Positivity and beneficial approaches
Hello My name is Dani, and I have enjoyed reading about everyone’s stories. I am a graduate student learning about fluency and love how supportive this area is and how everyone’s story is unique. My question for the panel is what do you find most beneficial when working with the fluency population and how does your perspective differ between age groups? Additionally, I was wondering if someone who experiences a fluency disorder if you would be able to give me insight on what has been most beneficial for you growing up and building confidence with communication.
Hello Dani
I suggest a reframing of the terms that you use.
Instead of learning about “fluency”, your college should be teaching you about stuttering. You will be working with the “stuttering” population, or, rather, with people who stutter and their families, not the “fluency population”.
Stuttering itself is not a disorder. We might develop disorders due to stigma, shame and the associated trauma. Disorders might include anxiety, and will most likely include the struggle response to the stigma of stuttering. The struggle changes “just stuttering” into so-called “severe” stuttering.
These clarifications are crucial if you wish to be a successful therapist to people who stutter. Your job is not to create fluency; it is to guide the PWS to being able to let go of shame and anxiety, to stop avoiding stuttering, and to “just stutter”. Then, the PWS will be free to live their lives.
If you have more questions, feel free to reach out for a deeper discussion.
Wishing you success in your studies and your career.
Hanan
Hi, Dani. Thank you for your interesting and important question!
My fluency disorder did not hold me back from communication as I was growing up. I realized from a very early age that not everyone had fluency of speech, and that people had different levels of abilities in different aspects of life.
Although I often had much difficulty in speaking (my stuttering is severe), I was looked up to and respected for skills and talents in areas other than speaking. I had strong academic abilities; I was a very early reader; I was playing piano and composing music from an early age; and I had mathematical abilities and memorization skills.
I realized that while most people around me had fluent speech and, unlike me, found the act of speaking to be easy, some people did have trouble speaking, similar to me. One of my father’s first cousins stutters, and when I was a little boy, she was a teenage girl – and I knew her well. Also, there was a girl in my elementary school class who stuttered, so I wasn’t the only one in my class who stuttered. My classmates were quick to learn – beginning in kindergarten or first grade – that some kids had trouble in speaking.
In school, I often had the answers to teachers’ questions, and was never afraid to give the answers. I also raised my hand a lot, and asked questions, if something the teacher was explaining wasn’t clear. My classmates and my teachers all knew that I spoke differently; everyone around me respected my knowledge and insight, and I never was afraid to stutter.
I built self-confidence from WHAT I was saying, and NOT from how I was saying it. My developed beliefs and attitudes were that different people had different areas in which they did very well, and other areas in which they didn’t have the same skills as others did. To me, this was natural, and not a big deal. I wax a different type of child in numerous ways – and I accepted that fact.
I had lots of speech therapy as a child (beginning at around age 4!), but it wasn’t helpful to me. The clinicians did not have any idea of how to treat my problem of severe stuttering. I realized that too from an early age, and I just accepted that I happened to be different. And that was that.
Best luck in your studies!
– Paul
Each person has their own unique needs and goals; as therapists, our role is to facilitate their communicative well-being. In my experience, the most beneficial approach involves learning to understand one’s own stuttering from a place of curiosity, while reducing avoidance and fear related to it.
Regarding age, it is essential to involve parents and teachers when working with children and adolescents; peers also play a crucial role in the therapeutic process. Another key factor is an individual’s cognitive and emotional development, which allows for interventions to be tailored to their specific capabilities and needs at each stage of life. Finally, when working with adolescents and adults, it is vital to understand the daily challenges they face in their own lives, as this enables us to effectively support them throughout the therapeutic journey.
Hello Dani!
As we see in both clinical practice and research, stuttering and cluttering are experienced in very different ways, depending on context and on a range of intrapersonal and interpersonal factors. I value David Shapiro’s observation that “stuttering is whatever people who stutter feel their own stuttering to be.” I therefore strongly support Ana Karina’s statement that each person has unique needs and goals. I think this principle should be central to our clinical work; that the process and direction of therapy should be guided by each individual’s experience, needs, and goals. We recognize that a range of approaches and therapy elements are regarded as useful by the persons’ who stutter themselves. This aspect I do recognize in my own clinical practice, as well as in research. When research related to adults is regarded, evidence so far point to several directions and there are still significant challenges as to what might be defined as positive therapy outcomes. In this sense, the perspectives from persons who stutter are therefore highly important to acknowledge. In the multinational study of Neumann et al. (2019; published in an open access format (https://www.sciencedirect.com/science/article/pii/S0021992418300789), we see that many people who stutter benefit from a mixture of behavioural and emotional-/cognitive-based approaches. Furthermore, perceived speaking ability and confidence in communication seems to be the most important clinical factors. We also know that stuttering therapy itself is not the only factor influencing outcomes. Rather a range of factors may play a role, including the person’s personality and motivation, as well as the quality of the therapeutic alliance. I believe that establishing a trusting, honest, and authentic relationship will create the best situations for exploring the therapeutic process together. In the MIST (Multidimensional Individualized Stuttering Therapy) study, I found that most participants chose and benefited from different combinations of therapeutic elements, tailored to their specific needs and goals. This information is also available for free, if you would like to continue reading about what the persons who stutter may regard as useful elements in stuttering therapy (https://www.sciencedirect.com/science/article/pii/S0021992420301209).
