How do I design speech therapy that actually works?

Running an exercise is following a recipe. Designing therapy is being the cook who knows why each ingredient is there. That leap feels large, but it is built on one question you can always ask: what exactly is getting in this person's way, and what is the next smallest step past it? Good therapy design starts with a clear picture of the specific breakdown, not a generic goal. Assess narrowly. Is it this sound, this muscle, this moment of processing? Then choose an activity that targets that one thing and builds on it. The plan is just a chain of next steps, each earned by the last. Take one patient and write down the single most important thing you want to change, then design three sessions that move only toward it. Watch what works and adjust. You learn to design by designing and revising, not by waiting until you feel expert. The skill is in the revising.