Beginning journey within speech
Hello everyone my name is Fatima I am a student going to school for speech. I know everyone responds differently to treatment, so I’m curious what has worked (or not worked) for you. I’d also love to learn more about what approaches you’d recommend for someone just starting out. Thanks for sharing your experiences!
Hello Fatima,
You write that “everyone responds differently to treatment”. One of the big problems that we face is that outdated and abusive therapeutic practices are still taught and still encouraged.
The modern speech therapist will learn, understand, and practice stuttering-affirming therapy, as opposed to stuttering-suppressing therapy such as fluency shaping.
If you want to be a helpful and effective therapist, be sure to learn about those stuttering-affirmative therapies, such as avoidance reduction therapy for stuttering and the CARE model. Learn about how cognitive behavioral therapies, such as ACT, DBT, and CBT support those stuttering-affirmative therapies.
Be sure, too, to attend conferences with people who stutter. We all learn from each other, and speech therapists need to learn more from people who stuttering themselves.
Hanan
Hi Fatima and thank you for your question.
The short answer is: ask questions and listen, before you even think of starting therapy. As we all bring different things to the table. Background, culture, religion, family, age, gender, and our many different experiences. This goes for clients of all ages. You may find out that not all clients come for total fluency. Some want answers, some want a family member to know more, some want some tools to speak with less tension, some want to practice job interviews, some are there because the parents want the child to be fluent while the child just wants to speak freely, some want help with self-esteem, etc etc. When you get a picture of the client and what they want, you can start offering a smörgåsbord. This can be all from speech training to refer to relaxation, mindfulness, NLP, speaking circles, theatre, art, presentation techniques, yoga, swimming, singing, and maybe even a combination.
Also show the way to the stuttering community. This group is not instead of, but can be a great addition to therapy. People who walked the walk and literally talked the talk. They can help with exercises, help to speak in school or at the workplace, support outside the therapy room, etc. They often have gatherings, camps and some even have virtual meetups, even international ones, with meeting friends and simply playing games together.
With acceptance being the safety net, you can start the journey of practice, challenging yourself, and go for your dreams. Acceptance doesn’t mean you’re done. It means you catch your breath and get ready for the next step, whatever that step may be.
And help me to find my true self, and my self-worth. Show me what I’m good at, and that stuttering is not bad and fluency good, but that stuttering just IS. And that it’s not up to me to make my listener happy, but maybe instead up to the listener to simply… listen. Help me to see there’s more in life then fluency. And that I’m good enough either way. But to also help me to find tools that fit me and my stutter, ways to explain to others what stuttering is, ways to meet bullies and other people not getting it. Ways to speak to my teachers. And show me the way to stutter camps, where I can be me, speak freely, without any therapy, and where my parents can come and speak with adult PWS. As the more we understand, the more we feel good enough, the more we lose the shame. So be a friend. 🙂
Most of these advices can work with both adults and children. With children however, make sure you listen to the child and not just to the parents, as they can have different goals, and the child might tell you what s/he thinks others want to hear. So have them both together and seperately. Also group meetings are good, to show they are not alone, and do exercises together, the same for parents.
Lastly: stop the counting syllables. Just because someone stutters less, doesn’t mean things are going great. It can also mean the iceberg is getting under the surface, and thus way harder to notice, and to treat. So listen not only with your ears, but also with your gut, to what’s not been said.
Sounds tricky? I promise you that, as soon as you gain your client’s trust, you’ll have an exiting road ahead, walking and working together, sharing ups and downs, and enjoy the progress, whatever this word includes for that very client.
Keep them talking
Anita
Hi Fatima,
Thank you for your question.
