Question
Hi, my name is Sierra, I am a future SLP and I was wondering if there was a time in your career in which there was a patient that would not progress no matter what technique you used. If so, what were your next steps in order to help the patient, and how did you feel about this experience.
Thank you
Hi, Sierra! Thanks so much for asking a question to the professional panel and congratulations on your studies. The field of speech-language pathologist is such an exciting one, and I hope that you enjoy this journey as much as I have. There have been times in my journey (notice I don’t call it “career” because for me personally it’s been a life passion and experience and not just a “career”) 🙂 as a speech-language pathologist when individuals that I see in the clinic have demonstrated difficulty with progressing towards goals. When this happens, we must first survey the goals themselves, and when establishing goals with individuals who stutter, it is a unique and special process.
First, when I teach my graduate students in their stuttering coursework, I have them draw a ship on their papers regarding the goal writing process. This sounds odd- but stay with me here. The ship is basic… just two main parts a main ship and a steering wheel. The ship is labeled as the SLP: the SLP provides the template in the therapeutic alliance/goal writing process and writes the goals themselves with the educational background and knowledge possessed. The steering wheel is labeled as the child with stuttering/parent/guardian or the adult person who stutters. They steer the ship. The person you are seeing in therapy determines the goals that we write based upon what they wish to accomplish in therapy. Just like I tell my physical therapist what I wish to accomplish in physical therapy based upon my personal lifestyle. Stuttering is an individualized experience- VERY individualized, and we cannot put stuttering therapy in a box that is a “one size fits all” treatment plan. So back to the ship analogy, the ship cannot function without the steering wheel and the steering wheel cannot do therapy with no ship. The therapeutic alliance with the person and the clinician must work together- but remember, the steering wheel (the person that you are seeing for therapy) steers the direction of therapy… because it is their stuttering experience that you are treating, not your own. Once we know that the goals established in the treatment plan are appropriate to the person that you are seeing for therapy, you then secondly want to look at how you as the clinician wrote your goals. You want your goals to be written to be attainable to encourage progress in therapy. For example, you don’t want to write a goal with multiple parts that isn’t possible to “master” so to speak in the time period with which it was written. An example of such a goal would be: “By December 2020, Sophia will demonstrate usage of the following strategies: a.) cancellation b.) pull-out c.) prolongation d.) bouncing e.) easy onset f.) light contact g.) decrease of foot stomping h.) decrease of eye blinking i.) decrease of head jerking secondaries with stuttering moments with 100% of communication interactions with peers in the therapy setting as demonstrated by clinical data.” Ok, obviously in no way would we ever write for someone to write for the use of strategies with “100%” of interactions… think of the metacognitive language maturity/skills that it takes to even use these strategies in the first place. We don’t even fully develop the language skills of telling a narrative in entirety until the ages of 8-10 years old that is fully cohesive…. So, think about what we are asking our children who stutter to do when we are focusing on these strategies…. The ability to stop during the stutter let alone use a strategy requires a very high level of thinking and is very very difficult (I can attest to this as someone who now stutters due to a head injury.) When you are speaking in a conversation- you have so many systems going- your mind is formulating what you want to say as you are speaking during the conversation, your motor speech pathways, the coordination of the muscles of articulation in patterns that form speech, pragmatic skills with. your listening partner- so much is going on and as a person who stutters you are supposed to stop mid-stutter and do something? That’s so hard. Think about it if you were six years old and perhaps haven’t developed the meta-cognitive skills yet to reflect on this. Was it an attainable goal then to use these strategies 8 out of 10 trials for this little guy or was it more attainable to use one strategy that is effective for this little guy personally with repeated trials with 3 out of 10 trials to start (then perhaps we increase it.) Repeatedly not mastering goals will also wear on the child and the parent….. and not all goals for all kids with all accuracies should match. It’s called an Individualized Education Plan (IEP) here in America for a reason. 🙂 So, that was a long response, but it’s very difficulty for a person I am servicing to absolutely make “no progress” as progress isn’t just a monumental “you can say your sound 20 times now!” Progress is the self-discovery of initiating a question for the first time in a small group for a person who stutters. Progress is a parent understanding that they should not want to “fix” their child. Progress is a child coming to you saying, “guess what! I stood up for myself today and explained to my peer about my stuttering and now they understand.” “Progress” can be so many things….. so most of the time it’s the clinician that learns to broaden the scope of thinking. 🙂 I hope that this helped to answer your question. Be a world changer, and take care!