Inside SLP

What does it actually mean to “work within the system”? Megan traces the history of member voice and decision-making within ASHA, from Richard Adler’s 1990 address to the Legislative Council to the governance changes that eventually eliminated it. Along the way, she asks what happens when a profession gets better at questioning authority without necessarily building better ways to disagree, deliberate, and act together. What would it take to build a profession that can hear disagreement without needing to eliminate it?

Sources:
Connect:

Creators and Guests

Producer
Megan Berg, SLP
Megan is an SLP based in Montana and owner of Therapy Insights.

What is Inside SLP?

Inside SLP is a limited series podcast that reveals how our profession came to be and why it functions the way it does. Most clinicians work inside a system they were never taught to see, shaped by decades of history, policy, economics, and unspoken assumptions. This show offers lightbulb moments that bring clarity to the structures beneath our everyday work and opens space for thoughtful, grounded understanding of the field we share.

Megan Berg:

Hi, everyone, and welcome back to Inside SLP. This series is about how our profession came to be and where it's heading. Most of us work inside a system we were never formally taught to see. This podcast is about slowing down enough to understand that system with clarity, calm, and context. I'm Megan Berg.

Megan Berg:

Let's look inside. I wanna start with a story from ASHA's history captured by Russ Malone. It begins in 1990 with an SLP walking up to a microphone. At the time, ASHA was governed very differently than it is today. There was an executive board like we have today, but there was also something called the Legislative Council, a large representative body made up of members elected from states across the country.

Megan Berg:

And the Legislative Council had a forum. Richard Adler, who was an ASHA counselor at the time described it this way. If you were a counselor, you could basically quote beef or bitch about whatever you want, which may be my favorite description of professional governance I've ever heard. The forum gave Adler a place to raise something that at the time carried considerable personal and professional risk. At the time, gay and lesbian speech language pathologists and audiologists had begun finding each other at ASHA conventions.

Megan Berg:

At the nineteen eighty eight convention in Boston, a group of gay men happened to be staying at the same gay guesthouse. They started talking about creating an organization. And by 1990, they were organizing more formally, but they were still afraid. Their first somewhat official gathering was held at a gay bar in the middle of the afternoon away from the ASHA convention. They didn't feel comfortable asking ASHA for a room.

Megan Berg:

They called themselves Le Gasp, and Richard Adler was one of them. At a legislative council forum, Adler was sitting in the audience waiting his turn to speak. He later said he felt almost like he was in a trance. He walked toward the podium, the ASHA president called the next counselor, Adler stood in front of the governing representatives of his profession. He had nothing written down.

Megan Berg:

He took a breath, and he said, I'm Richard Adler from Georgia. And then he came out. He told the legislative council that he was gay. He told them there was a group of gay and lesbian professionals meeting within ASHA. He told them about discrimination in workplaces and discrimination against patients.

Megan Berg:

He essentially said, we're here. There are more of us than you realize, and we want to work on this. Adler later remembered sweating through his shirt. And when he finished speaking, the legislative council stood and applauded. Other councilors walked over and asked for buttons supporting the group.

Megan Berg:

Members of ASHA leadership did too. And one of the people there later said that seeing ASHA leaders publicly support them made it easier for everyone else. And over the next several years, things began to change. ASHA provided meeting space at conventions. Legasp participated in dialogue with ASHA leadership.

Megan Berg:

Programs about homophobia appeared at the ASHA convention. ASHA eventually provided domestic partner benefits to the national office staff. And then came Cincinnati in 1995. ASHA was scheduled to hold its convention there, but the city had adopted a policy that denied certain protections based on sexual orientation. Gay and lesbian members told ASHA they did not feel comfortable attending the convention in Cincinnati, leaving the organization with a potentially expensive decision about whether to move it.

