It may seem strange to hear of a Speech and Language
Therapist (SLT) learning to language. Surely, 'language' is built into the job
description? Language is certainly very much part of an SLT remit, but where I
am now with my understanding of language, and what it is 'to language', is very
different to the place where I started my career. Evolving thoughts on language
and languaging have had a huge impact on the direction my journey has taken as
a practicing SLT.
Views and viewpoints
Most would agree that language is an important mode of human communication. Yet, when we look deeper, an agreement on what constitutes language, and how we understand and use the concept of language, is likely to depend on our beliefs and views of the world.
Historically, language has predominantly been seen as a 'verbal' medium, consisting of 'words, their pronunciation, and the methods of combining them, used and understood by a community' (Meriam Webster, 2025). Humans also communicate non-verbally. Non-verbal communication is the 'transfer of information from one person to another without the use of words or spoken language (and) can occur in a variety of ways, including through facial expressions, gestures, and body posture or position' (Britiannica, n.d.). Whilst non-verbal communication is recognised as an essential element of social interaction, by virtue of not using speech or words, non-verbal communication is often seen as separate and distinct from language (RCSLT, 2018).
The phrase 'body language' in English, and similar phrases in many other languages, implies that the relationship between language and non-verbal communication is less clear-cut. To explore this relationship further, it is useful to consider positionality, perspective, and the implications for what we see as knowledge.
There are some key terms that can help in this endeavour.
The first of these is Ontology. This is the theory of being and reality; considering what exists and what we can acquire knowledge about (Moon & Blackman, 2017). So much of the learning throughout my SLT career has been based on a positivist ontological paradigm: 'the assumption that a single tangible reality exists—one that can be understood, identified, and measured' (Park et al, 2020). This is broadly the foundation for the description of verbal and non-verbal communication above. Whilst this ideology underpins the definition of language widely accepted in SLT practice in the United Kingdom (UK), and elsewhere, it is important to acknowledge that other ideological viewpoints also exist. To work towards a place of independent ideological security, we must firstly have curiosity to look beyond what feels comfortable and understood, and then to go on to robustly appraise the journey the SLT profession has taken to date, before evaluating its current positionality, all the while staying in touch and in tune with our personal ideological beliefs. Critical based practice is a process, not an end point in itself.
A sociohistorical critical enquiry stance around language provides a starting point, acknowledging the legacy of colonial beliefs in defining language (Brea-Spahn & Bauler, 2023). A focus on the history of standardised SLT assessment in the UK and the United States (US) reveals a racist, ableist and capitalistic ideological background (Nair, Farah & Cushing, 2023). Renouncing a system that causes upset, distress, and devalues difference, is both justifiable and necessary in a healthcare climate that values equality, diversity and inclusion (NHS England, 2023). The Royal College of Speech and Language Therapist's (RCSLT's) 2025-2027 Equity, Diversity and Belonging policy, however, notably fails to even acknowledge the importance of an inclusionary and not-for-profit narrative in relation to the core business of SLT, that of assessment and intervention. Whether intended or an oversight, this omission is an ideological injustice, that obstructs curiosity and impacts individual safety to 'rock the boat' in which most SLTs travel (Brea-Spahn & Bauler, 2023).
A collective challenge to the status quo is nevertheless growing within the profession. There is a desire to 're-imagine' what SLT could be and could offer (Nair & Brea-Spahn, 2022; Nair, Farah & Cushing, 2023). In re-imagining there is freedom to subvert (Walker & Raymaker, 2021; Nair, Farah, & Cushing, 2023), and disrupt (Walker & Raymaker, 2021; Brea-Spahn & Bauler, 2023; Nair, Farah, & Cushing, 2023). There is also the possibility of creation and empowerment, to 'deviate from the embodied performance of being neurocognitively normal' (Walker & Raymaker, 2021). This is more than just changing our views, it is a complete cultural paradigm shift (Walker & Raymaker, 2021) that requires a wholly different road map on which to base our thinking and practice .
