support, I also want these kids, who often feel other-ed for having a disability or difference, to realize there’s others like them, and find community and support with one another.

In my ideal scenario, I’d…

This is the section I will probably not include in any proposals or scholarship essays. I intend to do good and the best I can for the people I work with, but I am also an artist, not scientist first. I love proven interventions, but I also want to push the field, and that requires experimentation and individualization that I think science is too slow for.

In my ideal scenario, I would be working in a hospital and/or school and being great at what I do, but on the side I would provide affordable services for those without insurance or for those looking for another option that’s much cheaper with the agreement that I have full creative license to try out new ideas with no promise they will work (only not harm). For example:

• deictic pronouns: On Lunar New Years, my family wanted to eat out for dinner, but my brother had a lot of classes to attend. My mom asked, “Do you want to come to dinner with us, or would you like us to bring you food?” My brother replied, “Bring YOU food.”
  “Bring ME food”, my mother corrected on his behalf.
  This mixing up of “me/you” is a frequent occurrence among many autistic individuals. During therapy with a child who struggles with first-person and second-person pronouns, I want to experiment with physical cues, like higher pitch for the child’s voice to possibly encourage embodiment of self versus other, or body gestures that accentuate what makes something “this/here” versus “that/there”.
• voice-to-IPA transcription tool: I would like to develop a mobile speech-to-text app that converts utterances into a phonetic or phonemic representation of those utterances. At the very least, I would like to figure out the specs and guidelines to make sure this is a device that would be as beneficial to speech therapists (and maybe linguists) as possible. I have many reasons to believe that once the ground rules are set and good data is collected, the program should be easy to build.
• AR/VR as engaging stroke recovery regimen: You may or may not have heard of mirror box therapy: For most bodies, there is a left side and right side that look almost identical but flipped. We can use a mirror to create an illusion that convinces us a “bad” body part looks like a “good” body part. Imagine if instead of using a mirror box, which might not work if the body is affected on all sides, we used an avatar that showed us a potential self. A combination of tactile and visual illusions, and we could potentially encourage brain-body connections that can create a positive loop of more connections -> more body control -> more connections…
• integration of passion and therapy: When I was in 7th grade, I wanted to be a middle school math teacher. When we were learning about ratios, I fantasized about having kids scale a drawing to paint a mural to practice the concept and do something cool. It’s really important for me that people I work with, especially students who may feel different for being pulled out of class, get to feel like speech therapy is this cool time where they get to do something they’re passionate about or would be excited to explore, and just happen to be improving their speech or language too.
  One scenario I imagine is I have a kid, or group of kids, who are into basketball. Based on everyone’s abilities, we would work together to determine the rules for some variation of the Horse game to practice their speech or language skills in a way that engages them.
• numerical literacy: Speaking of math, I’m a bit uncomfortable with the number of speech therapists who joke about being bad at math and science.
  Did you know that elementary school teachers that have anxiety with math pass on their anxiety to their students? There’s an even more profound affect on math anxiety between female teachers and their female students, and the majority of SLPs are female.
  Did you know that the math gap can be attributed to the number of spatial and math words a child hears in their first 3 years? Being exposed to words like “less than, greater than, area, volume, one third” etc. give those kids an advantage when they begin learning those math concepts in school. Speech therapists play such a huge role in early language development; I want to be a part of solution for numerical literacy, especially in our under-served communities, and encourage other SLPs to do the same.
• more movement and collaboration: Humans were not made to sit down for hours, and I don’t think therapy should (always) be done by sitting still. I’m inspired by Annie Murphy Paul’s book “The Extended Mind” to integrate body movement and incorporate collaboration (play) to help people embody speech-language skills and knowledge.
• changing how progress is measured and success is defined: Maybe eye contact isn’t the most important goal. Maybe hidden changes to brain activity, greater physical range that don’t affect a person’s independence but are still measurable differences should be included in the calculation for whether someone has improved. Even better if the client takes the leads on what they want to accomplish!

And beyond: Dismantling the System

I’m very worried for the future of public services in America: our healthcare systems and education systems, two systems that intersect with the speech therapy profession, are being cannibalized. Whether it’s the reduction of funds, mismanagement of funds, or high turnover and burnout rate in professionals in each industry, it’s clear various factors are leading to worsening but evermore needed services. I haven’t had time to do too much research, but I would like to work towards the following systematic changes:

• Affordable if not free continuing education units (CEUs): As of 2022, the initial certification fee is around $500, the annual certification renewal fee is around $200, and the separate member fee is an additional $25. On top of this, SLPs are required to produce an average of 10 CEUs a year. From a quick skim, it looks like 1 CEU will cost a professional about $100 — about $1000 a year. This is a lot of money for practitioners who may be making only $35k a year while the livable minimum wage is no lower than about $30k. Since there is now a catalog of courses which are prerecorded videos, there is no reason why these materials should not have already been covered by the cost of ASHA’s dues. I want to push for a system in which their current membership fees (~$25) should include access to that catalog, and maybe a $200 credit towards other continuing education courses.
• We need more professionals, and more professionals to stay: It goes without saying that everyone would be better off if patients and clinicians could have more time together; if there could be smaller class sizes and everyone had access to the support they needed to thrive. People who work in education and healthcare will always tell you:

1. We are working with too many people, and don’t have enough time to give them the support they need.
2. Because people are being asked to work with too many people in too little time, they burn out. They leave the field entirely.
3. Even without the attrition, there would still not be enough qualified people to do the work because we can’t train people fast enough.
4. Because there’s no incentive to work as an trainer because it doesn’t pay as well, we can’t admit as many qualified students to become professionals as we’d like because we don’t have enough people who want to teach.

• For this reason, not only do we need more qualified professionals, more people to train future professionals, we also need more hiring of said professionals if we are to improve the retention rate and quality of service. This might mean forming a union, scaling up training programs with improved technology and pedagogy, and replacing ASHA board members with people who will fight for better working conditions for SLPs.

I generally prefer to work within the system, but I’m not opposed to breaking off from the iron grip that is the monopoly ASHA. Who knows, maybe if an SLP’s ability to work was not solely dependent on the approval/need for ASHA, we could have a field that is more creative and innovative, and thus better serve our clients.

To Summarize:

If I had a life motto, it would probably be “One thousand little things will make the biggest difference.” I want to make little tweaks here in there in every aspect of speech therapy to revolutionize the field and make a meaningful impact in people’s lives, to help every person express themselves and connect with the world.