Megan Berg:

And the ASHA president at the time was Geri Logeman. Most of us know her for her enormous influence on the study and treatment of swallowing disorders, but apparently, her professional legacy also includes taking a pretty remarkable stand on behalf of her gay and lesbian colleagues. Logeman consulted with members of Legasp, people in Cincinnati, and members of the board as Asha considered what to do. When she later reflected on the decision, she described it this way. Quote, the question for me boiled down to, do we believe and follow our bylaws or do we follow our pocketbook?

Megan Berg:

I believe we either change our bylaws or we stand by them, end quote. Asha moved the convention. There was backlash. Logeman remembered some pretty vitriolic letters and unpleasant phone calls, although she also said the positive response outweighed the negative. Asha made the decision knowing it would cost money and anger some members, and it stood by it.

Megan Berg:

I keep thinking about this story because it would be very easy to tell it as evidence that ASHA can change and that's true. But I think there's something else in it that matters for what we're trying to untangle together. Together. Look at where Richard Adler was standing. He wasn't standing outside the institution demanding that someone listen to him.

Megan Berg:

He wasn't trying to build enough social media pressure that the organization would issue a statement. He wasn't submitting feedback to an advisory body. Richard Adler was a representative in one of the bodies that governed ASHA. And that structure has a history. When the organization that eventually became ASHA was tiny, members essentially governed it themselves.

Megan Berg:

The annual business meeting wasn't just some procedural thing squeezed between convention sessions. It was where the association conducted its affairs. Members were expected to attend. Members were expected to vote. They elected officers.

Megan Berg:

They established membership categories. They adopted the first principles of ethics. They debated policy. They appointed committees. The minutes even recorded who showed up and who didn't.

Megan Berg:

As the organization grew, obviously that couldn't continue forever. So in 1958, ASHA approved something called the House of State Delegates. State associations sent representatives to help connect the membership with the executive council. And by 1969, that body had evolved into the Legislative Council. So there is a pretty clear lineage here.

Megan Berg:

First, members governed directly. Then as the organization grew, members elected representatives. Those representatives eventually became part of ASHA's formal policy making structure, and that's the institution Richard Adler walked into in 1990. Then in 2007, something happened. The legislative council voted itself out of existence.

Megan Berg:

And I wanna be careful because I went looking for some big dramatic explanation for why that happened, and I haven't found one. ASHA didn't say its governance system was failing. In fact, the ASHA president at the time, Noam Anderson, said almost exactly the opposite. Quote, we didn't feel that our current governance model is broken, end quote. The problem was that it was big.

Megan Berg:

By then, the legislative council had about a 150 members alongside a 13 member executive board. ASHA described the structure as large and complex and said that it slowed decision making. So ASHA formed a committee. The committee reviewed 23 different kinds of governance models and it looked at what were considered best practices in a nonprofit governance. And what it found was that the vast majority of nonprofit organizations it studied were governed by a single board.

Megan Berg:

So it recommended that ASHA do the same. The ASHA leader actually asked the obvious question: Why change from a system with a legislative council and an executive board to one governing board of directors? And ASHA's answer is straightforward: efficiency and effectiveness. The argument was that a smaller governing structure could make decisions more efficiently. It could respond more quickly to members.

Megan Berg:

It could spend more time considering important issues. A smaller governing structure could make decisions faster. Authority would be more clear. The Board could spend more time considering high priority issues. ASHA believed it could become more responsive to members and more accountable for its decisions.

Megan Berg:

It's a very bureaucratic solution to a very bureaucratic problem. And I can imagine how appealing it might have seemed if you were actually serving on one of these bodies. A 150 person legislative council sharing authority with a 13 person executive board meant a lot of people, a lot of process, and sometimes genuine ambiguity about who had the authority to make a decision. ASHA's own account says volunteer leaders and members identified that as a problem. So I don't think we need to assume that anyone was sitting around thinking, how do we take power away from members?