I wish you all the best for your further education!
Hi Dani
I’m glad to read you’re learning about stuttering, not to much that you’re learning about fluency, nor “the fluency population”. I don’t even know who those would be. As fluency is not automatically the goal of every person who stutters, and for most of us it’s unattainable.
As we’re all different, want and need different approaches. Some might want total fluency. If so, make sure they understand that this might not be an obtainable goal, but that there are many steps in between. Some might want help to accept and live with stuttering. Some might simply want some techniques to get out of a block. Some might want to know more about stuttering. Some might want help to get family members to understand. And therapy can be a full smörgåsbord with different things to try, of which some are maybe completely different than speech therapy. F ex yoga, singing, art. Also bring your clients to support groups, stutter camps and online places where PWS meet. This has been life changing for me. And even goals may change along the way.
So please don’t think in fluency or stuttered syllables, nor in fluency being the (only) goal. And if it still is, try and find out if it’s the client itself who wants it, or if it’s family members, teachers, employer, or even the SLP. As, if it isn’t the client itself who comes for fluency, not only will therapy most likely fail, but also risks for the client to become silent, covert.
When I was you, stuttering was taboo. Nobody talked about it. Not at home, not at school. Noone told me there were others. When I was in my late teens my school wrote a letter to my parents (which I found out many years later) that I should see an SLP. This didn’t go well (private story), but a few years later I tried another one. Thsi didn’t go well either and I lost all trust in SLPs. I even other tried other therapists, f ex healing, hypnosis, etc. Long story short, they were all focussed on my breathing and fluency. I can breath. I play the saxophone. Stuttering? Wrong. the only goal was fluency. If their methods didn’t “work”, I was to blame. I was lazy. I didn’t want to be “cured”.
Later on in life I found a support group where we practiced public speaking. THIS became one of my keys to freedom. I could speak. Just not fluently. I also found other fantastic, dedicated SLPs who were no longer focussed on fluency, but on making clients talk freely again. I also found Mindfulness and NLP. More keys. And I found the stuttering community. The biggest key of all.
Unfortunately there are still SLPs who’s goal is fluency and less stuttering syllables. Fluency? Is it the SLPs who wants it? Parents? teachers? Employers? If it’s something others want, it’s doomed to fail. Even worse, it can lead to silence, covert stuttering, fear, shame, low self-esteem, or even worse…
So start with listening. Ask questions and listen, before you even think of starting therapy. As we all bring different things to the table. Background, culture, religion, family, age, gender, and our many different experiences. This goes for clients of all ages. You may find out that not all clients come for total fluency. Some want answers, some want a family member to know more, some want some tools to speak with less tension, some want to practice job interviews, some are there because the parents want the child to be fluent while the child just wants to speak freely, some want help with self-esteem, etc etc. When you get a picture of the client and what they want (at that moment, as it can change along the way, and if that’s reachable of course), you can start offering a smörgåsbord. This can be all from speech training to refer to relaxation, mindfulness, NLP, speaking circles, theatre, art, presentation techniques, yoga, swimming, singing, and maybe even a combination.
Also show the way to the stuttering community. This group is not instead of, but can be a great addition to therapy. People who walked the walk and literally talked the talk. They can help with exercises, help to speak in school or at the workplace, support outside the therapy room, etc. They often have gatherings, camps and some even have virtual meetups, even international ones, with meeting friends and simply playing games together.
With acceptance being the safety net, you can start the journey of practice, challenging yourself, and go for your dreams. Acceptance doesn’t mean you’re done. It means you catch your breath and get ready for the next step, whatever that step may be.
And help me to find my true self, and my self-worth. Show me what I’m good at, and that stuttering is not bad and fluency good, but that stuttering just IS. And that it’s not up to me to make my listener happy, but maybe instead up to the listener to simply… listen. Help me to see there’s more in life then fluency. And that I’m good enough either way. But to also help me to find tools that fit me and my stutter, ways to explain to others what stuttering is, ways to meet bullies and other people not getting it. Ways to speak to my teachers. And show me the way to stutter camps, where I can be me, speak freely, without any therapy, and where my parents can come and speak with adult PWS. As the more we understand, the more we feel good enough, the more we lose the shame. So be a friend.
Most of these advices can work with both adults and children. With children however, make sure you listen to the child and not just to the parents, as they can have different goals, and the child might tell you what s/he thinks others want to hear. So have them both together and seperately. Also group meetings are good, to show they are not alone, and do exercises together, the same for parents.
Lastly: stop the counting syllables. Just because someone stutters less, doesn’t mean things are going great. It can also mean the iceberg is getting under the surface, and thus way harder to notice, and to treat. So listen not only with your ears, but also with your gut, to what’s not been said.
Sounds tricky? I promise you that, as soon as you gain your client’s trust, you’ll have an exiting road ahead, walking and working together, sharing ups and downs, and enjoy the progress, whatever this word includes for that very client.
Keep them talking
Anita