July 22, 2020

Dr. Gwen:        Hi, friends. My name is Dr. Gwen, and I'm a clinical psychologist who's obsessed with empowering disabled individuals, their families, and the systems that support them. I had the pleasure of interviewing Justine Mufson, a speech and language pathologist. She breaks down the many pressure points that speech therapist ease, how her job is all about fostering connection and understanding, and how she is passionate about giving all kids a voice in any shape or form. She's another creative in this professional space and we are so lucky to have her. Timestamps are in the description below. Please enjoy this interview with Justine.

                         Hi, Justine, how are you?

 Justine:            I'm doing great now that I see your face. How are you?

 Dr. Gwen:        Good. Thanks, Justine, you always make me smile. Thanks so much for coming on to the video and for us to do some deeper dives into what a speech and language therapist does. But maybe what we can do is start with who are you? Tell us about yourself.

 Justine:            Absolutely, and I'm honored to be here. So, this is awesome for me.

 Dr. Gwen:        Thanks, Justine. You're so sweet.

 Justine:            So, me, I, at a very young age, absolutely loved working with kids. Not even working, just being around kids. And I think everyone who knew me knew that about me. So, I always was very passionate about that, I knew I wanted to work with kids in some sort of element. Initially, I thought, maybe I'll be a pediatrician? Maybe I'll go to med school? And I started that track in undergrad. But I quickly realized, I don't need to go through all of the Bio and Chem and all that crazy intense stuff to be a professional that works with the pediatric population. So, after I graduated with a Psychology degree in my undergrad education, the opportunity to be a behavioral therapist kind of fell into my lap. My mom had a friend who has a daughter with autism and she was looking for a behavioral aide to be with her in the school setting, and she knew that I love working with kids. I had never worked with a special needs population prior to that, so that was a little daunting for me, but I said, "Sure, I'm interested, I would love to meet your daughter." Went to go meet her, absolutely fell in love with this girl. She is beautiful, she is so cute, I used to call her the autistic version of myself. She's quirky but she loves music, she loves singing, she loves hugs, she loves pressure, all things that I'm super passionate about myself. So, this whole thing kind of started with me clicking with this particular soul, this particular individual, and really tuning in to how she communicates, tuning into what her needs were, what her sensory needs were, and this was all stuff that I really didn't have any information or education about. I kind of just like was thrown in and learned on the spot, and I was very lucky that I was surrounded by other professionals that had a lot more experience than I did and they were kind enough to show me and teach me. And, I was just a sponge, I took it all in. And that experience actually led me to my next job as an infant stimulation therapist. So, those other professionals that helped me kind of get me on my feet, they saw that I had a knack and passion for this and asked if I would be interested in working in a center-based program doing early intervention. So, that led me down that path. And that was super fun for me working with toddlers and just kids three years and under. And working with parents was a whole new thing for me as well. When you work with kids that young, you really have to tune into the parents, and their needs, and their emotions. And a lot of the time they're first-time parents.

 Dr. Gwen:        Yeah.

 Justine:            And it can be really scary, you don't know what you're doing, and you're just worried that your child might not be meeting the milestones that they should be meeting. So, that put me in a really nice position to learn how to coach parents and how to get them to trust me, how to really empower them to engage and interact with their children in order to like set them up with those building blocks to have language and communication. And it was really in that setting that I decided, "Oh, maybe speech pathology, maybe that's something that I would want to do." So, after being in that area for about three years, I applied to go to graduate school. And, I moved to Washington, DC, I went to the George Washington University which I absolutely loved. And again, I entered graduate school thinking, "Pediatrics going to do this, definitely want to work with kids." But it really opened up my eyes to how broad the speech pathology profession is.

 Dr. Gwen:        Yes.

 Justine:            There are so many-- and I'm sure we'll get into this later. But, it just opened up my eyes to how many things you can do with this profession, and I ended up actually falling in love with working with adults as well. I had the opportunity to work at GW Hospital's Outpatient Rehab Clinic. So, while I was there, I worked with a lot of head and neck cancer patients. So, doing a lot of work with dysphagia, and swallowing, and a lot of vocal rehab as well. Setting them up with different techniques and strategies to use their voice again. And I love that and that kind of coincided with my love of music and voice as well. So, that was really fun for me. And we also did a lot of cognitive linguistic work as well, so working with adults with traumatic brain injuries, or stroke patients working on their memory, executive functioning skills, social communication. And I was very surprised how much I enjoyed that, to the point where I left graduate school thinking maybe I'm going to switch to adults. That didn't end up happening and I'm totally fine with it, I'm happy where I am. But, yeah, after graduate school, I came back to Los Angeles and I started working at the NAPA Center. And NAPA stands for Neurological and Physical Abilitation Center. And it's a wonderful, wonderful place. They're located in Hawthorne, El Segundo area in Southern California. And this place is wonderful in how it's so inclusive of all abilities. You see children, and young adults, even some adult patients that come in, of all different backgrounds, all different abilities, all different religions, races, ethnicities, you see everything here. We have people traveling in from all over the world which is pretty awesome. And it really opened up my world to a more medically complex communication. So, in this setting, I had the opportunity to work with a lot of children who have brain-based disorders. So, cerebral palsy, epilepsy, seizure disorders, genetic disorders... We also have a lot of kids who have autism, and just you get the whole gamut at the NAPA center. And it really allowed me to grow as a clinician and learn all the-- I feel like, as I mentioned before, speech pathology is so broad, I had to kind of tap into all of like the micro-jobs, or micro professions in the speech pathology field to set up all these kiddos with success. So, I had the opportunity to get into the augmentative and alternative communication worlds, getting into feeding and swallowing for kids, which I hadn't done prior to working at NAPA Center. It was mostly adults that I did that with. It's been awesome. And I also see some private clients on the side, too, which is really fun. And it's been a really fun ride and I'm excited to continue growing and learning, and it's something that I'll be doing for the rest of my life as I'm sure you will be, too.

