Client Self-Assessment
Do you ask your client to asses the various aspects of his stuttering and stuttering affected activities (with a rating of severity) when he starts his/her therapy? Is the client periodically asked to revisit assessment and rating to see if the therapy is helping him or her?
What is the ideal desired outcome of your therapy?
Hi, Gunars, thank you so much for your questions. I personally approach stuttering therapy with a client-centered based outcome in mind. From the very first session, we discuss the client’s personal goals in therapy. This may be more communication confidence in certain speaking situations, or a variety of things. As clinicians, I personally believe we are to provide our educational background as the template for the client, and for specific therapeutic methodology conducive to the client’s needs rather than allowing our own personal biases of stuttering to steer the full direction of therapy. If a client has had extensive therapy in the past we may discuss what was effective, not effective, enjoyable, not enjoyable and so on. If a client has never been in speech therapy before or their goal expectations are very limited, then as a clinician I may need to explain what therapy may look like with different goal scenarios, therapeutic treatment options, etc. so that the client may think about what they feel is best to try for their given stuttering experience (does the individual wish to try fluency strategies, for example, and did the person even know they existed prior to coming into the clinicians office?) Sometimes therapy starts with education about stuttering in general and an individual just trying to become comfortable being a person who stutters to begin with….. regardless of what given speaking scenarios make them feel comfortable or uncomfortable so it’s all about meeting the client where they are at in their particular stuttering journey.
I do love a tool like the OASIS that can quantify the affect of different given social scenarios that stuttering is having on the client’s life, however, not all individuals are comfortable reporting this information initially to a clinician that an individual does not fully have rapport with yet, so it is a case by case basis. I complete things as the client is comfortable. Some clients prefer to discuss this information openly, when some may prefer to report this information privately in a questionnaire format or may not be comfortable to report this information at all at first. Also, knowing if therapy is benefiting the client or not is always important. This is not only how payor sources will continue paying for the therapy, but it is how you know as a clinician that the client will wish to continue coming to therapy. I always openly discuss with clients how they feel therapy is going, if there are any other areas we can add or be targeting to meet their communication needs and if therapy is what the individual expected it to be beyond just therapy data or goal information gathered during treatment sessions. I hope this helps answer your questions and I am looking forward to hearing further what some of my other colleagues have to say as well.
Hi Gunars, it is always important for clinicians to gather baseline information at the start of the therapy progress so that you have something to compare progress against. I think I speak for most if not all clinicians when I say that the first appointment is therefore something of a ‘fact finding mission’ with lots of questions asked about the individual’s life, communicative interactions and exploration of the way in which their stutter presents and the impact this has on their interactions and confidence. As Steff mentioned above, there are various assessment tools clinicians can use to gather information and to help the client rate their perception of stuttering severity and the extent to which they feel their stuttering impacts on activities (such as the OASES) but personally, I treat each client I work with as an individual and use a range of formal and informal systems to gather baseline information depending on the individual’s hopes and goals for therapy. This allows me to measure change for that individual, looking for therapy to have an impact on their day to day interactions and feelings about communication and stuttering.
With all clients, I set a care plan with clear goals and a clear time frame after which the goals are reviewed together before a review discussion about whether therapy is helpful, where we should go next and what the next steps should be. I believe this is (or should be) common practice.
To answer your final question, my ideal desired outcome for therapy is that clients are confident communicators. This may or may not mean direct work to help stuttered moments feel easier for that individual, but usually includes work to help clients understand more about their stutter, explore and feel comfortable with their knowledge of stuttering and increasing their knowledge of the skills that make someone a successful communicator (and that this doesn’t just mean not stuttering!)
Hi Gunars,
I agree with Stephanie and Jenny. Therapy goals need to be client based and dynamic. In the first session I complete a standardized measure like the OASES, which I may revisit later. However, I start the idea of solution focused therapy driven by the client from the first session. In asking them what their goals are for therapy, we can explore the path to treatment from that first session. After stating what the goal is that day, I asked them to rate themselves on a scale from 1-10 determining where they are that day. This is how I keep data and give feedback for progress. Each month I do a “check in” to see if goals need to be added/manipulated. I make sure that our goals integrate the speech motor system, in addition to cognitive and emotional goals. My language may change in the way I address the client goals depending on the individual. Often I use the idea of “Wish and Plan” to develop goals. What is your “wish” for communication and what is the “plan” to accomplish that wish. I also like the language of “hope”–what do you “hope” for and how do you accomplish that? The second part is most important. I believe that the language you use in the evaluation and in subsequent therapy will direct therapy and it is important to listen to the language that each individual brings to therapy.
Thanks for your question.