About the authors:
 Kristen Bragg is currently a second year graduate student working towards her Master’s Degree in Communication Sciences and Disorders at Western Carolina University (Cullowhee, North Carolina, USA). As a non-traditional, returning student, Kristen left the workforce in 2011 in order to pursue her true passion of helping others to communicate effectively. She is scheduled to graduate in the spring of 2014 and begin working to complete her Clinical Fellowship. After graduation, she hopes to work with children with a wide range of needs in a school setting. |
 Perry Fowler is currently a second year graduate student working towards her Master’s Degree in Communication Sciences and Disorders at Western Carolina University (Cullowhee, North Carolina, USA). Previously, Perry studied at the University of Mississippi and received herBachelor of Science Degree in Communication Sciences and Disorders in 2012. She is currently serving as Vice President of the National Student Speech Language Hearing Association chapter at Western Carolina University. She is scheduled to graduate in the spring of 2014 and begin working to complete her Clinical Fellowship. |
 David A. Shapiro, Ph.D., CCC-SLP, ASHA Fellow, Board Recognized Fluency Specialist, is the Robert Lee Madison Distinguished Professor of Communication Sciences and Disorders at Western Carolina University (Cullowhee, North Carolina, USA). In his fourth decade of providing clinical services for people who stutter and their families, Dr. Shapiro is a regular presenter at conferences and has taught workshops, provided clinical service, and conducted research in six continents. His book, Stuttering Intervention: A Collaborative Journey to Fluency Freedom, is in its 2nd edition (2011, PRO-ED) and continues to find a wide international audience. Dr. Shapiro is actively involved in the International Fluency Association (IFA) and International Stuttering Association (ISA), received IFA’s 2006 Award of Distinction for Outstanding Clinician in Dublin, Ireland, and was elected IFA President in 2012. He is a person who stutters, has two young adult children with his wife, Kay, and lives near the Great Smoky Mountains National Park. |
Stuttering intervention often is distinguished into two general categories – stuttering modification and fluency shaping (Guitar, 1998; Shapiro, 2011). Stuttering modification assumes that stuttering results from struggling with disfluency or avoiding feared words or situations; intervention seeks to reduce speech-related avoidance behaviors, fears, and negative attitudes, while modifying the form of stuttering. In contrast, fluency shaping assumes that stuttering is learned; intervention is based upon principles of behavior modification and seeks to eliminate stuttering in a controlled stimulus environment. In reality, however, most stuttering intervention utilizes a combination of stuttering modification and fluency shaping. This paper addresses an activity called “Catchphrase” that was used as part of a stuttering modification approach with “Jeff,” a school-age boy who stutters. In doing so, we will review characteristics about the case and the activity that led to the expected positive outcomes for Jeff and unexpected outcomes for the clinicians.
In an exemplar form of stuttering modification (Van Riper, 1973), desensitization aims to reduce speech-related anxieties so that the person who stutters can learn new ways of coping with and responding to stuttering. One way to do this is by stuttering deliberately (i.e., pseudostuttering) and then by making modifications in order to stutter more easily or with less effort. By pseudostuttering, the person’s awareness of fluency and disfluency increases, as does facility to control stuttering. But how can a clinician who has never stuttered understand the nature of stuttering and help a person who stutters become comfortable with the risk of fluency failure and the use of fluency controls? Manning (2004) posed this question directly for clinicians who do not stutter: “How can you understand stuttering? You don’t stutter!” (p. 58). This very thought is what prompted us – two clinicians who do not stutter (Bragg and Fowler) – to modify the popular game “Catchphrase” for the client to practice desensitization and for the clinicians to learn to pseudostutter. Though we prepared for a fun activity, we could not have been prepared for its impact on our client and, particularly, on us both personally and professionally.
Case Description
Our client, Jeff, was a 13-year old boy who, at the time, had been receiving fluency intervention services for two years. He had experienced significant progress by increasing his use of speech in social situations where he previously elected not to speak, and heightening his overall fluency in conversation by 17%. However, his use of fluency controls had reached a plateau in therapy. We were unsure of how to continue with therapy and even if it should be continued. The dilemma was that although Jeff had a significant number of observable disfluencies, he perceived himself as fluent. It was unclear whether Jeff was unaware, in denial, or apathetic. He was proud of his personal success since the start of therapy and received an immense amount of positive reinforcement from his family, friends, and clinicians. However, there was plenty of work still to be done in order to take fluency to the next level and to eventually work on stabilization, two objectives he indicated a desire to achieve.
The Clinical Activity
To help bring Jeff’s fluency to this next level, we knew that we needed to determine his awareness of fluency and his ability to distinguish it from disfluency. We decided the best way to do this was by creating a fun activity that included pseudostuttering. Since it is never fun to play a game by oneself, we decided that we must play by the same rules as the client and pseudostutter ourselves.
The rules of Catchphrase are simple yet difficult to follow under pressure. First, the players divide into two teams. One player at a time is provided a word and must describe it to the teammates without saying the word itself. The team receives a point when the fellow teammates correctly guess the word being described. We adapted the game and made a set of cards with our own words that were tailored to the client’s age and interests. The electronic version of Catchphrase has a beeping timer. We chose not to use a timer during therapy because it would create unnecessary pressure for the speaker. Rather, we added another element to the activity for usefulness in the clinic setting.
Specifically, we created a set of cards that directed each player to speak in a specific manner. These cards included: using fluency controls; speaking quietly, loudly, quickly, or slowly; stuttering with whole word repetitions, part-word repetitions, or phrase repetitions; or using prolongations, interjections, or revisions. During the game, which consisted of the client, two clinicians (Bragg and Fowler), and one clinical supervisor (Shapiro), each player was required to abide by the speech pattern specified on the card that was drawn. The prescribed speech pattern was required not only during the game, but also during related conversation that involved asking game-related questions, relaying how one felt, or making general comments to other players. For accountability purposes, each person started with the same number of tokens. All players rewarded the others with a token for speaking in the manner as directed by his or her card; all players removed a token from a player for failing to speak as directed by the card. The token system reminded all players at some point to “get back on track,” as it was easy to forget to stick to the directive on the card, especially if the card represented a novel way of speaking as it did for the clinicians.
Outcomes
First and foremost, Catchphrase provided Jeff with a heightened understanding and a sense of control and empowerment. After we reviewed what each card meant and provided examples, Jeff was eager to play. By chance, he first drew many cards directing him to stutter. When he finally drew a card directing him to use fluency controls, his overall fluency improved tremendously compared to previous sessions and the beginning of the present session. Before the Catchphrase activity, he demonstrated one or more disfluency on 18% of the words spoken during a two minute conversational sample. During the activity, he used his controls and demonstrated disfluency on less than 5% of the words spoken in a conversational sample of the same length. We used an audio recorder to play back Jeff’s use of fluency controls to further heighten his awareness and to offer positive feedback.
Catchphrase indeed was beneficial for the client. However, what we did not expect was the positive impact it had on both of us as clinicians. Although we knew that we would be stepping outside of our comfort zone to participate in a new experience, we couldn’t have known that we would be affected in the manner and to the degree that we were. When the game first started, we were more focused on how to stutter as directed by the card. With practice, however, throughout the two-hour session, stuttering almost became second nature. We were so dedicated to playing the game and trying to understand what it means to stutter that, at one point, we transcended the game and felt as if we were people who stutter. It is difficult to describe, but all people in the room, including our client and supervisor, realized what was happening and the significance of it. Both clinicians experienced moments of genuine embarrassment and frustration. Our own speech is something we never had actually thought about previously. One of us (Bragg) tried to make a joke and it took so long to get to the punch line that the joke was abandoned. One of us (Fowler) lost her train of thought when explaining directions for the next part of the game. We were so focused on how to speak that we forgot our place in the narrative. The demand created by speaking in a prescribed manner seemed to overwhelm our capacity to keep up with what was needed to be said. By the end of the session, we yawned incessantly due to interrupted breathing and our eyes watered from fatigue. When we tried to speak in our usually fluent voices, we continued to stutter on occasional words and experienced generalized speech disruption. Experiencing genuine disfluency for the first time and the related speech effort simply exhausted, if not humiliated, us. At the end of the session, we felt like we would rather not speak than go through all of the tedious effort it took to communicate. We had heard people who stutter explain this before, but we had never actually experienced it. As we expressed to Jeff and Dr. Shapiro at the time, “We knew this activity of pseudostuttering would be difficult, but never imagined that it would impact us both physically and emotionally.” In response, Jeff said, “Welcome to my world. Now you know what I’ve been going through. You’ve been stuttering for a few minutes, but try stuttering your whole life.”
