Summary and Conclusion

This brief excursion through history, covering some leading figures, and basic intervention approaches that have been used over the past century has revealed distinct trends in past practices and in so doing can offer some useful insights for how we go about doing what we do. The century was divided into four periods, based on the common characteristics. The first 45 years made up our formative period in that the profession established itself as a separate from medicine and speech communication and began defining its canons of clinical practice Included in the therapy approaches were medical treatments as well as educational ones. The educational approaches were typically atomistic in that they began with a small entity (speech sounds) and built to larger ones (word sequences). The therapies were also focused on peripheral aspects of speech-the sensory and motor training. Typical of therapy approaches for sensory training was sound bombardment. For motor training,clinicians instructed clients in the physical placement of articulators and carrying out tongue exercises. Therapy in this period was typically provided in practice drills, using discrete practice items.

During our second stage from 1945 to 1965, therapies became more wholistic and aimed at less observable aspects of speech and language. Rather than beginning with work on speech sounds, many programs began with words, and internal processes such as mediation, symbol formation and inner language became the conceptual focus of therapies. Also of concern were processing modalities-visual as well as auditory. The focus at this time was more on how language was processed than on how it was organized conceptually or how it functioned in specific communication contexts.

The third period of speech-language therapy (1965-1975) forced approaches even more inward and abstract. Here the shift was from processing to knowledge goals. Clinicians developed programs for teaching phonological and grammatical rules, paying less attention to how the rules were processed. The delivery of therapies during this period were often behaviorally oriented, using repetitive practice on discrete items that were not meaningfully related.

The most recent period, from 1975 to the present, saw the emergence of a new type of clinical practice, that having to do with pragmatic concerns such as how messages were used, and how they fit into the situational and cultural contexts of everyday life communication. New therapies were developed, in keeping with the notion of communication in context. Rather than conducting practice sessions in contexts separate from the client's ordinary communication situations, the clinical services were delivered in classrooms, homes, and in community settings.