It's all Good: Evaluation in Speech-Language Therapy Sessions

Abstract

Speech and language therapy can be characterized in many ways, but at its heart is some kind of action; action done, primarily, through talk. This thesis shows how participants in speech and language therapy interactions reach shared understandings of what therapy is, and, when no such shared understanding exists, how mismatches in understanding are managed. The primary focus is on how both participants orientate to and participate in the satisfactory completion of tasks and the ways in which client performance on tasks is evaluated.

This thesis is an example of ‘institutional applied CA’ (Antaki, 2011) where the focus of analytic attention is on the ways in which the work of speech-language therapy is collaboratively achieved. The research employs a conversation analytic methodology for the transcription (Jefferson, 1983) and analysis (Pomerantz and Fehr, 2011) of recordings made by speech-language professionals of naturally occurring therapy interactions involving children and adults engaged in therapy sessions relating to four of the six domains of professional practice in Australia (SPAA, 2011), namely: speech, language, alternative modes of communication and swallowing. CA research into communication disorders.

CA research into communication disorders has grown substantially over recent years. However, most of this CA research (Antaki, 2011) has focused on the aspects of interactional competence of people who have some kind of communication impairment. Our understanding of talk between people with communication disorders and their speech-language therapists, as a specific form of institutional talk remains fragmented. The impact of particular professional modes of interaction on clients’ contributions in therapy interactions has received little attention. This thesis seeks to address this gap by examining how a key feature of speech-language therapy practice, namely evaluating client performance on therapy tasks, is accomplished. This feature of speech therapy interactions links to three important aspects of therapy: the existence of some kind of short-, or long-term goals; the professionals’ technical awareness of the nature and potential of the implications of the communication impairment for client participation in everyday social interactions involving talk; and to the nature of learning in therapy.

The first four chapters of this thesis clarify the nature of speech-language therapy professional practice and relevant prior research on the institutional nature of speech-language therapy interactions (Chapter 1), the methodology used to collect, transcribe and analyze data (Chapter 2), the confusion of terminology relevant to the action of ‘evaluation’ (Chapter 3). Using data taken from naturally-occurring interactions, this thesis shows how evaluations are produced in three different sequential positions: SLT’s produce evaluations in first turns (chapter 4) with some difficulty, though overwhelmingly evaluations are produced in third turns (Chapters 5 -positive evaluation & Chapter 6- negative evaluation) of triadic action sequences related to task completion. In one interaction only, evaluations were produced by the client, in second turns that responded to requests (Chapter 7), providing an important contrast between the way professional and client evaluate performance and progress. The analysis of evaluation practices confirms the importance of evaluation to the institutional action of therapy, and highlights the inherent complexity of evaluating performances on tasks that relate to speech and language, showing how professionals use ambiguity in evaluation as a resource to balance the immediate task-related needs of clients with the longer term social aspects of the therapeutic relationship. This research raises important issues about the connection between evaluation practices and theories of learning and contributes to our understanding of the practices that participants utilize to manage their institutional tasks and roles. Show more