The neurodiversity paradigm, that sees neurodiversity as a natural and valuable form of human diversity (Walker, 2014), feels like an obvious choice. 'Neuro-affirming' or 'neurodiversity-affirming' practice centres 'neurodivergent individuals' identity, perspectives, autonomy and self-advocacy' at the heart of SLT (Gaddy & Crow, 2023). This is furthermore culturally responsive practice (Gaddy & Crow, 2023), showing respect for and honouring the cultural context and intersections of individuals' lived experiences. There are obvious links here to the deeply relational ontological perspectives of indigenous cultures that value mutual reciprocity and which 'care for, sustain and respect the rights of other living things, plants, animals, and the place in which one lives’ (Gould et al., 2023). Connection and interconnectivity with the environment and natural world are key ideas.
Epistemology, the theory of how we come to know something or how knowledge is created, is a further important compass point in directing our understanding of language. The neuro-inclusive and experience sensitive dimensions of humanistic care: Insiderness, Agency, Uniqueness, Togetherness, Sense-making, Personal Journey, Sense of Place, Embodiment (McGreevy et al., 2024) offer a framework for both assessment and intervention that is consistent with the much-needed paradigm shift in SLT practice. The video 'In My Language' (Baggs, 2007) provides a real-life example of how much there is to learn about language beyond words, when we take time to listen to lived experience, whilst further highlighting how perspective can colour judgement.
An experience sensitive approach is furthermore a relational way of being, knowing and doing. As SLTs we must honour and respect both an individual's and their community's language. We should also respect community perspectives on language use, such as the Augmentative and Alternative Communication (AAC) community's strong advocacy for the term 'non-speaking' over 'non-verbal' (Assitiveware, 2024). Allowing collective marginalised voices to be heard, their knowledge and experiences to be valued, is essential for individual and community wellbeing and flourishing (Chapman & Carel, 2022). This aligns with indigenous understanding of community, where “culture saves lives” and “culture is medicine” (Wieman & Malhotra, 2023).
There is further clear justification for working relationally to support communication success from a theoretical perspective. Double Empathy Theory (Milton, 2012) states that:
"when people with very different experiences of the world interact with one another, they will struggle to empathise with each other. This is likely to be exacerbated through differences in language use and comprehension" (Milton, 2018).
Research has subsequently gone on to show that interactions between members of the same cultural background, or who share an experience or an interest, have more 'flow' (Williams et al., 2021) and information is shared more effectively (Crompton et al., 2018).
To close any gap it is important that each party makes an effort to understand the lifeworld of the other, and to value their epistemic authority (Chapman & Botha, 2023). Indigenous epistemologies share the same belief in centering 'We consciousness', which teaches the responsibility for humility, generosity, respect and reciprocity to the collective (Gould et al., 2023). This is epitomised in the indigenous view on knowledge creation in healthcare, that of 'two-eyed seeing'
"Two eyed seeing (is an) approach to healthcare (that) sees from one eye with the strengths of Indigenous knowledge and ways of knowing, and from the other eye with the strengths of western knowledge, respectfully embracing both" (Wieman & Malhotra, 2023).
In short, there is much benefit at all levels to learning together and from each other; in valuing collective knowledge creation, rather than deferring to hierarchies and expertness.
The ideological and epistemological perspectives offered by the neurodiversity paradigm, and relational ontologies, provide a dynamic space for SLT professionals to be curious, learn and grow (Murphy, 2023). In valuing 'the infinite variation in neurocognitive functioning within our species' (Walker, 2014), and the beauty of the 'web of meaningful relationship knowing' (Gould et al., 2023), dismantling language hierarchies becomes both intrinsic and intuitive to our practice. It is within this unknowing, deconstructing, decolonising environment that SLT professionals can explore and embrace 'language as communication and communication as language', discovering and redefining the profession's role and purpose, where 'no one is actually bad with language' (Henner & Robinson, 2023).
In summary, learning to language together is transformational for all, both practitioner and the people we support:
'Languaging' is when individuals and their communities redefine their communication to represent “what it is they want to be,” beyond borders predetermined by geography, language names, and modalities' (Brea-Spahn & Bauler, 2023).
In moving from object to action, languaging is also the dynamic change needed, both to liberate SLT practice from its past, and to reimagine its future.
A personal journey towards languaging
Learning to listen and value all perspectives and subjective experiences, to see the world alongside and with another person, has been an empowering perspective, one I have been personally and increasingly drawn to, by virtue of my own lived experiences.