 Dr. Gwen:        Yeah, that kind of--

 Justine:            That winded answer to your question.

 Dr. Gwen:        No, I love it. I mean, I think the background is, it's so interesting because so many of the professionals that I've interviewed have a music background.

 Justine:            Really?

 Dr. Gwen:        Yeah, and it's so fascinating to me, we might have to just get all of your-- Everyone that I've interviewed will get like with the music background together, and we should talk about this.

 Justine:            Yes.

 Dr. Gwen:        Because I think that there's this inherent creativity in expression and the way you understand things-- Anyway, it's fascinating to me, but already for-- Anyway, side conversation. What's so cool is all of this kind of lateral movement that you can make as a speech and language therapist, right?

 Justine:            Yes.

 Dr. Gwen:        I think about that a lot in psychology. In psychology, there are so many different facets because human beings are so complex that there's so much movement and it really itches that or-- yeah, it itches that itch that I have where I'm always trying to learn something new or stay curious or evolve in some way shape or form.

 Justine:            Totally.

 Dr. Gwen:        So, it really allows for that. you've got this really lovely experience with so many different types of complex presentations. But they all have a similarity to them which is how do I communicate-- how do I use my voice in the world maybe it's another way of--

 Justine:            And what is that definition of voice, right?

 Dr. Gwen:        Yeah.

 Justine:            What does that mean? Because it can look so different for everybody. I think when people think about communication, people automatically think of the typical way of communicating which is verbal speech, but that's not the case. I mean, people communicate with sign, people communicate with picture systems, they communicate with high-tech systems, with eye gaze, with-- it's so broad, and I'm actually really excited that we're doing this so I can bring a little bit more attention to all the different forms of communication that are out there and kind of bringing more of a focus and hopefully reducing the stigma around other types of communication that don't fall into that verbal category, right?

 Dr. Gwen:        Absolutely, absolutely. Well, that's what the NAPA Center is giving you such a diverse exposure to all the different types of communication. I mean, you brought up augmentative communication, alternative communications, right, picture community. But there's so--that in and of itself is a huge specialty. It's uber-creative and I just feel like this is like where all these artists are coming from, are these artists that are now in some kind of professional capacity and in this field of disabilities, special needs. So, it's super cool. You know, Justine, let's get into kind of the more traditional maybe definition or idea of what a speech and language therapist does.

 Justine:            Absolutely. So, speech-language therapist or speech and language pathologist, same thing, two different words to describe it. When you hear "pathologists," that just means that a part of our job is to evaluate and figure out where the root of the problem is coming from, right. So, just like a pathologist in the medical field, you want to know what sort of infection or disease is going on in a person's body, the same thing with speech and language, or communication rather. I need to kind of dissect and figure out why is this child or why is this adult presenting with these communication difficulties, and what can I do to help support that person. So, as speech therapist, we work to assess, diagnose, and treat speech, language, social communication, cognitive communications, and swallowing disorders in children and adults. And honestly, it goes even beyond that, and we can get into that even more if you would like. We work with people of all ages, all the way from infancy to adults. So, we treat speech sound disorders, so that's how we say sounds and put sounds together in words. That's like your articulation or phonological disorders. We also treat language, so that's how well we understand what we hear or read and how we use our words to tell others what we're thinking or feeling. And then, we go into literacy. So, how well we read and write. We have that social aspect of social communication, how well we follow the rules of a community, those hidden rules, like taking turns or how to talk to different people, how close to stand to someone when you're talking to them.

 Dr. Gwen:        Yes.

 Justine:            And then, another element is voice. So, how your voice sounds, and is it functional for communication in everyday life. We have fluency, so that's stuttering, how well does your speech flow. We have cognitive communication, so that's how our mind works, how are we problem solving, how are we organizing our thoughts, and our thinking skills. There's also oral rehabilitation. That's if you have a hearing disability. So, kind of teaching you or setting you up with strategies to be able to communicate and get all the information, auditory information or visual information to be able to communicate. And lastly, we have feeding and swallowing, and I think this one is something that gets overlooked quite a bit in our field. It is in our scope of practice as a speech and language pathologist to look at how well we are manipulating foods and taking it down; how well we suck, chew, and swallow food. That's also a part of what we do. So, there's a lot, there's a ton, a ton, a ton, and if you feel like you need a career change, you can still have that title of speech-language pathologist but still really change what you're doing which is cool, it keeps you on your toes for sure, gives you a lot of variety. But, yeah, that's the huge array of things that a speech therapist does or can do.

