Therapy Room to Real World
Hi, my name is Paige Soehnge. I am a second year graduate student at Stephen F. Austin State University. I am a speech-language pathologist assistant at a local school district. In therapy sessions, generalization is our main goal. We want patients to be able to take what they learn in the therapy room and transition that into real-world situations. I have never worked with adults or older students who have received many years of speech therapy and have the experience of what did or didn’t work when it comes to their experience with speech therapy. I know many speech therapist are always trying to improve their fluency therapy and make it as practical to real-world situations as we do with language or articulation. In your experience with speech therapy, what do you believe helped or could’ve helped take therapy room tasks into the real-world? Thank you in advance for any replies!
Hi, Paige, and thank you for these important questions!
I had many decades of speech therapy, with a variety of different approaches. There are two points in particular that I want to raise, regarding the transitioning between speech progress in the therapy room and speech progress in “real life”.
One is that this is a very gradual process. It is best for a client to concentrate on his or her easiest situations first, building up confidence in those situations, using strategies, methods, or techniques learned in the therapy room. Then a client should gradually adapt these methods to more challenging situations, little by little. Trying to incorporate strategies and/or techniques into difficult situations too quickly could easily lead to frustration and disappointment. The clinician needs to be patient, and help supervise this very gradual process. The client should NOT avoid difficult situations during this period, but should simply not feel obligated (nor be encouraged) to try specific strategies or techniques in such situations, before he or she feels ready to do so.
Secondly, in the nature of stuttering, setbacks are very common. I have an education in speech-language pathology myself, and I realize that for many types of speech/language disorders, it is common to see progress in a relatively straight line upwards. But that’s not the usual case with developmental stuttering. In stuttering therapy it is most common to see a progress in a zigzag fashion. For example (to oversimplify): This could mean two steps upwards, one step backwards, two steps upwards, one step backwards, etc.
The clinician needs to be patient, and provide helpful encouraging advice to clients if they make some progress in a situation, but later experience renewed difficulties in the same type of situation. This is very normal in stuttering therapy.
It’s important to NEVER blame the client if he or she experiences such renewed difficulties in a particular type of situation. The clinician needs to explain patiently that this is very natural in the stuttering world, that therapy does not result in a straight line of progress upwards. It would probably greatly relieve a client to learn that such experiences are very common, and not anything to worry about or feel very negative about.
I hope that this has been helpful to you, and I wish you the best of luck in your future clinical experiences!
Hi Paige!
Something I wish I had done more of when I was younger in speech therapy was exposure therapy and practice talking to people to get you outside of your comfort zone and work on the fear of talking. When I was younger, all of my speech therapy was done in an isolated room where it felt “safe” and at times the strategies I was being taught would work, but they never really acknowledged how hard it can be to take those strategies and use them in real world situations. I used to avoid speaking to strangers and would have a friend or family member speak for me, which at the time was helpful, but you don’t really understand how that can impact you in the long term.
The last speech therapy I tried was in 2019 which was a three week intensive fluency program which I was not a fan of, but I am thankful that they had us practice making phone calls and took us to a mall to talk to workers in the stores. At the time I was terrified to do both but it really helped to start the desensitizing process and facing the fear of stuttering.
Matt
Thank you for your interesting question, Paige.
Yes. But it depends on what and how. There are therapists that send their clients into town to stutter in public, and to watch people’s reactions. As we don’t already know… But it can work later on, for your client to know that, if a person reacts in a negative way, you step in and show your client how to react to a person in a hurry, a disrespectful person, how to deal with a bully, to show how you cna prepare for different situations.
But it can help to do some exercises IRL, as with you in the therapy room it can be compared with walking on a plank on the floor compared with walking on a plank 1000ft up in the air. So take it slow. Baby steps. Just like trauma training. And let the client chose speed. You could also try ‘withVR’ (hello.withvr.app) (beware of copies), where your client can try different situations in a VR situation in a very realistic way. For adults there’s 50 million voices (50millionvoices.org) where PWS can practice real life job interviews.
So yes, it’s good to step our of your comfort zone, but baby steps, to make a person stronger, not more fearful. And why not let them bring a friend to practice together. You can also show videos of influencers who stutter and how they ask and explain to people on the street about stuttering.
Thank you for asking. I wish more people did. 🙂
I also gave some advice in my paper in this conference, so feel free to have a read. 🙂
Keep them talking
Anita