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Semin Speech Lang 2021; 42(01): 005-018
DOI: 10.1055/s-0040-1722756
Review Article

Mapping Meta-Therapy in Voice Interventions onto the Rehabilitation Treatment Specification System

Leah B. Helou
1   Department of Communication Science & Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Jackie L. Gartner-Schmidt
2   University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
Edie R. Hapner
3   Department of Otolaryngology, UAB Voice Center, University of Alabama, Birmingham, Birmingham, Alabama
,
Sarah L. Schneider
4   UCSF Voice and Swallowing Center, Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco
,
Jarrad H. Van Stan
5   Department of Surgery, Harvard Medical School, Boston, Massachusetts
6   Massachusetts General Hospital, Center for Laryngeal Surgery and Voice Rehabilitation, Boston, Massachusetts
7   Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts
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Abstract

Meta-therapy refers to the clinical dialogue via which direct and indirect voice treatments are introduced and discussed, and which helps build a useful conceptual framework for voice therapy. Meta-therapy was idiosyncratically defined in previous work. However, the current colloquial narrative of meta-therapy is not standardized or specific enough to be reliably taught, rigorously studied, or clinically delivered with high fidelity. Therefore, this article uses a standard framework (the Rehabilitation Treatment Specification System or RTSS) to further articulate and operationalize meta-therapy in vocal rehabilitation. Meta-therapy's conceptual framework generally aligns with the RTSS's treatment theory and associated concepts; e.g., the treatment component and its underlying ingredients, mechanisms of action, and target. Because the treatment theories in meta-therapy most frequently involve mechanisms of action related to information processing, they primarily map onto the RTSS's Representations treatment components. The treatment targets in meta-therapy are often focused on changes in the patient's cognitions, knowledge, beliefs, attitudes, intentions, and/or awareness regarding voice-related modifications. The ingredients in meta-therapy are frequently clinician actions conveying information with the goal of appropriately shaping the patient's mental representations, and are delivered with verbal cues, stories, analogies, etc. This manuscript provides specific examples of how meta-therapy is applied in clinical voice practice. Considerations for future investigation of meta-therapy are proposed.

Keywords

meta-therapy - Rehabilitation Treatment Specification System - voice therapy - treatment theory - expectations

Disclosures

• Helou is a salaried employee of the University of Pittsburgh School of Health and Rehabilitation Sciences. She receives honoraria and royalties for speaking engagements on the topic of voice therapy and meta-therapy. She has a contractual engagement with and receives royalties from MedBridge, Inc.


• Gartner-Schmidt is a salaried employee of the University of Pittsburgh School of Medicine. She receives royalties from MedBridge, Inc., is a consultant on R01 DC015906–01A1 for Optimization and Therapeutic Translation of Semi-Occluded Vocal Tract Techniques, and is adjunct professor, receiving annual honoraria, St. Mary's College, Notre Dame, IN.


• Hapner is a salaried employee of the University of Alabama, Birmingham. She receives honoraria and royalties for speaking engagements on the topic of voice therapy and meta-therapy. She has a contractual engagement with MedBridge, Inc. as a consultant for the voice curriculum and for her work as an instructor on several topics on dysphonia that include discussions of meta-therapy. She is the co-author of the book, Voice Therapy Clinical Case Studies with Plural Publishing with several references to meta therapy within its case studies.


• Schneider is a salaried employee of the University of California San Francisco. She receives honoraria for planning of continuing education course and speaking engagements on the topic of voice evaluation and therapy. She receives royalties from MedBridge, Inc. for her work on education courses including Auditory Perceptual Voice Evaluation, Resonant Voice Tips and Tricks, and two courses on Singing Voice Evaluation and Treatment. She is the Professional Development Manager for the American Speech-Language and Hearing Association Special Interest Group 3: Voice and Upper Airway Disorders.


• Van Stan's work was supported by the National Institutes of Health (NIH) National Institute on Deafness and Other Communication Disorders and the Office of the Director's Office of Behavioral and Social Sciences Research via grant R21 DC016124 (PI: Dr. Jarrad Van Stan). The article's contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The funders had no role in the preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication. Jarrad Van Stan is also one of 9 copyright holders for the Manual for Rehabilitation Treatment Specification.




Publication History

Article published online:
17 February 2021

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