I started to question the parameters of language with the growing condemnation of my Autistic son as he journeyed through mainstream and then into specialist education. The language of deficit around his very 'being' at school was etched into the fabric of our existence. "Your son is 'volatile'!" The idea that behaviour is communication, communicating that my son was amongst the least desirable members of humankind, was a message that permeated deep beyond the school gates. Those words of failure and despicability seeped into our worlds, contaminating his thoughts about self, bringing judgement on him by peers, and pointing fingers at us as parents. The harder we fought, the worse the situation became. We were problem parents and the failure was one that we had to own; we could learn to be better parents, our son would then learn to be a better human. To move towards 'accepted' he would need to learn to communicate within the expected parameters of societal standards. Being the same as everyone else was good, difference was bad.
For a while, the longest while, we fell apart. The system disrupted us. Climbing up and out of the darkest days was not a single, one-step process, but a series of footholds on a craggy cliff; sometimes we moved up, often we were left dangling, scrabbling for a hand-hold, just to stay still, but equally to fall back down. We refused to do the parent-training, instinctively knowing that our family was not the problem. We then pulled our son out of 4 of his 5 schools. Although still seen as the problem, we also knew that in many ways we needed to find our own path. We fought against convention and effectively embraced our difference in order to be well, to survive and honour our right to authenticity.
These were choices that took tremendous energy, and great leaps of faith, but paid off as our son's wellbeing slowly improved. The experience, however, left an indelible mark on us all. For me, as both a parent and a professional, I could see that the framework I had always held on to, and worked within to achieve progress, that of neuro-normativity, had only done us as a family harm. I had seen first hand that assessment, advice, treatment. based on there only being 'one right way' to be, missed so much of what it meant to be human, the essence of my son, the insiderness of our family.
My thoughts fanned out and thinking spiralled beyond just our own circumstances. What if I applied this learning to language, to the everyday focus of my working life? What if there was a different way to support communication; one where wellbeing was built in, instead of support built on what was going wrong?
As an SLT who trained over 20 years ago, my learning had taught me there was an expected way to language, and that those who language markedly differently from the standard would require support.
I had learnt that 'words' were the superior building blocks of language. Non-verbal communication always had a lesser status. Words grabbed the headlines of both assessment and therapeutic agendas. I learnt how to count the number of key words a young person could understand, and could put in a typical sentence. The higher the number of words, the more favourable the outcome. Words were the critical markers of success, with spoken words holding the lion's share of this focus. I was after all a Speech and Language Therapist! Non-verbal communication felt like an 'add-on', something to get to if time allowed, or equally to only spend time on, where words were 'late to develop' or were judged would never arrive.
Whilst I knew, or thought I knew, how to evaluate 'non-verbal' communication, this somehow always felt a lower priority. It was never the main focus of 'go-to' SLT standardised language assessments, such as the Clinical Evaluation of Language Fundamentals (CELF), with it's nod to pragmatic elements as part of a tick-box checklist. There was also in all of my learning nothing about 'non-verbal' forms of communication being 'language', nor a focus on how these skills may differ across cultures. There was only an expected bar. I knew what the standard was, and on either side was success or failure. It was black and white, clear-cut; no grey, but also no colour, no beauty, no awe. With this doubling down on non-verbal communication it didn't occur to me to think beyond what I could see, or thought I could see. When 'non-verbal' was deemed a necessary focus, this was wholly due to concern: a young person who didn't make eye contact, who talked too quickly, who didn't take expected turns in conversation. 'Non-verbal' became solely the domain of 'disorder'.
In all cases, whether verbal or non-verbal, I was the expert, I made the judgements, and I decided on the direction of any intervention or treatment. I knew no different. My professional opinion was part of my professional upbringing, journey and ongoing professional practice. In moving a young person towards a specified and targeted standard, typically closer to the 'norm', I was fixing a problem. SLT was therefore a profession that 'saved' and 'added value' at the same time. SLT supported individuals to have greater access to education, and by default be better at accessing the world of work. SLT was even growing as an important profession in supporting access to mental health and wellbeing. Yet in parallel to my own lifeworld, I wondered, with increasing frequency, how often the profession stopped to see the young person in their own world. As SLTs how often did we try to understand what young people's ways of being, and languaging meant to and for them in authentic and highly personal spaces, away from the push and pull of a system? What would happen if we did?