Megan Berg:

They were trying to make the organization easier to govern. And I think the interesting question for me is what becomes easier to govern when you make it easier to govern? Imagine trying to run a national professional organization through a 150 person legislative body. Imagine trying to respond quickly to federal policy changes or reimbursement issues or legal problems or rapidly changing clinical standards. Representative democracy is not particularly famous for being efficient.

Megan Berg:

And ASHA was becoming a much more complicated institution. So the legislative council took what its own speaker called a leap of faith and voted itself out of existence. But the other thing to notice here is that the representatives didn't disappear. ASHA created advisory councils. There would still be representatives from every state and those representatives could identify issues.

Megan Berg:

They could discuss them. They could rank member concerns. They could make recommendations, and their chairs would sit on the board of directors. ASHA actually listed, quote, greater membership input into governing actions as one of the desired outcomes of the change. So I don't think this is a story about some group of bureaucrats deciding that members shouldn't have power anymore.

Megan Berg:

The people making this decision were themselves longtime ASHA volunteer leaders. The legislative council approved it. They appear to have genuinely believed this would produce better governance. But this is where we need to acknowledge that input is not the same as governance power. Before the restructuring, state representatives were members of a body with governing authority.

Megan Berg:

Afterwards, state representatives served on bodies whose job was to advise the people with governing authority. Those are not the same thing. ASHA itself would later describe the transition this way. Before 2007, the Legislative Council was a state representative body with governing authority. After the restructuring, the advisory councils preserved the advisory and feedback role, but not the governance role.

Megan Berg:

And that has fundamentally changed how we grapple with the biggest questions in our field. Imagine Adler walking toward that microphone again. He doesn't remember walking. He's sweating. He has no speech.

Megan Berg:

He stands in front of the president of his professional association and representatives from across the country and says, I'm gay, or here, members of this profession are being discriminated against. Patients are being discriminated against, and we need to do something. What happened afterward depended on far more than just ASHA's governance structure. It depended on the gasp organizing, people taking personal risks, allies within the association, and a country beginning to change around them. But Adler wasn't standing there asking the people in power to hear him.

Megan Berg:

He was one of the people with governing power. He was an elected member of the legislative council, a body that shared responsibility for governing ASHA. And seventeen years later, that body voted itself out of existence. So today, an SLP can still speak. There are advisory councils.

Megan Berg:

There are committees. Members can contact the board. There are comment processes. There's elections. Although for many positions, election means voting yes or no on a nominated candidate.

Megan Berg:

Members at large are one of the places where voters actually choose among candidates. And there are even mechanisms through which members can petition for changes to the bylaws. But the board of directors is now ASHA's single governing body. Members of that board are fiduciaries of the association. That is a fundamentally different map of power.

Megan Berg:

And for me, I'm much less interested in whether the 2007 decision was right or wrong than in what it changed. Maybe governing a modern organization with hundreds of thousands of constituents through a 150 person legislative body really was untenable. Maybe decisions did become better. Maybe accountability became more clear. Maybe ASHA became more capable of responding to external threats.

Megan Berg:

Maybe the new structure solved exactly the problems its designers intended it to solve. But governance design always involves trade offs. Efficiency is a value and so is representation. Responsiveness is a value and so is deliberation. Clear authority is a value and so is distributed power And sometimes those values pull in opposite directions.

Megan Berg:

A room where a 150 people can, to use Richard Adler's immortal phrase, be for bitch about whatever you want, is probably not a very efficient way to run a national nonprofit. But maybe inefficiency wasn't entirely a problem to be solved. Maybe some of it was the cost of giving people power. And there's another transformation happening underneath all of this. The ASHA that existed when Richard Adler walked to that microphone was already much larger than the organization founded in 1925.

Megan Berg:

But over the decades since, ASHA has become an increasingly complex permanent institution. It employs professional staff, manages certification and accreditation systems, participates in federal policy and reimbursement work, owns property and manages investments, and has contracts and legal obligations and retirement obligations, and an enormous amount of institutional infrastructure. And none of that is evidence at all of corruption. It's just what institutions do as they grow. But eventually, an organization develops responsibilities that its founders never had to think about.

