Towards a consensus on the definition and nature of meta-therapy in voice therapy: Current state and future...

Meta-therapy is the nuanced relational dialogue employed by clinicians to facilitate effective and efficient behavioural change. Introduced within the context of voice therapy and recently applied in other domains of speech-language pathology, meta-therapy continues to evolve conceptually. This article presents a preliminary effort towards consensus-building about meta-therapy.

A structured expert consensus development process was conducted with voice-specialised speech-language pathologists using elements of a modified Nominal Group Technique and developmental pre-Delphi construct refinement. Sixteen clinicians and three facilitators participated in a three-hour online meeting incorporating presentation, guided discussion, case-vignette analysis, and anonymous polling to refine conceptual boundaries of meta-therapy. Four additional co-authors reviewed the meeting recording. These 23 and two additional speech-language pathologists with prior exposure and expertise in meta-therapy contributed to iterative manuscript drafting and revision.

Meta-therapy may distinguish experienced from novice voice clinicians. We refined the definition and disambiguated meta-therapy from indirect and direct therapy, counselling, and education. We proposed the function and role of meta-therapy in the context of voice therapy, next steps, and future directions.

This work represents the first attempt to seek consensus on how to define and operationalise meta-therapy as it pertains to voice therapy. Many concepts presented here should apply to other domains of behavioural therapy within the speech-language pathology field and in other rehabilitative fields. This work may guide future research in meta-therapy, including formal attempts to achieve consensus about the definition and nature of meta-therapy.