 About the Author:
Chamonix Olsen Sikora is the founder of Hope for Stuttering Speech Therapy, located in Milford, Connecticut. Her private practice, which she started in 2012, specializes in the treatment of stuttering and cluttering and specifically focuses on adults and teens. She offers individual, group, and intensive courses. She works with clients over Zoom from various states and abroad and locally in person. Chamonix is a holistic therapist integrating across fields with specific training in neuroplasticity, brain retraining, nervous system regulation, trauma therapy, emotional processing, and more. She entered the field in 2001 and in 2003 joined staff at the American Institute for Stuttering in NYC, eventually becoming executive director. In 2006 she received board certification in Fluency and later served on ASHA’s American Board on Fluency and Fluency Disorders. She’s been an adjunct faculty member at Southern Connecticut State University, where she graduated with her master’s in Communication Disorders. |
Are you traumatized by your stuttering or is stuttering just kind of annoying but not a big deal? Have you become imprisoned by the pressure to use physical tools or are you free to speak openly? Can’t wait to meet someone else who stutters or don’t want anything to do with someone else who stutters? These are just a fraction of some of the differences between clients who stutter. Come explore three of my client cases with me in this video to see how understanding ‘one size does not fit all’ helps create good stuttering therapy.
Thank you for sharing these stories about these three clients. It truly emphasizes the fact that not one therapy style fits all people. I also liked the point brought up about not always needing to be a leader, sometimes (a lot of time) it is more helpful to follow the person, to meet them where they are at. It is also important to not always educate, but to listen. This has been so powerful for me to discover, especially since I have a friend who stutters. Going in to conversations you have the urge to provide an abundant amount of resources, but sometimes you need to just listen, in order to eventually at some point provide education, or at the very least resources. Good stuttering therapy is not a structured set up, but rather goes like a flow chart based on each individual person.
Thanks for your comment! You can certainly learn a lot from having a friend who stutters, you are fortunate! Yes, finding out what their goals are vs what our goals are is important. It’s a balance because we aren’t sitting there unprepared without any structure for our session times. As a new clinician, I had great structure and prepared for sessions extensively. I still write a note after every session and I prepare, but over time your experience and wealth of knowledge and understanding grows and you have much much more to pull from spontaneously as you are there with your client. People who stutter grow on their journeys and we as clinicians grow on our journeys as well. 🙂
Great to see you, Chamonix! Your examples and explanation exemplify how stuttering therapy has evolved in recent years.
It is so great to hear from you Jim!!! It’s been so long. Thank you for your comment. Any chance you’ll be in Boston at ASHA? I’ll be there this year! :). I’d love to see you.
Hi Chamonix! The stories that you shared were so moving and captivating. I like how you said that as a clinician we need to meet our clients where they are and where they might be comfortable in. The therapy sessions should not be about having a structured session, but more about meeting the individual where they are and what they need.
Hello! Thank you for your comment. 🙂 Yes….I commented above to someone about the idea of structure. I feel structure as a new clinician is very helpful but with flexibility. Even now I have a plan of what direction we are moving in from where we left off in the last session. I have ideas of what might be helpful and I plan to introduce or show them. I always check in on how their week went, because sometimes that is an experience they haven’t shared with anyone yet. The session can then drastically change to talk out and meet what comes up around that. For example. we may end up using reframing and visualize a different way of responding to the situation that occurred or we may role play based off what was brought up. The client’s real life experiences with their communication often provides a framework for the session. There truly are times to listen and times to teach. Times to learn from our client and times they learn from us.
Chamonix,
Thank you for sharing your client’s stories. I find if very inspirational that you meet your client where they are, allow them to dictate the therapy path and don’t allow your opinions to impact therapy. What are some ways that you have found to build rapport and trust with your clients? Also, have you ever had a client that is offended when you stutter with them?
