Teletherapy: The top 3 benefits of Online Therapy

By Speech and Language Therapist, Catherine Clancy

Magic Words Therapy has recently collaborated with specialist, bespoke online speech therapy software, designed by tech experts and speech therapists to start offering the option of online therapy sessions with the aim of making our therapy services more accessible to more people.

Our use of Online Therapy has provided convenience and flexibility for families we already see for therapy. For example, some families who live further away from our clinic have now chosen to receive some or all of their therapy sessions via teletherapy, from the comfort of their own living rooms. Teletherapy completely cuts out the time they used to spend travelling and sitting in traffic, giving them more time in their week to spend together.

During online sessions, we can provide therapy in real-time to support communication targets via this motivating and versatile platform, so that clients can access our high-quality therapy in a way that works around busy lifestyles.  

We have found that the idea of Online Therapy can initially seem quite daunting for some clients, particularly to those who are a bit technology-phobic! However, having recently started delivering online therapy myself I’m excited to have branched out into this new and innovative field. Using teletherapy is actually pretty straight forward for both the therapist and the client. I was pleasantly surprised by how easy it was compared to my expectations.

I have been impressed by how teletherapy has supported children’s progress and positively influenced my delivery of therapy. Below are my top 3 benefits of using online speech and language therapy:

1.  Greater Flexibility: Teletherapy has allowed me to work flexibly around the busy lifestyles of the families I support. A parent decided to make the switch to teletherapy as it gave her family the ability to integrate regular sessions within a busy weekly routine, where commuting to clinic for therapy sessions would not have been realistic. 

2.     A Motivating and Versatile Platform: I have found that children love working with me via teletherapy sessions as they are really motivated to use technology they love like laptops and tablets. Online Therapy contains fun and engaging online resources that make it very enticing for children to join in with the activities. As a therapist I love that we can upload our own personalised resources onto the platform as well as being able to use apps from Virtual Speech Centre. Virtual Speech Centre is a well-renowned speech and language therapy app developer. https://www.virtualspeechcenter.com/

3.     Better Use of Home Resources: Teletherapy is an online service where families and clients link in from home whilst the therapist is usually in an office environment. Because clients don’t have access to clinic resources, the therapist has to work innovatively to use online therapy resources and toys within the child’s everyday environment. This often means therapy is more functional as families are supported to use activities, resources and toys that are easily accessible. This supports the carryover of therapy and overall progress with targets. 

In addition to my top 3 benefits of teletherapy, I think it’s really important to mention that the use of Teletherapy has also helped Magic Words Therapy and the families we support to reduce our collective impact on climate change. Online therapy sessions have resulted in less air-polluting car use for both therapists and families and a greater emphasis on online resources that don’t require printing which uses lots of paper and ink. 

Despite its undeniable benefits there are of course some limitations to Teletherapy. This way of accessing therapy can work well for most clients, but not all. For some clients, face-to-face sessions are essential in order to support their engagement in therapy and overall outcomes. If you would like to discuss teletherapy as an option for your child I would highly recommend speaking to one of our therapists about this. They will be able to get to know your child and identify whether teletherapy would work for them and their unique needs.

Meet Our Cambridge Clinic Team

By speech and language therapist Bethany Potter

My name’s Beth and I’m one of the Magic Words therapists based at our new Cambridge clinic within Chestnuts Nursery.  

My first experience of speech and language therapy was not as a therapist but as a child with speech sound difficulties. I was struggling to say sounds in words like ‘cat’…especially difficult when your favourite film is the Aristocats!

I remember not wanting to go to therapy sessions because I would have to just sit and say the sounds I found really difficult; it felt like failing and was no fun at all. Now when planning sessions as a therapist, this memory is what drives me to create fun, interactive sessions where children don’t even realise it’s therapy!

Before studying to become a speech and language therapist I studied English Language and Linguistics. I developed an in depth understanding of child language acquisition and phonetics; this increased my interest in the world of speech and language therapy. Following this, I worked as a teaching assistant supporting children with a range of needs such as deafness and hearing impairment, ADHD, and dyslexia. I had always had an interest in speech and language therapy, but it was my role as a teaching assistant that really sparked my passion and I decided to go back to studying and start my career.  

The field of speech and language is so diverse and broad. I love working with all types of speech, language and communication difficulties. I have a particular love for working with early years, speech sound difficulties, language delay and hearing impairment. I’m sure this will only continue to grow throughout my career!  

Outside of my working day as a speech therapist, I enjoy yoga, running and exploring the world! My most recent trip was to Peru including the Inca Trail to Machu Picchu, a home stay on Lake Titicaca and a visit to the Amazon!

