The Mindful SLP: More Than Tips and Tricks - Ep. 018

If you have ever had an R client that didn’t progress no matter what you did, you’ll want to tune into this week’s podcast on the elusive R. This is part two of a two part series, so you’ll want to listen to last week’s podcast too! This week we continue our discussion on the foundations of R therapy in our heart felt mission to spread the word on effective R treatment.

*** Show Notes ***

Episode 17: Foundations of R

Episode 3: Impossible R Made Possible

Impossible R Made Possible Course

Music: Simple Gifts performed by Ted Yoder, used with permission

Transcript 

Dan: Welcome to The Mindful SLP, the show that explores simple yet powerful therapy techniques for optimal outcomes. I'm Dan and I'm here with co-host Denise Stratton, and today we're talking about R therapy. Now being married to an SLP. I know that some Rs can give speech therapists a run for their money.

Denise: And that certainly was the case with me. Some of my R clients used to keep me up at night because they just weren't making any progress. And I didn't know what to do as a speech therapist. I felt really inadequate and maybe some other SLPs out there have had that same experience. Maybe you've agonized over why didn't they teach me more about R in graduate school?

So believe me, I've been there. I've done that. And it is so freeing not to have those feelings of inadequacy anymore. So on today's podcast, we're going to lay out the roadmap for how to get that freedom for yourself. We began this discussion on our last episode, where we talked about helping clients to build the capability for R, so if you haven't listened to episode 17, yet you might want to go back and listen to it. Today, we're going to go on from there and explore how to take the clients from the capability to even begin to say R to mastery.

Dan: Explain to me what you mean by building capability.

Denise: A lot of those clients who are having huge struggles with R don't even have the capability to move their jaw, their lips, and their tongue in the right integrated way to even produce an R. So they need to work on developing capability first. And that might mean as a clinician, you're not even asking them to practice R when they first come in, you're going to lay the groundwork first.

Dan: Now we've talked a lot about that in the last episode and laying that groundwork. That's the first principle of R therapy and you called that stability and mobility. There are two more principles and all three comprise your technique.

Denise: So that lane of the groundwork that I call stability and mobility is getting stability, the jaw, mobility, the tongue, things like that. And the second principle, I call precise placement, teaching them to place their tongue of precisely the right place.

And the third principle I call relaxed production. And those are all the building blocks for R therapy. But before we dive into precise placement, we need to spend a moment on the abundance of tips and tricks that exist for eliciting R. This is a conversation I don't hear very often, but I think we should talk about it more.

Dan: What do you mean by tips and tricks? Tips and tricks or what I see as the headlines on all sorts of things out there on the internet. And it's just, a lot of it is stuff that it may work, it may not work with us, just 'try this!'

Denise: Yeah. It's a really hit and miss approach, which I used to do when I was getting a little bit desperate to elicit an R from someone. So the speech therapy world is a minefield, of suggestions like try this, here's your go-to for R, or this trick never fails me to elicit R. But the thing is these suggestions will always just be tips and tricks until you understand the underlying principles. After understanding those principles, you might be able to get some of those things to work for you effectively in therapy, but generally they will not help your really challenging clients by themselves.

Dan: Give me a couple examples.

Denise: Okay. So in graduate school, one of our professors described how he elicited an R using what we call the L-to-R technique, and you're probably familiar with it, but you start saying an L, you drag your tongue back along your palate, drop it a little bit, and L sound's supposed to turn into an R.

Okay. Now that technique can work. And I use an adapted version of an L-to-R technique for many clients, but the important thing is that never, ever, ever worked for me until I begin to understand the principles behind it. Here's another example. The other day, I had a client put her fingers on either side of her mouth to keep her lips from over rounding when she was saying the R, because that W sound was interfering with R and it worked.

So that sounds like a really quick trick, but here's the thing. She already knew how to say R. She knows the exact spot her tongue needs to go on every time. And when she says pre-vocalic Rs, she never misses them. This is because of all the foundation work she's done. She just needed to control her lips when she was saying a final vocalic R, and that's why it worked. It would not have worked for her back when she was just beginning to learn to say R.

Dan: Those are a couple of really good examples of why that groundwork, that foundational part of understanding how to say R is so important, let's move on to precise placement. Where does that pick up?

Denise: Okay, so once you have stability and mobility in the client that setting the stage for success, but in all likelihood, your client still needs instruction how to place and move their tongue to get a perfect sounding R and getting it time after time.

Dan: It can be daunting. It sounds like to try and get this up, uh, getting that perfect sounding R, it's it seems like there's a lot. Is it going to give our clients a complex?

