Negative emotions and anxiety
Hello, I read the article Reducing negative emotions and anxiety using a mental approach on ISAD website and was left with some questions. In therapy, would you devote an equal amount of time in therapy to mitigate negative emotions and anxiety as you would to working on fluency? Furthermore, which method do you think is the most efficient for teens?
It would depend entirely on the clinical presentation and needs of the client.
Lynn,
Hi! You ask a great question, and thank you for that. There really isn’t a formula for doing counseling and fluency techniques. It really does depend on the client and what they want. It is our responsibility as clinicians to have the tools to help. Clients may like some of the things we do with them, and not like others things. Even children have a sense of what works for them and doesn’t. They might not be able to verbalize why they don’t like something, but they will most likely let us (or their parents) know. For me, the basic foundation for therapy is to make speaking fun and functional for the client. That involves talking WITH them, not at them. So counseling is always being performed, even if you are using fluency enhancing tools of any sort.
You might have all kinds of clients. I’ve had school-age children who essentially had the same physical behaviors but who required different paths of treatment. One client didn’t really care much about their stuttering (they would hesitate if theu had a long moment or prolongation but they would keep moving forward a second or two later), but their parents were concerned. So with parent counseling, and the subtle modeling of some comfortable speaking skills,which involved listening skills and relaxed speech (at home and in the therapy), the client’s environment changed at home and her speech became more comfortable and fun. To my knowledge she still has mild physical disfluencies here and there, and it doesn’t stop talking form saying anything. On the other had, I had child with the exact same physical behaviors who seemed to care more about their speech (avoided talking in school and with family), and their parents weren’t as activity with following through. With this client, we did more counseling, creating fun activities around their interests and talking about stuttering and their thoughts about their speech, all modeling comfortable speech. The client eventually expressed that “speaking is hard. I get tired.” We talked about and tried some different relaxed speaking techniques, while still creating fun activities to talk in. This client began talking in school, and got involved in activities where they talked in front of groups of people (cow judging) within a year.
Other clients I’ve had strictly liked fluency techniques to help them ease through their speech and they didn’t like counseling activities. While still other client only enjoyed counseling techniques and creating speaking situations where they found success, no matter how they talked.
Success is determined by the client’s perceptions of success, for them!
Here’s the point. Each client has different motivations, back grounds, and levels of support, along with different definitions of success. So, if we have a variety of tools, we can figure out (with them, of course) what is best for each client. This may not help answer your question, but the way I see it, clients are not cars. We can’t “fix” them. We can help them, listen to them, provide guidance, and tools. There isn’t a magic formula. There are many theories and philosophies, tools and techniques that might help. But the hard work comes on the end of the client, and their families. They drive bus, we are just a guide.
Thanks for asking a great question!
Have a wonderful day.
With compassion and kindness,
Scott
Scott, thank you for your great response. What has been your experience with collaborating with mental health professionals and referring PWS to a LCSW or Psy.D for counseling ? What were the outcomes ?
Thanks !
Nora
That’s a great question!
I agree with both the previous posts (the two that are currently viewable) – it depends on the client and their needs. I have worked with kids where the focus has been the emotions, where there is teasing or fear of talking out loud in class etc. There are many counseling based techniques, including cognitive behavior therapy, Mindfulness, that have been written about. The Stuttering Foundation has some workbooks to work on the emotional aspects of stuttering with children as well. It is important to work on what the client needs and for SLPs to be able to match their clients, rather than only focusing on a ‘one size fits all’ approach’
Thanks!!
Anu
Hi, Anu. Thanks for being a part of Ask the Expert.
I am a PWS and a mental health professional. In your practice, when do you determine that a mental health referral is needed ? What has been your experience with building professional relationships with LCSWs, Psy.D (etc) so when referral is made you feel confident that the provider has knowledge of stuttering?
Thanks.
Nora
Lynn, stuttering has many facets to it. The research is pointing it being a malfunctioning speech production system. This means that the brain is not producing speech in the way that results in normal fluency. The brain, however, is not only responsible for motor function and language formulation, it also holds our thoughts and produced the chemicals that are our feelings. The interaction of the whole system is such that I can’t see how we can treat only the thoughts and feelings or only the neuro-motor processing. I think all this has to be treated as part of an interacting system. Time-wise, it’s hard to say if we need to devote more or less time to one aspect or the other. However, I believe that we need to relate to both aspects simultaneously. That means, for instance, neurologically the person who stutters might be learning to produce a natural voice for speaking. While doing this there are thoughts going through the person’s mind. These thoughts need to be recognized and identified as either helpful or inhibiting progress. Thoughts can be changed when necessary. Sometimes, clients begin speaking with natural fluency, but their thoughts are the same as they were previously and the person believes that it will be difficult to speak that way in certain situations. That belief will send messages to the speech production to go back to its old behavior. On the other hand if we try only to help the person get over the fear of blocking without giving him an easier way to speak, it seems to me that we are trying to get the fireman not fear fire, while not giving him anyway to avoid getting burned. When clients change the way of speaking without changing the mind, or try to change the mind without making speaking flow more easily the result is conflict and frustration. You asked about teens specifically. That is an age when so much is changing. Thoughts and feelings are greatly fluctuating and the brain is still developing the ability to speak. I think the dynamics of nature at work here can be used to advantage. If we help the teen to be aware of his thoughts and feelings and how he is using his brain and speech musculature to produce speech, we can help the whole system evolve into a freer more comfortable system.
I tend to think about each client in terms of how they are affected the most by the ABCs of stuttering: How much impact do the affective, behavioral, and cognitive components have upon their overall communication effectiveness. For every client there is a different presentation of those components. I target my therapy according to which components need more time, according to the individual client.
In your practice, when do you determine that a mental health referral is needed ? What has been your experience with building professional relationships with LCSWs, Psy.D (etc) so when referral is made you feel confident that the provider has knowledge of stuttering?
Thanks.
Nora