Thanks for sharing,
Rebecca
Hi Rebecca,
Thanks for your comment and interesting questions. Ways to build rapport and trust: drop any “fix it” mentality and just get to know your client, genuinely care for them and their lives, find out about top 3 things they love outside of school or work, ask about pets, check in on their lives and how their week went…not just about how their communication was the past week, build a healthy therapeutic relationship with them which means we connect, care and love them but we don’t unload any of our stuff on them. The session is about and for them so we do keep that professionalism in mind as well. Laughing and listening and valuing them as a person are other points of focus. Those are just some of my thoughts that come to mind. Question two: I think over time you learn how to “read” your clients. Some of them I don’t voluntary stutter with for a while and for others it is right away. Some clients are very sensitive to hearing stuttering so as I shared in the video I teach them tools to help send messages of safety and calm to reassociate stuttering. Others can dive right in. I’ve never had a client who has been offended when I do voluntary stuttering. How you do this, your comfort, and tact are also all factors.
Hi Chamonix!
My name is Sydney and I am an SLP graduate student taking a course on stuttering. I enjoyed hearing you speak about some of your clients and learning more about how different each client is. There’s not one single approach that is going to work for everybody. We talk a lot in class about individualizing therapy and meeting our clients where they are.
Being an active listener is so important because it ensures that your client is being heard and that you’re taking their thoughts and ideas about therapy into consideration. It’s a powerful skill to have. You seem to have established a really great rapport with your clients, which is also super important in providing effective therapy and determining a plan of treatment.
Thanks for sharing your thoughts!
Thank you for your comment Sydney! I remember feeling like it wasn’t okay to spend much time building rapport when I first started out as an SLP. It was so much about data and goals and getting things done! Nothing else works as well if you don’t have this foundation of rapport and relationship. I’m fortunate to have my own private practice and not to have to be confined by external guidelines that don’t keep my clients best interest in mind. This is an art and a science. It’s not about being friends with your client but about knowing them deeply to be able to help them in the best way possible, because trust is everything and people share much more when they trust you and feel cared for, accepted, and loved.
Chamonix, thank you so much for sharing these three very different experiences with us. I love what you said about building trust and that no two people who stutter are the same. In the previous comments you mention how important it is to know your patients deeply, and how people open up when they trust you, feel loved and accepted. I am a 2nd year graduate student and work as an SLPA & know that this makes the entire difference. I have developed a real interest in Fluency disorders because of how relational and deep this part of our therapy is. I love hearing how varied each case is and when you meet the patient/client where they are and provide individualized care the results are limitless. How did you learn that you wanted to specialize in helping PWS? What were some things that you felt you had to learn and maybe unlearn to be a better clinician?
Hi! Thank you for your comment. Your SLPA experience must be so valuable as you navigate grad school! Yes, this area is very relational and deep. Although, we do follow our clients…for some clients it does not run as deep and we adjust to each person. To answer your questions…in graduate school I took the Fluency Disorders course and I loved it. After learning about different ways to stutter and practicing them in class, we went out as partners to stutter at stores in real life. This assignment has in recent years become controversial in our field, but for me it had a profound positive impact. I went up to a cute guy who worked at Staples and asked numerous questions with various kinds of stuttering. He acted so strange and would only look at my partner, not me. He acted like he wanted to get away from me, not something I was used to. I felt dismissed and the interaction emotionally impacted me. I remember after checking out, the glass doors slid open and as my partner and I walked out of Staples, I felt like I could walk out of the shoes of being someone who stutters, yet those who truly stutter could not and had to deal with these kind of interactions plus who knows what other kinds. I felt fired up to learn all I could, work and specialize in this area, and help however I could. I was also just fascinated by stuttering and the brain and reactions both internally and externally to stuttering and began to read research wherever I could around stuttering.
I also went to a bible study with my mom while in grad school and I met a man there who when he found out I was studying speech therapy, shared that his sister was a speech therapist in NYC and had started an institute for stuttering there. I told him stuttering is my favorite area. He connected us, and I became an intern for two of the “three week intensive programs” that used to be run there. I knew I wanted to work with people who stutter and specialize just in this area from the moment I met Catherine Montgomery. This was in 2000. I ended up working for her and being mentored by her for 9 years.
Interestingly I grew up with a mother who is hearing impaired and wore one hearing aid, which inspired me somewhat to this field but stuttering was my passion, not hearing. I am now a bi-lateral hearing aid user myself and so find some interesting things like social stigma and self advocacy things I face in my own daily life.
