Case study summary

This case study has shown how one SLT engages a client in the process of evaluating his own performance and the significant challenges there are for both parties in doing this kind of evaluation of performance. The SLT presents the client with a range of frameworks for evaluating his performance, starting with a 0-10 rating scale, then using more general parameters related to awareness of his performance (“how clear”) and his experience of the tasks (“how did you find”), and finishing with a format that constrains the client to agree with the implied positive evaluation (“do you think you’ve improved”).

The fact that the SLT had to occasionally halt the task in progress and signal a change of task to engage the client in self-evaluation indicates that there is no clear sequential location for ST s. A number of the SLT’s requests for evaluation actually occur after she has already produced an evaluative phrase in a third-turn slot. As the previous chapter showed, such evaluations are often signalling the end of an activity, rather than an actual evaluation, or at best a kind of ‘nominal’ evaluation (Clark et al, 2003). Nevertheless, producing a third-turn evaluative phrase just prior to asking the client to evaluate his own performance creates a tension for the client, in relation to how he himself evaluates his own performance. In doing these third-turn evaluations, the SLT inadvertently emphasises her epistemic rights to evaluation prior to engaging the client in self-evaluation.

In asking a client to give his opinion, the SLT is acknowledging that client’s epistemic rights – to evaluate his performance on tasks – as something that is part of his experience. When the client in this particular session was invited to actively evaluate his own

performances, his evaluations directly linked to aspects of his own performance that were less than optimal. In this way, his negative evaluations had merit, though often he

highlighted singular instances of poor performance without comment on the positive aspects of his performance that were also present. These negative evaluations are in line with client focus on improvement; they may also be a reasonable strategy to employ in terms of clients not over-estimating their own abilities. In engaging in evaluation of any sort, however, he showed an ability to enter into a dialogic construction of shared meaning around the nature of the ‘assessable’ – namely, the clarity of his speech.

The SLT acknowledges client epistemic rights to self-evaluate, both by directly asking him to do so, and through acknowledging his descriptions of his own performance. She also, at times, links her own positive evaluations onto his negative ones in what appears to be an attempt to balance his negative perspective. Having set up a pattern in the first few tasks, of asking him to evaluate himself, it is noticeable when the SLT re-assumes the right to evaluate him first herself at times; she does this to preclude the client from evaluating his own performances negatively, or when he is concentrating so hard on doing the task that his ability to monitor his own performance is likely to be more limited, such as in the ‘modifying volume’ tasks where he evidenced some difficulty initially.

The client’s ST s, and the discussions they engendered, provide a rich vein of information about the client’s frames of reference for evaluation, about which time period is relevant (before or after the accident), and about his tendency to focus on errors rather than on his overall intelligibility. But these post-evaluation expansion sequences also highlight the time required to discuss client evaluations. These were not actions that were done simply; they routinely involved some discussion, of the nature of his evaluations, of their merits, and/or the factors that impacted on him achieving optimal performance on tasks. Thus, inviting a client to evaluate can reduce the time available for actual practicing of skills. The SLT’s focus, in these discussions, is on how he is managing lapses in intelligibility, through self-correction, suggesting that she believes this to be a relevant strategy for managing his intelligibility. Both the fact that self-correction was not discussed in the initial revision of strategies, at the beginning of the session, and the SLT’s manner of

introducing this idea into the session, through various linking strategies, suggest that it is something of a delicate issue. Using self-correction, as a strategy for achieving good overall intelligibility, implies that the client is not going to reach a stage where he will be intelligible all the time; that he is not likely to re-gain his premorbid level of speech. This issue is not addressed openly in the session.

The noticeable feature of the evaluation sequences that the SLT initiates is that the parameters she and the client discuss at the beginning of the session are not oriented to in any way in her subsequent requests for him to evaluate his performance. While the SLT references these strategies in the lead-up to a number of the tasks, she does not reference these strategies in any way in the evaluation sequences that occur after the task is halted. Neither is there any attempt to explore the actual elements of performance that the client is orienting to in his negative evaluations. When he identifies specific words that he has had difficulty with, there is no discussion of the ways that different combinations of sounds are more difficult for him to produce. One example of this is the word institution: the fine degree of movement required to produce the range of sounds ([i], [s], [t], [n]) that have their focus of articulation at, or near, the alveolar ridge is likely to present a significant challenge to someone with reduced motor control because of dysarthria. The client’s evaluations are rarely taken up as an opportunity to calibrate intersubjectivity about the meaning of errors.

In this institutional interaction, it is ultimately the agenda of the ‘expert’ that takes precedence. By primarily referencing positive aspects of performance, and not overtly engaging with the perceptions that underpin the client’s negative evaluations, or attempting to reframe them, the SLT can be seen to be pursuing a ‘positive’ agenda. This runs counter to the client’s propensity to evaluate his performances negatively. At the heart of these disparate perspectives on the client’s performance lies the dichotomy between how good his speech was before the accident and how good it can plausibly be now. The introduction of the activity of client self-rating, and the repeated references to ‘self-correction’, indicate that these will be important parts of any future ‘improvement’. That is, in introducing self- correction as an important part of his performance, the SLT implies that the client will not return to his premorbid abilities and is likely to experience ongoing difficulty at times producing words clearly. The aim is to ensure that he monitors his own speech, and repairs any errors before his interaction partner can do so. The SLT’s knowledge and experience

with recovery of speech function following impairment of the speech mechanism give her the epistemic rights to ascertain whether he is likely to achieve any further improvement in actual motor functioning, and when he needs to turn his attention to using strategies, like self-correction, that minimise the impact on the listener of any breaches of intelligibility, when these occur. The client is still focused on returning to how he spoke before the accident. These disparate perspectives make encouraging the client to evaluate his own performance a challenge for both parties.

The next chapter will present a discussion of the key findings of this research, and the implications of the findings for SLT practice, along with recommendations for future research on the nature of SLT talk in therapy interactions.