SLP Apprehension with Treatment
Hey! My name is Lizzy Henley and I am currently doing my CAPSTONE research on various SLP perceptions regarding treatment of fluency disorders. One thing my research partner and I have consistently noticed is that many SLPs reported feeling apprehensive or underprepared to work with clients who stutter. I was wondering why you think that is, as well as, what do you think we could do to shift clinicians mindset about treating clients? Are there steps graduate programs, supervisors, or clinicians themselves can take to build greater confidence and competence in providing fluency intervention?
Great question, Lizzy! I believe the reasons relate to limited training (one course on stuttering, or sometimes half a course or none), minimal clinical experience with stuttering prior to entering workforce, small numbers of youth who stutter on caseloads, limited counseling skills (again, may or may not get this at the graduate level), and even conflicting therapy approaches (lots of controversy exists, which creates confusion for clinicians).
I would say one of the biggest barriers, if you will, is that there’s no “cookbook” for stuttering intervention. Within the SLP field, in many areas we have clear protocols or sequential programs to address specific areas of communication (e.g., articulation), so the clinical process and decision-making feels more objective and clear-cut. The stuttering experience is varied, complex, and nuanced, so there is no “recipe” to follow. It requires a deeper understanding of the many facets of the stuttering experience, and you don’t get that through graduate school training. You obtain this learning by listening to the stories of people who stutter, immersing yourself in the stuttering community, and diving deep into understanding the inner experience of stuttering.
That is why for me, as a professor, I hold what I call “Stuttering Cafe” talks, where I invite several people who stutter to share their stories with my students. Students learn different aspects of the stuttering experience through these individuals, and the takeaways are so valuable. I also assign blog articles, podcasts, videos, or books by people who stutter to teach about certain concepts (e.g., covert stuttering; stuttering experienced as trauma; etc.). I also use documentaries like “When I Stutter” to help students better understand stuttering. The key is that we must learn FROM people who stutter to truly be equipped to work with this community of amazing individuals. – Ana Paula Mumy
Hi Lizzy,
It’ s great to hear your project is around SLP perceptions of working with people who stutter – it sounds a really valuable piece of work.
Thank you also for your questions – so great!!
I wholeheartedly agree with what my fellow panellist, Ana Paula has written, and feel that our greatest learning comes from our connections with the stuttering community – listening to the voices of people who stutter, hearing their voices, their perspectives.
In answer to your second question about what we can do to shift mindsets, I think there are various ways that we can build confidence and competence through both our universities and supporting therapists in practice. In the UK, many students don’t have a placement with people who stutter/clutter – we could make these essential components of our courses? We could ask our students to volunteer to support community gatherings, conferences, etc. We often have ‘competencies’ to work towards when we are newly qualified which build our knowledge, skills and experience. Clinical supervision with a specialist therapist for stuttering/cluttering is so valuable. In the UK, we also have local and national clinical excellence networks for stammering/cluttering with regular meetings/study days throughout the year. These aim to enhance our work and continued professional development with people who stutter/clutter.
I don’t know this for certain, but I wonder how stigma may contribute to our confidence in working with people who stutter? I wonder how we as therapists can contribute to, or negate that stigma? I think with a more human approach which respects and values differences, some of the fear and apprehension that is felt may be dissipated?
We know that society holds a belief about the importance of fluency and shows preference of fluency over non fluent speech. I wonder if considering how we frame therapy, talk about therapy for people who stutter and the language we use to talk about stuttering will change expectations both for people who stutter themselves and importantly for the world around them? For example, I prefer to use the word stuttering to mean stuttering and cluttering when I’m talking about cluttering. I am less inclined to use the word fluency as I feel we are setting up an unachievable (and undesirable) ideal.
Similarly, I think the word ‘disorder’ can contribute to stigma. Instead, I prefer to talk about stuttering being the natural way that someone speaks and with this it becomes less scary to the clinician? It’s not something we need to ‘treat’ ‘fix’ or reduce. So, raising awareness of stuttering as a valuable way of speaking, as how some people authentically communicate, in our schools, in our workplaces, in the media, feels important to me.
Nic
Hi Lizzy! Thanks for asking, and I’m happy to help too! What a great topic for your capstone. It’s actually super common for SLPs to feel underprepared when it comes to working with people who stutter. Stuttering is such a complex experience, it’s not about using techniques to improve fluency. There’s a whole emotional and cognitive side to it, like how the person feels about their speech, how they’ve been treated because of it, and how it affects their identity. A lot of clinicians don’t feel ready to support those deeper aspects, and that can definitely make someone feel less confident.
Of course, there are other reasons too, but to build more confidence and competence, there are a bunch of things that can help. Listening to the stories of people who stutter is a really powerful first step, it gives perspective and helps SLPs understand the lived experience beyond just the speech behaviors. More exposure to stuttering, not just in terms of treatment approaches, but also in exploring advocacy, identity, and counseling strategies. Supervisors can also model openness and curiosity when working with these clients. For clinicians themselves, staying connected with the stuttering community, attending conferences like those from the NSA or FRIENDS, and receiving constant training can make a big difference. And maybe most importantly, just being willing to show up and learn with the client. You don’t have to be perfect, you just have to care, be open, and be ready to learn alongside them.
Hi Lizzy,
I would also like to congratulate you on your project – it’s such an essential and much-needed area of research. Some years ago, my colleagues and I also explored the perceptions of Polish speech-language therapists and SLT students on a similar topic. Unfortunately, our findings were quite similar to what you’ve observed.
I completely agree with my fellow contributors and the ideas they’ve shared on how to address these challenges. We also organize meetings where students can connect with people who stutter. Events such as ISAD provide us with a great opportunity each year to host open discussions at the university with individuals who stutter and their parents. All initiatives that help students and clinicians translate theory into practice are extremely valuable. For example, over the past two years, we have organized the Summer Student School of Speech-Language Therapy at our university (the University of Silesia in Katowice, Poland), where students from various Polish universities can participate in Camp Dream. Speak. Live. It allows them to interact directly with children and adults who stutter, as well as with parents of children who stutter. Moreover, they have the chance to take on the role of co-therapists. Findings from our qualitative study among students show that this experience is highly beneficial and significantly increases their sense of competence and readiness to work with individuals who stutter.
Courses such as the European Stuttering Specialization (ESS) can also be very valuable in this regard. Thank you once again for your thoughtful question and for bringing attention to this vital issue.
Warm regards, Kasia
There’s some amazing answers here but I have one more thing to add. I definitely think the lack of standardization in different schools/universities is something that adds to the apprehension or lack of confidence in treating stuttering. I don’t think having a stuttering course should be “luck-based” or something that you should seek out as a student, I think it should be offered in every school. On top of that, I think different professors belong to different schools of thought with stuttering, sometimes not offering anything other than their own experiences/understanding. With standardizing learning about all types of stuttering treatment and the what to do/what not to do with stuttering treatment, I think a lot of SLPs might be more confident in treating stuttering.
Also, I believe it also speaks to our lack of training in the counseling aspects of our field. A lot of our clients deal with trauma and grief that we are not prepared to treat alongside stuttering!