Discussion
Though we may never fully know what it is like to be a person who stutters, this activity gave us a glimpse into that reality. It brought us to the empathic “as if,” shortening the distance between our reality and that of the people we serve (Rogers, 1961; Shapiro, 2011). If anything, our empathy is stronger and we feel more prepared to work with and learn from people who stutter. It is our recommendation that speech-language pathologists who intend to work with people who stutter engage in pseudostuttering multiple times and in multiple settings to gain insight into the reality of stuttering. Our client related more closely with us in this session than in others, perhaps because he felt that we were beginning to understand his experience. He could see that we put ourselves into his experience, that we genuinely wanted to know more. He saw the impact that stuttering had on us. As clinicians, we learned more during this activity than we ever expected. We found the experience to be enjoyable and rewarding, in addition to being memorable, humbling, and inspiring.
Closing
Challenging experiences raise questions. We are considering many; we invite you to join us as we ponder the experience of stuttering:
- Do clinicians who stutter make better clinicians for people who stutter? Can a clinician who does not stutter work effectively with a person who stutters?
- Do people who stutter understand the experience of another person who stutters better than a person who does not stutter? Do clinicians who stutter have biases or predispositions that can interfere with or reduce the objectivity of the clinical process for a person who stutters?
- Can anyone ever truly understand the experience of another person? What facilitates and what inhibits a person’s understanding of another person’s experience?
- This paper addressed one activity – Catchphrase – that remarkably enhanced two clinicians’ understanding of stuttering. What other activities might help clinicians build their own understanding of stuttering and the uniqueness of the stuttering experience to each individual?
- What opportunities presently exist for student clinicians in professional preparation to understand the experience of stuttering? How might the graduate experience be enhanced to achieve such an understanding in order to deliver best practice for people who stutter and their families?
References
Guitar, B. (1998). Stuttering: An integrated approach to it nature and treatment (2nd ed.). Baltimore: Lippincott/Williams & Wilkins.
Manning, W. H. (2004, Spring). How can you understand stuttering? You don’t stutter! Contemporary Issues in Communication Sciences and Disorders, 31, 58-68.
Rogers, C. R. (1961). On becoming a person. Boston, MA: Houghton Mifflin.
Shapiro, D.A. (2011). Stuttering intervention: A collaborative journey to fluency freedom (2nd ed.). Austin, TX: PRO-ED.
Van Riper, C. (1973). The treatment of stuttering. Englewood Cliffs, NJ: Prentice Hall.
I found this paper to be very interesting and it opened up a question in my mind. I think it is said that stammering / stuttering cannot be copied. Kristen and Perry, would your experiences with Jeff make you question the accuracy of this statement?
Keith Boss
Hi Keith.
After reflecting on your question for a few days, I think I have reached a conclusion on my feelings regarding this. I think that audible, core behaviors of stuttering (word reps, prolongations, etc) can be replicated, like during our activity, and may even begin to feel natural over time with practice. However, escape and avoidance behaviors (word changes, eye blinks, pauses, etc)will only occur with those who really do stutter. When those who do not stutter pseudostutter, we are aware that we can stop at any time. So before escape and avoidance behaviors even start, we naturally just stop stuttering. Many definitions of stuttering also include the thoughts and feelings of those who stutter as part of the overall description. Of course, thoughts and feelings can never be copied and a person who does not stutter is never going to be able to experience certain associated feelings that a person who stutters may feel..
Kristen & Perry:
Your modified “Catchphrase” was a novel idea, thanks for sharing. I place great value on moments in which the “tables are turned;” when the client gets to observe vulnerability in the clinician. It sounds like trying pseudostuttering pushed you to go there.
Clinicians can choose sit behind a desk and talk at clients- or- they can model the human openness and vulnerability that is necessary to establish an effective client-clinician relationship. Kudos to you and Dr. Shapiro for advocating and practicing the latter!!
Daniel,
Pseudostuttering definitely pushed us to new limits as clinicians while the “tables were turned”. Thank you for your kind worded response. It was beyond a memorable experience in our days as two graduate students.
Your version of “Catchphrase” is an excellent idea and as a future speech language pathologist I could see myself using this in therapy. I have a couple of questions for you:
1.What ages are best suited for this game?
2.There are some speaking situations that we do have time limits for. Would you ever incorporate the use of the timer?
3.Have you tailored any other games after seeing such success with this one?
Thank you.
Hi Hannah,
In response to your 3 questions…
1. I think one has the option to tailor this activity to just about any age group. Adolescents and adults are more likely to have prior knowledge of the electronic game “Catchphrase” and therefore would be more familiar with the structure of the game. I would focus more on the client’s interests and select age appropriate vocabulary.
2. We chose not to use a timer because of the pressure it places on a speaker. It’s vital to remember that every client is different. Another client might have a personal goal of making a speech in an academic class, for example, or possibly have a presentation in their job setting approaching. I would consider using a timer in those types of instances. The clinician could then tailor the therapy environment to one more naturalistic and suitable for the client. Sometimes timers have the capability of hindering a fluency client’s feeling of success so, use caution and your best clinical judgement.
3. We have not tailored any other games at this point in time.
Thank you for your response. I do hope I answered your questions adequately.
Perfect timing! I just collected pseudostuttering experiences from my graduate students in Fluency Disorders class today. Question: You said that Jeff’s plateau might have been due to him being “unaware, in denial, or apathetic.” After the discussion about Cacthphrase outcomes, did Jeff share that it was one of these (” unaware, in denial, or apathetic”) more than others, or a combination?
And in answer to one of your “challenge Q’s” I have found that Taboo is a good way to use the negative practice of avoiding certain words, and that MadGab – esp when paired with acoustic displays (spectrograms and waveforms on various apps on the ipad, for example) allows kids who stutter to really play around with different ways of talking – elongating, pausing, etc.
Thank you so much for sharing both of your activity suggestions. I think that it is important for those receiving speech therapy to have fun during intervention and to see it as a positive experience. Games are a great means to achieve this. I can’t wait to try out both games, especially MadGab paired with acoustic displays.
Jeff’s fluency awareness was heightened during this activity and he was able to engage in a realistic dialogue during the session and in subsequent sessions about the results of the activity. Although he did not verbalize that he was unaware up to that point, he did admit that the activity made him feel in control. However, when Perry and I ended the semester, about a month after this session, Jeff had still not reached the level of maturity and personal awareness, needed to reflect on possible causes for his plateau.
Thank you for sharing this experience — it was very powerful! This is similar to what I read about Colin Firth’s physical reactions to “trying not to stutter” when he was filming “The King’s Speech.” Headaches, exhaustion, etc…
I was especially taken by your comment “The demand created by speaking in a prescribed manner seemed to overwhelm our capacity to keep up with what was needed to be said.” This reflects my concern with asking younger children to speak in a prescribed manner (using SM and FS tools) – the risk that it feels so overwhelming to them that they choose silence. Would you recommend this with elementary-aged children?
You have raised my curiosity regarding Colin Firth’s interviews. Although I have watched the film a few times, I have never thought to watch/read the interviews. I have now put this on the top of my “to do” list and can’t wait to learn about his physical reactions and how they compared to ours (although I am sure his filming spanned over a much longer time period than our activity).
As a student still new to intervention strategies, I consider myself no expert and am still learning what may work best for different ages. As of now, with my current experience, I think that this game may be better for older elementary-aged children. However, if I do decide to use this with any elementary aged child (older or younger), I would only do so after I have established a strong enough relationship to be aware of their individual characteristics to determine if this activity is appropriate. These would include level of awareness, maturity level, anxiety level, and how much pressure they can handle.
Thanks for your response — you can go to
http://www.stammering.org/colinfirth.html
to read his interview with the British Stammering Association. Very interesting…. best of luck to you!
Dori
Kristen & Perry –
I want to thank you for being part of this ISAD conference.
This thread holds great interest to me. First – I applaud your physical efforts and emotional honesty in undertaking the task of pseudostuttering in preparing yourselves to be clinicians; it is an absolute “right thing” and necessity as far as I am concerned towards becoming a clinician hoping to have the honor of working with children who stutter. Your bravery in doing what you did will make you a better clinician.
If I recall correctly, Colin Firth speaks to this undertaking in his preparing for his role in “The King’s Speech” as being terror filled and terrifying.
Regarding the use of Fluency Training and/or Stuttering Modification techniques with any child under the age of 18, I urge you to consider the following exercise as well:
Requirements for the speech & language clinician to complete prior to suggesting, assigning or demanding the CWS to use Fluency Training or Stuttering Modification Techniques while talking or interacting with others:
1. The person directing the child to use the
“techniques” must use the “techniques” in all
their own talking and interactions with others for
a full week.
2. If it is SLP directed, complete # 1… then, administer
the “techniques” to your own child, grandchild or a
much loved youngster, and assign them to use those
“techniques” in their talking and interactions with
others for a full week. Finally- if you still insist – administer
as # 1 indicates to the parents of the CWS in order to direct
you to STOP THE MADNESS!
Most clinicians gain deep insight as to the dilemma facing the CWS and therapy requiring the use of said techniques by engaging in this exercise as well.
Good luck in your professional careers. Give my warmest regards to Dr. Shapiro!
Retz
Your “Catchphrase” activity is a great idea and I enjoyed your reading your experience. I hope to be a speech therapist one day too. I have a few questions for you.
