Conversation Training Therapy (CTT) is a voice therapy approach that uses conversation to treat voice disorders.
It was developed by Jackie Gartner-Schmidt and Amanda Gillespie in collaboration with five other SLPs who specialize in voice treatment.
Is Conversation Training Therapy right for your adult speech therapy patients? If so, how do you use it? In this post, you’ll learn how and when to use CTT.
For print-and-go Voice patient handouts and worksheets, check out the Voice & Resonance Pack!
- Why Use Conversation Training Therapy?
- Who Is Conversation Training Therapy For?
- How To Do Conversation Training Therapy
- Learn More About Conversation Training Therapy
- More Voice Resources
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Why Use Conversation Training Therapy?
Conversation Training Therapy was designed to solve some of the issues that both patients and therapists had with traditional voice therapy techniques.
Namely, patients struggled to generalize the gains from voice therapy into their everyday lives.
How does CTT aim to do this? By keeping treatment short, functional, and by following the principles of motor learning.
Conversation Training Therapy was designed to take only four sessions.
Patient-led conversation is the only stimulus used for Conversation Training Therapy.
The approach doesn’t use hierarchies, word lists, or a gradual build-up to functional conversation. Instead, it jumps right into conversations with the patient.
It’s Based on Motor Learning
Conversation as treatment incorporates three motor learning principles that traditional voice therapy approaches miss:
- Conversation is a whole skill versus a part of a skill (i.e. lip trill or a sustained phoneme)
- Conversation closely resembles a real-life task (real-life talking!)
- Conversation is challenging enough, as it requires a lot of effort to hold a conversation while thinking about vocal quality
Learn more about The Principles of Motor Learning.
Who Is Conversation Training Therapy For?
Conversation Training Therapy treats voice disorders.
A recent study found that CTT improved voice outcomes for patients with dysphonia due to either muscle tension or benign vocal fold lesions (Gartner-Schmidt, J., et al. 2016)
The developers of the approach give the following guidelines for what voice patients are a good fit for the program:
- The patient can speak at the conversation level (i.e. mild to no aphasia, enough breath support to produce sentences, etc.)
- The patient is stimulable for clear speech
- Cognition is intact
- They can hear the difference in their voice with and without clear speech
- They can feel the difference in their voice with and without clear speech
How To Do Conversation Training Therapy
Conversation Training Therapy is not a set, step-by-step treatment approach.
Rather, there are six tenants that therapists teach and practice with their patients during the four treatment sessions.
CTT does have a few guidelines:
- Use conversation
- Teach Clear Speech right away. From there, it’s up to the therapist which tenants to work on next
- Mirror the target voice during conversation to add to their sensory experience of their “new” versus “old” voice
1. Clear Speech
From the get-go, encourage patients to use clear speech.
As a refresher, clear speech is speaking in a very precise and intelligible way. Model how to exaggerate articulation, pause between phrases, and use a slightly louder speaking volume. All while sounding natural and not forced.
Have the patient practice clear speech in a conversation topic of their choosing. Cue and model as appropriate.
2. Auditory & Kinesthetic Awareness
Ask patients to feel their voice when they speak in the “new” way. Then, ask how it feels when they speak the “old” way. Ask them to compare the two.
Next, ask patients to hear how their voice sounds when they speak in the “new” way. Then ask how it sounds when they speak the “old” way. Ask them to compare the two.
Have the patient come up with their own labels for their “new” and “old” voice. For example, a patient may report that their “old” voice feels strained and sounds weak, while their “new” voice feels supportive and sounds clear. This patient may then choose the labels “weak voice” and “clear voice.”
Use these patient-chosen labels throughout treatment to help them better feel and hear their voice.
3. Negative Practice
Negative practice means having the patient regularly switch to their ‘old’ voice.
During conversation, have the patient switch between their new and old voices, encouraging them to feel and hear the difference between the two.
The aim of negative practice is to improve auditory and kinesthetic awareness while empowering patients to realize that they’re in control of their voice.
Do this by engaging in patient-led conversation, along with your usual methods of building a trusting patient-clinician bond.
5. Embedding Basic Training Gestures (BTG)
BTG is a concept developed by Verdolini Abbott’s Lessac-Madsen Resonant Voice Therapy (LMRVT).
To do BTG, a patient sustains certain consonants with the goal of feeling the voice at the front of the mouth.
For Conversation Training Therapy, the patient is asked to sustain consonants at random during conversation.
For example, “I’mmmmm hunnnnngry. Wwwwwhennnnn is lunnnnch?”
Or, they may start each phrase with ‘Mmmmmm’ then connect it to the phrase. “Mmmm-I want to order a sandwich. Mmmmm-Or maybe a salad.”
Throughout, encourage the patient to notice how it feels to sustain the consonants at the front of the mouth.
Teach patients to improve pitch, timing, and loudness. As always, practice using conversation.
To improve inflection (pitch), ask patients to speak with just a bit more pitch inflection. You may encourage them to pitch each phrase higher, to avoid vocal fry.
Next, roll in Negative Practice by asking the patient to speak in a bit of a monotone. Mirror the monotone. Ask the patient to notice and describe the difference between the two (a bit more pitch inflection is better).
To improve timing, ask the patient to concentrate on clearly enunciating (articulating) the end sounds of each word. This will naturally lead to pauses during speech.
Next, ask the patient to speak without pauses, then compare how the two voices felt and sounded.
To improve loudness, ask the patient to project their voice while speaking slowly. Then, ask them to project their voice while speaking quickly. Encourage them to notice and compare how each impacts loudness (a bit slower is better).
Next, ask them to project their voice in conversation while their mouth is a bit wider than usual. Then, ask them to project their voice in conversation with their mouth almost closed. Encourage them to notice and compare how each impacts loudness (mouth a bit more open is better).
Learn More About Conversation Training Therapy
The creators of CTT, Jackie Gartner-Schmidt and Amanda Gillespie, teach their approach in a Medbridge course.
In it, they model all 6 tenants with a voice patient and give additional voice treatment tips and data.
More Voice Resources
- American Speech-Language-Hearing Association. (n.d.). Voice Disorders [Practice portal]. https://www.asha.org/practice-portal/clinical-topics/voice-disorders. Retrieved June 8, 2023.
- Gartner-Schmidt, J., Gherson, S., Hapner, E. R., Muckala, J., Roth, D., Schneider, S., & Gillespie, A. I. (2016). The Development of Conversation Training Therapy: A Concept Paper. Journal of voice : official journal of the Voice Foundation, 30(5), 563–573. https://doi.org/10.1016/j.jvoice.2015.06.007
- Gillespie, A. I., Yabes, J., Rosen, C. A., & Gartner-Schmidt, J. L. (2019). Efficacy of Conversation Training Therapy for Patients With Benign Vocal Fold Lesions and Muscle Tension Dysphonia Compared to Historical Matched Control Patients. Journal of speech, language, and hearing research : JSLHR, 62(11), 4062–4079. https://doi.org/10.1044/2019_JSLHR-S-19-0136
- Gillespie, A., Gartner-Schmidt, J. (n.d.) Conversation Training Therapy [Online course] Medbridge. https://www.medbridgeeducation.com/courses/details/conversation-training-therapy-jackie-gartner-schmidt-amanda-i-gillespie