Your second question…interesting to consider. I had to learn each year to become a better clinician. I was fortunate to be sent by my mentor to every stuttering conference that was going on at the time. I pursued board certification in stuttering as early as allowed to. Early on I followed the manual my mentor had created and I followed materials and programs for very young children and school-age. I needed some kind of structure. As I gained experience over the years, further learning, and eventually a lot of education outside of our field…I started to practice in a different way. You will see for yourself that as you devote yourself to your “craft” your passion your love, that you change. You develop skills that it’s hard to put a word to or to teach. There was a shift 5-10 years ago….maybe really in the past 5 years in the stuttering field. I’ve stayed open to continuous learning. I’ve never arrived. I also don’t jump on bandwagons. Things become popular in our field and then many of the CEUs circulate around those ways and everyone starts doing the same thing. My advice is be a critical thinker for yourself. Always stay open to your client’s perspective, new research, new ideas in the field, but trust yourself. Don’t try to be someone else. Learn from them, but be you. Trust your instincts. Love what you do and you’ll always continue to learn and grow.
Hi Chamonix
You sound like a brilliant therapist to me. Can you tell me which other therapists have most inspired you.
Here’s a question – if you stuttered yourself what therapeutic approach do you think you would have favoured?
Thanks
Tim
Hi Tim! Nice to meet you! Thanks for your comment. You guys are coming up with some great questions here in recent comments.
Catherine Montgomery most inspired me. She passed away in 2010 at the age of 57 and I consider myself so fortunate to have worked for her and been mentored by her for almost a decade. She was a pioneer. She was a fabulous model for learning and changing over your career. Way before anyone was doing anything with mindfulness or visualization, she brought it into her 3 week program that was running at that time. She took criticism for this, but she brought in ideas from sports psychology and even had a yoga bodyworks person who led sessions. Each client created a vision for themselves and created lists of positive affirmations. In addition clients were introduced to both fluency shaping and stuttering modification tools. She learned from others about desensitization and advertising and incorporated these into her program/therapy. Back in the early to mid 90’s she was doing these things when it was a polarized field of stuttering modification OR fluency shaping and fluency shaping was a big prominent force and I learned about Ron Webster. She started to integrate and think outside of the box. She listened to her clients. I learned from her originally but she also sent me to every stuttering conference that was going on and I learned from Barry Guitar, Kristin Chemela, Walt Manning, Phil Schneider, and many others. I watched everything SF had to offer and was exposed to VanRiper, Sheehan, and Johnson, and others. I read research. I was inspired by so many. Then I had a huge thing occur in my life and I began a long over decade journey of pursuing healing and transformation. At that time the stuttering world was the same stuff, nothing new, so I went off into other fields for my own healing but also began to integrate new things I had learned into my therapy. Those who have inspired me for the past decade have been from outside of our field. It’s been fun to see in recent years the things my mentor Catherine was using decades ago in therapy have research to back them and also have spread out and become more common to use. There are also new movements going on and it’s exciting to see change and shift. Yet, I don’t throw out the past. We truly morph as clinicians as we grow on our own personal journeys and we remain open to continued learning and also trust ourselves and be ourselves.
To answer your second question, which no one has ever asked me but I have thought of it myself, I think if I stuttered myself I would have pursued fluency initially. I so would have liked to have just said, I’d go for open free stuttering and loving me and acceptance and just living life and advocating for myself! But realistically, I think it would have taken me a while to get there. I think I would have wanted to see what those fluency tools could do for me. I would probably have moved to stuttering mod tools then after and eventually gotten to acceptance, pride, and freedom. It also depends a lot of what therapist I was able to work with and what they presented to me.
I think I would have loved to hear that my stuttering is just part of me and that the more I could love and accept that part, the easier it would be to self advocate and navigate this world. I value freedom, so I think eventually I would have pursued that strongly….the freedom to stutter openly and be me. I know the younger me though was sensitive and a pleaser, often co-dependent. I think this interplay with stuttering would have pushed me towards caring what made others feel comfortable over myself and would have led me to grasp at fluency. I remember in grad school the assignment to go out and stutter greatly impacted me emotionally. I’m sensitive. I feel other people’s feelings easily. Because of my own personal journey with other things, I’ve become a different strong resilient person with good boundaries and a voice. I think this true me would pursue very different goals for my communication and stuttering than the younger version of me would have, if I indeed were a person who stutters. 🙂
Hi Chamonix
Thank you for your very honest and thorough reply. I am very glad that you found your way through your’crisis’ and wish you all the best for the future.