 Dr. Gwen:        I think that's awesome that you reviewed all those because, traditionally, I think people automatically go to articulation, right?

 Justine:            Right.

 Dr. Gwen:        How do I sound? How am I pronouncing words? And having a voice and communicating is so much greater than just that. It's a very complex system actually. And so, it's a system that is in and of itself, one that also has to use like eyes and ears, right?

 Justine:            Right. Yeah.

 Dr. Gwen:        And so, yeah, even those two systems are so complex individually, right. So, the idea of getting to the heart of how are you being understood, right, how do you advocate for yourself, it's these things, especially for me...

 Justine:            Exactly.

 Dr. Gwen:        …working with teens and adults. How do you have the language, develop your lexicons, in order for you to advocate for yourself as an adult? So, this is like so fascinating. Justine, when do you feel someone needs a speech and language pathologist or therapist? Like, what is that kind of point in which someone goes, "You know, a speech and language pathologist or therapist would be really helpful here."

 Justine:            Right. So, I think the best way to kind of go through this is to kind of go through those different elements of what we do as speech pathologists. and I can kind of go through some signs in those different areas of what you might hear, what you might see, what you might be experiencing, and how that might lead you to getting assessed by a speech-language pathologist and seeing if you actually do need skilled therapy. So, if I go back to the traditional area of speech therapy that most people think of, articulation. This is when you might have trouble saying sounds or putting sounds together to create a word, right? Some signs might include substituting one sound for another, for example, saying "wabbit" instead of "rabbit." Leaving sounds out of words saying "winnow" instead of "window," or changing how sounds are made, that's kind of a distortion. Another thing, also, with speech sounds, it might also be a motor issue. There might be a disconnect between your brain and your articulators, meaning your lips, your tongue, your cheeks, your teeth. There might be a disconnect and the message of telling your articulators where to go to create that sound might be getting lost in translation. And when you have that issue, it's typically called apraxia of speech or childhood apraxia of speech. So, with that diagnosis, we typically have to wait until a child does have some words to be able to give the diagnosis, and there are specific signs for apraxia of speech. But typically, there's if you see a child that's groping, they're kind of getting stuck on a word, that's a sign of apraxia of speech. Another sign is if they're making different speech sound errors on the same word. So, for example, they're trying to say "dog," they might say, "dop, dab, bob". So, every different production sounds different, right. And then, another motor speech disorder is dysarthria. This means when there's a weakness of the articulators, your speech might sound a little bit slushy or slow. We might work on kind of strengthening your articulators and providing you with compensatory strategies to be better understood. So, that's speech sounds. Language, so some signs that you might be having difficulty with language is if you're having difficulty understanding what others are saying. So, following directions, for example, problems expressing your thoughts. So, you might have a decreased vocabulary, or you might be communicating in one to two words instead of full-length sentences, having trouble thinking of the right words to use, and potentially problems with reading and writing as well. So, if you might if you see that you're having trouble communicating your wants, needs, thoughts, feelings, or you're having trouble understanding other people, or you're having trouble reading and writing that would be seen in the school setting typically. You might look into getting an assessment for speech and language therapy. With social communication, you might have trouble knowing how to speak to other people, you might be interrupting or standing too close to others when speaking. Just like knowing those hidden social rules.

 Dr. Gwen:        Yeah.

 Justine:            You might use language that's not right for the listener in the situation, such as speaking to an adult versus a child; using slang during a job interview, that sort of thing. If you're having trouble with that, you might look into getting speech therapy. In terms of voice, if the quality of your voice sounds hoarse or breathy or there's a nasal sound to it, or if you're speaking with a pitch that's too high or too low, or if you're easily losing your voice, these are signs that you might-- first of all, you might need a consult with an ear, nose, and throat doctor to actually see if there's something structurally wrong with your voice box. And then, after you go and do that, then you can get referred to a speech therapist for the therapy and the rehabilitation process. And then, going into fluency or stuttering, you might be experiencing or observing-- Oh, do you hear that, Gwen? Did you hear that? Oh sorry.

 Dr. Gwen:        No, that's okay.

 Justine:            That was an oopsy. It was a phone.

 Dr. Gwen:        That's okay.

 Justine:            Okay. So, I'll go back to stuttering. With stuttering, you might hear or observe repeating sounds at the beginning of words. So, for example, b-b-ball;" or pausing while talking; or stretching a sound out saying, "sssnake" instead of "snake;" or saying "a lot" while talking. With cognitive-communication, this is problems with problem-solving, or problems with memory, if you're forgetting a lot or you're having trouble problem solving social types of situations, or thinking skills you might want to consult as well. And feeding and swallowing, this is also a huge range, can be all the way from birth, you might have an infant with a tongue tie who is having difficulty latching during breastfeeding. You might have a child who has sensory issues with food, they cannot stand the texture or the smell of specific foods, we might help with that. You might actually have actual motor issues so this goes hand in hand with speech if you're having trouble coordinating your muscles for feeding, you're going to need therapy to address that so that you can successfully chew and swallow safely. And then, the same thing with adults, a lot of the time we have adults who have had strokes or they're cancer patients, and through chemotherapy, the muscles and anatomy that's used for swallowing can be really affected. So, setting them up with strengthening and compensatory strategies to have a safe swallow. That's a huge part of what we do as well.

