Advice for SLP graduate students
Hello there! As a future speech language pathologist, I wanted to know what challenges if any, you have encountered when working with PWS either in therapy, with other professionals, in you work setting, etc., and how you overcame those adversities. Thank you in advance!
Young SLPs can best bless themselves by deliberately forcing themselves into situations that desensitize them of stuttering. The majority of ineffective stuttering treatment (that I have observed) stems from SLPs who never felt comfortable dealing with stuttering in the first place, and as a consequence, have chosen all the wrong treatment objectives.
Simply attending an NSA or Friends national conference may be the single best thing young SLPs can do for themselves.
Hi Greg, I am also a grad student and completing my fluency clinic now. I think this is wonderful advice, I just had a question: Are NSA meetups ok with having outsiders attend? I would not want to ruin a safe space for people by being nosy or intruding.
Thank you.
I do want to share one challenge here which is specific to India and any other country where joint family systems are prevalent. On one hand this can be a blessing, with the child / adult getting many and varied opportunities to communicate within the home environment itself. However, it can prove to be a challenge sometimes. E.g., in case of a child, the parents of the child and the therapist may well be on the same page vis a vis goal setting, expectations, and reactions to the child’s dysfluencies. However, this might not be the case with every other person in the family, which could affect therapeutic prognosis. What helps in such circumstances then, is to gradually make the child cognitively ready and emotionally capable of coping with with diverse reactions to his stuttering. In fact, isn’t that one of our aims behind using Cognitive Behavior Therapy for stuttering?
The greatest challenge that a young SLP faces is to clearly understand what stuttering is and is not. To overcome this challenge let me address what stuttering is.
Granted in a young child stuttering arises from a child getting caught up in repetitive speech as he learns to talk. Some children grow out of this phase and some appear not to. Yet, easy repetitions are not devastating. When they appear now and then during childhood and even adulthood they are quite innocent and normal sounding.
However, when the child starts to get frustrated with his inability to move on with speech he starts to force and struggle, hence, stutter.
When he or his caretakers call attention to his disfluent speech there is a demand that he talk perfectly. This request made by himself or caretakers as “take your time, talk slower, you can do it” sets off what the child perceives as a punishment or a definition of him as someone who is less worthwhile.
When he enters school and due to his speech he is either bullied or teased or at least not approved or respected, he feels diminished, less worthwhile.
Speaking becomes a dangerous situation where other people appear to be meting out punishment. He is classically conditioned to fear certain speaking situations. He is conditioned to avoid sounds, words, and situations. The punishment is stored in the limbic system, especially amygdala.
Then comes the next phase. The child gets stuck. Eventually he gets unstuck, but this he associates with forcing of air, blinking of eyes, pursing the lips, etc. Or he simply avoids the sounds, words, and situations. So next time he repeats the same forcing of air,…etc. This becomes automatic and a severe stutterer is created.
By the time he is in his teens stuttering has taken the form of four groups of habits:
1) Distorted cognitive/thinking habits that are self-defeating and propagate stuttering: 1) demands of any kind, including the demand for perfect speech; 2) belief that stuttering is awful and precludes the PWS from enjoying life; 3) belief that “I can’t stand stuttering”, 4) self-talk that “stuttering makes me less worthwhile as a person”; and 5) the always and never beliefs such as “if I have stuttered or reacted in certain ways in the past I will always continue to do so. I will never get better.”
2) Unhealthy emoting habits include feelings of shame, inferiority, anxiety, guilt, time urgency, low tolerance of frustration and discomfort, anger at self or others, and feelings of helplessness/hopelessness for never having learned not to yield to these feelings especially when the feelings are associated with stuttering.
3) The habit of avoiding words, sounds, situations and calculated risks in career/social situations. This usually impedes the PWS from pursuing career advancement and his/her erstwhile romantic interest.
4) And yes, what we call stuttering: the habit of tensing, struggling, and forcing speech including secondary symptoms (accessory behaviors).
