Emotional Support
Hello, my name is Gloria, and I am a second-year SLP graduate student. I am currently taking a fluency course, and there have been many discussions regarding counseling and including that piece into speech therapy sessions. As a future clinician, how can I help people who stutter navigate the emotional impact of stuttering, such as anxiety or social avoidance?
Hello, Gloria. Thank you so much for reaching out to the professional panel and I love this question! Also, best wishes on your graduate studies as you complete your second year- that’s so exciting. You are onto things- in knowing that counseling will likely be a part of stuttering therapy in some form or fashion (think of Joseph Sheehan’s Iceberg showing that 90% of stuttering is what we don’t see). There are really good studies on the emotional impact of stuttering, with a couple more recent being here (but there are other great ones):
Tichenor, Walsh, Gerwin and Yaruss, 2022:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9584136/
Engelen et. al, 2024:
https://pubs.asha.org/doi/abs/10.1044/2024_JSLHR-23-00562
With that, and in being fully transparent- counseling scared me as a new clinician as much as doing a video swallow study did! The first thing that helped me personally with that (and this may sound odd) but was to realize I was treating a human being in front of me, and not the case history I had read on a piece of paper before they walked into the room. Every client you treat is an opportunity to be a part of a life being lived with a story, and you get to potentially be a part of that story (that framework helped ease my thoughts a bit)- also, you have likely been counseling friends, family, colleagues- this whole time without even realizing it- and without having a formal label on what you are doing when you do it. I was so worried about saying the wrong thing (I don’t know if you can relate to that or not)- and knowing counseling can’t be scripted- that was a bit intimidating when I first started out! I highly suggest the work of David Luterman (if you can get in on a CEU with him he’s excellent, or he does have a book for Counseling in CSD that is available for purchase). Counseling involves listening, and active listening (there is a difference). We can use motivational interviewing to really help gauge where the person is at in terms of the stages of change going into a therapy journey.
Here is a cool video on motivational interviewing and what it is:
https://youtu.be/Pfn3Zvkby_A
This all can contribute to helping determine where the person is at emotionally with their stuttering journey specifically- and that’s what it is about is meeting them where they are at in the beginning, to grow and learn together throughout therapy. Also, recognizing that a lived journey with any entity (stuttering, apraxia, aphasia, other areas that we treat)- the acceptance of it happening and the framing of mind- isn’t linear- and can change over time- so make sure to continue to ask your client questions, stay curious, and continue to meet them where they are- wherever that is in their journey. There are methodologies that we can use with counseling including (but not limited to) Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy (CBT) and there are CEUs in these areas on online CEU websites for SLPs. Also one last thought- make sure to stay within the scope of practice of speech-language pathology when providing counseling- if you are in the United States, the American Speech-Language Hearing Association does a good job of describing what that scope of practice and our roles in counseling are (because the line of our scope can get confusing at times). I hope this was helpful and I look forward to more information offered by my colleagues in their responses. Be well and take care!
Thank you, Gloria, for these really important questions!
I have a personal story of how I managed to conquer social avoidance:
This took place at about the ages of 19 and 20, over a half-century ago. My stuttering was very severe at that time, almost constantly, with long blocks on almost every word.
A speech pathologist who I was seeing at that time dragged out of me the reluctant admission that I had no friends to speak of.
(This speech pathologist – they weren’t called SLP’s then – stuttered himself.)
He told me what I needed to do – and he offered some really profound advice. He told me that I MUST make a special effort to meet people, to try to make friends, to introduce myself to people, and talk to as many people as I possibly could – regardless of how my speech was in that situation, and regardless of how severe my stuttering happened to be.
It was a very tough assignment, and one that I was really afraid to take on. But I was desperate to make changes, and so I followed the speech pathologist’s advice as best I could. I met as many people I could socially, on the college campus where I was then a student.
I introduced myself to other students, sought out familiar faces and at the same time met unfamiliar faces, and really tried to be as social as I could. I was stuttering very severely in these situations, but still I did it.
And guess what? That was such fantastic advice. I quickly made many friends, and my social life became really satisfying, and my life in general became so much happier. Life became fun! I was still severely stuttering, but life became fun! And I made an incredible discovery – that nearly everyone I met DID NOT CARE in the least that I had severe stuttering. Almost everyone was patient and listened to what I had to say – long blocks and all.
