Meta-Therapy Applications for the Voice Evaluation

Abstract

Purpose: Meta-therapy is conceptualized as the conversation between clinician and patient that guides treatment. Because the area of meta-therapy and behavioral change is so broad, the focus of this clinical focus article is on laying the patient's foundation for therapy during the initial voice evaluation. Conclusions: In 2012, the American Speech-Language-Hearing Association developed evidence-based recommendations for a complete physiologic voice assessment. While the standard goal of this voice evaluation is to obtain a diagnosis, it behooves clinicians to apply meta-therapy techniques even in that early diagnostic space, for instance, to assess and facilitate readiness for change. Therefore, we present stimulability testing (assessment of an individual's ability to modify a behavior when provided with models or cues) as a critical additional component of the voice evaluation. In this light, during the voice evaluation, the patient understands that voice functions physiologically like a moving instrument rather than a static organ, that the production is a learned skill that can be optimized any time, and that the patient has potential for voice change. The evaluation should also be used to assess the patient's individual voice goal, the importance of the goal, and level of self-efficacy to pursue the goal in therapy. The patient is introduced to both the “what” of therapy—the specific exercises designed to improve voice quality—and also the “how,” the dialogue about treatment rationale and expectations for ongoing voice change and ultimate therapeutic success.