Denise: Well, nothing's too demanding if you break it down step-by-step and yes, I do use the word perfect. When a client produces that R you been waiting and waiting for, I say, oh, that's your perfect-sounding R. So I use it as a, as a compliment, just so they really know that it's the exact R we're going for, and that's part of building that capability so that they can get that repetition again and again and again, and it's absolutely critical to your client success. And yours as a therapist that you aim for that perfect sounding R.

Now brutally honest, may feel harsh if you say oh, that wasn't an R, but after years of therapy, I know that it's only accurate feedback that will help them. They must hear, they must feel, and they must know how they've said the R so they can have the power to replicate it. Fuzzy feedback, sliding scales, they do not help your R clients.

Dan: What do you mean by a sliding scale?

Denise: Sometimes clients produce sounds that are closer to R than others. And as a therapist, you're just dying for them to have some success. Right. And we feel like they're getting closer to that R, so we say, oh, on a scale of one to five, that was a two, or that was a three. Um, but it doesn't work. It just confuses them. They don't know how to make that perfect R, they absolutely need clear yes and no feedback. When I used to use sliding scales because I did, it was because I didn't know how to instruct clients on how to say a precise R. We were both kind of feeling our way in the dark together, and as a therapist, I was trying to whole bunch of different words and praying that they would stumble on the accurate sound and be able to replicate it. Well, some clients, with easier ones, with enough time and enough trying different things, they'll find it and you can move forward. But those clients who have these really challenging Rs and what I came to think of in my mind as 'this is impossible.'

So these kids, that won't work and sadly, these kids tend to get labeled unmotivated sometimes. And they're really just lacking good instruction.

Hey speech therapist, this is Denise. You know, that feeling you have when your R clients are not progressing? I've had it. Have a client who just can't elicit R no matter what? I've been there, but I'm not there anymore. And I want you to get there too. Join me for a free masterclass, and I'll teach you one technique that can quickly elicit an R in about 30% of your clients.

It's my favorite go-to with new R clients. Go to SLP proadvisor.com/masterclass to reserve your spot now. Spend a little time with me and we will get your clients moving. Visit SLP proadvisor.com/masterclass to sign up today. That's SLP proadvisor.com/masterclass. Now back to the show.

Dan: Can you tell us exactly how to elicit a perfect are in this podcast?

Denise: Well, it's beyond the scope of a podcast format. I think it would come across as kind of 'tips and tricks,' and my main message would be lost. My main message being that we as SLPs need a deep understanding of the principles behind R therapy. So what I'm giving you right now, the principles, this is the most important part, but that's why I wrote a book and I later made it into a video course.

The video course is called Impossible R made possible because of all those clients who I finally figured out how to make their R possible. Well, the great thing about the video courses is it shows how to elicit an R, a picture is worth a thousand words. In this case, you see it, you hear it, and you're like, I can do that.

Dan: That's really important. And I think that one of the main features of the course is having that video there to show exactly your clients doing it, and, and how you correct them and how you help them along. I think that is, you know, well, if a picture's worth a thousand words and the video is worth a million, it's so much easier to pick it up when watching it over just listening to someone talk about it. This is one of the nice things about this course, and then there's going to be a webinar that we're putting on and we encourage everybody to go sign up for the free webinar. That webinar's going to be offered at the beginning of February. You can sign up for that webinar at SLP pro-advisor dot com. There'll be a link on the front page, announcing the webinar and how to get access to that. But in that webinar, you're going to show one elicitation technique that you use and that's going to be really valuable in itself. And of course, that is for free there on that. And that's yes, we're, we're introducing the course, but you know, this will be very valuable to you, don't miss it. We've covered stability, mobility in the last podcast, precise placement now. What's the third principle?

Denise: It's relaxed practice. And once you've got stability, mobility, and precise placement down, oh, relaxed practice is a walk in the park. It's the icing on the cake. I love it. When we get there, you've done most of the heavy lifting.

You and your client, I should say, have done most of the heavy lifting. And here's the thing. Your client might only be at the syllable level, but believe me, if they are at the syllable level with a precise R, they have come a long, long way.

Dan: If they can say are consistently, yeah. That's gotta be a great foundation to build on.

Denise: Yeah, you have everything you need with this little piece of relaxed practice. So imagine you're climbing a mountain. Getting the stability and mobility and the precise placement that like takes you to the peak of the mountain. That's the hardest part of the journey. And the rest is just going down. I mean, you have to do it. There's important principles, but it's not so hard. The rest of your journey is downhill. That's what I tell my clients, we're on the downhill slope now. There are two concepts I use to help clients understand relaxed practice. So I want to start first with a quote by Charles van Riper, and if you're not familiar with Charles van Riper, we call him one of the grandfathers of speech therapy.