After doing this activity, you said your client’s fluency improved, was he aware of this as well? Have you tried this activity with any other clients? And, Do you feel that you are better equipped to help those you stutter now that you have had this experience?
Megan
Hi Megan. We are glad that you enjoyed reading about our activity. 1.)Jeff was aware of his improvements during the activity. We offered positive feedback throughout the session and even played back an audio recording of long time periods of total fluency. He indicated verbally that he was aware of his improvement. 2.)I have not had an opportunity to use this activity again. My fluency clients since Jeff have all been in preschool/kindergarten and have not yet learned about fluency controls. I do look forward to the opportunity to soon play it again.3.) I feel that this experience certainly better prepared me to work with those who stutter. Although I can never claim to know exactly how someone feels, I think that a clinician can only be effective when they have an empathetic understanding of their client. I also think that in many cases a client can sense/read this understanding which in turn shapes their level of motivation. This experience allowed me for the first time ever to feel negative emotions regarding my speech. Even though it was only for a few hours, it led me one step closer towards a genuine and deeper understanding of those I serve, which in my opinion makes me feel better equipped. Good luck in your future plans of becoming an SLP!
The experiences of the “catchphrase” activity reminded me of a pseudostuttering assignment we had in our stuttering II class this semester. We were required to go out with a friend and stutter in a community environment. One person would stutter and the other person would watch and observe the reactions of the speaker and the listener. Taking part in the experience, I realized the courage it takes to speak and the amount of frustration that can be caused by stuttering.
I found this experience to be both enlightening and rewarding. I would encourage every SLP to try stuttering with an unfamiliar and familiar communication partner. Stutter in the community and gain an understanding of how people react and feel. It may not be possible to understand completely what it is like to stutter everyday, but you can gain at least an overview or glimpse into the life of a person who stutters.
Thanks for sharing. I like how you were also required to observe the reactions of a listener, who was unaware that the person was pseudostuttering. I think that this gives those of us who do not stutter insight into the realization that listeners are not always as understanding and patient as we hope that they will be.
Kristen,
Thank you for sharing your experiences. I am also a second-year graduate student of speech/language pathology, and was required to “pseudostutter” for my fluency disorders class. As a clinician, I also do not see how it is possible to treat an individual who stutters if you do not have a deep (not full) understanding of the experience. My own personal triumph was getting over the fear of “the unknown”, being the reaction of the listener to stuttering. Catchphrase is a wonderful activity and could act a a stepping stone for practicing pseudostuttering in real-world situations.
“Headbandz” is an activity that I used in therapy with a school-aged boy who stutters. I did not think to practice psuedostuttering while playing the game, but it is definitely one that can be modified as well!
I have played Headbandz with friends before. I think that it would be a great game to play and that it could easily be modified in the same manner that Catchphrase was. Thanks for sharing.
As a current Speech and Language Therapy masters student in the UK I have found this a really interesting paper. I have come across activities where the individual who stutters is directed to stutter but had not previously thought about asking that of the clinician! It sounds like a positive learning activity for Speech Therapy students and, as your final question points out, it may be interesting for training courses to include this kind of activity.
Glad that you enjoyed reading about our experience. I hope that as a future clinician it has encouraged you to try pseudostuttering. Good luck in your future career as a SLT.
I thought this article was great! Currently I am a first year Master’s student in speech language pathology, but this reminded me of an activity we had to do as an undergrad. We were instructed to go into places of business and pseudo-stutter with people who worked at the store. It was a really beneficial experience because as a person who does not stutter, it is hard to really understand the feelings that would a PWS may go through on a day to day basis.
Do you think you will eventually incorporate a time aspect with this client as he becomes more fluent and/or comfortable?
Would this be something you would encourage parents to do at home with their child?
Thanks for a great therapy idea!
Allie T.
To date, we mainly focused on fluency in conversational speech with Jeff. Specifically regarding Jeff, I don’t see a time aspect being incorporated in his treatment any time soon. One great thing about Jeff as a client, and as young teenager, is that he loves to talk. We have been focusing on keeping that verbal dialogue up, and at this point a time aspect may do more harm than good for him. With that said, a time aspect may be highly beneficial for another client, or even Jeff in the future. In our experiences we have actively aimed to not add unwanted and unnecessary pressure during speaking times.
I left out the answer to your second question…
Incorporating parents and the Catchphrase game could be highly beneficial. One idea that just crossed my mind is inviting the parent or caregiver or other family member into the therapy room when the Catchphrase activity is “played”. It might be a great learning experience for that family member who can then possess the knowledge to incorporate the activity into a natural environment, such as their home. I imagination new perspectives would be formed through this experience which has the potential to improve the family-client relationship, as well as the family-clinician relationship.
What a great idea! I also had to participate in pseudostuttering as an undergraduate student and was terrified. As I was going through that process I couldn’t help but imagine what it would be like to go through that on a daily basis. I have a few questions. First, did Jeff’s stuttering improvement in therapy generalize to other situations? If so, how much? Is this an activity SLPs could feel comfortable teaching parents to use? I am curious as to parents, friends, and family members would react after partaking in a similar activity!
Jeff’s stuttering improvement did generalize into other situations outside of the therapy room. He is a kid that loves to talk, which is great and refreshing. He is a great communicator and feels comfortable speaking with a wide range of individuals. I cannot speak to how much he generalized quantitatively at this time. I don’t have my clinic notes with me.
I just wrote in the comment above about teaching parents or other family members how to utilize this activity if you want to take a look there as well. We did not partake in this aspect, therefore I cannot be certain of the outcomes. I think it has the potential to be beneficial and improve relationships by gaining new perspectives.
Hello,
I loved reading about this type of therapy technique. How fun to use a conventional game like Catchphrase and turn it into an individualized therapy for this boy who stutters. I honestly think this is something I will want to try should I ever have a client who stutters and is at a plateau, or even not at a plateau for that matter. I do have one question: Did you continue using Catchphrase with this client in order to keep him from plateauing again, and did he reduce his dysfluency rate further than shown in this first attempt at the activity?
Thank you,
Briana
We did continue to use Catchphrase, but not every time we met with Jeff. We were focused on providing opportunities for Jeff to gain awareness of his stuttering in conversational speech. We kept our focus on this aspect rather than focusing on the plateau at hand. Each time we participated in this activity Jeff’s overall dysfluency would reduce and he would gain more and more awareness of the idea that he himself can control his fluency.
That’s awesome!
Great idea for therapy! Have you tied your ideas from catchphrase into any other therapy sessions? Instead of doing specific words he needs to describe, giving him a characteristic of PWS and using characteristics in conversation for 5 minutes, then after having him use techniques to help him for 5 minutes and seeing if that helps still? If you’ve done this, does he still dramatically increase and have less that 5% disfluencies? Or are his disfluencies greater when he does not have a set topic?
Thanks for the positive feedback. We did not have a chance to pseudostutter in sessions when then game was not played. However during the times when we did play the game, all players spoke conversationally (which was frequent)in between turns and still used the cards. Doing so allowed for us to have a sufficient amount of practice, including Jeff. Throughout the entire session, topic or regular conversation, Jeff’s overall disfluencies decreased after stuttering on purpose and then focusing on using controls.
This is such a cool activity!
You said that Jeff’s speech improved a lot during that activity- did it carry over to other situations too? Did he still speak as well during his next few sessions, and do you think he was able to stutter less because he left more comfortable around you guys? I had to go out in the community and psuedostutter in two different situations as a undergraduate, and the experience was terrifying and embarrassing, but also very eye opening as I got to experience a small glimpse of what PWS go through on a daily basis. Is this activity something you will try with other clients who stutter?
Hello. Jeff’s overall fluency did improve in future sessions. Perhaps this was because he felt more comfortable around us. As far as carry over I am not sure. Although Jeff reported overall improvement and awareness in his home and community, whenever he would first enter therapy sessions it was clear that he needed to refocus his awareness. As a result, he would gradually become more fluent as the session progressed. Since the semester ended I have not had a chance to talk with Jeff to see how he has been doing. I plan on inquiring soon to find out. I will definitely play this activity in the future with appropriate clients.
This was a great idea! I really liked that pseudostuttering was turned into a modified game instead of just another “assignment” or practice in therapy. I did have a couple of questions. You mentioned the frequency of his disfluencies but what were the type of disfluencies that he made earlier which he was able to control? Also, did pseudostuttering help him ease out any physical tension or other behaviors if he previously exhibited any secondary behaviors?
Thank You,
Rachita
Thank you for your kind words, Rachita.
The types of disfluencies Jeff most commonly exhibited were whole word repetitions, part-word repetitions, and phrase repetitions.
Pseudostuttering did assist Jeff in reducing some physical tension, such as gripping the arms of the chair. He often fidgeted with his jacket, but that was also reduced through the pseudostuttering.
I love Catchphrase! This was so awesome! This activity seemed to benefit each one of you! I was curious if there were any flaws or challenges you came across when trying to modify the original game, or things you had to change each time you played the game?
