NARRATIVE TWO A Personal Sense of Training
1.1 An Introduction to the Profession: Training and Practice
In any language group there are people whose communication marks them as different to the norm of the group. Dependent on the societal rules operating within it, the differences are perceived as problems or not. The rules change over time. For example, thirty years ago a 'lisp' in a female may have been regarded as acceptable in English speaking language groups, but currently be regarded as an 'impediment' to be remedied.
The kind of forces that operate to change a certain language society's rules about problems in communication are heavily influenced by the level of media, technological, and educative sophistication operating within it. For example, 'Attention Deficit
Disorder/Syndrome' (ADD/S) was, while I was a student ten years ago, a phenomena that teachers most often noted in children around age eight, resulting in their inability to 'sit still and listen' to what the teacher was saying. Often, the children were placed on a drug such as Ritolin so as to calm them, and speech-language and/or occupational therapy was recommended to teach strategies of effective listening, and thus help the child learn in class. Last month, I was told of an English speaking seventeen year old boy who had just been diagnosed as having ADD, and placed on Ritolin. This was not because he had ever failed in class, but because his parents were fearful that he would not achieve an 'A' aggregate in his school leaving examinations, and thus compromise his chances of being accepted for medical training. The young man was, therefore, pathologised by a doctor, a psychologist, by his teachers and parents, in order to meet the expectations of hisso~ietal/languagegroup.
Itcan be seen from this example that problems of communication cannot be separated from the class interests of those who do the problematising. To pathologise the young man in the first place, considerable financial, educative and professional resources were needed. In addition, what is regarded as a problem will differ across language groups, dependent upon the linguistic norms of the time. Problems in human communication do not, therefore, con~titute stable 'disease' entities. They shift; responsive to changes in society, and also responsive to the resources of a society in being able to own them.
The goal of the SHT profession is to help all people who are experiencing either a permanent or temporary breakdown in their ability to communicate within these norms.
These breakdowns are referred to as 'communication disorders' and constitute a range of pathologised differences from the .cultural and linguistic norms of a given language group and/or society. What ranks as professional knowledge, therefore, depends upon the structure of the society it finds itself within. To extend this crucial point in a preliminary way: the profession succeeds by virtue of society finding congruence with its beliefs about what constitutes a problem of communication. What is taught to students in training, therefore, reflects the societal/linguistic norms of the society the profession serves.
The help the profession offers is through the process of therapy; a dialogue between helper and helpee.1 Stated technically, the helper improves the client's particular problem through a process of facilitating self-conscious reflection and control (Fairclough, 1989). Put more simply, the therapist, and by teaching a variety of' strategies, aids the client to alter her communication. It is helpful - although not essential in the presence of an interpreter - for the client and therapist to share the same language in the teaching of these strategies. What is important to note, however, is that only a few of the wide range of possible communication problems actually get 'cured.' The therapeutic role is more often that of teaching contextually relevant strategies to allow more effective communication, or by working with care-givers to increase the communicative effectiveness of the family/social unit. These facilitative roles presume in-depth knowledge of the socialised norms of the speech community concerned, as carried by the specific linguistic symbol system. In other words, these roles presume linguistic competence(Langue).
The training of South African SHT's occurs within specialised departments at five English and Afrikaans medium universities. It is a non-elective and nationally accredited curriculum leading to compulsory professional registration as autonomous practitioners with the Interim Medical and Dental Council of South Africa (IMDCSA).
The profession's interests - and with it, its curriculum - are represented within the IMDCSA by the Professional Board for Speech-Language Therapy and Audiology. One of the key functions of the Board, and related to the national professional accreditation system, is to rigourously examine the five training institutions every four years to ensure that their teaching and leaming programmes conform to the national standard.
Although content of the teaching programme varies between institutions, the concern is with maintaining a normalised national product. Effectively, therefore, if an individual institution engages in wide-sweeping changes to its curriculum without national consensus, it does so at the risk of losing its professional accreditation. If this occurs, the programme will close. There are, therefore, significant interests at work in maintaining the curriculum and its current standards, a topic that will be returned to in more detail in Chapter Two (2.1.5). At this point, however, it is sufficient to highlight that the Professional Board defines and maintains the national standard of training, and
I N.arrative Three: 'TheProces~and Procedures of Therapy', accompanying Chapter 2 (2.1.2.2) provides an m-depth example of profeSSIOnal therapeutic process.
that this standard is located legislatively within the powerful medical establishment - even though much professional practice activity lies outside it.
The four year, honours equivalent training has historically prepared students for contexts of practice in mainly schools, hospitals, 'special' or rehabilitative facilities for a range of disabled persons, or private practice. In response to health care policy changes in the country, there is currently an additional trend to prepare students for 'community' practice, a point to be extended in 1.2.1 below.
There is no doubt or debate regarding the rigour of the training process. Of the twenty- one mandatory courses, two are four year 'major' subjects; speech-language pathology and audiology, and Psychology is a three year major. In addition to theoretical courses such as the anatomical sciences and linguistics, are the clinical, or applied, courses that fmm part of the compulsory training process. Both speech-language pathology and audiology have separate clinical timetables. Both, however, teach the theory of particular communicative pathologies the year prior to students practically applying the knowledge with clients demonstrating the learnt pathologies. Without passing the theoretical examination, the student may not progress to practice.
The rigour of the training process is frequently used as a tautological argument defending highly selective entrance criteria. Mathematics and/or physical science are pre-requisites for entry, not because content knowledge of these subjects is needed except at most basic levels, but because it is generally believed that the thinking skills demonstrated by success in these subjects at a school level will support the learning process of the student in training.
Potential candidates with the appropriate academic requirements are then interviewed and/or tested by Departmental staff. By matching candidates to prior knowledge of who, and how, students succeed in negotiating the arduous training, a self-perpetuating cycle is established of matching potential student to training success. In this sense, therefore, the curriculum remains central and st&tic. It is the task of the people concerned in its teaching and learning to negotiate it.
Once accepted for training, the pressures of workload are aggravated by the context within which it occurs. The training programme in each institution is small, with an average of 80 national graduates per annum (Aron, 1991).Itis, however, staff intensive, with 10-15 (dependent on the resources of the institution) permanent teacher- professionals involved in the teaching and learning process. With the training occurring in a specialised unit, following a common syllabus that allows little free time, the training process is not only closely observed, but the students themselves have little opportunity to engage in campus-wide activity. This point will be returned to in more depth in 1.3.
What I hope to have pointed out in this preliminary discussion is that although the goal of professional service lies within the ever changing, societally located, and interpersonal nature of human communication, the nature of the training process is structurally rigid and concerned with academic mastery. With this as a background, the following section inserts it within the South African context of policy in order to highlight the responsibilities of the training programme to government legislation.