 Dr. Gwen:        Amazing.

 Justine:            So, that was another long-winded answer, Gwen, but--

 Dr. Gwen:        It's amazing.

 Justine:            So, yeah.

                         Gwen: It's actually amazing, Justine, I mean, I think what's so helpful, even for me, being around speech therapists for the last two decades, right? I knew about some of these but I really didn't know about all of it. And so, I think that's so great because they're, I guess for me, what it provides is hope.

 Justine:            Right.

 Dr. Gwen:        Like, "Oh, I'm struggling with this, there is someone that knows about that." You know, there was someone that that they're an expert in that, and they can help me with that. And so, it's kind of like this idea of relieving a pressure point or addressing a pain point that people have because I feel like those pain points are exactly what drive people to seek help, right? Hopefully, anyway.

 Justine:            Right.

                         Gwen: So, for you, what are your hopeful outcomes for someone who's coming in? Obviously, there's a lot of different areas that someone would come in in meeting the needs that they have. But, for you, in general, what do you hope people get from speech and language therapy?

 Justine:            Right. So, I'm going to talk about this in terms of pediatric population. I think a huge pain point for these families is just being able to know the needs of their child. So, providing relief for parents and their kiddo that they're being understood and their needs are being met, providing relief and decreasing frustration that a child is not being understood. So, providing the support to elicit and maintain meaningful social interactions, maintaining strong communication, and building a relationship with your child through communication whether that means verbal speech, signs, using alternative communication, doing voice therapy so they actually have a voice to use verbal speech, right? It can look different for everybody but I think the huge takeaway here is being able to advocate for yourself, being able to communicate your wants and needs, being able to have those meaningful interactions, and connect with your friends and family.

 Dr. Gwen:        Yeah.

 Justine:            Right? And then, also providing a healthy and safe relationship with food; and providing you with the skills necessary to have a safe swallow; and getting the adequate nutrition that a patient needs.

 Dr. Gwen:        Yeah. And so, we see language or even the mouth as being a conduit for so many things, right? Whether it's, "I need to express what my needs and wants are," "I need to ask for help," right? "I need to be safe because I need to eat," I mean, in order to survive.

 Justine:            Right.

 Dr. Gwen:        So, how important language is or this field is to so many pieces of our life. I love how you brought up how language and the social communication aspects really are important because having relationships with people is a critical thing.

 Justine:            The best, it's the best part of life. It's the best part about being here on this Earth, having that connection and really bonding with someone. I mean, I don't know what I would do without that. And, oftentimes, I get families that come in and they're defeated, like "I cannot connect with my child." And it breaks my heart, but that's what I love to do. That's my favorite thing is kind of diving in and figuring out what's going on here and how can I set this child up with a communication system that best meets their needs and their family's needs, and how can I coach the family into using this new communication system. Because essentially they're learning a new language, right? Because the way we're communicating and they know to communicate is not working for their child. So, we have to kind of change the way we think about communication, educate the parent and set them up for success in the home. Because a lot of the time I'm seeing patients one, maybe two times a week, that's not enough, we're not going to see a ton of language acquisition and improvement just by seeing me for one to two hours a week. It really is a team effort and the parents and caregivers, friends, family, siblings, they all need to be on board and kind of carryover everything that I'm working on in therapy and using it in the home, in the community, at school, right? Otherwise, we're not going to see-- we're not going to get the biggest bang for our buck if it otherwise.

 Dr. Gwen:        Yeah. I mean, I think what's so awesome is this focus on practicality, right? Because you and I both know that what's the solution is skill-building. There needs to be a different skill set here that's used in order to fill this gap, right, in order to make the connections, in order to be more understood, whatever that is that our jobs as therapists, I see this in myself as well, that more work happens in between the sessions than in the session, right? It's really just kind of me guiding you and giving you very practical things to practice or do or try or experiment with and be curious about. But it's really that in-between time though where big movements happening, versus me, I can kind of maybe give you the GPS roots to get there, different routes to get there, you know. So, that's great. And having worked with you on a team, and this is how you and I know each other, you have this real knack of getting to the heart of an issue, and then implementing something very quickly that the whole team can understand and implement. So, I see that in you.

 Justine:            Thank you.

 Dr. Gwen:        You know, and that's exactly what it is because I think sometimes people don't know what to expect out of therapy, right? It's not just I bring my kid to you, you fix them, and we leave, right?

 Justine:            Right, no.

 Dr. Gwen:        I'm just a part of this team, I'm a part of this process, this happens to be my expertise, and I'm going to give you-- I'm going to share my knowledge with you specific to this as just one part, right? And so--

 Justine:            Exactly.