We didn’t come across any problems while we modified the game. We knew the timer used with the electronic game would be a problem, hence why we eliminated it. Each time we played the game we would have a new set of words ready so there were none repeated. Thank you for your enthusiasm!
Thank you for sharing your paper! As a current graduate student in Speech Pathology, I found your findings very inspiring. You present a novel approach to building both the client and clinicians’ awareness of not only stuttering behaviors, but also the emotional and physiological changes that can manifest with disfluency. Connecting with the client is so important in treatment (Cooper, 1996), and you managed to do so in a really dynamic way.
Also, You brought up the question if we can ever truly understand the experience of another person…I believe as clinicians, this is something that we can always strive for through knowledge and empathy. However, what is so profound about your game was that it was shared experience and there was almost a role reversal in terms of who was being disfluent.
I also thought your teamwork exemplified responsible mentorship thorough including an experienced professor who is also a PWS in the game (Minifie, 2011). I was wondering how Jeff responded to this, do you think it made him more comfortable?
Thank you for all of your comments, I’ve enjoyed reading your ideas about how to include family and keep the activity going over several sessions!
I think it definitely made Jeff more comfortable because he responded well. Jeff had been coming to see Dr. Shapiro prior to Kristen and myself seeing him in the clinic. He really looks up to Dr. Shapiro and is very appreciative of the services he has received. With that said, there was a level of comfort previously established between Jeff and Dr. Shapiro, and through this activity, Kristen and I were able to connect more with Jeff. I believe we all gained new perspectives.
Thank you for your kind words and enthusiasm.
What a great idea for therapy! ☺ A couple interesting questions you pose are “Do clinicians who stutter make better clinicians for people who stutter?” and “Can a clinician who does not stutter work effectively with a person who stutters?” After reading your paper, I had the same questions myself! I, too, am an M.A. student who has had to pseudostutter in public for an assignment. I thought the experience was eye-opening, and I think I can view myself as a better clinician because of it. But, I was curious to see if there was anything written in the literature about this particular topic. Through my search, I came across a paper by Joe Donaher and Joe Klein titled “Can a Fluent Stuttering Therapist be as Good as a Stuttering Fluency Therapist?” (2008). Joe K. is a fluency therapist who stutters while Joe D. is a fluent stuttering therapist. Interestingly enough, both of them state that underlying the question is a more critical issue that needs to be addressed, which is “What makes a good fluency therapist?” or “What is the role of a good fluency therapist?” I encourage you to read their responses!
Also, through my search, I found that therapeutic alliance or client/clinician relationship seems to be one of the most influential outcome measures (Lambert & Barley, 2001). So, I think you made a great decision to implement the activity that you did so that you could better your relationship with Jeff! Plexico et al. (2006) also gives some insights about the characteristics of an effective (and ineffective) fluency therapist. Some of the characteristics that Plexico et al. (2006) say make effective clinicians are that they are passionate, are committed, have a belief in the therapeutic process, have a belief in the client, are professional, are knowledgeable about stuttering, are active listeners, and make clinical decisions based on the client’s needs as well as the client’s capabilities and personal goals. On that note, what was the relationship like between you and Jeff? Based on what you recounted above, I think you displayed many of these qualities while working with Jeff! What other qualities do you think made therapy successful for you and Jeff?
Sorry–Plexico et al. (2010)!
Andrea-
I am impressed by your enthusiasm to dive deeper into the topic. I will certainly take a look at this paper when time allows. I’ve always taken the position that good fluency therapists have a healthy balance of all of the characteristics of an effective clinician that you list above. However, I do feel like a “stuttering fluency therapist” has an advantage (been there done that)over those of us who do not stutter.This advantage not only includes the obvious, but the client also will likely feel that they can relate on a deeper level to the “stuttering fluency therapist.” I will have to see what the paper says. The relationship between Dr. Shaprio (a “stuttering fluency therapist” has been developing for many years. Jeff trusts Dr. Shapiro and really sees him as a positive role model. I think Jeff built trust in Perry and I because of his trust with Dr. Shapiro. I think something that aided in our success with Jeff was that instead of just diving into therapyy like activities and drills, we really took the time to buld a relationship and get to know each other. We allowed Jeff to ask us personal questions when we first met. We remained professional but still allowed Jeff an opportunity to see us for who we really are.
Also, sorry for all of the typos. I accidentally hit “post comment” as I was trying to edit 🙂
Thank you for sharing this experience. I am currently a first year graduate student. I have yet to have any clients who stutter, but I am enrolled in a stuttering course and may have such clients in the future. I look forward to using similar techniques in order to enhance my own therapy in the future.
In regards to your reflection question, “What opportunities presently exist for student clinicians in professional preparation to understand the experience of stuttering? How might the graduate experience be enhanced to achieve such an understanding in order to deliver best practice for people who stutter and their families?,” I’d like to share my own experience. An assignment was given in my stuttering course in which we were to pseudostutter in public and write a reflection on the reactions of those that we interacted with. I had quite the eye-opening experience. A woman that I spoke with while I pseudostuttered completely disregarded what I was saying and was unable to hold a conversation with me once she was distracted by my disfluency. Although it was only one incident, I was able to feel the frustration that many who stutter go through daily.
From your experiences with Jeff, were there any other activities or techniques you found worked well once you had made this connection?
Thank you again,
Johnna
Johnna,
Thanks for sharing your experience.
We played Catchphrase again a couple of times after the initial game and it was always effective for Jeff. We also found that positive feedback worked well via audio recordings. We would record his speech and play it back, only focusing on periods of fluent speech. As it was played back, we would offer praise and encourage him to talk about what he heared and the controls that he used. He was very receptive to this encouragement.
Has Jeff’s fluency improved since playing this game? Does it generalize to other contexts? I think adapting a game for Jeff when he hit a plateau helped give him another area to focus on rather than doing a technique in therapy, allowing him to be more in control of his fluency.
Have you thought of any other games that would be appropriate to use for a young child who stutters?
One of your challenge questions asks how student clinicians can get part of the experience of a person who stutters. I am a graduate student and a requirement for my class on stuttering is to simulate a stutter in a variety of situations. Playing Catchphrase during therapy is great for the pseudostutter to become natural feeling rather than planned.
Brianna
I haven’t been in contact with Jeff this semester due to a new clinical placement, but I do plan on reaching out soon to see how he is doing. With that said, I unfortunately cannot speak to Jeff’s level of generalization. Catchphrase was a fun, and enjoyable therapy activity. It was different for a fluency session which was great because it shed new light on the topic. It’s too easy to talk at a fluency client, and we as clinicians must steer away from that at all costs. Catchphrase broke new ground for all of us involved, and Jeff’s awareness of fluent moments and disfluent moments was heightened. At this time we have not thought of any other games appropriate for a young child who stutters. If you have any ideas we would love for you to share them with us here.
Thank you for posting this paper! It is very interesting, and I love the fact you incorporated a fun game into therapy. I can relate in some way to this topic because both as an undergraduate and graduate student at Illinois State University I was assigned a pseudostuttering assignment in my stuttering classes. We were told to go to a coffee chop, store, restaurant, etc. and pseudostutter while speaking to someone who, of course, had no idea of the assignment and thought we were really PWS. As a class we all had very mixed responses to this assignment. I was very nervous to stutter in public, and found myself using simpler language to communicate my needs than I would if I were speaking fluently. Although the people I spoke to were very kind and understanding in my situation, classmates reported people acting impatient, and sometimes even rude to them.
Overall I agree that pseudostuttering exercises are extremely beneficial to any clinician working with a stuttering client. We are taught how important it is to counsel stuttering clients, but we can never truly understand what it is like for them to struggle with communicating on a daily basis. In regards to your question “Can anyone ever truly understand the experience of another person? What facilitates and what inhibits a person’s understanding of another person’s experience?” I believe that no one can 100% understand another person’s experience. As fluently speaking people, no matter how many classes we take telling us what it is like to stutter, we will never be able to fully grasp our client’s experiences.
I would love to know how Jeff has progressed since this activity, and if any other similar activities resulted in similar improvements. Thank you so much again for this posting!
Thank you so much for sharing your experience in school, as well as speaking to one of our questions. I feel similarly regarding that specific question. I think even though we may never be able to fully understand another’s experience, it doesn’t hurt to try. For us, Catchphrase was our attempt.
Unfortunately, I have not been in contact with Jeff this fall semester due to clinical placement. He’s a great kid, and loves to talk to anyone and everyone. I plan on reaching out soon, and would love to share what’s learned at that time.
I recently had to pseudostutter in three different situations as an assignment for my fluency course. I was able to feel and understand what a person who stutters may go through on a daily basis. I believe playing Catchphrase was a wonderful idea to build a connection between the client’s feelings and the clinicians and would love to use this game when I have a client who stutters.
I also have listened to a panel of speakers who felt that most of the strategies learned and used during session, were not helpful to them in their daily lives? Do you feel that this activity has helped Jeff generalize his strategies? Or, do you feel it helped build a connection between the clinician and the client?