Cheerio
Tim
Hi Chamonix,
This was such a great video. I noticed how you were able to probe and notice trauma responses in your clients, which allowed you to move forward, or pull back. In your bio it also talks about how you are trained in trauma therapy. I would love to become a more trauma informed therapist as an SLP. Where is the overlap between SLP and psych/counseling in this realm? And do you have any resources/suggestions on how I could get started?
Thanks
Liz
Hello Liz!
Thank you for your comment and for your questions. Ahhhh….it’s quite a question…where the overlap is between SLP and pscyh/counseling in this realm. I am also assuming by this realm we are talking about stuttering specifically. I personally feel with adults and teens who stutter, understanding how the experiences with stuttering and responses to stuttering can be traumatic for some is important. Fear can come in also and play such an extremely large role. Thoughts and beliefs are so critical. Where does avoidance come from? If we feel reducing avoidance is helpful to our clients, then understanding that a big “Part” can form, I’ll call it the Protector, and it’s in the subconscious mind. This part is trying to help and protect the person by using avoidance so being able to understand this part of the mind and talk to it before having a client try to give up their avoidances…it can really help, in my opinion. “Parts Work” is from Internal Family Systems, developed by Richard Schwartz. As for a resource, his book “No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems model” could be helpful.
I personally feel very comfortable using these approaches from the world of psychology, trauma healing, self -help, positive psychology, neuroplasticiy, brain retraining, nervous system regulation, etc. and apply them to my work with those who stutter. We are the experts in stuttering and understand it at a level other professionals almost never do. Sending a client to a psychologist to work on the feelings, cognitive pieces, and reactions around stuttering usually back fires because they don’t have intimate extensive experience working with people who stutter. Some can be good therapists, but I’ve spent my career becoming educated, trained, and good at these other areas because I LOVE them and because I feel they are needed for much of the therapy I do. I have some who I use very little of these skills with because they don’t need it. I also went on a journey myself where I intensively used trauma therapy for myself and brain retraining and learned so much about the nervous system, emotional freedom technique, understanding my vagus nerve, breathing and meditation practices, how to shift brain states and uplift mood and use the positive brain chemistry to re-associate triggers, a lot of neuroscience based and neuroplasticity practices and so much more. The years I spent deep in that world and healing myself was intensive training and then I did some training myself for use with clients.
If you have a client with a separate psych issue then refer out, that is not our area and that is an ethical obligation. I don’t refer out if someone’s emotions and responses and thoughts are all connected to and related to stuttering because we can work on it, they don’t have a psych dx. Of course if someone is suicidal or deeply depressed or severely anxious, even if it is related fully to stuttering only, then yes, refer so they can get some stability and safety while you continue to work on the stuttering angle. They may need to first work on psych stability first then return to speech therapy. I’ve had multiple clients in both psychotherapy and working with me. Consulting with the other therapist is helpful, both ways. I had one client who was quite mentally ill and it was a tricky situation as he wanted to continue therapy but the massive need for psych support was so blatant, I had to navigate that and he took a break from therapy to get his mental health and well being prioritized. His psych issues were totally unrelated to stuttering. We do run into all kinds of situations. Most clients are not like this one I just mentioned, which was a complex situation and a challenge for me to navigate. Most on my caseload are not working with a psychologist.
Back to recommendations, Steven Porges is a psychologist and neuroscientist and he created the Polyvagal Theory. Deb Dana, a LCSW, has created the polyvagal ladder and many exercises to use to calm the nervous system and come into a ventral vagal state. She has a new book: Polyvagal Practices: Anchoring the Self in Safety. In addition, Dr. Peter Levine created the Somatic Experiencing Method, traumahealing.org is his website. I personally worked with Cathleen King and did her Primal Trust program, which integrated many pieces from those I’ve mentioned above plus brain retraining, which is based off of neuroplasticy/neuroscience area, which is an entire emerging field. I used several programs such as DNRS and the Gupta program for my own healing process but Primal Trust Program was integral. HeartMath Institute also has some great research and nice tools for regulating the nervous system and creating “coherence” and increase heart rate variability.