I discovered something that I simply had not known – that the only person who really cared about my stuttering was myself. People were interested in me as a person, and were interested in what I had to say. I discovered that the friendlier I was to people, the friendlier the people were to me. The more that I cared about other people, the more they cared about me. And they didn’t care at all that my speech wasn’t fluent.
I soon had plenty of friends, really close friends, and before long I had a girlfriend too.
Some of the friends I met around that time have remained my friends for many decades.
No matter how severe one’s stuttering happens to be (and mine at that time was really very severe), one can make many friends and have a great social life. That’s what I discovered back then, a long time ago.
Hey Gloria,
I hope you’re enjoying your course. Happy ISAD for yesterday. It’s so great that you’re having these discussions around counselling and integrating them into your speech therapy sessions. And you’re absolutely right to be thinking about the emotional impact of stuttering, anxiety and avoidance.
Steff has given you such a thoughtful and thorough answer, so I have little to add in that respect. I liked her vulnerability in expressing how scary this felt to begin with, which I can echo. It resonates with me too. We are in a very privileged position to hear the inner most thoughts in a person’s life and just being present, listening and validating those stories without feeling the need to fix or do something helped me….but I think it took time for me to get there. Clinical supervision has also been an important factor in my working life. We can hear some tough stories that can sit with us, so it’s important to care for yourself too.
Another thing I think is important is our work with caregivers and others within the child’s environment when a child first starts stuttering. Is it possible to prevent the negative feelings and emotions? (I don’t know the answers. I think there are many complex factors that influence it, but I do know there are things that can be supportive). Steff has mentioned the iceberg and that big chunk under the water. We can also think about what is in the water, what is surrounding the iceberg – the person’s environment. This may be the reactions the child receives from others – overt reactions such as someone laughing, but also the more subtle reactions – someone looking away when the child stutters. We can empower caregivers to talk about stuttering, to be open about it, to affirm it, so that a child enjoys communication no matter how much they stutter. A child needs to grow up knowing the way they speak is valued, cherished and important, they need to know that it is okay to stutter (and the way they speak is beautiful). A resource for caregivers that I love to share with families that I’m working with is Nurturing and Empowering Your Child Who Stutters by Spero Stuttering: https://youtu.be/GPjKPYUB9qw?si=Gv8pbb786KOzRXu6
Thanks for being a part of the ISAD online conference. I hope this gives you a little something to think about. Best wishes for the rest of your course,
Nic
Hi Gloria
Thanks for asking this important question.
Many advice has already been given, so I’ll just add my advice as a PWS.
Firstly the word “fluency course” shows the goal is fluency, which adds to the pressure and the feeling that fluency = good, stuttering = bad. Keep using this word also keeps the coal glowing in society, while I’d instead would change it into talking = good, being forced into fear and shame = bad.
Try to get to know your client, it’s “luggage”, background, cultures, fears, dreams, etc. And also what s/he wants from therapy. Maybe it’s not fluency, maybe it’s understanding stuttering, maybe help with fearful situations, maybe it’s for you to educate the people around your client.
Try and put yourself in your client’s position. Realize that stuttering can be tough, but that people’s reactions can be the mayor issue. Having heard during my entire childhood and youth that stuttering is shameful, should be gone or hidden, that I’m just looking for attention, that bullying would stop if I would stop stuttering, that there was nu use for me to study as I wasn’t going anywhere anyway, that I and/or my parents were cursed/punished, etc etc etc. The change came when people saw ME, Anita instead of the stutterer, and acknowledged my personality and my skills. My first boss, my first boyfriend, but mainly meeting others just like me. PWS who are just the way they are, who have succeeded in love and life, who lifted me up and cheered me on along my journey.
You can be one of these people who are your client’s circle of support. Showing your client who they are, behind the stutter. Personality, skills, goals, let them come forward and help your client to help him/herself to find that road to happiness. And if you feel a certain client is out of your range, don’t hesitate to ADD other people. A psychologist, a coach, or even direct to support groups (in-person and online), stutter camps, invite a PWS to the class, workplace, invite a friend to the therapy room. The stronger the circle of support, the more all of you together can help your client to be the person s/he really is. And don’t hesitate to you yourself seek support from support groups, as we’re here for you too. 🙂
Keep them talking
Anita