Carmen
I think Catchphrase definitely helped build a stronger client-clinician relationship. We (the graduate clinicians) were able to get a glimpse into the daily life of a person who stutters. Jeff even said to us, “welcome to my world”. The relationship was stronger after Catchphrase because it put stuttering into a new perspective. Jeff seemed to appreciate our act of “walking in his shoes” so to say, and I gained so much more out of the activity than I ever had expected. Even though we will never be able to fully relate to a fluency client, we now have a knowledge base to refer to when we work with other clients in the future.
I’m not sure on how much Catchphrase helped with Jeff’s generalization of fluency controls. In Jeff’s case, Catchphrase was a beneficial tool we used to heighten his awareness of fluent moments, as well as disfluent moments. It was successful in that regard, and also because we were not clinicians talking at him.
As a second year graduate student at Appalachian State University, I too, participated in a puesdostuttering assignment that heightened my overall awareness of the impact stuttering has on an individual’s day-to-day life. Before I officially began my psuedostuttering assignment, I avoided 5 different locations before completing the face-to-face experience using disfluent speech, with unfamiliar people in unfamiliar settings. This assignment allowed me to personally understand the emotions and anxiety that can build up in pressured speaking situations.
Currently, I am providing therapeutic services within an elementary school where I have had the opportunity to work with an amazing 3rd grader who is a PWS. The student is generally fluent within the therapy room as I, too, have created games to work on monitoring/identifying his own speech and stuttering behaviors. I have the student write in his fluency journal to describe different feelings and his understanding of stuttering, as well as stuttering situations that may have occurred since his last therapy session with me (I am only there twice a week). Although this student presents with very minimum stuttering (usually whole-word reps and phrase reps) in the therapy room, I have talked to my supervisor about creating situations that are not so familiar or relaxed and increasing the communication pressures in other environments around the school (i.e., library, lunch room, hallway, office.) Do you two feel like this would be too much?
Just like you two, I want to determine whether or not the student is really “aware” of his disfluent speech because the only time he reports situations of disfluencies is at home or when he is excited or mad. Though this may be the only time he really does stutter I am unable to see those instances outside the therapy room.
Today, I incorporated his recent interest of dinosaurs with a visit to the library to find books with further information. Although we planned in advance what he was going to say, he still used interjections such as “um” and avoided eye contact with the librarian. No disfluencies were noted.
My question to you two: Do you think I am creating unneccessary pressure by trying to utilize other environments to make sure fluency control techniques are being generalized?
In addition, though this game was used with a student who exhibited “a significant number of observable disfluencies,” would you use this game with a student who exhibits minimal number of “observable” disfluencies?
Thanks for sharing your experience and activity!
Danielle
Danielle-
As a fellow graduate student, I by no means am an expert regarding fluency clients. On a side note, I haven’t worked with a fluency client younger than 13 years of age. I think it’s great that you’re trying to see what fluency control techniques are being generalized, however, if he isn’t responding well to the new environments perhaps scale it back to the therapy environment. He is still young, so it may just be his age playing an additional role in his timid actions in new environments. Grad student to grad student, I would suggest recording him during sessions. Moments that he is fluent could be played back for him to hear. That would reinforce his feelings of successful communication. I would not suggest re-playing the moments that he is not fluent. Instead, openly talk about what was going on in that instance and what he thought, how he felt, and maybe then it would bring on more conscious awareness. Like I said, he is still young, so I would hate for him to be knocked down by hearing himself stutter on a recording. I think the Catchphrase game we used would be a great tool with him. Be sure to thoroughly explain what each type of dysfluency means, and use age appropriate words. It sounds like you’re doing well in your placement and studies at App! I hope this response was somewhat helpful. Please post again for any additional inquiries.
-Perry
Hi Danielle,
I’ve been following your post with Perry and I fully support what Perry has shared. She and Kristen are amazing clinicians and I am thrilled to see them so involved in this conference. Let me emphasize also that, from my perspective, your job as an SLP has three foci. These are to engage the client in collaboration (where you initially design activities for him, soon design them with him, and eventually have them designed by him), to create opportunities throughout the clinical process for the client to experience success (analyzing and approaching the client’s objectives so that success begets success), and to enable the client and the clinician to be and to have fun. That said, you might design hierarchies with the client such that the tasks get more difficult but in which – importantly – the client continues to experience success. This will require tailoring the hierarchies and the resulting activities on the bases of the client’s unique strengths and interests. Remember that such hierarchies always are in evolution; contexts that might be expected to be relatively easy and others that might be expected to be relatively harder can prove otherwise. Remember to involve the client in the clinical process in all ways possible. He is most expert regarding his own communication and he is our best teacher. Give my regards to Dr. Klein and, however unlikely, I hope WCU gets the jug back from ASU. Good luck.
David Shapiro
Great idea for an interesting and unique therapy technique, kudos! It has always been a difficulty of mine to “step into the shoes” of individuals I have worked with during therapy. I appreciate your efforts to do just that and really gain the perspective of your client. I am curious, do you think this type of therapy could be used with something other than fluency issues; or is that something you’ve even considered? As a second-year graduate student myself I am inspired by your creativity but understand that SLP’s work with a variety of disorders and clients, and I am still looking for some insight for taking client’s perspectives.
Thank You
Daniel Carnley
Idaho State University Graduate Student
Daniel,
I had not considered adaptations of this activity to additional areas in the field before. Although I believe that Catchphrase could be modified for a variety of language clients, I am not sure how to incorporate the clinician into the game, in order to take the language client’s perspective. For the game itself, instead of creating cards to intentionally stutter or to use controls, cards could be created for different language goals. This would be great for those who need to improve specific areas in expressive language like using correct grammar, recently learned vocabulary terms, and word finding. It would even work for social pragmatics (ex: being concise in descriptions, describing facial expressions). I welcome anyone who has a good idea of additional activities that may help to gain insight into a client’s perspective to join the conversation and share.
Thank you for sharing this creative activity. I would like to try this with a client someday. I have also had some experience with pseudostuttering at an intensive stuttering program. It is difficult to put yourself in that place of vulnerability, but really gives you as the clinician insight into how your client feels much of the time. I believe that for most clients it is helpful and beneficial for the clinician to be willing to do whatever we ask them to do. It helps build a connection between clinician and client and demonstrates that you support their efforts to speak in difficult circumstances. Out of curiosity, did you have any experiences of pseudostuttering with Jeff outside the therapy room?
Christy Johnson
ISU Graduate Student
Christy,
We did not have an opportunity to pseudostutter with Jeff outside of the clinic. I understand why you are asking this question though. Not only would doing so allow Perry and I to experience the additional emotional aspect of being uncomfortable around an unfamiliar and unknowing person and their reaction, but it would have also strengthened Jeff’s understanding of our support towards him. I think that this should certainly be an extension of this activity in the future.
Thanks so much for sharing your experience. For a recent assignment in my graduate fluency course, I pseudostuttered on several occasions. I too, felt feelings of frustration and embarrassment and a overall sense, that I would rather not communicate than deal with the physical and emotional effects. However, as difficult and uncomfortable these situations and experiences are, it is so important for us as future clinicians to develop a greater understanding of what it is like every single day for our clients. Or as better said by Jeff, “Welcome to my world.” I have been thus far been quite limited in my experiences with clients who stutter, but your paper has provided me with a new outlook on how I will approach therapy with my clients, and I thank you for that!
Thanks for your positive feedback. Good luck as a future clinician.
I was immediately drawn to this article, because as an SLP graduate clinician, I too have successfully used the game catch phrase with modifications in my therapy sessions! I used the game to facilitate intelligible conversational speech between myself and an older gentleman with dysarthria secondary to a stroke. The man I was working with produced a variety of imprecise consonants, but the larger problem was that he spoke at an extremely fast rate however he denied doing so. While playing catch phrase, we followed the general game rules, by taking turns describing a word without saying it however we also drew a card that instructed us to speak at a slow, medium, or fast speaking rate. When I spoke very quickly, my client was unable to understand me and almost never guessed the word I was describing correctly. More rapidly than I expected, this activity allowed my client to understand and “buy in” to the importance of slowing his speaking rate and his intelligibility improved significantly thereafter.
In response to one of the questions you posed at the end of your article, I don’t think any of us can truly understand the experience of another, however I think we can all act as allies in developing solutions that help one another and bring us closer to mutual understanding. Therapy activities that require us to perform the same speech acts as our clients seem, in both of our situations, to have been very successful and natural ways to do just that. Your article is a wonderful example of the benefit in moving away from a traditional clinician-client relationship, and towards a successful partnership. Thanks!
Thanks for sharing! A couple of days ago another fellow student asked us(posted above) if we have thought of additional perspective taking activities to better understand our clients; for not only those who stutter, but for those with additional disorders. I replied by encouraging others who have to share ideas. I am not sure if you saw the post, but so pleased that you shared how you used Catch Phrase with an older client with dysarthria.