 Dr. Gwen:        Good, yes. So, it's what people can really expect when they receive therapy is, "Oh, I'm part of this; I'm getting empowered through skills."

 Justine:            "Empowered" is the best word to use here and not only the child's, the family.

 Dr. Gwen:        Yes, yes.

 Justine:            Absolutely.

 Dr. Gwen:        Yeah. As a parent myself, being disconnected from my child, not understanding maybe what it is they need would be a very uncomfortable position for me to be in as a mother. I mean, I can really relate to that.

 Justine:            I can only imagine, I'm not a mother yet, I hope to be someday. But, I see it, I feel it, and like I said, it's heartbreaking when you don't have that connection or there's something that's holding you back, something that is creating this space, and finding out how to move these two beings, or three or four beings together towards each other. That's the magic; that's my passion. And I'm sure everybody and everyone that you've interviewed in these related fields, it's their job, too, within their wheelhouse. For me, specifically, it's communication and food or feeding. But for you, it might be more, it's that psychological aspect, those emotions and what's really going on in the family system, what are those constructs that are going on and how can you help everyone connect better.

 Dr. Gwen:        Yeah. I'm always fascinated with language because language serves as the symbols to our feelings and thoughts. So, if we have the language at our disposal to use, that allows us to connect, it allows us to get help, it allows us to feel understood. And just being with people who you felt seen by or understood with, right, there is that sense of-- that's like the sweet spot of being a human with other people, right? And you know exactly who those people are in your life, that you don't really need to say much but, boy, do they get you, it's very easy to be with those people, you know. And so, I see language as being that kind of symbolic, archetype, if you will, lexicon, that allows that to happen, and we want that for everybody to be quite honest. We want everyone to have that, those experiences.

 Justine:            Everyone deserves to have that.

 Dr. Gwen:        Absolutely, absolutely. Can we dig into the social communication aspects just a little bit?

 Justine:            Yes.

 Dr. Gwen:        It's definitely my bias because this is where I see a lot of my clients skidding out, right? This is where the rubber's meeting the road and I'm seeing smoke coming out of the tires which is you've got language, you know how to communicate, but, oh, boy, we apply it to different, dynamic social situations, and we have a little bit of a mess on our hands.

 Justine:            Yes.

 Dr. Gwen:        So, talk to us about how a speech and language therapist might approach something like that.

 Justine:            Right. So, we're digging into the social pragmatic area of language. And this starts as early as infancy, so making eye contact, finding your parents' face, smiling, having that joint attention where you know that you are referencing on the same object or activity and having that shared enjoyment, right? This starts very early on and I feel like a lot of the time, parents are just kids that grew up and had more kids, right? A lot of us aren't kind of educated with these early developmental skills and milestones to look for and also to elicit in early childhood. So, I think if we are seeing these red flags of my child isn't making eye contact, my child doesn't really enjoy playing with me or other children, they prefer playing by themselves, my child doesn't really find me in a room, they don't even know I'm there, right? So, looking for these red flags and finding them early and getting in with early intervention is going to be huge, in general. We can directly teach these skills very early on. And there are some wonderful programs out there. I don't know--I'm sure you're familiar with these, Gwen, but Hanen It Takes Two to Talk...

 Dr. Gwen:        Yeah.

 Justine:            ...Hanen More Than Words. So, these are wonderful programs where, me, as a speech-language pathologist, I am the coach and I am coaching the parents on how to interact with their children, right? Communication, social communication, those interactions, they're going to come from these meaningful pre-linguistic skills of connecting with one another. So, having eye contact, having joint attention, before we can have words, whether it's verbal speech or signs or using a device, we need to have that interaction, we need to have that connection. That's the building block, those are the building blocks to having words, whatever those words look like. So, first of all, trying to look for these milestones or these red flags, getting in early so that not only the child but the parents can be empowered to get this social language out, right? Teaching them how to interact with others, setting them up early, that doesn't always happen and it's fine, totally okay. Sometimes we get kids or young adults much later who didn't necessarily learn these skills early on. There's still a ton we can do, and help them be a little bit more successful in making these meaningful interactions and having social communication with others. So, we will continue to work on eye contact and also-- but if we, hopefully at this point, we have some more language where we are having conversations, right? So, we really dig deep and do some direct teaching on like what should a conversation look like?

 Dr. Gwen:        Yeah.

 Justine:            What are the rules of a conversation. First of all, we need to greet someone, right? And when we greet someone, are we looking at the wall, are we looking at the person, right? Looking at the person shows that you're thinking about them and you have that theory of mind and you want to be speaking to them, right? Having that back and forth, knowing the rules of turn-taking, not dominating a conversation, and not letting the other person doing all the talking. And all of this comes through practice, a lot of it comes through feedback, visual feedback, I love to videotape a lot of the kids that I work with, play it back, and have them kind of ruminate, think about like, "How did I come across in this social interaction?" "Was it appropriate?" like, "Was that an expected behavior?" "Was it unexpected?" "How did the other person feel about X, Y, or Z?" Right? A lot of this can be directly taught, and it doesn't come naturally to everybody and that is okay, that's fine. But, just you might-- if you are having difficulty with this, get in with a speech therapist that can dive deep with you and teach you these social skills to be more functionally able and communicative in life and being able to have these beautiful interactions with other people. Because, like we said, that's the magic in life. There's probably so much more that I'm missing but that's what came to mind.