Stammering is Universal – Part 2

By specialist Speech and Language therapist Frankie Paterson

Remember Beatrice and Ugandan speech therapist Duncan Musasizi? When Beatrice and her guardian came along for a second therapy session it was great to hear that Bea’s fluency had improved significantly in the week since the last session.

It’s a joy to watch Duncan in action as a therapist. He has such a warm and engaging therapeutic manner with children. His face, as you can see in the photo, is incredibly expressive and animated, this is a great quality to have as children are drawn to animated faces and they are most likely to join in play activities if they can see that the therapist is excited about the activity.

Duncan makes impressive use of a limited array of therapy resources. There are no big cupboards full of toys here, so this is essential. He has a set of colourful building blocks that he shows great ingenuity at using in lots of different ways. He used them in a fluency shaping technique aimed at helping Beatrice reduce the rate of her speech by saying a word each time she put a new block onto a tower.

At our last session Duncan had demonstrated a very simple activity aimed at slowing Beatrice down; her speech and everything else. Bea is inclined to want to get everything done in a rush, speaking and moving very quickly, always worrying about being late.

Duncan got Beatrice up and moving for this, a signature feature of his therapy style. They took steps along the tiled floor, stepping from tile to tile with a pause in between each step. As they’re taking steps they count from one to ten, saying a number per step. The first time Bea tried this she was characteristically rushing, taking much quicker steps than Duncan and seeming to be so intent on doing this perfectly she was hardly pausing to breathe. Over the session he managed to get her to slow right down to his slow pace of walking and counting and to copy his relaxed walking style.

Beatrice’s guardian reported that her fluency had improved significantly since our previous session. She had told the people at Beatrice’s Sunday school that they must let her talk and always let her finish what she is trying to say. She ordered the local children Bea plays with to be kind to her, to always let her talk at her own pace and never to laugh at her. I have a strong suspicion these people will do what she asks; I would certainly not mess with this woman! I was very struck by how fiercely protective of Beatrice this lady is. A real force of nature. I felt happy for Beatrice that after her difficult start in life she now has this kind and strong woman to look after her.

www.yellowhouseoutreach.org/

Stammering is universal

By specialist Speech and Language Therapist Frankie Paterson

It is my pleasure to introduce you to speech and language therapist Duncan Musasizi and his client Beatrice (to protect her identity I’m not using her real name). Duncan is an outstanding Ugandan speech and language therapist who I worked alongside at Yellow House Health and Outreach Services in Kenya earlier this month.

Beatrice was accompanied to the clinic by her new guardian, a friend of her Grandma who had died only a few weeks before. Beatrice’s Grandma had been her sole carer and she had entrusted this kind lady to be her new guardian once she passed.

Beatrice came across as a highly conscientious little girl with a propensity to want to do everything perfectly. She and her guardian arrived super early for the assessment as Beatrice had been insistent that they must not be late as she wanted to get back to school ASAP!
Her guardian described Beatrice a worrier and prone to always doing things at high speed. We have not used Beatrice’s real identity because, although her guardian was keen for Beatrice’s story to be told, she was wary of condemnation from people in their community who see having a stammer as being a curse from God. In parts of Kenyan society all forms of disability are seen as a huge weakness, the effect of curses or witchcraft. Parents of children with disabilities can have an incredibly hard time. They often feel they have no option, once their child’s disability becomes more obvious, but to keep them locked away indoors, away from potential judgement and rejection. These children often stop going to school and are socially isolated, exactly the opposite of what children with communication disabilities need.

Beatrice is lucky to have a guardian who is bravely ignoring the judgement of their community and doing her best to get them to accept her. Beatrice will be coming for weekly therapy with Duncan and I supported him to devise a treatment plan. Beatrice is aware of her stammer but is still so very little and has a lot of adjustment to make to her new life. Duncan is keeping it very simple, starting off with a few practical activities aimed at slowing Beatrice down. Not just her rate of speech but everything else as well. We gave her guardian advice on slowing down her own speech and holding herself back from giving Beatrice advice on how to talk, like that old chestnut ‘take a breath and start again’. We asked her just to focus on letting Beatrice talk and listening to the meaning of what she’s saying, instead of focusing on any moments of stammering.

Working with people who stammer in a very different culture has been hugely beneficial to my understanding of stammering as a universal human phenomenon. People who stammer across cultures may have daily struggles that differ somewhat but fundamentally the nature of the adversity they face is the same everywhere.