I also really like your perspective regarding the question that we posed. I believe that it is sincere and realistic. Good luck as a future clinician.
I am also a second year graduate student studying speech-language pathology and recently I was asked to pseudo-stutter in one of my classes. It was a terrifying and enlightening experience that gave me a stronger feeling of empathy for my current and future fluency clients. I have a school aged fluency client right now and I am going to suggest to my supervisor that we try this Catchphrase game with him. Thank you for sharing your clinical experience and your version of the game Catchphrase!
That’s great! Thank you for sharing. I hope you’ll find success through the use of Catchphrase. Best of luck to you in your studies.
This activity is such a great idea, as I was reading the article I was imagining what it would look like in therapy, and it seems to be a very effective task! According to Guitar (1998), stuttering modification works to decrease the fears related to dysfluent speech and, in turn, modify stuttering moments, and I think desensitizing the client by having the clinicians pseudostutter themselves was a fantastic idea. According to Blomgren et al. (2005), stuttering modification alone is not effective in reducing stuttering behaviors and fluency shaping techniques are needed to increase fluency and reduce stuttering behaviors, and I think this task does a great job at combining to two therapy approaches. This activity also supports the idea that the affective and cognitive components of stuttering need to be addressed in therapy along with the behavioral components (Yaruss & Queasal, 2006). By talking with the client and discussing not only his reaction, but also the clinician’s emotions and frustrations during the game, you bring up a comfortable opportunity for the client to share his reactions and feelings as a person who stutters.
The question that I have after reading this article is whether or not the client’s speech remained more fluent after the experiment. If yes, how long did the client’s speech remain at an increased fluency rate? If no, I am curious as to how long it took for the client’s speech to return to his typical fluency rate? I am really curious as to whether this interaction had a long-term effects on the client’s speech and if it were to be repeated in the clinical setting and also modified to be repeated across numerous settings, would it have lasting effects on the client’s overall fluency rate? What a fun way to conduct therapy and work on fluency targets! Thank you!
Diving right into your question, after we engaged in the Catchphrase activity during therapy in the clinic on campus, Jeff’s typical dysfluent speech pattern noticeably picked back up by the time we got back to the waiting room in conclusion to the session. I cannot speak to any similarities or differences in his speech pattern had we played the game over a series of multiple sessions. Catchphrase gave Jeff the opportunity to see that he himself can be in control of his speech. Because of this I feel that generalization will be attained in long term even though it was not immediate.
Thank you for sharing your experience. I love when I get more than I planned from my sessions. I recall when I was required to pseudo-stutter for a class assignment. I was nervous and anxious at first but after my first experience it heightened my awareness of possibly some of the emotions a person who stutters may feel. I highly believe that the best clinicians are the ones who take their time to understand their clients. In this case, by experiencing what the client goes through in his daily life and allowing yourself to vulnerable to various reactions and emotions can help form a better connection between the client and clinician and will assist the clinician in empathizing with the client. In turn, the activities, strategies, techniques used in the sessions may be more beneficial to the client. The client may be more appreciative and agreeable to participate in different activities during the therapy session as well as use different strategies or techniques outside of their sessions. Due to this, I feel it is difficult to say if a clinician who stutters is a better match than a clinician that does not stutter for a client who stutters. A trustful relationship between the client and clinician is more important than if the clinician stutters or not.
Thank you for your response and perspective. Trust in the client-clinician is vital, yet for some reason I had not considered that aspect when thinking about this question myself. I appreciate you planting this new seed in my mind!
Hi Perry,
I’m glad to hear I was able to bring something to the table. Although you may not have considered it, I felt Jeff experienced the trust during the session and it was a pleasure to read. I recall when my professor discussed our pseudo-stutter assignment, she completed the task herself in front of the class. By doing so, we formed a feeling of trust and a sense of unity. Thank you again for sharing and your response.
-Sandra
Kristen and Perry,
I absolutely love this idea! I’m currently a second-year grad student at App and one of our first assignments was to pseudostutter several times over the phone and in real life situations. Before completing the activity, many of us were concerned about stuttering inadequately or the response we would receive from our listeners. Though I will never be a PWS, the pseudostuttering exercise was an incredible learning experience for me. Thank you so much for sharing your clinical experience with pseudostuttering and the game of catchphrase. I think it is a wonderful activity for both therapy and for future clinicians of PWS. I was wondering if during the game you would discuss how the disfluencies were produced with Jeff? Or reinforce his disfluencies, by saying something like, “Oh that was a great stutter” if he drew a card that said to use a disfluent speech pattern? In addition to removing the token, how did you respond if Jeff was disfluent when he drew a fluent speech pattern card?
Thank you again for your insight and best of luck in your studies!
Abby
Abby,
Thanks for sharing your experience. Before we started the game we reviewed and modeled how different disfluencies sound. During the game if Jeff needed a reminder whenever he drew a card, we would assist him. However, when he did not stutter on purpose for the sake of the game, we did not discuss his disfluency types. Instead we tried to focus only on his fluent speech and use of controls. We did give him feedback whenever he stuttered as the card directed by saying things like, “That’s exactly what it sounds like to use many interjections, you really know how to provide a good example.” He would also praise us by rewarding us with a token whenever he thought we did a good job. By the time Jeff drew the use of controls cards he seemed to have the game under control and was barely disfluent, so we just offered praise for the fluents speech.
You have done a remarkable job explaining your experience! I also respect that as clinicians, you allowed yourselves to step out of your comfort zone. I am currently a second year graduate student becoming a speech language pathologist and recently experienced pseudostuttering for the first time with random strangers; in person and via phone. I was able to relate with your article as I went through the same emotions you described. I believe my experience pseudostuttering has allowed me to develop a deeper understanding for those who stutter and made me feel more competent when working with clients who stutter. To be honest, I initially felt nervous and scared to pseudostutter which allowed me to relate to the covert features associated with stuttering. When I approached the first stranger and asked “Where is the library?” while pseudostuttering, I instantly became comfortable when I saw that she maintained eye contact, waited patiently for me to complete my questions, and then provided me with multiple routes to the library. Thereafter, I gained courage to pseudostutter and that “scared” feeling was abandoned. This experience helped me to understand some of the struggles of a person who stutters. Without this experience, I feel that my advice/guidance would not be as meaningful and influential.
Thank you for sharing your experience! I plan on taking your advice to continue to expand my insight into the reality of people who stutter by psuedostuttering many more times and in various settings.
Thank you for your sharing your experience!
What a wonderful experience! I really enjoyed hearing about how often the children we work with teach us more about our selves than we realize. It was also a very good reminder to continue learning about how the children we work with view their world. What does daily interactions feel like through their eyes?
This paper is consistent with the current research regarding the value and importance of having clinicians and family members working with the child who stutters participate in the act of pseudostuttering. Yaruss and Quesal (2004) stress the importance of collaboration between the client and the clinician, especially when discussing treatment outcomes. Yaruss and Quesal (2004) have reported that clinicians are sometimes reluctant to make treatment strategies that are not behaviorally based. They attribute this to the fact that clinicians are not always aware of the aspects of stuttering that are not physically seen, such as the client’s feelings or anxieties and their attitudes about their stuttering. However, Cooper (1993) cautions clinicians not to overlook behavioral characteristics alltogether because of the possibility that some clients may never achieve full fluency. All individuals are different and, in order to plan an adequate treatment plan, clinicians must become aware of how it feels to stutter. One way this can be achieved is by non-stutterers experiencing the “pseudostuttering” process. Manish, Rami, Kalinowski, Stuart and Rastatter (2003) have found that, although student clinicians only experience what it feels like to stutter for a short time, the experience makes a powerful impact on the students and this approach has been proven to help student clinicians further gain empathy. Students who participated in pseudostuttering during telephone conversations became withdrawn and self conscious, expressing many of the affective factors that people who stutter approach every day. Pseudostuttering is a powerful way to remind non-stutterers of the hardships that people who stutter face. Experiencing the anxiety associated with stuttering will hopefully remind professionals and loved ones that stuttering is not just about the behavioral components, or just about their anxiety and other cognitive stressors.
Thank you,
Kristina Escoto
Kristina,
Thank you for sharing your thoughts and providing further research demonstrating the importance of the clinician being able to attempt to gain empathy. As you pointed out, it is vital that we are comprehensive in our strategies in order to be effective clinicians.
This was such a great paper! I love how you creating a game to suit your individual client. This is such a good idea for building a clinician/client rapport; I will definitely keep this in mind for the future. I’m sure your client was more than appreciative of you, as his clinicians, to put yourself in his shoes, even though it was for a short period of time. I’m curious if your relationship with Jeff became more relaxed or if there were any changes in therapy after doing this activity? My guess would be that he felt even more at ease, but it does seem like he was quite comfortable before. Also, were you able to increase his fluency past the plateau that you had reached? Thank you for writing about your experience!