 Dr. Gwen:        Yeah. And I think the message there, too, Justine, is it doesn't matter how old you are, right?

 Justine:            No, it doesn't.

 Dr. Gwen:        These are skills, like there's models and structures and programs that can help, you know. And I've never worked, in all of my years with a client, who didn't want a friend.

 Justine:            Right. Yeah, me neither.

 Dr. Gwen:        Or a girlfriend, or a boyfriend whatever this is. By the time they come to see me and for me they're 16 and over, with most of my clients being in their 20s, they're desperate for some meaningful human connection with their peers. You know, and I think a lot of times because they're so far out of early intervention by their 20s. That people are like, "Well, we're just going to throw our hands up and like give you some, I don't know, give you something else to do, redirect you." And it's like, "Oh, my gosh, like there's so much more we can do." You know, and especially when they're motivated and bought into this where you can say, "This is what's really going to help you, make a friendship, maintain a friendship, have a friendship for a long time, these types of things."

 Justine:            Yeah.

 Dr. Gwen:        You know what I love--

 Justine:            For me, not even-- Yeah, oh sorry.

 Dr. Gwen:        No, go, go, go.

 Justine:            I was going to say not only that but setting them up to be more-- I think a lot of these social skills sets a young adult up to be independent and setting them up with those essential skills of going on a job interview, "What do I have to do in order to be successful in a job interview?" That eye contact is going to be huge, knowing your audience is going to be huge, knowing not to use slang in an interview or knowing who you're talking to is going to be instrumental in getting hired in a job, right? Just so setting them up with those life skills, the communication aspect of life skills is huge and I know that's a lot of what you work with, work your kids with.

 Dr. Gwen:        Yeah, I mean to be an adult, we have to do a lot of speaking, we have to do a lot of listening, we have to do a lot of talking, and communicating, hopefully, communicating more than just talking.

 Justine:            Yeah.

 Dr. Gwen:        You know, this idea of what came up to my mind was kind of shaping your self-narrative, right? If we can feel more confident with expressing our needs in getting our needs met and connecting with people, that does have a feedback piece that shapes our self-narrative, which I think is intimately tied to empowerment and advocacy and agency as a person. So, the other piece, too, is as a parent, if I can see and trust that my child whether they're a kiddo or an adult kiddo for that matter, if I can trust that they can communicate what they need appropriately when they need it, that helps me pull back a little bit, right? That helps me let go a little bit, it helps me trust that they're going to be okay. And so, this is such-- it's a critical skill, language is critical as a skill. So, I just love that we're playing.

 Justine:            Yeah. Love it.

 Dr. Gwen:        We're playing. Justine, let's talk about really quick, we're going off the rails just a little bit, but I can't help myself.

 Justine:            I love it.

 Dr. Gwen:        Some of the things that you're talking about promote introspection and self-reflection. Because we have to have this kind of observer view of our self in order to know who our audience is, how we look and should present ourselves in that moment, right? So, and you really talked about this through videotaping as a strategy or as an intervention strategy which I will say to you is incredibly insightful for the populations that I work with. Because they don't realize, it's not intentional, they just don't realize the way they look.

 Justine:            No, they don't. Yeah. Another part of it, too, like going beyond videotaping is having a communication partner on the other side who might be a therapist or is an individual that's kind of aware of the client's needs and where they're trying to grow. And being able to paint the picture of what they're feeling and how the client is making them feel in terms of their communication. I find that to be very powerful.

 Dr. Gwen:        Yeah.

 Justine:            So, me critiquing my clients is very different than the communication partner critiquing the client. When it comes from someone else who's actually experiencing the client's communication skills and their pragmatic skills or social skills, it becomes a lot more powerful, right? Because they're not necessarily looked as this professional that's just trying to teach them all these things that they need to know. Hopefully, they're speaking to someone that-- Hopefully, the client is speaking to someone that they want to have a relationship with. So, when they hear from that person, "It really kind of frustrated me when you were talking about iguanas for 10 minutes," you know what I mean? Or whatever it is like, "That's not what I want to talk about."

 Dr. Gwen:        Yeah.

 Justine:            You know, or, "It made me feel like you didn't really want to talk to me when you had flat affect, or you were monotone the whole conversation."

 Dr. Gwen:        Yeah.

 Justine:            So, hearing that from someone else other than me, other than a parent, can be really insightful.

 Dr. Gwen:        Yeah, and powerful.

 Justine:            Yeah.

 Dr. Gwen:        It's like that relational currency. It's the idea of how dynamic relationship building is and how communication plays a huge role in that. Not only for individuals with disabilities but for all of us for that matter that when we can communicate with our families and our partners and effectively, we tend to see those relationships deepen and they're more robust or rich. And sometimes, I'll speak for my clients, they need guidance and a formal way to understand that relational currency, right? Wow, when this happens, this is what happens for that other person. And then, I kind of think about, "Well, hmm, do I want the relationship to continue or not?" Like, "Okay, then I need to move in these directions."

 Justine:            Exactly.

 Dr. Gwen:        The other piece, too, is liking who you work with. This learning business is really risky and so, you hope that you're with someone that you like and you trust because that relationship is going to bridge the difficulty and the risks that you need to take as a learner. And that's what you're doing, right? You're teaching new skills, that's really-- Because I really believe that people don't purposely miscommunicate.

 Justine:            Yeah, I agree.

 Dr. Gwen:        It's like if you had the skill that you would use it. So we can maybe be more generous in our judgment sometimes or we're like, "Well, that didn't go well. I can't just move to-- well, they purposely did that to make me feel upset." You know, when I get on some of my Zoom calls now, my clients tend to be quite blunt and direct, and don't have a really big filter. And so, it might be like, "What happened to your hair?"

 Justine:            Love it.

 Dr. Gwen:        To which I'm like, "Why? I think it looks great." You know, or whatever that is. But to be able to say to them, "Well with me, we're really comfortable." And that's okay and we have a structure for thinking about where I fit in your schema. You might not want to start a Zoom call that way, though. I'm just saying, you know.

 Justine:            Yeah.

 Dr. Gwen:        It can really take people out of the knees. But anyway, so, Justine, let's get to, and let's talk more about your private clients because I think it's very clear that NAPA has their own, they have a specialty and people know what they do and they get. For you, though, who is your in-the-pocket client? Like, who do you love to work with?

 Justine:            Right. So, I think I want to reference back to the situation where I have a family come in and they're just so disconnected from their child. And that's all they want, they're dying for a connection, and it's just like water, they need water and they haven't had it for a month. Well, I think they'd probably not be living at that point, but, you know what I mean. They're craving this sense of closeness with their child. So, and that can be across all ages.

 Dr. Gwen:        Oh, yeah.

 Justine:            You know, it can be a toddler that is just not hitting those milestones and is not really understanding that there are other humans to connect with quite yet. So, I absolutely love doing that early intervention work, too. It's really my first love in this field. I started with early intervention and now having even more training. I think it makes me even more effective as a clinician having that background and then now, having some more training on top of that. So, helping parents kind of change and tweak the ways that they interact and play with their child to elicit more communication, more interaction. I love doing that. And that can be more for a-- It could be even with a typically developing child who's just language delayed, it could be with a kiddo who has cerebral palsy and can't use his or her articulators for verbal speech. Cognitively, they might be brilliant but they can't get any of their thoughts across because their body is not allowing them to. So, finding and experimenting, this is where like the creativity aspect comes in.

 Dr. Gwen:        Yeah.

 Justine:            So, like experimenting with a ton of different elements of communication to find what works for that child and that family, it might be a picture system, it might be using switches. And I should probably discuss or explain what a switch is. It's basically a device where you can-- if you hit it or activate it, either there's some sort of effect, it's cause and effect, right? So, you can start with hitting a switch to activate a toy or turn on a song. And cause and effect is one of those essential pre-linguistic skills. And then, later, once the child starts to realize, "Oh, if I hit this button or if I hit this toggle switch, something's going to happen." Once they understand that, we can start to use the switch in a way to communicate. So, for example, you can start giving the child different choices. "Do you want to play with bubbles or do you want to listen to music?" And this becomes kind of like partner-assisted scanning and that you're giving verbal choices or visual choices. And, "When you hear or see what you want, hit your switch." "Bubbles?" Give the wait time. "Oh, you didn't hit your switch." No, that's not it. "Music?" Hits the switch. "Yes, you want music. That's what you wanted." And then, once they start to kind of get that, we can kind of move on to more high-tech communication systems. But there's so much out there and I think I do enjoy the challenge of figuring out what works best. And I think through my time in this aug com world, I've also realized that what I think is best for the child and family isn't necessarily what we should move forward with. Research shows that really digging into the family system and seeing what's important to them, their customs, their background, what's going to work for them. Because if they're not implementing it and they're not bought in, everything, all of my work just goes down the drain. So, kind of finding and collaborating with the parents and caregivers of what's going to work best for that family system and then setting them up with it. We can always change as we go. And that's what's so beautiful about augmentative and alternative communication is that as skills change, we can also change the system. We can change the technology to best meet the child's and family's needs. So, I just love figuring out how to give children a voice, and it doesn't necessarily need to be verbal speech, right?

 Dr. Gwen:        Right?

 Justine:            So, the kids that come in and they're just not able to communicate with their families with the world around them, how can I set them up with the tools to be able to advocate for themselves, communicate their wants and needs. That's what I like to do.

 Dr. Gwen:        Yeah. And maybe even a family system who's open to creativity is open to trying and experimenting, right?

 Justine:            Exactly, exactly.

 Dr. Gwen:        We know that things are not so linear. Then, when you get into this field, really, it's not very linear. You want to use logic because that makes sense, but so many times I have to go to Z to get to B.

 Justine:            Right.

 Dr. Gwen:        And it's okay. Like, "Oh, I actually had to use a different-- I had to use like the Roman alphabet to get back to A." Whatever that is, it doesn't matter, but it is that creativity. And so, when there's a family or a client that are willing to go with you in this journey.

