Interview with an Adult Speech Therapy Client about the Natural Language Acquisition (NLA) Approach

Interview with a Gestalt Language Processor Adult

Graciela is a 20-year-old client who uses a variety of ways to communicate including speech, a communication device with speech output, typing, and spelling on a letterboard. She is a Gestalt Language Processor (GLP).

She was given the below interview questions to complete at home in hopes of gaining a better understanding of the Natural Language Acquisition (NLA) approach. She answered the below interview questions using a letterboard to spell out the words and sentences. For more information and background of the NLA approach, see Practical Speech Therapy’s previous blog here https://www.practicalspeech.com/post/gestalt-language-processing-it-s-never-too-late

Disclaimer: The purpose of this interview is to gain an understanding of the client's and parent’s perspectives on the NLA approach. It is not to discredit other speech therapy approaches. Traditional speech therapy is appropriate for analytic language processors and others alike.

Graciela’s responses are in purple italics (the client)

Susie’s responses are in blue (the client's mother)

How has NLA impacted Graciela and your family’s life?

I want to say that we are making so much more progress with my speech this year and it is because of the work we are doing using the NLA framework. I have been able to work in my

own way and want to make it clear that my own words are the best place to start because I have been saying them for so long and have a long relationship with them. A lot of my past therapists I have had never had the idea to use my words as a beginning point. I want to be able to use my words when I have something to say. I have a lot more really helpful strategies now and can talk more than ever before. I have been making a lot of progress and am doing what I can to make more. These days I want to be able to really talk to many people to be able to be more a part of everything. Opening the ability to say more has been amazing. Really I have been true to my work ethic and will forever give it my all. I want to have beautiful relationships with the people whom I love.

For me, it has allowed me to be more connected with Graciela. By responding to Graciela’s echolalia in a more respectful way and by seeing it as having communicative intent, she and I have been able to engage with one another with such fun and joy again. Graciela has always had a lot of echolalia and scripting and “chatter” going on and it’s always felt overwhelming to know how to respond - do I repeat it back and maybe make it worse? Do I ignore it? Do I try to correct it? There is no real roadmap for us parents in these situations. With Graciela now being 19, I think I have tried everything and then some, but I realize now that the key has been to really just let go of all the “worry” and to put the focus on the fact that she is making the effort to communicate and is using the resource she has the most access to in the moment. Now that I have been interacting with her and responding to her through this lens, there has been such a significant shift in the dynamic - and especially in her desire to keep communicating! She finally feels heard and understood and, of course, this makes her want to communicate more. So, we have seen a real shift in her attempts at communication with us - so much more purposeful speech/self-generated language coming out and more interest in using her AAC device to engage and communicate with us. We have seen this expand into other areas of her life including her use of technology and her desire to read more intricate and complex books as a result of her intentions/desires becoming more clear to us.

How long has Graciela been receiving speech services?

Graciela started receiving speech services a few months before her 3rd birthday when she was diagnosed as having a global developmental delay by our county’s early intervention team. She continued to receive speech services in a small group setting in a Special Education Public School Preschool program when she turned three. We eventually started private speech therapy services as well because we felt that the services she was getting at the school were not enough. We eventually pulled her out of that school program in the midst of her 2nd year there (too much sensory overwhelm). She has been receiving private speech services off and on ever since!

What did traditional speech therapy look like for Graciela?

There are so many things to be a lot of the time thinking about understanding as well as possible when working with a client like me with both autism and dyspraxia. I needed so much more than suggested games that meant nothing to me and made me feel like my own interests were not important. Making life even more difficult for me was the fact that people saw my way of speaking as reliable and satisfactory even though I could hardly speak! I was not considered a candidate for AAC at an early age because I had the ability to say what I wanted to eat! I could have made so much more progress as an AAC user at an early age if someone had given me the access I needed. Challenges with traditional speech therapy made me so frustrated. I see now that if I had access to the Gestalt Language Processing framework, I might have been making more progress. I cannot say enough great things about how therapy through this lens has changed my speaking in such a short time. A lot of the things that my speech therapists assumed about me and my learning profile were wrong. Seeing me for who I really am and giving me the support I need as a gestalt language processor has impacted happier days filled with communication and connection! We have to have better education around the communication styles of people like me.

Looking back on it, all of Graciela’s speech therapists over the years had the best intentions and worked hard, but the sessions often revolved around whatever speech goal the therapist was trying to work on and some activity that he/she thought would help them reach that goal. In other words, it was very goal-driven and not as child-led as we have experienced the sessions to be under the NLA framework. There were also a lot of expectations placed on Graciela in these sessions because of the desire to “reach the goal”. These expectations, of course, come along with a certain amount of pressure to “perform” in a set, prescribed way that was often quite difficult for Graciela. The thing that makes me most distraught about our history with speech therapy is the absolute LACK of knowledge among the speech therapists we saw around AAC and how it could be helpful for a child-like Graciela. We even had a very expensive private AAC evaluation done when she was around seven years old and that team came back to us saying that she did not need an AAC device because she could tell us - through her speech -what she wanted to eat. I have thought about this so much over the years and see this (now) as one of the biggest disservices done to Graciela. I often wonder what she could be communicating now if she had been given access to an AAC device early on and if we had been supported in our understanding of how to support her use of that AAC device - especially within an NLA framework. I absolutely believe she would be a much more proficient and elaborate communicator had all of these things been in place early on in her life.

How long has Graciela been receiving Natural Language Acquisition (NLA) speech services?

10 months.

Describe a recent NLA session Graciela has had.