Megan Berg:

The institution itself becomes something its leaders are responsible for maintaining. And that changes the kinds of decisions leaders have to make. As the institution grows, its leaders become responsible for more than the needs and priorities of the profession. They also become responsibility for the stability and continuity of ASHA itself. And this is one of the things I'm becoming increasingly interested in as I research the history of speech language pathology.

Megan Berg:

We tend to tell stories about institutional change as stories about people. We need better leaders. We need different people on the board. We need younger SLP's involved. We need more diverse perspectives.

Megan Berg:

We need people willing to speak up. And all of those things may be true, but people operate inside of structures. And structures determine what kinds of power people actually have. ASHA's governance history seems to have moved through several different answers to the same question. When the organization was tiny, members decide.

Megan Berg:

When it got bigger, representatives decide. And after 2007, members provide input and a board decides. Maybe that was necessary. Maybe it wasn't. But it happened.

Megan Berg:

And if we're going to talk seriously about changing this profession, we should probably understand it. Because right now, there is enormous frustration among speech language pathologists. And one of the most common responses to that frustration is get involved. Run for office. Join a committee.

Megan Berg:

Volunteer. Work within the system. And I'm not saying don't do those things. I'm asking a different question. What does within the system actually mean?

Megan Berg:

What authority does an individual member have? What authority does an adviser have? What authority does a committee have? What authority does a board member have? What responsibilities constrain each of them?

Megan Berg:

And what formal mechanisms exist when members believe the people governing their professional association have made the wrong decision? Because Richard Adler worked within system, but Richard Adler's within doesn't exist anymore. And this question about the difference between having a voice and having power doesn't stop at ASHA. We keep creating new places for people to speak. Social media, grassroots organizations, petitions, advisory groups, comment periods, surveys, coalitions.

Megan Berg:

We have more mechanisms for expressing what we think than probably any generation of SLPs before us, and yet we remain remarkably confused about where the power to decide actually lives. Creating more opportunities to speak does not answer the question of who gets to decide. Being heard is not the same as governing. Having followers doesn't give you a mandate, expertise doesn't give you the right to decide, and holding institutional power doesn't necessarily mean you represent everyone that's affected by how you use it. There's also also a larger American story running underneath all of this that we've explored in earlier episodes in season one.

Megan Berg:

A lot of our institutions were built at a time when the people allowed to participate in them represented a much more narrow slice of the population. Our political institutions are an obvious example. For much of American history, participation was explicitly restricted by race, gender, property ownership, or some combination of the three. And over time, we expanded our understanding of who had the right to participate even as many of the institutions themselves continued to exist as they were built. I think something similar happened in this profession.

Megan Berg:

ASHA was founded by mostly men. The early leaders we've encountered in this series, the people defining the profession, establishing its standards, and building its institutions were overwhelmingly men. Over the course of the twentieth century, the profession changed. It became overwhelmingly female while slowly becoming more racially, culturally, and economically diverse. And when you expand who gets to participate in an institution, you also expand who gets to question the assumptions it was built around.

Megan Berg:

Who gets to define normal communication? Who gets to be the expert? What does professionalism actually mean? Whose knowledge counts? What happens when our clinical practices reflect racism, ableism, sexism, or assumptions we inherited without realizing it?

Megan Berg:

Those questions have changed this profession. They've changed me. But I think there's another part of the story that we're still living through. What happens when a profession learns to question the authority it inherited? Because questioning authority doesn't make power disappear, and challenging formal authority can create new forms of power of its own.

Megan Berg:

And some of that power has moved into places our founders never could have imagined. Social media, grassroots organizations, online communities, public criticism, calling in, calling out, screenshots, open letters, blocking, unfollowing, statements, apologies, demands for accountability. And to be clear, I've done all of these things. I've used social media to challenge institutions. I've built a grassroots organization.