Once the young therapist understands what stuttering is, he can choose a therapy such as Cognitive Behavior Therapy (CBT), especially Rational Emotive Behavior Therapy (REBT) to address the beliefs, emotions, and avoidance behaviors and Stuttering Modification techniques to keep his speech forward moving.
What jumped to mind when I read your question was adults who view stuttering as a weakness, i.e., they feel they can’t show it because of how it would affect partnerships, promotion opportunities, or other facets of life important to them. Ironically, they often view themselves as strong for not displaying their “weakness,” which makes the message of acceptance difficult for them to receive. In therapy, I try different counseling techniques with them, often centering on their own interests or backgrounds (e.g., talking with the baseball player about how dwelling on an error would be counterproductive). Sometimes it works, but unfortunately there are other times I can’t cut through the barrier of denial.
Hello,
I experience frequent challenges when working with all of my school-age students who stutter. That is because of the nature of stuttering at this level: it is complex; it is variable; and it has been, and may continue to be, persistent. Working with school-age children who stutter requires continual, ongoing problem solving and alterations to the treatment plan. In my experience, it is helpful to view these ongoing challenges as opportunities to help school-age CWS become successful overall communicators. In my consulting work with other school-based SLPs, a couple of opportunities frequently arise. First is the opportunity to complete a comprehensive, differential evaluation for each child that assesses not only fluency and fluency breakdowns, but also attitudes and emotions surrounding stuttering, thoughts and beliefs about stuttering, and a range of contributing factors, both within the child and in the child’s environment. Second is the opportunity to work not only on “speech techniques,” but also to help school-age communicators keep evolving their overall communication skills in many ways, and recognize that they can be successful communicators and still stutter at the same time. Best,
Rob Dellinger
Good question and some great responses already! In my experience, working with teens/adolescents can be challenging when the parent has a set of expectations (often that the child should be fluent) but the teen is not ready to work on fluency. Often helps by having joint sessions with the parents and talking openly about stuttering, the fact that techniques only work when the person actively uses them (and even then sometimes they do not!) and last but not the least, talking to the parents about what they feel will be differently if the teen suddenly stopped stuttering. Basically, helping the parents realize that they are equating fluency with success and that is not a 1:1 correlation, not all who stutter are unsuccessful and not all who are fluent are successful!
One teen-age girl I worked with was a master at avoiding her stuttering. I wanted to make a hierarchy for her to use to try to pseudostutter, and she revealed that she would not even want to pseudostutter to her mom. I wanted to reach her, so I dropped the idea of pseudostuttering as I realized this was not for her. We worked on giving her lots of practice in saying her name, which was a goal of hers. We dismissed her from therapy and four years later, she graduated from the university and wanted to come back to therapy to work on job interviewing. I talked to her and found she was regularly pseudostuttering in her job at a local Walgreens. It was amazing to see that and she was much more accepting of her stutter. It showed me that it is best to work hard to help the person who stutters meet the goals they set for themselves at the time. If they are not ready for something, that is fine–work on what they want to work on and trust them to know what is best for them. We can always suggest and practice, but if the client does not like what we suggest, move on. Building rapport with the client and having empathy really is key, too.
Hi!
I really enjoyed reading your reply. I’m in graduate school right now and we are learning a lot about stuttering. We are taught that each client is an individual therefore we, as the professional, need to find what’s best for each client. I enjoyed reading your application of this. I thought it was really cool to see the examples of how you made alterations to your treatment plan as your worked with the client. It was also a good reminder that we need to focus on their wants over ours. I have one question. Right now I see an elementary aged child that is not very aware of his stuttering moments. I’ve gently brought up stuttering and he seems to not know what I’m talking about. How do I go about increasing awareness without creating any type of anxiety for the child? I can tell he is hesitant to talk and it makes me wonder how much avoidance is happening in his daily life. Thank you!
Great responses! Thank you all! I liked how Gunars stated, “the greatest challenge that a young SLP faces is to clearly understand what stuttering is and is not”. As a current graduate student, I’ve learn aspects of stuttering that I didn’t even know existed. I believe in order to provide the most effective therapy techniques to a PWS is to understand what you are addressing, factors that have contributed to the stutter, and likely outcomes.