Gayle Emery Merrefield , MEd, CCC/SLP

Meet our new featured therapist, Gayle Emery Merrefield , MEd, CCC/SLP.  Gayle is a Speech Language Pathologist whose training and expertise does not stop at the mouth!   Gayle has spent much of her professional career learning and understanding the "whole child" and the success she has with her clients is a testament to her hard work.  Her training encompasses a broad range of areas, including child development, psychology, neurology, biology, and genetics.  These are the "lenses" through which she studies her clients and the outcome is an incredible understanding of how to get each child to achieve their maximum potential.  Take a moment to read about Gayle and we assure you, you will be impressed.

1. As allied health professionals, we have the opportunity to work in different capacities --i.e.diverse populations, varied settings...etc. You take on many different "roles" as a Speech Language Pathologist through out your week--please take a moment to briefly describe the different "hats" you wear.
   
   There is plenty of variety in what I do these days. I spend one day a week evaluating children with Dr. Marilyn Agin, an SLP and developmental pediatrician. In that setting my role requires me to be a diagnostician, collaborator, listener and counselor, and then interpreter/reflector of the findings as we prepare the formal report for the family. I'm also an instructor for the PROMPT Institute, teaching the 3-day 'Introduction to Technique' course 6 or more times a year. In addition, I treat a very small caseload privately - and even that has quite a bit of variability. It keeps me in touch with the 'roots' of my training and experience. However, the families I'm involved with also ask that I help them coordinate the activities of the SLPs on their teams, so that the treatment decisions are consistent and unified. This is a wonderful part of what I do, as I really love mentoring other clinicians and helping them grow. I also do some individual mentoring of SLPs who have asked for help in developing their PROMPT skills

2. At Dr. Agin's office, you perform arena assessments--what is that like?

   It's more like a very small circus than a full arena! Our days are busy and intense as we typically evaluate two or three children per day. I work with Dr. Agin or one of the other physicians on her staff. Together we try to learn as much as we can about each child, in order to provide the best diagnostic information and treatment/educational recommendations to support the child and parents. Our approach is holisitic, meaning we hope to understand about the child's development in physical, neurological, sensory, cognitive, language, speech and social areas. We're also interested in the biomedical components (such as diet or allergies) that contribute to a youngster's profile, and we're alert to the family dynamics and needs as we offer our opinions and advice. We design some of our activities to elicit information in these areas, but a great deal of what we do is careful observation and listening. I have become a copious note-taker! A particularly enjoyable aspect of our sessions is the 'flow' we develop in working together. We know our expectations for the session, so it often doesn't matter who administers a particular test or works with the child on a specific task. The challenge is to be thorough yet efficient, so that we have plenty of time to talk to the parents.
   

3. As a PROMPT Instructor, you travel all over the country teaching workshops..that must be exciting! How does it feel to be apart of such an innovative technique that is helping so many children (and adults)?
   
   PROMPT has helped me become the best clinician I know how to be. Being an SLP has meant, for me, having continuous opportunities to learn and grow. Several individuals have contributed to my journey in this field, sometimes without knowing it, but my experiences with PROMPT have been singular. Deborah Hayden has developed not just a technique for helping individuals speak, but rather an entire system of treatment that links the act of motor speech to functional communication within a context that is holistic in its consideration of the individual client. Researchers are just beginning to learn how providing tactile-kinesthetic input can alter both the speech product and the neural representations in the brain. Teaching others about PROMPT has helped me understand the components of communication from a motor-speech perspective even more fully, and teaching has influenced what I take back into my clinical practice.
   

4. You haven't always been in NYC--you lived and worked down south for many years. How does that experience differ from New York? Do you miss it?
   
   I did spend the first decade of my young adult life in Georgia, but I grew up in Ohio and Delaware, so I've always been connected to the Mid-Atlantic region. After college, where I earned a degree in speech, theatre and English, I was casting about for a bit, and Atlanta seemed to be a good enough place to 'find' myself. All I knew at age 23 was that I did not want to be a classroom teacher.
   