Another angle here is from the emotions and energy field of psychology and I did some training in Emotional Freedom Technique, also called Tapping. There is a website, The Tapping Solution, that has a lot of info and also does training. The thing to remember is, not everyone who stutters has traumatic responses and experiences. You don’t use these tools with everyone. They can be the missing piece at times, or they can also help us not traumatize or even just dysregulate our clients by throwing them into situations they are not ready for yet or do not yet have the regulation tools to get themselves back into a calm regulated state after stepping out to feel the fear and do it anyway. I had one client love EFT and that filled in the last gap for him and I discharged him from therapy not long after. I had another client laugh at the idea and say that’s too woo-woo. So you go with what your client is open to as well. Ironically, that same client had a huge turn around after I recommended he read the book, Complaint Free World. Yep, very interesting.He had a huge mindset change after that.
Using tools to help regulate before stepping into challenging situations is also really helpful…whether challenging speaking situation as part of therapy plan or a speech they have to give or a presentation at work. I also used the DARE app myself and book to overcome anxiety I had leftover from having to live a very restricted life for a long time. Many of those techniques helped me to face fear and gain my life back. I find these concepts helpful when working with some of my clients who have fear or anxiety or panic around gaining ground back in their own lives after being used to “living small”.
I do want to make sure it’s clear though that stuttering is neurophysiological….not psychological in origin. I am only working on all these other parts…nervous system, responses, emotional regulation, trauma, etc. because we are psychological beings and at some point for many clients these responses to stuttering create a very complex picture involving emotional and cognitive responses that get wired in. Societal stigma does not help at all. For these clients, a clinician with understanding of trauma, nervous system education, IFS, polyvagal theory, etc. can be very helpful. One of the main goals and preventative things we get to do with kids who stutter, is to support them so that these many and varied unhelpful (and normal) responses to stuttering can be prevented and freedom and okayness can take root.
Wow, long response from me! Hope something in here is helpful to you (or even someone else who may read this) in some way. 🙂
Hi Chamonix,
I enjoyed listening to your perspective on how you approach treatment for each of your clients. I am a second year SLP graduate student and am currently in a fluency class. In the class, we have talked about how to plan for the way you will collect background information on the client to create a treatment plan. We have also discussed the importance of listening to the client and more of the counseling aspects to incorporate. So it was reassuring for me to hear you mention that we should know when to teach and when to listen. Since a large part of therapy consists of discussing the client’s feelings, perceptions, and, like you also mentioned, any trauma associated with stuttering.
Thank you,
Kaylee
Thanks for your comment Kaylee! Enjoy grad school, it’s a wonderful time of learning!
Hi Chamonix,
Thank you for sharing your experiences as an SLP. I am currently in graduate school to become an SLP. I am also taking a course on fluency now. I love that you discussed the “one size does not fit all” model and that every client should choose the type of therapy they receive. This was a good reminder for myself as I treat children who stutter. My hope is that all of my patients feel received and understood. Thank you!
-Lauren
Thank you for your comment Lauren! Clients do need varying amounts of education…some of them quite a lot to be able to make informed choices as well. Some clients are also so open or not sure what they really want so you just dig in and get started and they find out as they go along.
Hello,
I am a current second-year grad student who has very little experience with stuttering with only one client on my caseload. I really appreciate hearing different methods of therapy for stuttering from different people, and I loved your emphasis on having therapy be individualized and creating a safe place for your clients! I also appreciate your response to the question above about when to refer out as that has been something I have been curious about. Thank you so much for sharing your experiences and knowledge!
