Collaborating with mental health professionals
Hello all – thank you for being part of the 2014 ISAD conference. There seems to be a trend towards a more holistic approach to treating those who stutter, including working with mental health experts who can address the issues of fear and anxiety in a person who stutters. I know from my own research that this has been a contentious issue in the field of speech therapy. How do you all feel about this trend? Why is this trend happening now? Would you be comfortable teaming up with a mental health professional when treating people (including children) who stutter? Again, thank you for your participation.
Best,
Dori Lenz Holte
Treating the whole person (a “more holistic approach”), not just the outward symptoms of stuttering, isn’t a trend that is just happening now, Dorie. If you study the background of so many of the fathers (well, grandfathers and great grandfathers now) you will discover many came from a background in psychology or psychiatry – Van Riper, Freund, Sheehan, Travis, Bluemel, Wendell Johnson, Frick, and probably many others I’m forgetting right now. Years ago some did psychological experiments in trying to discover the cause and most effective treatment that made an unfortunate mark on my field. And some like Coriat and Fenichel believed that stuttering was totally a psychological problem, which of course is not true. In my opinion, if you look at the “historical progression” of treating stuttering in my field, you will see the trend to look more at the outward symptoms also emerged from the same psychological background when the “behaviorists” made their mark on the field. And yes, there have been “stuttering wars” in the history of our field, some even continue today;-)
Added to the mix has been the strong influence (not inappropriate) of the consumer community that has searched for (and sometimes demanded) a “cure” for centuries, when there still is no “cure” on the horizon for adults who stutter.
We (speech therapists, psychologists, psychiatrists, researchers, counselors, rehabilitation specialists, teachers, people who stutter and their families) all need to be willing to work together with mutual respect as we continue to find the best solutions for stuttering. And since I believe there is not one “cause” for all stuttering, there will not be one “cure” either. Effective treatment needs to be tailored to the individual client. And the relationship between the client and the clinician is vital. Different clients will work best with different clinicians. If the treatment approach doesn’t work, it is not a “failure” with the clinician or the client. One size or approach does not fit all. I certainly don’t have all the answers. . . .
But yes, of course I would be comfortable collaborating with a mental health professional when treating people who stutter, or a person with any other communicative disorder that I felt my personal training with degrees in speech pathology and another in counseling were inadequate. Another important part of that collaboration is a support organization such as NSA and FRIENDS in the US. There are other support organizations in many other countries as well.
Judy Kuster
Hi Judy -nice to hear from you and I STILL want to have coffee!!
You are absolutely right — this is not a new trend. In fact, much of my book was inspired by those fathers, grandfathers, and great grand fathers who valued a psychological component to treating those show stutter. I should have used the phrase “pendulum swinging back towards more of a psychological focus” and away from behavior mod.
I completely understand what you say about the consumer community – and I only speak for children/parents, not for adults who stutter. I was one of those consumers who just wanted it to go away. Now I believe parents should be fully educated about the risks of focusing on minimizing or eliminating speech errors and the tremendous role that anxiety plays in this issue. prior to engaging their child in therapy
I also agree that the cause of stuttering can be multi-faceted and different for each person, hence the ongoing difficulty of finding effective treatments. But you know my mantra — “first do no harm.” I hear from school-based speech therapists who acknowledge their fear discomfort around treating children who stutter but are told they have no choice. They proceed believing that it won’t hurt — they find an instruction book full of speech tools and away they go. They truly have no clue as to how much damage they can do. It breaks my heart.
From a parent’s perspective – we are clueless as to “what will work best” and “which size is going to fit our child.” Too often the damage of silence and withdrawal will occur long before a parent figures this out. And I know that any child who stutters, regardless of treatment approach, is vulnerable to silence and withdrawal — but therapy focusing on eliminating/minimizing speech errors runs a tremendous risk of exacerbating that behavior.
I am so encouraged by the direction of the pendulum – my involvement with local NSA support groups (Minneapolis, St. Cloud, River Falls) has been so encouraging. Minneapolis NSA recently had a Family Fun Day and a workshop for therapists on Cognitive Behavioral Therapy…I just hope that speech professionals will enthusiastically embrace a collaboration with the mental health community early on in the therapy process. A lot needs to change in order for that to happen — especially around how success is measured and reported.
Thanks again Judy, always great to hear from you…
I am not sure that the issue of mental health and stuttering is all that contentious. There have been some minor controversies, such as whether those who stutter are at risk for personality disorders. However, it seems incontrovertible that those who stutter and seek clinical help might experience social anxiety to a clinically significant extent. As such, if a speech-language pathologist does not have sufficient qualification to manage anxiety with a client, it is only natural to work in collaboration with a clinical psychologist. A potential solution to the obvious practical problems with such an arrangement is foreshadowed with the clinical trials of a standalone Internet CBT treatment for stuttering.
Thank you Mark for your response. I interact with grad student and speech therapists quite often who feel they have not at all been quipped to address the anxiety issue. You acknowledge that this can happen to a “clinically significant extent” but at this time, at least in our experience and in my frequent interaction with speech therapists (due to my book) there are very few speech therapists that I know of teaming up with a clinical psychologist to address the issue. I love your vision of these professional naturally working together – but you’re right, we have a long ways to go to overcome the practical problems. As a leader in this field, you are one who can make things happen — and I appreciate your efforts… I believe this needs all the push we can give it! THanks again.
Best,
Dori Lenz Holte
There might be cultural differences, but my impression is that many SLPs acknowledge the expertice from other mental Health Professionals, and do collaborate With them in contexts when necessary. Sometimes it is hard to find Professionals who are available, and having possibilities to collaborate, but this is another challenge or issue. Related to my practice, I find it very helpful, especially in situation where the person is very much depressed or the person’s attitude or self-confidence is to complicated or negative to handle. In some cases with children I have involved other mental Health Professionals, but, in my experience, this is the case mostly for adults who stutter. I don’t think that including other mental Health Professionals is a New trend, I believe it is more depended on differences in clinical traditions, cultural differrences and what kind of Professionals who are available at the specific time. Best wishes, Hilda Sønsterud
I believe the key word is colloboration. It’s one thing to appreciate a holistic approach and make a referral to a mental health professional. It’s another to take steps forward and create professional relationships with mental health professionals. I would like to see SLPs educating mental health professionals on stuttering, so when referrals are made that the treatment is appropriate and effective.
As a psychotherapist, I am happy to begin colloborating with Gerard Maguire, MD, Loryn McGill, SLP and Lisa LaSalle, SLP to work together to treat the person who stutters.
On a personal note, as a person who stutter – I needed counseling way more than speech therapy in highs school. Even better would have been an SLP and LCSW worming together to provide me treatment.
I welcome thoughts, suggestions, questions from the experts.
Best,
Nora
http://www.center4betterliving.com