All over the world, what people who stammer need is for non-stammerers to have more awareness about what stammering really is. That having a stammer does not make someone weak, stupid or cursed or even that different to anyone else. That having a stammer is never a defining characteristic and that people who stammer need to be shown the same respect as any other person. People need to know what to do when talking to someone who stammers. Mainly: you don’t need to do anything special, just let them talk, in their own way and in their own time. People who stammer just want you to listen to them with the same respect that you would pay to any other person.

Eco Team at Magic Words Therapy

We'd like to introduce you to Susan Woodley, our new Eco Rep. Sue is one of our speech and language therapists and like the rest of us here at Magic Words Therapy she cares greatly about our planet and preserving our natural environment.

Sue is going to be spearheading Magic Words Therapy's campaign to make our organisation as eco-friendly as we can possibly be by making changes big and small. We want to reduce our waste, reduce our carbon emissions and possibly even plant a Magic Words Therapy garden. Watch this space!

Stammering and the Iceberg Beast

By Specialist Speech and Language Therapist Frankie Paterson

I was interested to learn about a proposed new way of thinking about aspects of stammering as a ‘beast’ that can be strengthened or weakened. Dr Rick Arenas thinks of a stammer as an ‘Iceberg Beast’ that can be slain. Rick, associate professor at the University of New Mexico, researches developmental stammering and is himself a person who stammers.

The idea of the Iceberg Beast originates from the iceberg analogy that’s been used to describe stammers since 1970 (J Sheenan).

The top of the iceberg, that’s visible above the water’s surface, represents stammering behaviours such as repetitions of sounds, words or syllables. This is the part of a stammer that is visible for others to see. The part of the iceberg that is submerged under the water is vastly bigger than top part. This underwater part represents the underlying aspects of a person’s stammer that tend to be invisible to others. These include anxiety about speaking, avoidance of speaking or of situations, emotions about speaking and stammering and beliefs about yourself and your place in the world as a result of the stammer.

Although Dr Arenas thinks this iceberg analogy is effective in portraying what being a person who stammers is really like, he has built on this iceberg idea using his own experiences as someone with a stammer and experiences that other people with stammers have shared with him. Dr Arenas has observed that for a person who stammers, the unseen part of the iceberg can be like a living entity that has the power to hold them back from living their life as they’d like to, and that it can grow, shrink and change over time. He has come to identify these undelying parts of his stammer as the Iceberg Beast, that can feed on certain types of things that give it fuel to grow and get stronger. At the same time, there are things that he can do that he knows will weaken and shrink his Iceberg Beast.

Rick explains “the beast is a cohesive collection of beliefs about stuttering that we allow to negatively impact how we live our lives”. Rick believes that as a person who stammers there are specific choices you can make that will make your iceberg beast either grow or get smaller. These choices are not ones you are stuck with and are destined to make forever. You can decide to make different choices.

What types of things allow the beast to grow?

· Not talking about your stammer with others or being open about it.

· Avoidance. Of words, situations, thoughts or truths about yourself and your stammer.

· Not accepting that you have a stammer.

· Being in denial about the stammer as being something that affects you or how much it affects you.

Rick believes that negative thoughts and feelings about stammering that are harboured for a long time and not talked about openly can ultimately transform into core negative beliefs about yourself and your stammer that your iceberg beast loves to feed upon, helping it to grow. For example, believing that you will always be too slow to get your words out, that people will always get impatient and bored when you try to talk or that you are weak or faulty because of your stammer.

Weapons Against the Beast

Rick lists ‘weapons’ that people who stammer can use to weaken and shrink the iceberg beast and so reduce the control that the stammer has over them:

· Daring to be open and vulnerable about your stammer.

· Allowing yourself to stammer openly and freely.

· Being honest with yourself about the impact the stammer has had on the way you’ve chosen to live your life.

· Self-Acceptance. Accepting all parts of your identity, including that you are a person who stammers.

· Authenticity with yourself and others.

· Talking openly with others about your stammer and thoughts, feelings and beliefs surrounding it.

Dr Rick suggests that useful questions to ask yourself are:

· What would you ideally be doing in your life that you currently are not doing because of the stammer?

· What do you avoid because of the stammer?

· In what ways is this actually impacting on how you live your life?

Dr Arenas believes that real lasting change comes from an exploration of your attitudes and beliefs about the stammer as opposed to focusing on the stammering behaviours themselves. He emphasises the fact that it is your beliefs and reactions to your stutter rather than the stuttering behaviours themselves that negatively affect your life. This echoes an idea from the stoic philosopher Epictetus that I have personally found invaluable in my own quest to change negative thoughts and the beliefs that underlie them. Epictetus stated that “Men are disturbed not by things, but by the views which they take of them.” To bring this back to stammering, it could be said that the act of repeating words is not the cause of your pain as a person who stammers, the root cause of pain are the negative beliefs you hold , e.g. that stammering somehow makes you a lesser person or that other people seeing you stammer will make them dislike you or think you are weak.