Megan Berg:

I've made public criticisms. I've called people out. I've asked other people to be accountable. I'm not describing a system that I'm standing outside of. I'm describing the system I've been participating in.

Megan Berg:

And for a while, I don't think I thought very much of that as a form of power. It was just what you did when the existing channels didn't seem capable of addressing the thing you were trying to change. These spaces have made it possible for people who historically have had very little institutional power to challenge the profession publicly, and that's a meaningful change. But they've also created forms of power that don't come with a lot of structure around how that power should be used. There are no bylaws for this kind of power, no defined jurisdiction, no clear process for separating what someone says happened from what we actually know happened, no term limits, no appeals process, and it's often unclear who gave anyone the authority to adjudicate the dispute in the first place.

Megan Berg:

Which brings me back to Richard Adler. He walked into a room in 1990 and challenged his profession. He said something deeply personal, professionally risky, and profoundly disruptive to the norms of the time. And somehow, the system had somewhere for that disagreement to go. Apparently, it was a giant cumbersome room full of representatives where you could be for a bitch about whatever you want.

Megan Berg:

And maybe there was something valuable in that. Because I'm starting to think that the problem isn't that speech language pathologists haven't learned how to question authority or think critically. I think we've gotten really good at that. The harder question is what happens after the question is asked. Who listens?

Megan Berg:

Who deliberates? Who decides? Who gets to disagree with that decision? And what keeps disagreement from becoming either institutional suppression or public punishment? Maybe that's why so much of our professional discourse feels strange right now.

Megan Berg:

We keep arguing about who is right. I'm becoming much more interested in who gets to decide, but maybe even that question isn't big enough. Because before anyone decides, people have to be able to disagree. They have to be able to say what they need. Someone has to listen.

Megan Berg:

And when those needs conflict, which they inevitably will, we need ways to be leader of proud in And of itself is evidence of harm or bad intent and to keep working together afterward. Maybe the question is, what would it take to build a profession that can hear disagreement without needing to eliminate it? Part of why I keep coming back to this question is that I'm not sure where I would go to participate in that kind of profession right now. I chose to stop maintaining the CCC because I fundamentally disagree with the relationship it creates between certification, payment, and participation in the professional association. So when someone says, if you want ASHA to change, work within the system, that's not really an answer for me.

Megan Berg:

Working within that system would require me to reenter the very arrangement I'm questioning. I can work through my state association on issues at the state level. I can submit public comments. I can make this podcast. But I remain frustrated by how few places there seem to be in between.

Megan Berg:

And I don't have an answer for what should replace them. I don't know what the right governance structure is. I don't know how we create places where SLPs can disagree, actually hear one another, and turn what we're hearing into collective action. But I do believe disagreement doesn't have to be the end of the conversation. I can think that you're wrong about something and still believe there's something I can learn from you.

Megan Berg:

We can want different things and still have interest in common. And maybe part of what we've lost in all of this absolutism is the ability to stay in that discomfort long enough to find out what those things are. I'm learning this as I go and making plenty of mistakes along the way. So if you've made it all the way through this episode, thank you for being willing to learn alongside me. These aren't simple questions, and I'm becoming increasingly suspicious of simple answers to them.

Megan Berg:

I don't know where all of this takes us yet, but I'm gonna keep looking. Thanks for looking with me. I'm Megan Berg. This is Inside SLP. If you'd like to contact me, you can reach me at therapy insights dot com slash inside SLP.

Megan Berg:

If you'd like to learn more about my research into the structure of the profession with my colleague, sociologist, doctor Emily Ekl and our board of advisers, you can head to pactsurvey.com. That's pactsurvey.com. If you're going to the Nebraska State Conference, I look forward to meeting you in Lincoln. Come by my talk at 08:00 on Friday morning, October ninth at the Innovation Campus, where we will be exploring these topics together.