He was a severe stutterer in his life and figured out how to treat stuttering, but he said, "I think we have to learn how to feel our mouths in our free speech. Look at all of us. We have more free speech than we have stuttering. We ought to use this." Well, I take that principle that we have correct speech, a lots of correct speech, lots of relaxed speech that doesn't contain the R.

So what I will tell a client is let's take the Mmm sound and let's say ma ma ma ma ma ma ma ma ma, and I'll say, did you notice how easily that came out? Did you notice how your lips just open and, and it, and it was so easy. It wasn't hard. I compare it to water, running down a stream with nothing to stop it and we'll practice a few of those, maybe a sha sha sha sha sha sha sha, and then we'll say, okay, now we're going to the same thing with R, but we're just going to do two.

So remember they have a perfect R syllable at this point, perhaps it's rah. So they can say it like this, rah. Okay. Now you're going to move them from that to rah, rah. What most of your clients will do is they'll either go back to the wah or ah-wah, cause they're not used to pulling their tongue back again to get it back for another R, right? They're just used to getting their tongue in place and starting with it. Or they'll go rah... rah. And put that pause in cause I know they have to get their tongue in place again. So your only job is to get rid of the pause if there's a pause or make sure that R doesn't turn into a W and get a rah-rah. And it is so fantastic.

And then to get, um, rah rah rah, but just start with two. I mean, it's the hardest going from one to two is the hardest, so they can get the feel of it and the understanding. That's what I call relaxed practice. And then once we get some words, I'll do the same thing with a technique I call word builders.

So I'll just give you one example with the word rain. Okay. So I'll say, okay, we can say rain. Now. I bet you can put a word after it and still keep that beautiful R, perfect R. So maybe it'll be rain today. Okay. That's not hard. Then I haven't put a word before R and that's the tricky part. Maybe we'll say wet rain. I just, one word, just one word. And this is where it will get a little bit tricky because they're not used to moving in to another R word. So it will turn into wet wain or they'll go wet...rain. See, it's the same thing that's happening with the syllables, but now we just move into words. So your only job is to help them realize I got to get rid of the pause, wet rain, and I got to keep the R. You know, and then you can just move on from there and embed it in a sentence, the syllable practice, the word builders. That's my first concept that I use for getting that relaxed practice. Now, the second concept is so easy, falling off a log, you're going to say 'seriously?' But it's to lower their voice and you can hear some clients, especially if you record them, like 'wait a minute, their voice sounds a little high pitch.' Some clients unconsciously carry this tension that's involved with all the hard work they put into saying R over the years, and you can hear in their voice and you're like you don't need that, just let it go. And when they lower the voice, sometimes that R just clicks into place and you're like, oh, wow. How beautiful is that? We want everyone to have their natural sounding voice. And actually in the course, you'll see me coaching one, a young man, to bring his voice down. And it sounds much more natural and it sounds like his voice.

I'm like, Hey, that's your voice. And he can feel it. These same skills that they practice when getting two syllables together or two or three words together without pauses or extra tension, guess what? These are the skills they need to integrate R into conversation, right? I mean, that's all you need is that integration, no pauses getting back to the right place.

And so you are working on generalization from the very first two syllables that you're putting together. And I think that is so interesting that you can have all the building blocks for R in place, when they were only repeating a single syllable. It's a completely different way of looking at R than I used to.

Dan: So you say that all the hard work is at the beginning. Now, did you used to think it was at the end?

Denise: Oh, I so did, I would sort of rush through these what I called the easy beginning R, not knowing what to hear or listen for and think, well, and I would dread kind of, oh, now we got to get into vocalic R, the vocalic R is so hard.

Then I've got to get them to remember to use this R in their conversation. It's completely flipped. Lots of times the vocalic R just emerges on its own with these skills, not all the time, but lots of times. And the generalization lots of times will take care of itself in a great measure. So, yeah, it's flipped.

Dan: So this is a complete mindset change from where you started working with R, to really spending a lot of time just working on that foundation. And once the foundation is rock-solid, everything else is easy to build and to add up on top of it.

Denise: Yeah, I know, and I should say comparatively easy, of course, because you do run into a few things, but if you can get to that place where they have gotten that precise syllable and can replicate it. You are so far down that road.

Dan: So we want everybody to come and join us for the free webinar that is coming up here at the beginning of February and come and listen to this. See how easy it can be and where that foundation really starts to build. I'll let you in on a little secret. If you come to the webinar, there are some amazing bonuses that we're going to give away to people who join us there that day.

So please make sure you come, go to SLP proadvisor.com and sign up for the webinar there.

Denise: That wraps it up for today. Thank you so much for listening and be sure to join us next time. We'll be interviewing a former client of mine and his mother about his R journey, and I think you'll find his story really eyeopening.

Dan: 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. 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. .