I continued this internal dialogue, as I moved from a community-based caseload, to working as an SLT in mental health; my lived experience the push behind this professional move. Here, at last, I had the opportunity to explore different horizons in earnest. I came across the neurodiversity paradigm, and have stayed here ever since; no longer seeing language as a narrow band of receptive/ expressive inputs and outputs, with a set of scholarly measures of how each individual compares to a set of pre-determined outcomes. Gone is 'non-verbal', replaced with 'non-speaking'. Words no longer hold court. Language and languaging is expansive, embodied, relational and unique to each individual. I see this with every young person and family I work with. I feel privileged to do so. And whilst I fight hard for the system to value what I see, to recognise human worth, beyond outcomes, checklists and 'progress' in a number-crunching way, I know that real progress is measured in ways that cannot be counted, but can be felt. I see the progress in young people beginning to feel secure in being themselves, in families feeling, as we did, that they are not broken, and neither is their young person.
A final thought
To end, an idea that is also the beginning of every clinical encounter I have, and that helps me to reimagine my infinite journey in languaging and learning to language.
"Care happens in the space between
people, in an unhurried encounter." (Heath & Montori, 2023)
In taking time that is needed to learn to language with and alongside another, I am already offering the best care that an SLT can offer.
References
Chapman, R., & Carel, H. (2022). Neurodiversity, epistemic injustice, and the good human life.
Journal of Social Philosophy. 53. 614-131.
https://doi.org/10.1111/josp.12456
Crompton, C. J., Ropar, D., Evans-Williams, C. V., Flynn, E. G., & Fletcher-Watson, S. (2020). Autistic peer-to-peer information transfer is highly effective.
Autism, 24(7), 1704-1712.
https://doi.org/10.1177/1362361320919286
Gaddy, & Crow, H. (2023). Sig 1. Tutorial. A Primer on Neurodiversity-Affirming Speech and Language Services for Autistic Individuals. Perspectives, Ashawire.
Heath, I. & Montori, V. J. (2023). Responding to the crisis of care, British Medical Journal. 380:p464
Henner, J. & Robinson, O. (2023). Unsettling languages, unruly bodyminds: A crip linguistics manifesto. Journal of Critical Study of Communication and Disability, 1(1), 7-37.
McGreevy, E. et al. (2024). An Experience Sensitive Approach to Care With and for Autistic Children and Young People in Clinical Services.
Journal of Humanistic Psychology, 0(0).
https://doi.org/10.1177/00221678241232442
Moon, K. & Blackman, D. (2017, May 2). A guide to ontology, epistemology, and philosophical perspectives for interdisciplinary researchers. Integration and Implementation Insights: A community blog and repository of resources for improving research impact on complex real-world problems.
Nair, V. K. & Brea-Spahn, M (2022, February 21). Reimagining Social Justice in Speech and Language
Nair, V. K. & Farah, W. & Cushing, I. (2023). A Critical Analysis of Standardized Testing in Speech and Language Therapy. Language, Speech, and Hearing Services in Schools. 54. 781-793. 10.1044/2023_LSHSS-22-00141.
NHS England. (2023, June 3). NHS equality, diversity, and inclusion improvement plan. https://www.england.nhs.uk/long-read/nhs-equality-diversity-and-inclusion-improvement-plan/
Park, Y. S., Konge, L., Artino, A. R. (2020). The Positivism Paradigm of Research. Academic Medicine 95(5):p 690-694.
RCSLT. (2018, November 21). The Royal College of Speech and Language Therapists Justice Evidence Base Consolidation: 2017.
RCSLT. (2025, March 19). Diverse Voices, United Purpose: the RCSLT’s vision for Equity, Diversity and Belonging 2025-2027.
Walker, N. & Raymaker, D.M. (2021). Toward a Neuroqueer Future: An Interview with Nick Walker. Autism in Adulthood. 1;3(1):5-10. doi: 10.1089/aut.2020.29014.njw.
Wieman, N. & Malhotra, U. (2023). “Two eyed seeing”—embracing both Indigenous and western perspectives in healthcare.
British Medical Journal 383.
https://doi.org/10.1136/bmj.p2614
Williams, G.L, Wharton, T. & Jagoe, C. (2021). Mutual (Mis)understanding:
Reframing Autistic Pragmatic
“Impairments” Using Relevance
Theory. Frontiers in Psychology. 12:616664.
doi: 10.3389/fpsyg.2021.616664
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