Being brave enough to be vulnerable

The qualitative research professor Bréne Brown pioneered the idea of vulnerability being a powerful act that can be immensely healing and galvanising in her viral TED TALK . So what’s vulnerability all about for people who stammer?

· Daring to be truthful with yourself and others about your stammer.

· Being brave enough to show things to others you’d really rather hide from them because you are ashamed, namely openly stammering.

· Daring to really look inward at yourself and to share those observations with others.

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Unicorn or Beast?

I think this idea of imagining the internalised part of a stammer as a fluid entity that can increase or decrease in power depending on choices within your control could be incredibly liberating for many people who stammer. Giving limiting core beliefs an identity, so that you can put them under the microscope can be an empowering and healing exercise.

This is very much in the spirit of an exploratory assessment I often use where the client is asked to draw their stammer. The results are of course unique to each person and can be hugely valuable in understanding a client’s relationship with their stammer.

I think it’s important to recognise that each person’s core beliefs about their own stammering will be unique to them and so the identity they give them will be unique as well. For one person their internal stammer might well be visualised as a beast to be slain. But someone else might see theirs quite differently, for example as a majestic but troubled and misunderstood unicorn, to be tamed and calmed! Warlike imagery of using weapons to destroy a beast could be negative and unhelpful for some people who stammer. I wonder if for some people, attaching a more neutral image to their stammer could be somehow helpful in reducing the negative hold it might have over their lives.

If you want to hear more from Dr Arenas he is interviewed about his Iceberg Beast theory on the excellent podcast Stutter Talk.

What have Cleopatra and children with listening difficulties got in common?

by Wai Seng Thong (Speech and Language Therapist)

Attention and listening – the foundation of communication

When I think about communication, I always imagine the Egyptian pyramids which, like communication skills, need to be built on a solid foundation. Also, both the pyramids and communication are really amazing things! For communication skills to develop, the solid foundation you need is attention and listening skills and just like those builders of old, if you are not listening or paying attention things can go awry (Check out the pyramid of Sneferu, it went awry big style!)

What are attention and listening skills all about?

‘Attention and listening skills’, is a concept that we as speech and language therapists talk about regularly. So I decided for this blog, I will talk about this foundation of the communication pyramid (and no you don’t need to be Cleopatra to make sense of it!) 

Often I hear parents and teachers use commands such as ‘Sit down!’, ‘Stop!’, ‘No!’, ‘Don’t do that!’ when children are not listening and running around like headless chickens. This can be during meal times at home or even in the classroom during reading lessons. We all know how daunting it can be when children don’t listen. This can be so stressful for parents and teachers. It can even cause emotional tensions within families. Well let me tell you this, if you struggle with children who don’t listen; you are not alone.

Does my child have problems with attention and listening?

Have a think about these questions:

·         Can your child sit still?

·         Can they keep their hands still e.g. without fiddling?

·         Does your child look at the teacher or at you when you are talking?

·         Can they concentrate when there is a lot of background noise like TV or music?

·         Can they repeat an instruction back to you?

·         Can they sound out words?

·         Can they remember long words?

·         Do they seem not settle with one activity, but tend to flit from task to task or toy to toy?

·         Does it often look like they are tuning out?

If you have answered ‘yes’ to any of the questions above, your child may have difficulties with their attention and listening skills.

You may be wondering why are these skills so vital? Or do we really need this skill nowadays as humans? To answer these questions lets go back to the desert in Egypt. Imagine the builder wasn’t paying attention or listening and cut the first stone for the foundations of the pyramid to the wrong size. This would obviously be disastrous. Difficulties with attention and listening can have an impact on all areas of learning; if a child is not able to listen and pay attention, they will find it difficult to process and then utilise important information in lessons when it is given to them. And then success in their classroom learning will be very hard to achieve.

How to assess?

Based on Reynell’s research there are six levels of typical development of attention and listening, these levels may be used to assess and understand the child’s development of attention and listening skills in relation to the developmental norms. Remember; there is a huge variation on what is considered ‘normal’ and I would urge people to question whether the term ‘normal’ is really fair or useful anyway? Levels like these are useful for the most part as they help us to see a sequence of levels of attention and listening development. For example, if a child is at a particular level, these levels help us by telling us what that child needs to be able to do next, to push on forward with their skill development and to reach the next level. These levels are:

Level 1 (typically birth to 1 year): Child’s attention is fleeting, shifting from one object, person, or event to another. The child will get distracted immediately by any new event such as someone walking by.