   Eventually, I found myself volunteering as a reading tutor, and not long after that, the thought came to me that speech-language pathology might be a good career path. It was the mid-70s when graduate school admission was not quite so competitive. So, I was able to spend two years at the University of Georgia earning my master's degree. What the program may have lacked in well-known faculty or NIH-funded research projects, it made up for in solid core clinical skills. I had several excellent externship placements, and our university clinic provided a good range of clients. I really was ready for my first job in the field.
   
   I worked in two school systems in Georgia for a total of 6 years. I was a wonderful learning experience, and I have long appreciated the challenges school clinicians face. I had some opportunities to develop specialized speech and language programs with other SLPs, but mostly I learned to function as part of the school team. And I got to develop some administrative skills, serving on school committees and taking on other responsibilities within the school. The children I treated in those days are in their 30s now. At Christmastime I still hear from one mom whose son was four when I started treating him for fluency problems. He's grown and has two young sons of his own. It is humbling to know that that parent, now a grandmother, still remembers and feels I brought a positive change to her child's life.
   
   We moved to New York in 1984, when my husband was offered an advancement from his employer, so it has been a long time since we considered ourselves anything but New Yorkers. We lived on Staten Island for 22 years, where I had a series of wonderful work experiences. I spent about eight months working with diabled adults in a workshop setting, which I found very interesting, but ultimately not the best fit for me.
   
   From there, I worked for an early intervention program, well before IFSPs and team meetings. We had a full-time staff, which allowed us wonderful support for one another, and caseloads that ranged from 'late talkers' to children with very rare syndromes. I was very happy working in homes, spending time with the parents, and I feel this experience really made me a self-reliant clinician. After four and a half years, there was no question I could deal with any situation that came up in a session...and there were some pretty wild experiences!
   
   I also worked six years at a special education preschool, which was another tremendous experience. It put me back in the classroom, at least part of the time, and I enjoyed the day-to-day team dynamic. I that setting, in addition to treating a caseload, I supervised new clinicians and took on many administrative responsibilities. I even spent four or five years, one class at a time, earning my 6th year certificate in administration and supervision.
   
   Finally, in 1996, I was ready to reorganize my work world, so I opened a private practice with exactly one client. A friend allowed me to rent her office space by the hour. In less than a year I was working four days a week and renting the space full time. Later, I joined with two colleagues (an SLP and an OT), so we could rent a new office together. I felt I had the best of both worlds - a collegial atmosphere and the independence of being my own boss. It was a great environment to share work with people I cared for and to develop special relationships with the families who came to me. In 2006 my husband and I decided to move to Manhattan, so I closed the practice on Staten Island, ready for the next adventure.
   
   To go back to your question, though, my work experiences have been so varied over time, there's almost no way to compare what I was doing in the south all those years ago, and where I am today. I see it all as part of the continuum that brought me to 2008, where, as you noted in your first question, I wear many hats, and they all fit me at least part of the time!

5. What thoughts do you have for new graduates?
   
   First, give yourself time to grow as a clinician. That means, seek positions where you will have colleagues from many disciplines and where you will have frequent and supportive supervision. Give yourself time to develop in a place where you can learn within a structure, such as a school or hospital. My strong recommendation is that new clinicians NOT put themselves into jobs in which they are expected to function independently - such as in home visits. There will be time for that in your career, but it's not a great starting place. There is too much to learn, so develop some patience with yourself as you consider your first experiences after graduation.
   
   I urge new clinicians to find mentors for themselves. It doesn't have to be one's direct supervisor, and it doesn't have to be another SLP. But look at your work colleagues, and make friends with the ones who have experience and are willing to share with you. Observe not only what these people do as clinicians but also how they function as members of the larger organization. Watch and learn! Remember to find new mentors as your skills develop and your needs change. Develop study groups among your work colleagues or your old classmates from graduate school. Self-mentoring and helping each other is part of the growth, too.
   
   Become a mentor to others. One of the unusual aspects of my own career was that among all the employment settings I worked in, I never reported to a supervisor who was trained as an SLP. So, the way I dealt with that was to share my experiences and be available to help clinicians with less experience.
   
   And of course, start studying PROMPT as soon as you can!