Because I specialize in adults and teens, it's pretty rare that I am someone's first-ever speech therapist. The majority of my clients went through some form of speech therapy as a child, and a significant number have pursued subsequent rounds as an adult. Past therapy experiences range from school-based once-a-week sessions to intensive multi-week programs consisting of 8 hours of speech therapy per day.
Clinicians have a term for this: "therapized". This refers to someone who has been through the therapy process, has been taught the basics, and knows the routine. They know what to do and how to do it. Sometimes clinicians are wary of patients who have been "highly therapized"...how do you help someone achieve meaningful change when all the obvious things apparently haven't worked?
When I ask about previous therapy experiences, I almost always hear positive responses (unless you really didn't like being pulled out of class in first grade). Whether it was weekly sessions with a private practitioner in college or at a week-long intensive as 30-something, the most common sentiment is:
"I learned some things that were really helpful, and my speech improved during that time, but after I stopped speech therapy my old patterns came back." When I ask, "What do you want to do achieve this time?", the answer is typically "Learn new tools to better manage my speech."
For individuals with prior therapy experience, my approach is to build on previously-learned skills and teach new tools as appropriate and necessary. People are usually more excited to learn new techniques than review old ones, even if they acknowledge that the old ones were useful. We practice both types, and speech improves. As the new speech pattern solidifies, we phase out therapy. Then comes the six-month check-in.
"Everything was really good...but I haven't been practicing lately."
There is a tongue-in-cheek definition of insanity: "doing what you've always done and expecting different results." This is as true for speech as for any other aspect of life. Ultimately, it does not really matter which technique(s) you decide to focus on to manage your fluency or improve your articulation. Learning new tools is not what will "do the trick" this time around. What matters is that you are consciously changing your old habits. And, more importantly, committing to maintaining that change.
When I stop to think about the principles of exercise, I get very annoyed. Staying in good physical condition requires constant, permanent effort. You can't be a bodybuilder in your 20s, "save it up", and carry that physical benefit into a couch potato lifestyle in your 40s. Years ago, I got an A in trigonometry, but I couldn't begin to solve a problem today.
Our speech and voice work exactly the same way. You can learn all the best, new, cutting-edge techniques in the world, but to cultivate a transformation, you need to apply them intentionally and consistently. Our brains are "use it or lose it": if we don't use that new pattern, it decays. Muscle memory comes from repetition; lack of practice means we fall back into old patterns of movement.
Transformation is difficult. It requires determination and discipline. And, the more years we have of "doing what we've always done", the longer it will take for us to retrain our brain and body into a new pattern.
But, even though it's hard, what I find amazing is that we are capable of transformation. It's why I don't shy away from therapy, even if it's the fifth time around (although you better be prepared to practice!). Our brains and our bodies respond to our behaviors. We can always make changes.
Thomas Edison said, "If we did all the things we are capable of, we would literally astound ourselves." What I love about speech therapy is being astounded by a person's transformational progress. It becomes about much more than speech-- achieving lasting change in your communication means you can achieve lasting change, period.
Change that reverts back to baseline is disappointing. Transformation is exhilarating. And all it takes is practice.