Every week Brittany comes out and welcomes Graciela. Graciela is always happy and excited to be there! In the most recent session that I can remember Graciela was the “driver” of the session and started things off by engaging vocally with Brittany. It seems that Graciela finds great joy in saying certain words and sounds (i.e., fork) with a lot of exclamatory glee and she loves that Brittany joins her in this and follows her lead. After a few minutes of these joyful exchanges, Graciela requested to “watch tennis” on Brittany’s computer and - together - they searched for and watched some tennis. Graciela then requested “Big Elmo cloth eyes” and proceeded to start searching for this. Along the way she came across the teal forks she had searched for in a previous session. Throughout these searches and exploring, Brittany followed Graciela’s lead and matched her level of joy, excitement, and enthusiasm. Brittany also responded to all that Graciela communicated in a way that demonstrated to Graciela that Brittany understood the communicative intent behind Graciela’s comments and requests. Brittany also made attempts here and there - through her responses - to expand on some of Graciela’s comments, usually including some sort of adjective or descriptive comment in her response. Brittany also has Voice Memo open on her iPad to record their session in order to collect a language sample. These language samples have been so helpful in being able to definitively see Graciela’s progress over time.

How is traditional speech therapy different than NLA speech therapy?

I see that I can say something and be heard instead of being told what to say. It is great to be heard and to do things that I want to do in therapy instead of being required to interact in many uncomfortable ways. It is beautiful each time to do things with Brittany because I feel respected.

As I mentioned in my response to one of the previous questions, traditional speech therapy was often goal driven while NLA speech therapy is focused on meeting the child/client where he/she is and going from there. There is a lot of pressure in traditional speech therapy to “perform” in a certain way. This pressure is released in NLA speech therapy because the client is in the driver’s seat.

Describe the progress you’ve seen with Graciela since she’s been receiving NLA speech therapy.

When we started with Brittany I could play one word to her most of the session even though I wanted to say so much. What I have been able to do with her support is get more access to all of the language that I have. What we are so calling nonspeaking is really so much lack of attention to the real problem and total frustration for the individual. When I say that life has been hard to deal with, I am not making it up. Just try to imagine the frustration, and without so much understanding, the fear that life will be hard to endure. That is hard to feel. I have hope again that my really complex thinking will be heard. The things that I want to say. To say them is getting easier. I have to say that I have been in speech therapy for years but I have only been truly benefiting from it since working without expectations. A lot of the treatment I received that was meant to help me actually did more serious damage by making me feel like I could never do things good enough. I want to get what we do across to other people so they can see how it could work for them. I am so thankful that we have had the opportunity to learn. The NLA approach is what I have wanted all along. There is the respect I do not get in many other places and there is the support that I need to have my speech improve. I can live my life more comfortably now that I have more help with my communication.

In general, Graciela is able to communicate more effectively with both her speech and with her communication device. More specifically, Graciela has become more able to share (via speech) more about her day-to-day experiences and/or her internal experiences. She is also able to have a wider range of “conversations” and is able to stay in that conversational turn- taking for a longer period of time than in the past. She is also constantly exploring new sounds, new words, new phrases, new questions, new ways of saying things on both her device and with her speech whereas in the past she was staying more “stuck” within the same, repetitive words, phrases, topics, etc. I have seen the most development in her speech over the shortest period of time since she started receiving NLA speech therapy. It’s been a game changer for us and I often find myself wondering where she would be if we had been utilizing the NLA framework since the beginning. I do believe Graciela’s communication would be in a much better place.

What do you think is the biggest difference/has made the most impact in her speech development since learning about the NLA framework and receiving NLA speech services?

I think there have been a few things that have had the most impact on Graciela’s speech since using the NLA framework. The first is that we (the adults and ‘communication partners’ in Graciela’s life) started viewing her echolalia and “chatter” (as we have historically called it) as communicative intent and we LET GO of the need to control the conversation. I saw the biggest shift when I stopped myself from talking so much and let her take the initiative and then just followed her lead. This was a real game-changer for us. I think she finally felt like she could say what SHE wanted instead of always having to follow down the path of where I was taking the conversation. As a result, she started talking more and was really trying so hard to talk about new things since she was finally feeling heard and understood. In addition, learning about the stages in NLA and being able to utilize different strategies depending on where Graciela was at was so helpful! She is now able to mitigate many of her gestalts because of our more intentional practice of responding to her using specific gestalts. As a result, her speech has acquired a completely different level of flexibility than it had in the past.

What are some struggles you've experienced since starting the NLA approach?

The thing that I have been struggling with the most is the way in which I am still getting stuck for some time saying words that are fun to say but that I do not want to say. Having needs not be met - because I cannot get myself to communicate them - always is so exasperating. I want to stop this mumbo jumbo from tumbling out of my mouth, but I cannot control it. Having a solution to this problem would make such a difference for me.

I still have a lot of questions and sometimes find myself getting wrapped up in my wanting to have all the answers! Currently, I’m struggling the most with how to support Graciela when she seems to get “stuck” on the same sounds, phrases, and words, both in her speech and in her use of her communication device. She has shared in the past that - because of her dyspraxia - she often needs support to help her get unstuck because there are times when she cannot do it herself. I’m still trying to figure out the best way to support her through these moments. I know that I also still get trapped in my own wanting - I want all of this to be easier for her. I want her speech to come out easily, I want her to be able to use her device with ease, I want her to be fully independent and versatile in whatever way she chooses to communicate. So, my own anxiety and desire for an easier path for her gets in my way. It can be difficult at times to let all of that go and to just stay in the moment. When I have been able to do this, it has opened the door to so many possibilities.

As an Amazon Associate, I earn from qualifying purchases. Below is the link to the teal forks Graciela enjoys searching for on Amazon: