Question Regarding Setting-Specific Disfluencies
My name is Molly Bebko; I am a second-year graduate student studying to become a Speech-Language Pathologist. I am grateful the opportunity to learn from seasoned experts in this field! For the first time, I have begun to work with fluency clients. Each has specific profiles of strengths and weaknesses; however, I am curious about a specific type of client. How would one go about working with a client who only experiences disfluencies in a certain setting? (for example, only at work or only at school) and never in the therapy room?
Hello Molly, I think we have all met with clients whose stutter presents differently in different settings! I will quite often see children whose stutter seems to ‘magically disappear’ in the therapy room, much to the frustration of their parents who then worry that I will think there isn’t a stutter at all!
Stuttering is variable in nature, and different factors related to the environment, people present and linguistic demands of the interaction will lead to more or less stuttering for different individuals. The clinic setting can be a nice calm environment with minimal distractions, and as a therapist your communication style may involve a relaxed rate of speech, comments rather than lots of questions, a welcoming demeanor… all things that may lead to the client feeling more relaxed themselves which for some people means less stuttering. There is also the fact that stuttering can be a contrary thing… for some, the clinic setting almost gives them ‘permission’ to stutter and that in itself reduces tension meaning stuttering is less likely, or less tense when it does occur! A strange phenomenon indeed, but one that I think most clinicians will have seen at some point.
Consideration needs also to be given to the role of avoidance and interiorized stuttering. The person may not feel comfortable yet to stutter openly in therapy if avoidance has been their safety net.
The important thing when faced with a situation like this is to reassure the client that you do believe them when they say their stuttering is different elsewhere to the presentation in therapy. You can still work together, exploring information about stuttering, using videos of others who stutter or demonstrating different stuttering behaviors yourself to work out which types of stuttering behavior the client feels occur most commonly for them (when they do stutter) and setting tasks for them to consider in relation to situations where they do experience more stuttering. As with any client, it is important to work at a pace that suits them and to be mindful of the need to ensure they are ready for each step (for example desensitization may be needed before showing lots of videos of others stuttering if the client is very sensitive to watching and hearing stuttering in general) but progression and growth through therapy is still very much possible, even without stuttering in the therapy room.
Hope that helps,
Jenny