About the author: Amanda M. Glover is currently a second year graduate student striving to attain her Master of Science degree in Communication Sciences and Disorders (CSD) at Western Carolina University (Cullowhee, North Carolina, USA). For her Bachelor of Science degree, she studied CSD at the same university. She is honored and blessed to study at such a beautiful institution with devoted and experienced faculty members. Amanda is fortunate to have a loving, supportive family encouraging her to pursue her goals and aspirations. She is eager to work with all people who have communication disorders, including people who stutter.

About the faculty sponsor: David A. Shapiro, Ph.D., CCC/Speech-Language Pathology, is a Fellow of the American Speech-Language-Hearing Association, a Board Certified Specialist in Fluency and Fluency Disorders, and the Robert Lee Madison Distinguished Professor at Western Carolina University (Cullowhee, North Carolina, USA). For 39 years, Dr. Shapiro has taught workshops and presented papers, provided clinical service, and conducted research on six continents. His book, Stuttering Intervention: A Collaborative Journey to Fluency Freedom (2nd ed., 2011, PRO-ED, www.proedinc.com) 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 Award of Distinction for Outstanding Clinician, and served as IFA’s President from 2012-2014. Most recently, Dr. Shapiro received the 2016 Oliver Max Gardner Award, the University of North Carolina Board of Governors’ highest honor for faculty in its 17-campus system. Dr. Shapiro is a person who stutters, has two adult children with his wife, Kay, and lives near the Great Smoky Mountains National Park.

“There seems to be an element of magic in stuttering therapy, an elusive, ephemeral, and yet powerful force which most clinicians acknowledge but few can precisely identify.” (Emerick, 1974, p. 92)

This paper emphasizes the importance of academic, clinical, and supervisory instruction within professional preparation of speech-language pathologists (i.e., SLPs, clinicians) who provide clinical service to people who stutter (i.e., PWS, clients). It also acknowledges the uniqueness of stuttering and stuttering intervention, which requires specific knowledge and skills to address the necessary affective, behavioral, and cognitive elements of stuttering and communication.

The purpose of this paper is to take a closer look at one elusive yet powerful element that operates within the clinical interaction, indeed an aspect of the interpersonal relationship between the client and the clinician that may in part determine the outcome of treatment. Specifically, this paper will define faith, also referred to as confidence and hope, and its relevance to stuttering treatment. To do so, I will describe briefly the professional preparation I am experiencing as a graduate student in speech-language pathology and the SLP I aspire to become, share the personal beliefs that guide everything I do, define faith as a clinical variable, and finally, raise questions that invite clinicians and clients to take a closer look at an aspect of the client-clinician interaction that impacts the process and outcome of treatment.

Professional Preparation

As a graduate student studying speech-language pathology, I have completed the first year of the two-year Master of Science degree program at Western Carolina University. Our program requires 60 semester credit hours of extensive academic coursework and 400 hours (including 25 hours of observation) of supervised clinical practicum. Among other courses, last year I completed the Fluency Disorders seminar and participated in a group treatment experience combining self-help and modified direct treatment, all of which Dr. Shapiro coordinated. Five graduate clinicians met weekly with teens and young adults who stutter. Initially meeting as strangers, the clients soon realized their many commonalties, only one of which was that they all were PWS. Similarly, the clinicians soon realized their commonalities, including that all were new to fluency intervention. Furthermore, both the PWS and clinicians began a new journey together. These discoveries contributed to a relaxed, comfortable, genuine environment, leading to trusting relationships among all participants of the group. Such trust developed a shared sense of confidence in the abilities of all to succeed. That trust and confidence generated respect, dignity, and recognition for oneself, each other, and the collaborative commitment to positive change.

More specifically, clients and clinicians initiated topics for discussion and related activities. The clients elected to receive modified direct treatment from the clinicians. The clinicians regularly involved the clients in planning, implementing, monitoring, and reflecting upon each treatment session. Data were collected to monitor measurable client progress, including behavioral (i.e., use of fluency facilitating controls and self-corrections) and both affective and cognitive (i.e., feelings and thoughts regarding oneself as a person and as a communicator) aspects of communication.

As part of the instructional experience, I am encouraged to reflect on what I learned and what it means, namely the type of SLP that I aspire to become. I want to be the type of professional who never replaces the most essential elements of human interaction and best practice with expediency. In other words, I want to be as true to my profession as to myself. For me, service is a calling. I want to have the type of relationship with all of my clients where they feel comfortable with me not only as a professional, but as a person. Hopefully my clients will consider me to be a friend. Reflecting further on the academic and clinical experiences, I have begun to wonder if faith, which will be defined shortly, should be looked at more closely as a variable that could significantly impact the process and outcome of treatment.

Who I Am and What I Believe

I am a person who is fortunate. Growing up in the southern USA, I am surrounded by two types of people: fisherman and Christians. My father is both. Our frequent father-daughter time on the lake always begins with his familiar remark, “We’re gonna catch ‘em today.” Despite often reeling in an empty lure, he remains confident. THAT is faith. On a more serious note, my dad has experienced challenges in life; he has had his heart broken too many times. Whether the challenges are large or small, he leans heavily on the promises of God. As sure as he will catch a fish, he remains sure of the truth that lies within the promises.

