Integrating Evidence-Based Practice with Person-Centered Approaches in Stuttering Therapy
Hi my name is Victoria and I am a second-year graduate student! As a graduate student learning to view stuttering through both clinical and humanistic lenses, I’m curious how do you balance evidence-based fluency techniques with approaches that honor the person’s lived experience of stuttering especially when traditional therapy goals might unintentionally reinforce the idea that fluency equals success?
Hello Victoria
I am not sure what evidence-based fluency techniques exists. The long-term evidence for efficacy for fluency shaping is sparse, as far as I know. Academic research aside, I Know from my own experience and that of the thousands of PWS whom I have met that unconditional acceptance of stuttering, and rejection of fluency goals, enhances our lives. Fluency techniques can be a trap. Their nature it suppress stuttering, and that keeps the fear, anxiety, and shame alive and flourishing. It’s no way to live.
Traditional therapy goals absolutely reinforce the idea that fluency is success. The most toxic form might be the statement from the therapist that “It’s ok to stutter, but try that sentence again without stuttering”.
Fluency has no value. There is value is what we say, there is value is communicating. Effective therapy would prevent the iceberg in young children and resolve the struggle to avoid stuttering in older children and adults. From my perspective, traditional therapy goals that measure fluency have absolutely no place in modern therapy. Many professionals would agree. Modern therapy approaches such as avoidance reduction therapy, the CARE model, and REBT and ACT applied to stuttering.
The goal is not fluency. The goal is communication. Severe stuttering that results from avoidance behaviors can be treated, but the goal shoudl never be fluency, and fluency shoudl never be measured. Measure non-avoidance. Measure engagement in life. Measure how the PWS avoids letting stuttering limit them. Sure it’s challenging. But though these approaches we can build resilience in children and adults who stutter.
All this said, since there is no cure, and fluency techniques are well known to be fickle at best and abusive at worst.
Of course, it’s a complex topic, and more discussion would be needed to address all the nuances and complexities.
Hanan Hurwitz
Thank you for your question, Victoria
My advice is to always start with your client. Not with a book, therapy, research, or whatever else you’re taught to use. Start by asking questions. Get to know your client. What is s/he here for. Is it fluency, or just to get out of a block, or to learn relaxation techniques, or to learn to find confidence to talk when, where and how we want to and leave the shame behind, or to simply learn more about stuttering to be able to explain and teach others?
As Hanan already mentioned, fluency should not be a goal. Talking should be. If you measure fluency you risk for your client to feel less when fluency is not acchieved. To get mental health issues, or even physical. To become covert. To stop talking.
You’re on the right track questioning what’s right or wrong. And there is no right or wrong, as we’re all individuals. What I need can be something completely different to what another client needs. So start by asking questions and to listen to what your client is telling you, and not telling you. Go from there. And think out of the box. Maybe the client would like to get a few techniques to get a better flow when in a block, another might benefit from yoga, another one maybe needs help with acceptance, another might want help to face tough situations (have a look at withVR f ex). Offer a smörgåsbord with things to try, even if they might seem unconventional or not something you can offer, like a mix of Mindfulness, the gym, presentation techniques and a choir.
Have a look at my paper in this conference. You might find some interesting thoughts there. 🙂
Happy ISAD and keep them talking
Anita