-Courtney Bull
Second Year Graduate Student
Idaho State University
Hi Courtney. Thank you for reading our paper. I hope that you will consider giving it a try as a future activity. I think that this activity did create a more relaxed clinic environment for us all in future sessions. Jeff, Perry, and I were all initially nervous when we first met. Throughout the clinical process we all gradually became more relaxed as we became better aquainted. I think the game only accelerated this. Jeff’s fluency increased past his previous plateau during all therapy sessions afterwards. It was reported however (by Jeff’s mom)that this did not always transfer long term into his personal environment. Since we worked with Jeff in our school’s speech and hearing clinic, we have been unable to see Jeff since the semester ended. Perry and I both are currently inquiring about Jeff’s progress since the spring semester ended.
Hello Kristen, Perry, Dr. Shapiro,
My name is Maureen Duggan and I am a graduate student studying to become a speech language pathologist. I am currently taking a fluency class that is focused on stuttering and I participate in an externship program at a behavioral and emotionally disturbed school.
One of our assignments in our stuttering class was to go out into any environmental setting and pseudo-stutter. At first I found it very difficult to even try to start stuttering, feeling kind of embarrassed. After the second time of pseudo-stuttering, I started to feel desensitized, becoming more comfortable with the thought of it. I could relate to how Kristen and Perry felt when playing the Catchphrase game with Jeff. I liked how you both explained that you forgot your train of thought when telling a joke or explaining directions because it helped me understand how frustrating it can be in the stutters point of view. It’s great to see that Jeff realized how frustrated both of you were and at the same time you could finally relate to how he felt when stuttering.
The game Catchphrase was such a fantastic idea, one that I will definitely have to try in therapy with my student. Another game that may be helpful in therapy is Scattergories. It is another game that has a time aspect, but that necessarily doesn’t have to be used. My question is, how did you explain to Jeff that you were going to pseudo-stutter? My fear is that he would think you were making “fun” of him. I would love to try this with my student, but I feel as if he would feel very uncomfortable with the fact that I was pseudo-stuttering. If you could provide any pointers for me I would greatly appreciate it.
Thank you so much for your informative post.
Maureen,
Thanks for sharing you thoughts and experience pseudostuttering. I think your question is very relevant and an important detail that many may not consider before pseudostuttering in front of a client. We clearly explained to Jeff before the game why we were going to stutter. We made sure that he understood that it was in an attempt to put ourselves in his shoes and not make fun of him. I believe that we even posed the question in front of him, “Can clinicians who have never stuttered be as effective as those who do stutter”? Jeff verbalized that he was okay with the game and actually seemed excited that we were playing. I think that it was important that we had built a strong foundation before purposing this activity. It is also important to gauge your client during the game and if for any minute you believe they may feel uncomfortable, stop and discuss why. Hope this helps. Good luck in you future as an SLP.
You all showed two of the crucial aspects of being an effective clinician; empathy and genuineness! Once you gained Jeff’s trust and he realized that you were there for him and genuinely wanted to understand “his world of stuttering” did he allow you guys in. It’s almost as if the real therapy for him, as well as for you, started during that very session. Tackling those covert behaviors is crucial. We all experience vulnerability at some point in our lives and try to avoid those situations as much as possible. I’m glad that you were able to show Jeff how vulnerable you guys were during the process.
I worked with children with autism for 3 years as an assistant teacher. We followed the DIR Floortime model, which is based on developing relationships. What I learned early in my career is that you must build a rapport before anything else could ensue! My students needed to be able to trust me and somehow see that I was trying to relate to them before they allowed me into their world. Plenty of days you would find me laying on the floor next to a child or sitting next to him/her on a beanbag chair. Many times words were never spoken, but my presence and being there was enough.
I applaud you ladies on your hard work thus far. Empathy, genuineness, and rapport (amongst others) definitely go a long way in this field!
– Stefanie Hicks
Stefanie,
Thanks for your kind words. Although I am a beginning clinician and still gaining experience, I learned in my previous career (in the mental/behavioral health field)the importance of building rapport and trust. Thanks for sharing your experience in doing so. I think you hit the nail on the head when you said that you must build rapport before anything can truly ensue.
Kristen and Perry,
Wow! Thank you for sharing this experience with us. You guys are so creative! This sounds like a great exercise to help increase awareness of stuttering for both the PWS and the clinicians themselves. I am a graduate student studying speech-language pathology. In class, we were recently discussing the benefits of pseudostuttering during therapy. It is great to see that you had a positive outcome with this approach. Do you think this activity can work with PWS of all ages?
-Michelle
Hi Michelle,
As a student still new to intervention strategies, I myself am still learning what may work best for different ages. As of now, with my current experience, I think that this game may be best for older elementary-aged children, adolescents, and adults. However, if I do decide to use this with any elementary aged child (older or younger), I would only do so after I have established a strong enough relationship to be aware of their individual characteristics to determine if this activity is appropriate. These would include level of awareness, maturity level, anxiety level, and how much pressure they can handle. I hope this helps. Good luck in your future as an SLP.
What a Great idea I really enjoyed reading this paper! As a second year graduate student I have done pseudostuttering assignments both in my undergraduate and graduate programs. As an undergraduate I was very uncomfortable stuttering in public. As a graduate student who is very interested in fluency it was easier. I had to have phone conversations as well as face-to-face speaking interactions. While I found it easier to stutter to strangers I have a hard time doing it during therapy sessions with my fluency client. So bravo for doing it for an entire session!
My question is this: Did you do any pseudostuttering in any over you other sessions with Jeff? If so how did it go?
We only pseudostuttered during our sessions with Jeff when we utilized the Catchphrase activity. The result was always nearly the same.
Thank you for showing your interest in our paper and for sharing you experiences!
What a great idea! I love the game Catchphrase and this is a very clever way to adapt it for therapy. It seems to be a great way to not only increase fluency in the client while keeping him/her entertained, but also bring awareness and empathy to the clinicians.
Thanks!
Emma
Thank you for showing interest and posting a response to our paper!
Thank you so much for sharing your experience with pseudostuttering and how it benefits both the clinicians and the clients. I believe it is essential for clinicians to practice pseudostuttering in order to really understand what it is like for a person who stutters. I am a graduate student in speech-language pathology and in my fluency course, we were asked to go around the room and practice the different types of stuttering behaviors. Having to pretend to stutter in front of all of my classmates really gave me a glimpse of what it might feel like for someone who stutters.
I really enjoyed hearing about the “Catchphrase” activity and I believe it can be tremendously effective in therapy. Do you know if Jeff showed improvement outside of the therapy setting because of this activity?
Thanks again,
Chaya N.
That is really interesting that your fluency class participated in such an activity during class time! I imagine that exercise is very eye opening and beneficial. Pseudostuttering was exactly that for us.
Unfortunately we were unable to gain Jeff’s cooperation in utilizing a fluency journal. We were only able to gain a glimpse of his generalization based on the recall he would share with us in his therapy sessions. He did report that his fluency was much better at home and at school.
Thank you for sharing this intervention activity. As many readers have already posted, Catchphrase proved to be an effective activity, encompassing many of the components therapy seeks to target. I hope to have the opportunity to use this technique when conducting my own therapy.
My interest is actually on the effect this activity had on the clinicians. I was extremely surprised to read your outcome stating, “When we tried to speak in our usually fluent voices, we continued to stutter on occasional words and experienced generalized speech disruption.” How long after the activity did these disruptions last? Did all clinicians experience this phenomenon? I am curious if the experienced generalized speech disruptions would have persisted longer if the activity continued for several days.
The disruptions we experienced didn’t last too terribly long. For me, my naturally fluent speech was restored within the hour post therapy session when speaking pressures were alleviated. If the activity had lasted over a period of days I think the speech disruptions would have lasted much longer also.
Thank you for showing your interest!
I am currently a graduate student clinician in my first semester of clinic. One of my clients clutters, but also demonstrates some stuttering-like disfluencies. This therapy activity seems as if it can also be used with people who clutter. I have wanted to target desensitization with my client, but have not yet thought about/found the right activity….until now. I think this is a phenomenal therapy technique and will definitely try this with my 9 year-old client. I want the session to be productive while incorporating fun ideas/activities/games and this seems to be it.
In relation to your client, what type of fluency control did he seem to be most comfortable or knowledgeable using compared to the others? Or what was the fluency control he demonstrated difficulty with during the game? If you were to play “Catchphrase” again with “Jeff” (After playing the game a 2nd time) have you thought about incorporating a timer to the game?
– Monica
The fluency control that Jeff utilized was gentleness, evenness, and naturalness.
We had not considered incorporating a timer. Also, we did not plan on incorporating a timer at any time due to the amount of unnecessary pressure a timer would add.
I was so excited when I read about your “catchphrase” modification. I can really relate to the feelings you had when you experienced the embarrassment and frustration with pseudostuttering. I am a graduate student and I am in a stuttering class. One of our assignments was to try to understand how people who stutter feel when they stutter. I went out and tried to stutter to a stranger. It was scary. However, what I felt only lasted for a few short minutes. I thought to myself, how can anyone manage to live that way? I think, as a clinician, it is important to put yourself through these uncomfortable and vulnerable situations. After all, doesn’t your client have to feel uncomfortable and vulnerable in every therapy session? I am sure that Jeff truly enjoyed having his world realized by his therapists. I can only imagine that it helped to build a stronger relationship between all of you. Keep up the good work!