 Justine:            Yes, that's a huge element that I missed and I'm glad you caught it. Having a family that is on board and ready to take the journey with me.

 Dr. Gwen:        Yeah.

 Justine:            That's my sweet spot client.

 Dr. Gwen:        Yeah, it's so fun because there's a real-- There's so much education that comes along from the ferreting and the sleuthing and the trying and the experimenting and staying curious. So, much education is derived from that process, versus, "Okay, listen, here it is. Okay, research shows that you have to do these five steps in a row. And the first step is just hanging yourself upside down by your toes. It works for everybody, just do it." You know, versus, like, "Well, I don't have any toes." No, I don't know, whatever. Okay, that's a very bad example.

 Justine:            But what you're saying, it's not a one size fits all. It's not the same-- one thing that works for one family is not going to work for the next.

 Dr. Gwen:        Yeah, I love that you take into account the values and the cultural piece of a family. So, many times I'm trying to figure out, is this young adult going to live on their own eventually? Well, I'll tell you for many, many cultures, they don't want their kids, their adult children to move out, right?

 Justine:            Right.

 Dr. Gwen:        And for me to say, "Well, this is what they need to do." That's not going to work and that's not me being very sensitive of the support system that is probably going to support that adult client of mine for a very long time, right? That's not really acknowledging the nuances of their system and to make it work for them. So, I love that you do that. So, Justine, how do people typically access your service now? We'll talk about the private practice aspect versus the NAPA because I think people can go to NAPA and figure that out.

 Justine:            Right.

 Dr. Gwen:        But for you specifically, are you specifically private pay right now?

 Justine:            Right now, I am private pay. I do provide my families with a superbill and they can submit to their insurance companies and hopefully get some reimbursement. Potentially down the line, I might look into venturing with insurance companies, but at this moment, I am private pay.

 Dr. Gwen:        Yeah, I think that's good to know and because you are a licensed person, you can provide superbills for parents to seek reimbursement for your service. That's great. Okay, Justine, I always end all of my interviews this way. Are you ready?

 Justine:            I love it. I'm ready.

 Dr. Gwen:        Okay. So, if you could only choose one skill to empower an individual with, what would it be and why?

 Justine:            Well, I think this is just the theme of the whole interview: social communication, 100%. I will go down to the bare bones of it: just having that eye contact, that back and forth communication. And it doesn't have to be spoken language back and forth, it can be a smile returned by a smile, it can be a vocalization returned by a vocalization, right? Just having that back and forth, that reciprocity in language and communication, that in itself just connects two people, right? That is the one thing that I would do, just being able to have those circles of communication between child and parent, child and sibling, child and caregiver, right?

 Dr. Gwen:        Yeah.

 Justine:            That connection, that bond is more important than anything.

 Dr. Gwen:        Yeah, agreed.

 Justine:            And it makes life so much better.

 Dr. Gwen:        Yeah. And it serves as your emotional foundation. It's this idea of being seen, being felt that you are understood on this very felt sense. It's so critical for our emotional well-being and our self-concept, right? I love it, I love it. Oh, my gosh, I love it. Okay. So, Justine, if someone wants to reach out to you, how could they do that?

 Justine:            So, you can email me directly, my email is [email protected]. You can also learn more about me on my website, www.JustineMufson.com. I'm also on social media, so you can always visit me on Instagram or my Facebook page, my handle is JustineTheSLP. I love sharing all kinds of different informational tidbits about what I do and how you can apply it to your everyday life. So, go on and follow me, ask me a question, direct message me, or even contact me for a free consult. I'm happy to help.

 Dr. Gwen:        Yeah. Awesome. And I'll include all of those details in the description below. The other thing that you forgot to share is that you also have a YouTube channel.

 Justine:            I do have a YouTube channel. It's very new but I did start a YouTube channel. It's also JustineTheSLP.

 Dr. Gwen:        I love it because, in your first video, you show people how to convert their toy with a switch.

 Justine:            Yes.

 Dr. Gwen:        The switch that you described earlier, and I was like, "Ah, I wish I had that video 20 years ago." Because when I was working with kids one-on-one, I would have loved to-- I mean, there were so many things I wanted to attach to that. That wasn't me.

 Justine:            Right.

 Dr. Gwen:        Anyway, so they can check you out there, too. I'll put all of that information below.

 Justine:            Beautiful.

 Dr. Gwen:        Thank you, Justine.

 Justine:            Thank you, Gwen.

 Dr. Gwen:        Thank you for spending time with me. Love it.

 Justine:            Thanks for having me. It's so fun.

 Dr. Gwen:        I love it. Oh, I love that you're in the space. I love it. Hey, thanks for joining me today. I hope that this interview with Justine helped you understand the vast role that speech and language therapists play. If you got any value from this interview, please hit that Like button. Also, if you haven't subscribed, please do. Liking and subscribing to these videos helps to get them to others who may be looking for the same information that you are. It is my intention for this channel to empower through connection, inspiration, and transformation. Until the next time. Take good care.