How Speech Therapy Can Support Mental Health

I'm so often met with confusion when I tell caregivers and counselors that this is an area we can help with - with good reason! When people hear the term "speech therapy" they understandably think we only work on pronouncing words. In reality "speech therapists" are really more like "communication therapists".

There are nine broad domains we can work on: alternative communication modalities (AAC), articulation & phonology, cognition, fluency, hearing, language, social communication, swallowing, and voice. Of those, only one - swallowing - does not directly support either mental health or the client's ability to communicate with a counselor. (Although of course being able to consume desired food/drink without choking certainly can be indirectly helpful!) Here's a brief overview of how the other eight domains can be beneficial.

"Alternative Communication Modalities" (AAC)	When a person either can't speak or speech is too difficult/unreliable for them, we provide them with alternative and augmentative communication methods (AAC). Augmentative methods could be something like a voice amplifier to increase the volume of a person's voice to a level at which it can be heard. Alternative methods are things like communication boards or devices so that the person can touch buttons with words/symbols that correspond to the words they want to say. By both teaching a person how to use these and by providing them with the words/symbols needed to support their mental health (emotion words, ways to report problems, etc), speech therapists can play an important role in decreasing frustration, increasing the ability to communicate with a therapy, and helping users be able to talk about their feelings.
Articulation & Phonology	These are "speech sound disorders". That includes cases with a person who can't pronounce their "r"s, for instance - but it also includes cases such as apraxia of speech, where the person's brain struggles to get the message to their mouth of how to form words at all. Even with "milder" articulation disorders that only affect one speech sound, speech therapy can support mental health by improving an area a person is self conscious or teased about. (Given that we're supporting the person's own goals for their speech.) And with more significant disorders, we can be helping the person be able to make themselves understood verbally at all, as well as helping eliminate a serious source of frustration in their lives.
Cognition	There are many ways in which cognition affects our ability to communicate, but the biggest are in memory and executive function. I could do a deep, deep dive on this one, because the effect of these is so massive and unnoticed. Long-term memory likely makes sense from the perspective of counseling, considering you'd need it to process past events. But the hidden sides of this domain - working memory, metacognition, attention, inhibiting impulses, self-monitoring, planning, initiating, and many others - have impacts that both lead to negative real life consequences and are also blamed on moral failings. People with these struggles are labeled "disrespectful", "irresponsible", "ditzy", and "lazy", and if they're children they're called "behavior problems" or "kids who just need some discipline". As you might imagine, the mental health effects of living with these labels are broad and painful.
Fluency	Even though we now know that fluency disorders, such as stuttering and cluttering, are not caused by anxiety, there is still a deep relationship between fluency disorders and mental health. Not only can they make it difficult to communicate generally, but they can also cause so much self consciousness and frustration that the person might start to avoid talking in certain contexts at all. This has a massive impact on their mental health and on their ability to communicate with counselors. (Although again, it's critical to note here that this has to be done in a way that is empowering the person with a fluency disorder to address their own goals, not trying to make them change even if they are fine with how they talk.)
Hearing	The "hearing" element is not referring to the ears themselves, but rather, the brain's ability to interpret sound as speech. This includes working on auditory processing and helping people with reduced hearing to be able to use the hearing that they have and/or the aids that they have to their fullest to help their brains interpret spoken language. (Again, though, only as a support to the goals of the person themselves!) If a counseling session is via spoken language, having a speech therapist work on hearing can be very helpful.
Language	Language breaks down into receptive language (understanding) and expressive language (language a person speaks, writes, signs, etc). There are so many categories of ways in which we can help here. The biggest I typically do is working on teaching: 1. Feelings vocabulary The first set of feelings words I try to establish are happy, sad, mad, scared, hurt, tired, and sick. But I don't stop there! True emotional literacy requires having access to words for all categories and intensities of feelings. I call them "intermediate emotional vocabulary words". So the next words I prioritize are: angry, annoyed, anxious, ashamed, bored, calm, comfortable, confused, disappointed, disgusted, distracted, embarrassed, excited, focused, frustrated, guilty, healthy, hyper, jealous, nervous, overwhelmed, proud, relaxed, safe, shy, silly, stressed, surprised, terrified, thrilled, uncomfortable, unsafe, and worried. Teaching emotional vocabulary words like this helps a child to both understand their feelings and to share them with others. 2. Words for thinking about thinking Metacognition is what they call it - but for me, I just think of these as building the foundation for my kid to be able to succeed in counseling and in expressing themselves. The first thing many therapists teach, for instance, is the connection between thoughts, feelings, and behaviors. This is great! ...but only if your kid understands what those words actually mean. I remember a therapist giving me a handout from a workbook they were using to teach one of my kids mindfulness concepts. I went through and found SO many words in those explanations that my kids didn't know! From then on I asked them to tell me what lesson they were going to working on that week ahead of time, so that I could pre-teach some of the vocabulary, and suggest ways to simplify some of the other language. 3. Reducing the frustration of communication This applies both to the frustration of not being able to get across what you want/need and the frustration of not understanding what others are telling you (or thinking that you understood and then getting in trouble because you didn't understand right).
Social Communication	This can be an area of great benefit - but first, it's important to ensure it's being done in a neurodivergence affirming way. If there is social skills therapy that is conducted in an ableist way that pushes learners to try to hide their neurodivergence (known as "masking" or "camouflaging"), or that their way of doing things is inferior/incorrect compared to the neurotypical way of doing things, that can be quite harmful for mental health. We have studies showing the connection between camouflaging / masking autistic traits and poorer mental health outcomes for both children and adults. And unfortunately right now, the majority of the social skills therapy I've seen has at least some ableism in it. That said, neurodivergence affirming social communication treatment can be incredibly helpful. For one thing, teaching the communication skills required for interpersonal safety - which is inherently social communication - is going to help prevent future trauma. Compliance is drilled onto most neurodivergent people in school and other therapies (such as ABA), and so learning the times you need to be non-compliant, and how to respond to them is absolutely critical. For instance, if someone tells you not to report abuse or an adult tells you to drop it when you tell them about a safety problem, you absolutely need to be non-compliant. Understanding the communication of neurotypical people in the dominant culture in your area - both how to interpret what they say/do and how they will interpret what you say/do - can also be very beneficial. For instance, if you know how to tell when someone's words are likely genuine and when they likely aren't, that can help prevent a lot of grief. Being able to predict what others will do in social situations can also decrease the anxiety of uncertainty.
Voice	Speech therapy for voice can be beneficial in two different categories. One is helping people with disorders affecting their vocal folds, which helps alleviate the frustration and depression fed by how hard speaking is, can decrease pain, and of course help improve communication. The other category is that speech therapy for voice can help people to achieve their goals, such as improved vocal techniques for singers, or helping someone learn how to align their voice's pitch with their gender without causing strain on their vocal folds.

I could write an entire post on almost all of these, but hopefully this has been a good initial overview of just some of the many, many ways in which good speech therapy can support mental health!