Lindsey
Thank you so much for sharing. I really appreciate your positivity and perspective.
Hi Ladies! Great work on this. Also, as a student, I respect the time and effort it takes to create motivating and relevant materials to use with our clients. After reading this and thinking about the fluency class I am currently enrolled in, I see a great need for more information on counseling our clients. I was struck by your comment that the client had not yet reached the level of “emotional maturity” needed to speculate on potential causes of his plateau. What if any modifications do you think would be helpful to the curriculum of Masters students in order to enhance our clients’ ability to think more critically about their own care? Also, do you feel that it is right to dismiss clients who have plateaued and are not yet capable of the introspection needed to propel his or her own therapy further?
Thanks! Kim
Hi Kim. Thanks for your praise and thought provoking questions. I agree with you about needing more information on counseling our clients. No matter what path we decide to take in this field, it seems that we are often in counseling like situations (whether it be with the client or even a client’s parents).It just so happens that I have a several years experience working in the mental/behavioral health field, so I feel comfortable in this area. However, I realize that this is something many new clinicians do not have experience with and feel very uncomfortable with. What I am getting at is that I think a counseling class would be very beneficial in serving our clients and teaching us how to handle uncomfortable situations, like how to talk about issues with Jeff like his plateau. However, Jeff is extremely sensitive (or was during this semester) so we had to be careful about how we worded things. I think no matter how prepared we were at thirteen he just didn’t show signs of the ability to apply metacognition. I do feel that it is right to dismiss if no progress is being made and this is something that we considered greatly mid-semester. We brought up the possibility to Jeff and his mother and stressed the importance of making an effort taking therapy to the next level or dismissal until he is ready to do so. Jeff thought about it for a few weeks and decided that he was ready to work harder and try to progress. So we decided to continue with treatment. You pose great questions! Thanks for contributing. I hope that this helps.
Hi!
I too have had a few instances in which I have had to pseudostutter, two in my undergraduate and three in my graduate career. However, I have not psuedostuttered in front of an individual who stutters. I feel as if I would have a really difficult time pseudostuttering in front of an individual who stutters, although I have read how about its increase in effectiveness. I really respect the time that you placed into your client to push him past his plateau while additionally putting yourselves into vulnerable positions. When preparing for your sessions, did you find that you had an increased anxiety? If so, is this something that you discussed with Jeff? Is he at a level of awareness where he could discuss the anxieties of his stuttering and the ‘ramifications’ of that anxiety? Thank again for sharing your experiences!
When we initially prepared to play Catchphrase, Kristen and I didn’t expect to feel the way we did during the session. We planned the activity solely with Jeff in mind, not ourselves. We were aiming for him to experience fluent moments during the session which would address the concept of he himself having control over his own speech. Once we were in the session and experiencing the unexpected anxiety, Jeff was very candid with us, and we were as well. We tried to be open about our feelings, which only opened the door for Jeff to share more of his personal feelings and story with us.
Thank you so much for sharing this therapy tool with us! As a first year graduate student I am very eager to add to my bag of therapy tricks and this Catchphrase game seems like an important technique to include. It is a great idea to use for stuttering therapy. In my opinion it is difficult to use games in therapy with adolescents and young adults in a way that doesn’t seem condescending. I really liked how you used this game in therapy and engaged in the activity in the same way you expected your client to participate, by following the same set of rules you put yourself on the same level as your client, which is hard to do. I love that the game helped improve the clients fluency and acceptance of stuttering. I also liked that it was so beneficial for the clinicians to practice pseudo-stuttering and gain a small understanding of what it feels like to have to stutter, and not having the choice to speak fluently even though you want to. I think it would really help the client to see that you have gained some insight into what it is like for them on a daily basis. This helps you to connect more with them, which can build their comfort and trust in you.
In closing, I would like to give my opinion on one of the questions you asked at the end of your paper and that is, “Do clinicians who stutter make better therapists for people who stutter? Can a clinician who does not stutter work effectively with a person who stutters?” Personally I feel that a clinician who does not stutter can be just as effective in stuttering therapy as a clinician who truly stutters, that is if they show willingness to understand what it is like to be a PWS. I think doing this game is a great example, both clinicians actively participated in pseud-ostuttering and wanted to show that they are trying to understand what it must feel like to stutter. On the other hand, as a clinician who does not stutter, it is important not to assume you know how it feels. You should tell your client I will never understand what it must feel like to be a person who deals with stuttering on a daily basis, but I am willing to learn from you and would love for you to share experiences with me so I can do whatever I need to do to help you.
That’s all, thanks again so much for sharing!
Laura
Illinois State University
Thanks for your insight Laura.
After doing therapy with catchphrase were you eventually able to dismiss the client or is he still currently receiving therapy? Also, as a student clinician did you feel more anxious going into the session knowing that you have to pseudostutter? We thought this was a great paper and an excellent tool for therapy. It was a great way to modify a motivating game for his needs. Thansk for the suggestion!
We did not dismiss the client from therapy. We ended the school semester with some various topics to think about on his own time, and with his family, regarding where he envisioned therapy going and what he’d like to accomplish as a communicator.
There were definitely some anxious feelings when I knew I was going to pseudostutter. The end result for myself, and for the client, outweighed my anxiety. It’s worth it even though it is scary, in my opinion.
Thanks for your positive comment and good luck in your studies!
This article was very interesting to me and I value what the clinicians learned in this experience and am very intrigued by this game but I am wondering what the effects would be in a group of children who stutter. Has this been done? Would you consider implementing this game in a group with multiple children who stutter rather than with clinicians who do not? Focusing on the child’s treatment rather than what the clinicians gain.
Hello. We have not played this game with a group and I have not heard of any instances where a clinician implemented an activity like this in a group setting. However, I think that it would be a good idea with older children (Jeff’s age) if they are already paried in a group and are well acquainted with each other. Since the main purpose is for the client to realize that they are in control, I think an activity like this is essential and would be fun for a group. Thanks for sharing.
I really enjoyed reading your article and I thought that your therapy idea was really neat. I need to add this one to my bag of tricks for the future! I am currently a second year graduate student and I am in counseling this semester. As I was reading this I wondered if Jeff seeing you and your fellow clinician stutter and experience frustration, if that provided an opportunity to further explore his feelings towards stuttering?
It definitely opened the door to further discuss his feelings towards stuttering. Jeff had made remarkable progress prior to mine and Kristen’s work with him. The great thing about him is that he enjoys talking now! This activity really helped us get to know Jeff more personally. It provided him an opportunity to share more of his personal story. It was a very profound session to say the least.
As a first year graduate student/beginning clinician, I was immediately drawn to you presentation. I was expecting the “unexpected benefits” you found to be about your client was surprised to learn how much you as clinicians gained through the activity. I am in my first Fluency class this semester and we just completed our pseudostuttering project as well. For our assignment we had to stutter in several different public locations and after experiences mockery and abrasiveness, I can say that I was also frustrated, angry and exhausted. But the benefits of the assignment were enormous. All though I can never understand what it is like to truly stutter; I have a better understanding of the emotional aspects one who does stutter may face. I think that pseudostuttering should be an essential part of graduate programs to help clinicians understand what it is like for someone who does stutter. Thank you again for sharing your story.
Breanna Minor
UW-Stevens Point
Thank you for sharing your thoughts and story as well. Psuedostuttering is tremendously eye opening. More so than one thinks, until they participate in it. We had no idea what an impact Catchphrase would have on us as clinicians.
Hello all,
Like many others who have commented, at both the undergraduate and now graduate level, I have engaged in pseudostuttering in a variety of settings. I can agree with many of the points you discussed regarding your feelings and reactions to pseudostuttering. As a student, I cannot agree more with your statement regarding SLPs intending to work with PWS to engage in this activity. Additionally, being able to carry out this pseudostuttering experience while providing therapy allows you as the clinician to grow leaps and bounds in quick time frame. How great that Jeff was able to see you as clinicians beginning to relate – you can’t ask for a better client/clinician relationship.
One question. You discussed using audio feedback with the recorder, have you ever thought about using video self-feedback using an iPad or other device with quick playback? I wonder what type of affect this would have with individuals who stutter. Thanks for sharing this rich experience!
Lauren
Thanks so much for your positive comments! It was a very neat, and eye opening experience.
I believe the clinicians that worked with Jeff prior to me and Kristen used video self-feedback at times. Honestly, we didn’t use, or consider using, video self-feedback because we had success with the audio playback. Had we experienced a major setback we could have quite possibly turned to that option. It can be an extremely beneficial tool in therapy. We were careful to only re-play utterances in which Jeff was completely fluent. A video in addition to the audio may have been a great experience for him now that I am thinking about it. Thank you for raising this idea and consideration!