You have accessSIG 3 Voice and Upper Airway DisordersIntroduction14 Jun 2023Introduction to the Perspectives Forum on the Topic of Meta-Therapy Leah B. Helou Leah B. Helou https://orcid.org/0000-0001-5840-0160 Department of Communication Science & Disorders, University of Pittsburgh, PA Google Scholar More articles by this author https://doi.org/10.1044/2022_PERSP-22-00243 SectionsAboutAbstractPDF ToolsAdd to favoritesDownload CitationTrack Citations ShareFacebookTwitterLinked In The emerging ontology of meta-therapy was first articulated in 2011 at a continuing education workshop that I co-presented on the topic of gender-affirming voice and communication training. It has since evolved through conversations with colleagues, formal presentations at workshops and conferences, and a couple of formal writings in peer-reviewed journals. These inputs facilitated convergence upon a broad definition of meta-therapy: it is comprised of the dialogues, schemas, and reflective tasks that clinicians employ during voice therapy to shape the therapeutic process and patient response to that process (Helou, 2017; Helou et al., 2021). In the most recent article (Helou et al., 2021), several goals of meta-therapy were proposed. These goals facilitate modified cognitions, knowledge, beliefs, attitudes, intentions, and/or awareness in one or more of the following: The process of vocal improvement during treatment; The patient's role in treatment; The role of self-efficacy in treatment; How the patient's relationship between their voice and identity can affect treatment; and How affective states can influence treatment. While attempts to formally define and operationalize meta-therapy are relatively recent, the essential mechanics of meta-therapy are probably as old as the field. Historically, effective and efficient meta-therapy is (a) passed down from expert to novice clinicians essentially through oral tradition; (b) learned over many years through clinicians' direct trial-and-error experience with patients; or (c) not explicitly communicated to or independently learned by novice clinicians, and as a result they lack both success and self-efficacy as voice therapists. Despite a lack of formal presentation of meta-therapy in textbooks and graduate training programs, it has substantial clinical value. As such, it should be formally acknowledged as one key pillar of behavioral voice therapy, alongside the three “classic” pillars: direct therapy techniques, indirect therapy techniques, and counseling/education. Or, perhaps the better word is that meta-therapy is the substrate of therapy, that is, that which appropriately nourishes and scaffolds the core elements of voice therapy. With clinical dialogue as its real-life substrate, meta-therapy is perhaps unavoidably complex. It shares some features and “feel” of both counseling and education but is theoretically distinct from both. It can be presented in the style and using the tools of motivational interviewing (for example), but the concepts are not equal. Unfortunately, distinguishing these elements of “good therapy” is fraught with cognitive and linguistic challenges, which is perhaps why the topic receives so little formal attention. Meta-therapy's closest relative in the extant literature seems to be that presented by Jenny Iwarrson (2015) and colleagues, and it should be accommodated by the Rehabilitation Treatment Specification System (see Hart et al., 2019, and Van Stan et al., 2019). Anecdotally, other clinicians have articulated the benefits of applying meta-therapy concepts to various clinical domains, but to date it has not extended outside of conversations around voice therapy. Thus, this Perspectives forum provides a space for speech-language pathologists to present how meta-therapy applies to their own clinical practice. Four articles were invited to address clinical work in (a) voice disorders, (b) fluency, (c) dysphagia, and (d) cognitive communication and aphasia. Invited authors were asked that their offerings be educational to novice clinicians across several specialty domains, be informed by authors' expertise and experience with behavioral therapy as well as in the craft of teaching that therapy to novice clinicians, and result in an articulation of how meta-therapy “maps onto” the authors' clinical area of expertise. I thank readers in advance for helping advance the domain of meta-therapy by sharing reflections and constructive critiques of these offerings. References Hart, T., Dijkers, M. P., Whyte, J., Turkstra, L. S., Zanca, J. M., Packel, A., Van Stan, J. H., Ferraro, M., & Chen, C. (2019). A theory-driven system for the specification of rehabilitation treatments.Archives of Physical Medicine and Rehabilitation, 100(1), 172–180. https://doi.org/10.1016/j.apmr.2018.09.109 CrossrefGoogle Scholar Helou, L. (2017). Crafting the dialogue: Meta-therapy in transgender voice and communication training.Perspectives of the ASHA Special Interest Groups, 2(10), 83–91. https://doi.org/10.1044/persp2.SIG10.83 ASHAWireGoogle Scholar Helou, L. B., Gartner-Schmidt, J. L., Hapner, E. R., Schneider, S. L., & Stan, J. H. V. (2021). Mapping meta-therapy in voice interventions onto the Rehabilitation Treatment Specification System.Seminars in Speech and Language, 42(1), 5–18. https://doi.org/10.1055/s-0040-1722756 CrossrefGoogle Scholar Iwarsson, J. (2015). Reflections on clinical expertise and silent know-how in voice therapy.Logopedics Phoniatrics Vocology, 40(2), 66–71. https://doi.org/10.3109/14015439.2014.949302 CrossrefGoogle Scholar Van Stan, J. H., Dijkers, M. P., Whyte, J., Hart, T., Turkstra, L. S., Zanca, J. M., & Chen, C. (2019). The Rehabilitation Treatment Specification System: Implications for improvements in research design, reporting, replication, and synthesis.Archives of Physical Medicine and Rehabilitation, 100(1), 146–155. https://doi.org/10.1016/j.apmr.2018.09.112 CrossrefGoogle Scholar Author Notes Disclosure: The author has declared that no competing financial or nonfinancial interests existed at the time of publication. Correspondence to Leah B. Helou: [email protected] Editor-in-Chief: Mary J. Sandage Editor: Robin A. Samlan Publisher Note: This article is part of the Forum: Meta-Therapy in Speech-Language Pathology. Additional Resources FiguresReferencesRelatedDetails Newly PublishedePub Ahead of IssuePages: 1-2 HistoryReceived: Oct 31, 2022Revised: Nov 15, 2022Accepted: Nov 22, 2022 Published online: Jun 14, 2023 Get Permissions Add to your Mendeley library Metrics Topicsasha-topicsasha-sigsasha-article-typesCopyright & PermissionsCopyright © 2023 American Speech-Language-Hearing AssociationPDF downloadLoading ...