What makes a good SLP?
HI my name is Meaghan, I am a graduate student and we have talked about what makes a good SLP. My question is, could you tell me about an SLP you enjoyed going to/liked vs an SLP who maybe you had a bad experience with and what were those different qualities each of them possessed? Additionally, what is one thing you would want future SLP’s to keep in mind when they work with PWS in the future.
Hi, Meaghan, and thank you for these interesting questions!
I had tons of speech therapy, beginning at age 4 (or possibly earlier), and continuing throughout my childhood, teenage years, and early adulthood. I also had much fluency shaping therapy in my 30’s.
I estimate I have seen about 35 different therapists for my speech, with varying approaches. Some were speech-language pathologists (although that phrase wasn’t around until my adult years); some were professional psychologists who specialized in stuttering treatment.
Of all those therapists, there were only 7 who provided me with significant help; and of those seven, only 5 provided me with substantial help.
Of all the therapists I have had, I believe the most helpful was a speech-language pathologist who stutters himself, and who is a master at using techniques of the Precision Fluency Shaping Program. When I was 30, I enrolled in a three-week Precision Fluency program at the Hollins Communications Research Institute, Roanoke, Virginia. (Today the institute is gone, and I don’t think Precision Fluency Shaping is still around.)
Precision Fluency techniques were very helpful to me when I engaged in intensive daily practice of techniques (for an hour or more!), and carefully monitored every conversation. I should mention that I no longer practice such techniques; about a quarter-century ago I decided to simply and calmly accept myself as a person who happens to stutter.
The clinician I’m referring to, named Ross (now retired), ran a fluency shaping clinic in Norfolk, Virginia. This was largely based on the Hollins program – in which he was trained – but had some small differences.
Ross incorporated his own experiences as a person who stutters, and as one well practiced in these techniques. Hollins emphasized and analyzed tiny aspects of these targets (as they were called); Ross preferred to look at all the targets as a whole, put together as a unit. To me, this was a more useful approach. Ross also was more realistic: Hollins taught that the targets need to be monitored 100% of the time; Ross told us that 90% would be sufficient – and indeed it was. Hollins considered HOW one spoke to be the only point of importance in therapy, and placed no emphasis on content at all; Ross emphasized content as well as techniques.
And Ross’s therapy was dynamic. In his therapy he was friendly, informative, and helpful; and he also had caring, compassion, and understanding. Ross to me was the ideal speech clinician, helping clients with knowledge, wisdom, personal experience, and deep understanding. I had many fluency refreshers with Ross during a four-year period.
Now to an example of a bad clinician:
One summer, when I was 19, I attended a university speech clinic several times a week. I had therapy with a student clinician (under supervision), who I found to be really ignorant about stuttering. I found that I was teaching her more than she was teaching me. In fact, I recognized the text she was basing her therapy on, and I always knew exactly what she would say next.
No, this is not the example of a bad clinician I’m referring to, as I realized her shortcomings were due to lack of knowledge, training, and experience.
But this is what happened next:
On the last day of therapy, she called in her supervisor to take over.
He was a tough-looking guy, and for an hour, he berated me, insulting me, harshly criticizing me, yelling at me. He told me I had made no progress whatever that summer, and the only reason why was ME. He told me I did not work hard enough, that I was not motivated to “improve” myself, that it was obvious I did not want to “get better”. He told me that my attitude was all wrong, and that with my attitude, I would never make any “progress”. He told me that I was entirely to blame for this “failed” therapy.
Now that is an example of a terrible clinician. And he was a supervisor of a university clinic, a position he should never have held.
He was the classic example of what a clinician should NOT be.
You also ask for “one thing” you would want future SLP’s to keep in mind.
If I could choose one thing, this would be it:
Every person who stutters is different, and the best therapeutic approach (or approaches) for stuttering therapy vary from individual to individual.
Too often I have encountered clinicians who believe that “one size fits all” in stuttering therapy. Please don’t fall in that trap. You need to mold a therapy program individually for each client, based on the needs and desires of that individual client.
And I’ll add piece of advice No. 2: NEVER blame the client for a relapse or for what appears to be a lack of progress. In other words, don’t be like that clinical supervisor I mentioned above!
And No. 3: Be caring, compassionate, and friendly to all – as well as knowledgeable. That is, have the qualities that I mentioned above, that my clinician Ross had when doing therapy.
Best of luck to you in your career!
Hi Meaghan
Thank you for your question. When I was young SLPs didn’t really know how to treat stuttering. I was told to say the days of the week in one breath. (I played the saxophone, so air wasn’t the issue.) I’ve had SLPs telling me to breath properly. (Again breathing.) I’ve had an SLP who became my psychologist, but when I told her my story, she threw it back in my face. All of this made me feel less, incapable, a failure. Today most SLPs understand that fluency is not the one and only goal, but for a client to say what s/he wants to say, the way s/he feels comfortable with. Whether that’s with some help to get out of a block, to gain more self-esteem, to expend comfort zones or even to help explain stuttering to others or to find the answers to raise awareness. A good SLP works together with the client, listens, asks questions, and together find a way to set up baby step goals, while stepping out of the box and see what this very client wants and needs. S/he is maybe asking for something that’s not in your textbook, and you may have a suggestion that your client never heard of. So work together. As you have the tools, but we have the experience. 😉
There are some things I wish SLPs would do.
1. Listen and ask questions. Don’t just listen to the stuttered syllables, but listen to the story. The background. The goals. The culture, religion, anything that makes the person the way s/he is. As stuttering is so much more than what comes out of the mouth. Also listen to the parents and maybe even a friend, a partner. If a PWS doesn’t feel heard or safe, s/he will not give you the information you need.
2. Think out of the book, or box. One size does NOT fit all. One client (or the parent) might want to be fluent. Tell them fluency might not be for all. That climbing the Mount Everest is too hard for most people. So to set up reachable goals. Maybe tools to get out of a block. Maybe working on acceptance and self-worth. Maybe by giving them the knowledge to learn more about stuttering and explain to others. Maybe by suggesting something else but speech therapy. F ex presentation techniques, yoga, a choir. Or all of the above!
By listening, asking questions and providing a smörgåsbord of things to try, TOGETHER you might find something that fits that very client to reach acchievable goals.
3. Show the way to meet others who stutter, like camps, meetings, chat groups (check out Penny’s paper on playing video games with other kids who stutter). But also group therapy to proof they are not alone and can support each other. Let him/meet other adults who stutter. Bring a friend into the therapy room and let them do homework together. But… add fun!! When it’s fun, it’s more likely to continue, and to open up. And when giving assignments, do them yourself too. Don’t give assignments you’re not willing to do. Also offer help to speak to the classroom, you or your client, or maybe someone from a local support group. To talk to the class and/or the teachers (but decide that together).
I recently was at a weekend where a group of PWS who stutter practice public speaking together. With the funniest assignments, that made us ROFL! I had a social studies teacher in school who literally jumped on the table to make a point. Don’t just be the therapist. Be the friend. 🙂
Keep them talking