Interview with Katie Gore of Speech IRL

Note: You should consult with your doctor or speech pathologist for recommendations on treatment. The views and opinions expressed in this article are those of Katie Gore and do not necessarily reflect the official policy or position of SpeechPathologyMastersPrograms.com

What inspired you to start Speech IRL?

My answer to “what inspired you” questions is always the same: my clients!

During my CFY, I worked full-time in a SNF and contracted with a private practice on the side. The private practice was primarily a pediatric clinic, but they were looking to expand into accent modification services, something I was interested in. I told them I was generally interested in working with adults.

Over the course of that year, they would contact me every few months with a non-accent-mod adult speech therapy client. An architect with a lisp. A medical resident with a stutter. All their other clinicians focused on pediatrics, so I got all the older outliers.

These clients got me thinking. If I was a 35-year-old consultant who was self-conscious about a lisp, where would I go for help? Hospital outpatient clinics wouldn’t make sense, I’m not sick or in need of rehabilitation. I would feel embarrassed and awkward calling up a typical pediatric-styled speech therapy practice (even though that was very much the branding of the very practice I was contracting with).

I realized that speech therapy as a field has been constructed as though the only people who have communication concerns are under the age of 18 or over the age of 65. If you’re between that age and need speech therapy, that probably means you have a developmental disability.

What if you need communication help, but don’t fit that description at all?

That was my inspiration for speech IRL. Since I live in Chicago, my guess was that there would *probably* be enough of my theoretical underserved population to sustain an income for myself.

Five years and an ever-growing team (currently at six people) later…turns out it was a pretty good guess.

What do you hope your readers get out of your posts?

This may be terrible to say, but I don’t really write for my readers. I write for myself.

I’ve always enjoyed writing, so starting a business was a convenient excuse to give myself an outlet. My blog posts are just a reflection of whatever I’m thinking about. Sometimes it’s about the field of speech-language pathology, a topic of interest to fellow clinicians. Sometimes it’s musings and philosophizing about communication, which is suited to a lay audience. Sometimes it’s agonizing an existential issue on a specific experience, like stuttering. And sometimes it’s just me having fun applying my speech-language pathologist brain to nerdy pop culture, like trying to diagnose Hodor. Those posts certainly seem to have the most appeal!

We love that you say “The city of Chicago is our clinic”. What are some quick and easy tips for integrating speech therapy into daily routine?

This is a great question, because it reveals a lot about how we think about speech, communication, and speech therapy.

The average person utters somewhere between 5,000 and 20,000 words each day. Yet clinicians and clients alike go out of way to create extra “speech assignments” to support therapy. Why is that?

The most expedient way to integrate speech therapy into daily routine is through mindful intention. It’s not easy– in fact, if you’re really practicing therapy goals, it should be much harder than your default approach. Do you order coffee on your way to work every day? Great. Pay attention to how you’re ordering coffee. Order it in a way that’s consistent with your communication goals.

Whenever possible, I prefer to assign clients homework through actual conversations they would normally have, rather than creating “just for practice” assignments. For example, I’ll have a client tell me all the upcoming calls they have to make at work over the next three days. We’ll agree that when they talk to Sally on the Google sales team at 3:00 pm on Thursday, they will practice [communication goal].

Sometimes it is necessary to create “just for therapy” speaking assignments to get outside your comfort zone or tackle a very specific skill. My belief and experience is that it is most impactful to take advantage of the myriad communication situations that we experience every day of our lives. The goal is to be able to do it “IRL” anyway, so why not practice where it counts?

You wrote a very interesting piece on a reflection paper you did in school about pseudo stuttering, where you assumed the role of a person who stutters to see what it was like. How important is it in speech-language pathology to understand the point of view of the client? How did this affect your approach to therapy?

Understanding the point of view of the client is the MOST important part of therapy. My clients have created my approach to therapy.

Everything I’ve learned about stuttering has been from people who stutter. Unlike a lot of stuttering specialists, I didn’t have an expert mentor who molded me in my formative clinical years. I knew basically nothing about stuttering when I started, but I spent a lot of time at NSA chapter meetings and conferences having heartfelt conversations about what it means to experience stuttering until the wee hours of the morning. I wrestled with how those myriad and nuanced lived experiences fit into a therapy box. (Hint: they don’t, or not very cleanly at least.) It made me realize that you should fit therapy onto a person, not fit the person into therapy. That’s a philosophy that I think is embraced by most experienced clinicians, but it is not the way we are taught in graduate school.