Level 2 (typically 1 – 2 years): Single channelled attention and the child can concentrate on a concrete task of their own choosing, however, will not tolerate any verbal or visual intervention from an adult.

Level 3 (typically 2 – 3 years): Child’s attention is still single channelled, but the child is not able to shift their attention away from the current task and then go back to the original activity with adult support.

Level 4 (typically 3 – 4 years): The child can alternate his/her full attention (both visual and auditory) between the adult and the task and now does this spontaneously without adult support.

Level 5 (typically 4 – 5 years): Double channelled attention. The child understands verbal instructions related to the task without interrupting the activity to look at the adult. Concentration span can still be short; however, they can cope with group situations.

Level 6 (typically 5 – 6 years): The child’s attention is well established and sustained.

How to support?

Due to the huge importance of attention and listening skills, I am often asked by both parents and teachers about how they can support children to become better at paying attention or listening to them. So I tell them this true story:

One day a good friend of mine shared her super-secret mouth-watering ‘Honey Mustard Chicken’ recipe, something I had tried for years to get to her to share. She really quickly told me all the ingredients, how to cook and prepare the chicken. Once I got home and tried to cook it, I found I had completely forgotten some of the ingredients and was hazy on the method, leading to a somewhat disappointing chicken dinner. However, when I went back grovelling again for the recipe, she told me the recipe step by step with great instructions and even with pictures and videos of her making it (such a kind friend she is). Then I went home and made the dish, following her instructions and step by step guide and as you can imagine it was YUM.

What would you rather do? Attempt to remember a long stream of complex instructions or remember a simple step by step set of instructions, with pictures? You are probably like me and would opt for the second method. Well it’s the same for children following adult instructions as it is for us as adults who are given a recipe or a set of directions to get to a place; too much information and no structure or visual support and we can all fail.

Now I am not saying this is easy. I do realise it’s hard to find ways to keep children focused especially in this busy and fast-paced Netflix and iPad era we now live in. So below I have shared with you my nine easy tips to support your child’s attention and listening skills:

1.       Always call your child’s name to gain attention. Like in a football match a player will call their teammate’s name when they want to pass the ball and get their attention.  

2.       Make sure you get your child’s eye contact before pointing to something, giving an instruction or asking a question as this not only shows them the good behaviour of eye contact but also helps to keep them focused.

3.       We sometimes forget children are smaller than us, so crouch down and get down on your child’s eye level to make sure they can focus on you.

4.       No one can focus on anything for too long. We as adults have our limits as well. We all need breaks from having to concentrate. So break times are important! This needs to be negotiated breaks with the child, for example giving 5 minutes’ free time once they have achieved a certain amount or focused on reading a book with you.

5.       Praise! Everyone loves praise so give specific and positive feedback to the child about their listening skills with phrases such as ‘Thank you for looking at me’, ‘Well done for waiting your turn.’  Sticker rewards are an amazing and cheap incentive to help children to be motivated for good listening. I have been reliably told smiley face stickers are their favourite (so a group of my preschool children told me!).

6.       In this manic world of noise and distraction try and create a quiet environment by reducing background noise such as TV before trying to get your child to listen to you.

7.       If a child looks confused or you’re not sure they understood what you have said to them, encourage ‘active listening’ by asking if they have understood or listened. You can help children use this as a strategy to compensate for their difficulties with attention and listening.

8.       Most vitally, like with my friend telling me the recipe, break longer instructions into short steps and leave plenty of time for children to process the information. Giving visual support to what you are saying is also highly useful.

9.       As adults, talking about things we are interested in with our friends means that  conversations flow. So when you’re talking to a child try to follow the child’s lead by talking to them about what they’re interested in or focused on. They will be more focused on the conversation if it’s interesting to them than if it’s not.

If you only remember only two pieces of advice from this blog, let it be these. Firstly: be like Cleopatra and make sure your child’s communication pyramid has a solid foundation. Without this structural base skill of attention and listening, everything else we try to build on it can end up wonky like poor Pharaoh Sneferu who has gone down in history as the Pharaoh who couldn’t build his pyramid straight! Secondly take heart in the knowledge that the Great Pyramid of Giza was not built in a day. It took many years and great patience to build. In the same way, developing a child’s attention and listening skills can take great perseverance and time, so do not worry if you do not get overnight success.