I come from India and while growing up, I had quite limited options on ‘speech therapies’ ,both in terms of best practices, and SLPs. In a small town, the options were far less, so we had to go to general therpaists, who ewere not experts in speech and language, but would cater to other conditions as well, like Autism, Mutism, and in some cases, mental health problems. So you can see, how misinformed were we, re what are the best practices for someone who has a stutter. I am not proud to say, that I had a worse experience of my first ‘true’ speech therapy sessions, when I was an adult- a 20 year old, in a distant city of New Delhi, which was a 4 hour drive from my home town, and having to live in a hostel facility provided by the speech therapy centre which was a different type of trauma all together. Needless to say, it did not work for me. However, I did get to know about TISA (The Indian Stammering Association) which I eventually joined 2 years later. And it was a blessing for me. I found my tribe and loved meeting the stammering community,both nationally and internationally. One piece of advice I would give to the therapists, is to encourage people who stutter,to find their community 🙂 It would do wonders to them!
Hi, Fatima. And thank you for your most interesting question!
To answer from my own experiences: Things are a little complicated, as I’ve gone through numerous phases in my life of different perspectives, attitudes, experiences, and goals with regard to stuttering.
I stutter severely.
When I was a child, I went through many speech therapies, but no therapy helped to improve my speech until I was in high school.
In high school, I began learning speech techniques (stuttering modification) that helped to decrease my disfluency. I later went through four different fluency shaping programs, hoping to transform myself into a Fluent Speaker. By far, I had the most success with a program that no longer exists – the Precision Fluency Shaping Program (PFSP), developed by the former Hollins Communications Research Institute in Roanoke, Virginia. Through that program I was able to reach the point of being fluent in all my situations, by practicing intensively and daily after completing the three-week program. Three months after leaving the program, I finally achieved fluency in all situations, for the first time in my life. I was then 30 years old.
I loved the fluency. BUT – there was a catch. My fluency was entirely dependent on intensive practice every single day (breathing and speech exercises), an hour or more each day. I quickly discovered that when I didn’t maintain that regimen (and due to a busy life, I really couldn’t), my speech began to fall apart. I kept going back for fluency “refresher” programs, always resuming fluency for a while, but always experiencing relapse some time down the road. Sometimes i was fluent for weeks, sometimes for months. But there was always a relapse eventually.
Finally I had enough of this. About 25 years ago, I decided to shift my attitude entirely. I began to completely accept myself as I am, with full self-confidence. I gave up the grind of daily practice. I now accepted myself as a person who happens to stutter, a person with a speech difference. And it was so much more relaxing, and so much less pressured, to finally accept this. I really had no desire to spend all that time practicing, so that I could speak fluently to everyone. Who cares? I could communicate everything I wanted to communicate, stuttering and all. And life became so much more pleasant!
I have difficulties in speaking – I severely stutter. But I still speak exactly what I want to, to whoever I want to, and whenever I want to. And if I happen to stutter, so what? If someone has a problem with that (very few do), then it’s their problem, and not mine.
With regard to what approach to first try with a new client, or for a clinician new to the field of fluency disorders, it is difficult to generalize. Each person who stutters is very different, and has had different experiences in their stuttering journey (and many have tried various types of speech therapy, with varying results).
Too often, clinics and clinicians have a “one-size-fits-all” approach, which in my view is wrong. To respect the individualities of the nature of stuttering in people who stutter, it is important to have an assessment beforehand, with interviews of the client (and/or the parents, if the client is a child who stutters). The optimal approach to stuttering therapy varies from client to client. Some benefit from fluency techniques (not all do). Some need emphasis in building self-acceptance and self-confidence, along with reducing situational avoidances (and word/sound avoidances, if applicable). For some clients, a combination of these approaches would be optimal.
One needs to find out how the client has done in past therapies, and which types of therapies the client has tried (if any). If the client is just starting out in therapy, it is necessary to assess how stuttering has affected their life. Is the client in need of building self-acceptance and self-confidence? If stuttering is severe, speech techniques may be helpful. Often it may be best to try a combination of approaches. I wish I could give more definite advice, but I wouldn’t want to say: “First try this approach. Then, perhaps, try this approach.” We must assess all people who stutter as individuals, and make choices based on each client’s case (or what the client may prefer, if he/she is informed of some of the different approaches available).
Best of luck in your future career.
– Paul