Elizabeth Usher memorial lecture. Models, mind maps, and metacognition: How theory is the true hero

Within the educational context of identifying the critical ingredients of an effective speech-language pathologist, this paper highlights the centrality of theory in underpinning every level of our practice. A spotlight is placed on us knowing how language and communication work, what makes our interventions work, how we can make the most difference through our choices in therapy, and what makes both us and our clients respond. So, what are the critical ingredients of an effective speech-language pathologist, of an effective therapy, of an effective therapeutic alliance, and why is this so important? While there are many foundational and guiding habits upon which new graduates, early career, and experienced clinicians shape their practice, no one habit is regarded as more important than us exploring the theoretical underpinnings of what we are doing and why. To underscore the role of theory in our everyday practice, a discourse level intervention for people with aphasia is used as an exemplar to track the complex contribution of different theories to a single intervention. Discourse level interventions are relatively new on the scene in the area of acquired language disorders. Child language interventions, on the other hand, have frequently revolved around the story, aiming to bridge the oral-literate divide through the development of narrative structure. This paper will aim to weave its own story around discourse level interventions, combining the narrative genre with the everyday genres used by adults in conversation. I will highlight how this approach taps into lexical theories, sentence processing theories, discourse organisation, and the cognitive underpinnings of language, and closely examine how this multilayering of language in context may hold some of the answers to questions around generalisation, impact, and making the greatest difference to individuals.