I always tell students and clinicians that if your only experience with a particular client population is in the therapy room, your therapy is going to be severely inhibited. Going outside the therapy room in the context of a therapy session does not count.

To really be effective clinicians, we must accept that we can never fully understand what our clients are going through. We must live with them and love them as people first, and clients/diagnostic label second (or third, fourth, seventeenth).

Another topic that you have talked about several times is the natural difficulty of conversation and public speaking- you mention that the advice that is out there is often obvious and doesn’t address the underlying challenges. How can we better approach these subjects?

Communication and speaking advice places a lot of emphasis on doing or avoiding, historically. “Do this, don’t do that.” The assumption seems to be that there is a knowledge deficit, that people don’t know how to communicate well or speak confidently. My experience is that most people know very well what they should be doing and what they want to do. Sometimes it is less defined than others, but the general sense is almost always pretty spot-on. But if we know these things, why don’t we follow our own advice?

What seems to be missing is that we pay very little attention to why we aren’t doing or avoiding these respective behaviors. The why is everything. Wrapped up in the why is cognitive science, psychology, culture, stigma, life experience, and more.

It’s like losing weight. Most people know how to lose weight. Eat less sugar, exercise more, cut calories, or various more technical approaches like keto or intermittent fasting. Finding the information on what to do is very easy. What we need help with are all the things wrapped up in why is this so hard.

Why is a hard question, and I think it’s one we are becoming less and less skilled at tackling. In some ways I think this is an unfortunate side effect of the emphasis on EBP. We are trained to diligently seek out what works “the best”– is it keto, or IF, or a vegan diet?– and hit a wall when “the best” (or even not-the-best) seems to not be working.

What do you like best about working with the adult population?

I like working with clients who are like me.

Of course, for the most part my clients are NOT like me– age, gender, race, upbringing, nationality, all kinds of differences. But I enjoy working with fellow adults who are going through active adult life, whether that’s just graduating from college or starting to think about retirement. Our clients come to us with questions and struggles around communication, but they are also dealing with questions about marriage, dating, child-rearing, home-buying, friendship, career changes, family stresses, financial planning, and all the same things that we as clinicians deal with.

Communication exists in every plane of human existence, and it is most taxed during these key life questions. Most of our clients come to us during a period of transition: a job promotion, an upcoming marriage, change in family role. They come with questions about communication, but the answers are closely tied to the life situation answer itself– and I never know what that is!

But we figure it out together, and that’s why I love this job. Our clients write their own paths, and we are fortunate enough to be a sidelines coach for some specific skills. Being invited to experiencing the process of figuring life out, with my clients, has changed who I am as a person.

I like working with adults with communication struggles, because they help me understand myself.

What is your advice for SLP graduate students?

Embrace not knowing.

I look back on my graduate student experience and recall a strong pressure to know everything. This is ridiculous, since that is the point in your career at which you know the least. But I felt it anyway.

When I began working with people who stutter, I questioned myself every day. Most of the stuttering experts seem to be people who stutter themselves. Who did I think I was, working with people who had such a profound experience that I had never had myself?

The welcoming arms of the stuttering community taught me that embracing the role of a listener, a learner, a wide-eyed newbie is a wonderful thing. We learn more through listening than through hearing ourselves talk.

There are few things that get me more excited than hearing one my team members say, “I don’t know what to do.” On the one hand, it’s a terrible feeling (five years into running a business, it’s a very familiar one). However, that’s where opportunity is. It’s the step-outside-your-comfort-zone cliche, but the challenge is to allow yourself to STAY THERE.

Be willing to respond as a person, not just a service provider. Speak up (we witness a lot of injustice in our roles, we can do something about it). Be willing to sit in grief and fear with those who come to you. Admit you don’t have the answers and you don’t know what will happen next, but you’re willing to stick it out and see.

Be the person you would want to have as your speech-language pathologist.