– Avery
Thank you for your comment Avery! Welcome to a wonderful field. 🙂
Hello Chamonix,
As all of the above comments have mentioned, I, too, appreciate your post and your sharing the experiences of three very different cases. To some, it may seem to be common sense that one size doesn’t fit all. However, I’ve worked as an SLPA for eight years, but I am currently a second-year graduate student, and after all those years, this semester in my fluency class was the first time that I realized how many SLPs I’ve worked with lean on the “one size fits all” mentality. I was unknowingly doing the same thing until recently for years. That’s quite embarrassing looking back. 🙁 But thanks to people like you, sharing things like this will continue to grow this field and change perspectives. So, thanks again! One question that I have for you is, how do you keep a session going with a patient who exhibits avoidance behaviors heavily without making things too awkward and not exhibiting a “fix it” attitude? I know you mentioned experiencing a client who was avoidant on Zoom. What helped you both get through those times? I am currently working with a high school sophomore who is pretty avoidant. Thanks for any feedback provided.
Respectfully,
Jazmon
Jazmon,
Your honesty is refreshing!! Awareness is so key, it leads to change and how wonderful you’ve expanded! Programs and doing the same thing…one size fits all…you know, it’s easier in many ways. You can get stuck in a rut also. But what keeps our jobs and this field so exciting is that we are always learning and changing. As you gain experience, learn new things in and outside of this field, and keep your client’s best interest always in mind…you inevitably will change as a clinician. You will have so many tools and approaches to move in and out of and use with your clients…things you can teach them but also various ways of interacting with them. You get to meet them where they are at the more you learn from each client that you work with. You just keep expanding as a therapist…keep that intention in mind as you go through your career. Also, being overly busy or burdened or over achieving I feel can stagnant this process. So balance in your life…is another key. We are givers and you must fill up. Don’t lose touch with what else you love in life. For me it’s dance, getting to the beach, connecting to women in bible studies, getting time in the ceramics studio, laughing, caring for my body and emotions, meditation…etc. This also helps prevent burn out.
Well, none of that is related to your question, which is another interesting one and evident of your current situation your are looking to grow in. With the particular client you mentioned whom I saw on Zoom, I really did have to carry the conversation. It’s was very out of balance but it had to be for where she was starting. I focused on really getting to know her. I tried to ask questions that could not just be answered with yes or no. We talked about things way outside of stuttering and just about her life. I also taught her about avoidance reduction….I did a lot of teaching of a new philosophy. She didn’t know openly stuttering was an option and I celebrated every tiny bit of eye contact she gave me. I gave her a ton of positive reinforcement….which in her case she responded to really well. I had to basically behaviorally train her that, at least with me, her stuttering was awesome and accepted and it was more of the true her so it was valued and sought after. I said a lot of, “yes that was beautiful”, “amazing not popping out of that one”, clapping, “yes, fabulous”, etc. (*just a note that some this kind of feedback isn’t helpful for all clients, some it’s asking “how did that feel?” or toned down comments or more descriptive praise also, which I did intermittently throw in. She needed one person who she could trust to explore what her stuttering would even look like if she let any of it manifest.
We go as fast or as slow as our clients are able to. She needed to go very slowly. For some clients, their true stuttering feels so out of control and scary and weird that they want to a keep a lid on it for themselves and others. It’s an honor to have our clients trust us enough to allow us to hold space for them to explore at their rate their stuttering. We never go for perfection. We talk about “parts” and the “fix it” part….what is driving it. I taught her that it’s normal for the old patterns to pop back up with different people or situations or at random….it’s nothing she’s done wrong. We are laying down a new set of neural circuitry to stutter openly so the old circuitry of avoidance or whatnot is there still and you add any stress or change the person you’re talking to and you can end up on old pathways. Totally fine and normal. The therapy process is about transfer or carry-over so that the person can begin to move what they are doing with you to others and engrain the new circuitry in expanded situations. For many I’m moving us to that as soon as possible. This client needed a LOT of time with just me first. When I had her do paired sessions or observe one of my groups eventually and later join a group and later move to just that group….she would revert to barely any speaking or old patterns of avoidance were running…. but we would focus on bringing the same things she did with me into those new environments. Your relationship with them is everything. Our client has to trust us to share their hidden stuttering with us if they use copious amounts of avoidance. Find ways to connect. That’s a great skill we learn as therapists…we learn how to get to know anyone and change all kinds of things to find the way in.