Imagine this scenario:
Your voice therapy patient is having trouble finding the relevancy of how using non-speech sounds like lip trills, sustained vowels, and rote phrases will help their voice problem, despite your explanations as to why these exercises may help. After a couple sessions, it’s clear that your new patient is leaning toward self-discharge and discontinuing therapy altogether.
You could keep this patient if you had a treatment protocol that immediately addressed your patient’s biggest challenges, especially as they pertain to conversation.
Fortunately, this therapy exists—Conversation Training Therapy.
Conversation Training Therapy is the first voice therapy program to eliminate the traditional therapeutic hierarchy and use patient-driven conversation as the sole therapeutic stimulus from the first session and throughout therapy.
What Is Conversation Training Therapy?
Conversation Training Therapy (CTT) is a voice therapy approach that focuses exclusively on voice awareness and production in conversational speech from the outset of treatment and in all sessions. The goal of CTT is to achieve generalization of the target voice technique in everyday conversational voice as quickly as possible.
CTT does not use a traditional therapeutic hierarchy, prescribed voice exercises, or non-speech sounds to achieve voice goals. This distinction is important, because the literature shows evidence that patients think generalization practice is the hardest—and most needed—aspect of voice therapy.1
CTT is based in theories of motor learning. Motor learning is the process of changing a behavior based on practice or experience. For example, the principle of “part versus whole” practice states that complex skills are learned when practiced as a whole and not broken down into component parts. Similarly, neuroplasticity principles of salience and specificity state that learning occurs when the tasks trained are relevant to the learner. In voice therapy, practicing voice techniques in conversation represents whole-skill practice—and is highly relevant to the speaker.
The Components of Conversational Training Therapy
CTT is composed of six interchangeable components:
- Clear speech
- Auditory and kinesthetic awareness of voice production
- Rapport building
- Negative practice and labeling
- Embedding basic training gestures into speech
- Varying prosody, projection, and pauses
Because CTT is not hierarchical, the only recommendation is to start with “clear speech” and then use your clinical judgment to determine the order of the remaining components most relevant for your patient.
A Paradigm Shift
CTT represents a shift in the current prevailing voice therapy paradigm, demonstrating success with a program that does not include prescriptive exercises but allows the patient to use speech as stimuli in their activities of daily living. As an SLP, you have the chance to fine tune and guide treatment to the patient’s personal, occupational, vocational, and vocal demands. Progress is determined by the patient’s own vocal discoveries in their conversational speech, and the SLP guides the patient with questions more than modeling.
Is CTT Effective?
A recent NIH-supported preliminary investigation into the efficacy of CTT in 47 patients with hyperfunctional voice disorders, compared to a control group of patients treated with traditional voice therapy, revealed significantly greater improvements in patient-perception of voice handicap following CTT than traditional therapy. Further, vocal acoustic, aerodynamic, and auditory-perceptual outcomes improved after two sessions, as well as after short (one week), and long-term (three month) follow-up after four sessions of CTT.2
Ready to learn more about CTT so you can add it to your therapy toolbox? Discover the science behind it, the primary therapeutic components, and troubleshooting tips in the MedBridge course, “Conversation Training Therapy.”
- Van Leer, E. & Connor, N. P. (2010). Patient perceptions of voice therapy adherence. Journal of Voice, 24(4), 458–469.
- Gillespie, A. I., Yabes, J., Rosen, C. A., & Gartner-Schmidt, J. L. (2019). Efficacy of conversation training therapy for patients with benign vocal fold lesions and muscle tension dysphonia compared to historical matched control patients. Journal of Speech, Language, and Hearing Research, 62(11), 4062–4079.