[ Contents | Search | Next | Previous | Up ]
From: Kelly Snead, MA student at the Univeristy of Memphis
Date: 09 Oct 2005
Time: 11:39:11 -0500
Remote Name: 66.61.41.27
Hi Bob, A very thought-provoking article! Although ASHA's definition of EBP addresses the importance of individualizing therapy, the current focus of EBP seems to be more concerned with scientific "proof" of efficacy. I think it is very unefficacious, if not unethical, to apply the same "prooven" treatment program to all PWS without consideration of that client's individual characteristics. Just because a treatment has data to support it does not mean that it is appropriate for every PWS. Understanding the innate characteristics of the client in question requires the clinician to become empathetic to that person's individual set of circumstances. This need to callibrate one's self to the client's individual needs and goals necessitates empathy for the PWS as an individual. Also, since a critical component of fluency thearpy involves modification of the client's underlying thoughts and feelings about themselves and their speech, a clinician who is unable to empathize with her clients and relate to their thoughts and feelings won't have a clue about where to start addressing these underlying thought processes. I sometimes feel that the current push for EBP, while necessary, is understood by some to create rigid, mutually exclusive lines between the "art" and "science" of therapy. In my opinion, effective clinicians are those who are able to combine the two; they use the current scientific evidence and combine it with careful consideration of the client as an individual and their own clinical expertise to determine the most appropriate course of treatment. This is perhaps more true for clincians working with PWS than with many other disorder populations because PWS are so heterogenous; they bring a wide vareity of personalities, surface behaviors, and underlying psychological or emotional components with them to the therapy table. Having a researcher tell you which therapy program is "the one" to use with all PWS (or with any disorder) eliminates the need for critical thinking and makes personal connections with your clients a less relevant component of the thearpy process. I think empathy is the key to the art of understanding your clients as individuals and selecting the most efficacious treatment from there. Your article addresses all these issues and then some, and these concerns will hopefully help refine the direction of EBP for fluency disorders. Great paper!