Last Updated May 2012
“I was told I was not allowed to…”
I had just decided to leave my dream job and work as a speech language pathology therapist on private practice. Why, you might ask, would I be leaving my dream job? For over a year, I had petitioned my supervisor to allow me to design and teach a preschool classroom for children with severe sound system disorders— functional articulation problems, phonological delays, and childhood apraxia of speech. Now, I was doing just that, and having great success with it! I loved my assistant and the other speech language pathology therapist who came into the class for half of the day. I loved the students. Work was fun, challenging, and rewarding. Still, there was nowhere to go. No corporate ladder to climb. No chance of being the boss. I had to ask for everything I needed for the class. I was told what I could and could not do by the higher-ups. In no uncertain terms, I was told I was not allowed to contact the Department of Elementary and Secondary Education to ask questions regarding IEPs, eligibility, or protocol. There were many other don’ts—don’t diagnose, don’t mention suspected conditions, don’t make waves, etc. The last straw was when I was yelled at by my supervisor, a hot-tempered woman who gesticulated wildly while raising her voice, for making an innocent comment at a staff meeting. This was right in front of my colleagues. I felt like a five year old. How humiliating! I gathered up my wounded pride, took consolation from those who came up to me afterwards and professed how unwarranted the rebuke was, and quit within the next week.
Should I Start A Private Practice?
For months, my husband had been suggesting that I start working as a therapist on private practice. I could work right out of my home, in the basement bedroom, which we could convert to an office. I could start slowly, and build up to however many clients I wanted. I could make my own decisions, order my own supplies, call the Department of Elementary and Secondary Education if I so chose, and I could mention suspected conditions if I felt the need! I was covered by my husband’s insurance plan from work, so that would not be a problem. It was a scary prospect, but I was hoping I could find a way to bring my preschool class to the public, on a private level. 
That, in itself, was motivating enough for me to say yes to the prospect of private practice.
Still, something nagged at me. What if I failed to help my clients? What if I bit off more than I could chew? The onus was on me. No assistants, no colleagues to fall back upon for support or suggestions, taking peoples’ hard earned money with the expectation of providing results worthy of the amount I was charging. Would I be deemed a charlatan? What made me think I was knowledgeable and experienced enough to get out there with the big boys, so to speak? Where would I even get my clients in the first place? Did I believe in myself enough to make the leap? Apparently, I did. Armed with the resolve to learn that which I did not know, to help to the best of my ability, and to refer onward those I was not sufficiently confident I could help, I made it known to all the speech language pathology therapists in my own and neighboring school districts that I was hanging up a shingle.
My First Clients
My first client, or clients, I should say, came from a fellow therapist with whom I had shared a good working relationship at the school district, and who did some part-time private therapy. She had been approached to see a couple of sisters, and she did not feel she had the time to see them herself. She referred them to me. These girls, ages 13 and 14 both had years of therapy, but were not progressing with production of /r/. The younger one also had trouble with /s/. While the younger sister was still in therapy at her elementary school, the older one had been dismissed from therapy by her middle school speech language pathologist. The therapist told the girl’s mother that she had done everything possible, and that the teen would never be able to produce /r/ any better than she was. Fortunately, the girl’s mother was not ready to give up and resign her daughter to sounding like Elmer Fudd. Uh oh, I thought, my experience was primarily with preschoolers with whom I only touched on /r/, and only to familiarize them with it, not to perfect it. Was I in over my head already?
Finding the Right Treatment Approach
When I first saw the sisters, the younger one, Anna (not her real name), was lively and chatty, despite her poor articulation of the two phonemes. The older, Katie (not her real name), was withdrawn and quiet. It was obvious from the start that she felt defeated and subconscious about speaking. Despite being a beautiful girl, she had few friends and socialized little. She appeared almost painfully shy. I felt great empathy toward her, and vowed to do what I could. Her mother was not expecting miracles, but she thought that maybe the /r/ could be improved a bit. I had recently taken a video course by Charlotte Boshart, one dealing with the motor aspects of speech. At that time, I was not yet aware of the major controversy brewing among SLPs regarding activities for speech improvement such as the oral-motor activities. I asked Anna and Katie’s mother whether anyone had ever taken a more oral-motor approach to correcting their /r/ sounds, and she said she did not think that they had. She was willing and anxious to have me try it, so that is what I did.
Mission Accomplished!
The approach I took on oral-motor speech therapy activities was not based on doing repetitive exercises to strengthen musculature, but to familiarize the girls with muscles in the tongue that they were not currently using. Whether these muscles were lacking in tone, I cannot say for sure, but I can say for a fact that the girls were unaware that they existed until we did these activities. After a couple of weeks, I started seeing progress in the therapy sessions. After a month, the girls’ mom started noticing a difference when they practiced their speech homework. After a few months, she started noticing some carryover into conversation. By a full six months after starting therapy, both Anna and Katie were producing perfect /r/ phonemes in conversation, with nearly 100% accuracy. We had also corrected Anna’s /s/, and she was released from school therapy. What’s more, Katie was no longer the same introverted, defeated girl she had been six months before. She was an absolute social butterfly! In the last couple of sessions, I had to wait for her to get off the phone with her friends. Her mother said she was on the phone constantly, and she was now the belle of the ball. Once she hung up her phone, Katie was lively and chatty and an absolute delight! Mission accomplished!
Three and a Half Years Later… 
With such an auspicious start to therapy private practice, I could only think ahead to whom else I might be able to help similarly. Now three and a half years into it, I have had many successes, and each one buoys my spirits and makes me feel that this endeavor is entirely worthwhile. I am thankful that my first clients helped me to see that!
Rhonda J. Banford, M.A.T., CCC-SLP of Tip of the Tongue Speech and Language, LLC
Contact: 636 220 8200