Abstract
Meta-therapy refers to the clinical dialogue via which direct and indirect voice treatments
are introduced and discussed, and which helps build a useful conceptual framework
for voice therapy. Meta-therapy was idiosyncratically defined in previous work. However,
the current colloquial narrative of meta-therapy is not standardized or specific enough
to be reliably taught, rigorously studied, or clinically delivered with high fidelity.
Therefore, this article uses a standard framework (the Rehabilitation Treatment Specification
System or RTSS) to further articulate and operationalize meta-therapy in vocal rehabilitation.
Meta-therapy's conceptual framework generally aligns with the RTSS's treatment theory
and associated concepts; e.g., the treatment component and its underlying ingredients,
mechanisms of action, and target. Because the treatment theories in meta-therapy most
frequently involve mechanisms of action related to information processing, they primarily
map onto the RTSS's Representations treatment components. The treatment targets in
meta-therapy are often focused on changes in the patient's cognitions, knowledge,
beliefs, attitudes, intentions, and/or awareness regarding voice-related modifications.
The ingredients in meta-therapy are frequently clinician actions conveying information
with the goal of appropriately shaping the patient's mental representations, and are
delivered with verbal cues, stories, analogies, etc. This manuscript provides specific
examples of how meta-therapy is applied in clinical voice practice. Considerations
for future investigation of meta-therapy are proposed.
Keywords
meta-therapy - Rehabilitation Treatment Specification System - voice therapy - treatment
theory - expectations