My father’s faith is a welcome influence on me to the present day. Like my dad, I see the world as full of possibilities. I believe that the Lord has led me to where, what, and with whom I am studying. I know that He will lead me to a bright future. When I meet new clients, I see their positive potential. Nevertheless, I have my doubts occasionally. For example, having never stuttered, I wonder if I can come to understand – as fully as I must – the world of someone who does. Can I become the competent clinician I want to become? Yet I know He has a plan for me, and my faith in that plan, combined with ongoing instruction and professional experience, will lead me on a path to the full understanding that I seek.

Faith Defined

A Biblical background has molded my personal definition of faith as simply believing before seeing or possessing. Faith enables me to believe in the potential of others, particularly my clients, even before we begin. For example, I knew before participating in group treatment that the clients and clinicians would learn, succeed, and have a positive experience.

I realize, however, that what I believe is not necessarily shared by others. I have seen faith, or confidence yielding to hope, result from various other sources. In more secular terms, faith may be viewed as shared confidence between individuals before the manifestation of successful results. This seems to be essential within the clinical process, particularly when working with PWS. PWS benefit from having confidence that the clinician possesses the necessary qualities (i.e., knowledge, skills, abilities, and temperament, among others) to help him achieve communication success. PWS also benefit from a clinician who believes in the client’s potential for positive change (Daly, 1988; Shapiro, 2011).

Faith as a Clinical Variable

Faith within the clinical process can come from various sources. Data increasingly reveal the importance of the client-clinician interaction, as well as specific clinician attributes that elicit mutual hope, confidence, and more positive treatment outcomes. For example, DiLollo, Manning, and Plexico (2010) analyzed the characteristics of SLPs whose treatment resulted in their clients achieving fluency improvement compared to SLPs whose treatment was less successful. One characteristic of SLPs whose clients achieved success was the clinician’s belief in the client’s potential. Similarly, Daly (1988) indicated that one of the most predictive factors of treatment outcome is the clinician’s attitude toward the client’s ability to reach his communication objectives. Shapiro (2011) structures treatment so that the PWS experiences success at each stage of intervention and within each treatment activity. Nothing motivates more than success itself. Success begets success; success leads to confidence and hope in positive change. Shapiro (2011) reviewed attributes of effective clinicians, including empathy, warmth, genuineness, personal magnetism, and realistic optimism, among others. Cooper (1997) also delineated characteristics of effective clinicians. These qualities include being honest, positive in their attitudes, reflective, open-minded, informative, perseverative in their pursuit of goals, and detailed.

From my clinical experience, I learned that PWS often take on the confidence of their clinician. Fortunately, clinicians and clients each possess significant roles within the therapy session. In conversations with two bright, insightful men in our fluency group, I asked what role (if any) faith played in their achievement of fluency success. One remarked, “If someone has confidence in me, then my confidence is built, which positively affects my fluency.” The other explained, “If I am confident in myself and my clinician, my speech will get better, and it will be reflected in the numbers,” in reference to the numerical data taken on his fluency. Both clients make reference to their own ability to express faith in themselves and their clinicians.

Summary and Implications

In order to consider the relevance of faith (i.e., confidence or hope) within treatment for PWS, I have reflected on my experience as a graduate student in SLP, shared my personal beliefs, and defined faith as a clinical variable. What I have learned particularly is that sometimes things that are considered small can have a huge impact. My father couldn’t know the extent to which his life of faith has influenced my outlook and the way I live my life. Similarly, faith within the clinical context might possess more significance than we often assume. From the literature and my initial clinical experiences, I have made an important discovery: the clinician’s confidence in the ability of the PWS to succeed and the extent to which the PWS perceives that confidence both impact the process of treatment and its outcomes. Now more mindful of the importance of these variables, I reflect on a number of related questions. I invite you to share your thoughts with me.

Questions to Consider

1. What role, if any, does faith, also defined as confidence or hope, play within the clinical realm? How might faith contribute to fluency improvement, motivation, and continuation in treatment?
2. In what ways might faith within the clinical realm present in different forms, functions, and at different levels?
3. How can a clinician create faith in a PWS who, from previous treatment or life experience, feels that communication success is impossible?
4. As a PWS, what advice would you offer a clinician to create a faith-filled clinical environment? As an SLP, how would you enable every PWS to develop his own sense of faith and to achieve maximum communication potential?
5. What possible role might God play in the treatment experience and its outcome? How can personal faith (i.e., religious interpretation as believing before seeing) and evidence-based practice (i.e., seeing before believing) merge?

References

Cooper, E. B. (1997). Fluency disorders. In T. A. Crowe (Ed.), Applications of counseling in speech-language pathology and audiology (pp. 145-166). Baltimore: Williams & Wilkins.

Daly, D. A. (1988). A practitioner’s view of stuttering. Asha, 30 (4), 34-35.

DiLollo, A., Manning, W.H., Plexico, L. W. (2010). Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering.  Journal of Fluency Disorder, 35, 333-354.

Emerick, LL. (1974). Stuttering therapy: Dimensions of interpersonal sensitivity. In. L.L. Emerick & S.B. Hood (Eds.), The client-clinician relationship: Essays on interpersonal sensitivity in the therapeutic transaction (pp. 92-102). Springfield, IL: Thomas.

Shapiro, D. A. (2011). Stuttering intervention: A collaborative journey to fluency freedom (2^nd ed.). Austin, TX: PRO-ED.