Working With People Who Stutter
Hi Professionals,
An observation, then a question . . . . .
All of the professionals on this panel are women. It still seems significant that the majority of PWS are men and the majority of SLPs are women . . . .
Question . . . . . I have always heard that stuttering is (has been) one of the most challenging and intimidating speech issues that SLPs face. Do you panelists agree? Why do you think this is the case? Is there anything the professional speech associations can do to help better support SLPs working with people who stutter?
Hi Pamela,
Thank you for your observation. And great questions!!
It is interesting that the panel is all female! It seems to reflect what I know about the numbers in the UK entering the profession and how it’s always been here. Certainly, when I did my degree over 20 years ago, my course was made up entirely of females. My team is still made up of entirely female SLPs.
The stats on male:female ratios show that more men continue to stutter into adulthood. I do wonder myself about the accuracy of this and often chat with colleagues about it. We discuss whether we think it is reflective of the real picture – do more females hide their stutter, do they disclose stuttering, and is their experience is different??? I don’t know the answers.
I have also always heard that stuttering is/has been one of the most challenging and intimidating things for SLPs to work with. It’s my absolute favourite thing and can’t understand anyone not loving it like I do! The things that I’ve heard from other SLPs is that they haven’t spent long enough at university learning about it, it involves additional training (for example in varying psychological/counselling approaches, such as ACT), they don’t feel they have the knowledge or skills, they express a fear of making things more difficult for a person and say that they don’t have enough people who stutter on their caseloads, so they don’t build experience. My passion for working with people who stutter stems back far before I got my qualification, so for me, it was the only path that I wanted. I think there are SLPs out there who want this too. I do believe that therapists must follow their hearts in their work, because it emits from you as you work and transfers to the person/people you’re working with. I was always keen as a student to search for opportunities to volunteer and to learn more about stuttering, for example at the British Stammering Association conferences (now STAMMA), local therapy groups, etc. I spent my time reading/researching and learning more about stuttering (and still do). My biggest learnings have always been from my interactions with the community itself. I think that professional speech associations, along with universities teaching stuttering, can better help support SLPs working with people who stutter by encouraging engagement with the stuttering community, dedicating more teaching time on courses, supporting continued professional development and funding additional training.
I’m keen to hear what the other panellists think and discover whether there are similarities or differences based on where we are in the world.
Thanks for asking!
Nic
Pam,
Hello! This is such a good question and thank you for asking it. Nic has a very thorough and helpful response as well. I also really love Nic’s thought provoking statements about males versus females- wow! (Nic we will have to chat about this more!) I think the answer to this question has several component/parts and that there isn’t really a straight answer but many variables that in themselves have component/parts but I will try to touch on some different thoughts and I hope this information is helpful. I agree that the treatment of stuttering is often seen as intimidating by SLP clinicians. First, there is the university component like Nic mentioned. I know that there are still university programs that do not offer a full course in stuttering (in some programs its a specific weeks-long section of a combined course), but there are still clinicians going into treatment settings that require them to treat stuttering (like the public school setting here in the USA) that haven’t had the proper coursework. This is really difficult. I also feel like clinicians learn so much about evaluation and treatment during their clinical placements and their first jobs (which may or may not involve treating folks who stutter). With that, there is also the component of perceived therapy progress. Since stuttering therapy isn’t going to stop stuttering (which many graduate students I think still go into their schooling still thinking there is something we can do as therapists to stop it-but they only know what they know going into a graduate program), some clinicians think that stuttering therapy is very difficult (I have even heard the term “frustrating” used) because you “don’t get results” (I have heard this said)- When I hear clinicians say this, like Nic, stuttering is my favorite area to treat and the concept of “results” can be very skewed based on the clinician’s knowledge of stuttering (treating stuttering does get beautiful and amazing “results” and is so rewarding and great to treat because we get to be a part of the lives of humans). So, I think clinicians need a very firm basis on the nature of stuttering and what stuttering is and what stuttering isn’t- and that would really help therapeutic concepts and framings. Finally, I can mention the counseling component (Nic mentioned this in terms of special trainings). Clinicians still do not feel that counseling is being covered well enough in graduate coursework (and we really counsel in everything we treat as SLPs- which is also not fully realized). Some graduate programs offer counseling as a course in itself, but it is often weaved into all of the courses. The treatment of stuttering has a very thick counseling component given what we know about the lived-experiences of stuttering (like Joseph Sheehan’s iceberg from the 70s that 90% of stuttering is the covert of not-seen aspects and only 10%-the part of the iceberg that is above the water- is what we see like overt stuttering moments). Even for folks that wish to learn and use speaking tools, there is still usually a counseling component somewhere in therapy even if it isn’t blatantly labeled “counseling” in a therapeutic goal or plan. I used to be terrified of counseling when I was a graduate student and new clinician- but now I love it so very much but I did also take trainings beyond graduate school. So I think that intimidation in the counseling component alone is very valid. Counseling can’t be scripted- and clinicians love a checklist (I do, too- I love doing something like a method that involves clear steps) but stuttering treatment doesn’t involve that. With all of this, I always tell my students that I wish there was a “Stuttering and Cluttering 1” and “Stuttering and Cluttering 2” course with how much there is to cover in one semester within graduate programs. I also can say- that even though there are shortcomings, in an attempt to keep a “glass half-full” framing, we are making progress. There are beautiful and amazing advocacy efforts happening, programs like the STEAR Circle program for graduate-student clinicians (Spero Stuttering Inc) to further their knowledge on stuttering, and increased access to continuing education coursework has been so helpful. I see a lot of clinician guilt in terms of SLPs coming for mentorship saying, “I feel so bad that I don’t know enough”- I first listen, but I tell them “you know what you know but you are here now.. but being here for mentorship shows you care so much about your children who stutter that you want to know how to do better and do better-so moving forward you will know more!) 🙂 If you want to discuss this further Pam I would love to, and I am excited to see what other panelists say and components they add to the discussion. Take care and thanks again!
Thank you both Nic and Steph – I thought it was an important first question to ask and I am really interested in hearing what others on the pro panel might think.
I heard this all the way back to the time when I “attempted” therapy as an adult in my early 40’s – the student clinicians I worked with seemed very intimidated by stuttering and seemed either unwilling or unable to “relax” into what I needed. My therapy was very short lived. The students were totally focused on fluency shaping only – sitting across from me, counting off and checking stuttered syllables – not even looking at me, until I couldn’t stand that anymore. I was not an easy “client” as I demanded respect and finally found one clinician who “got me” and worked some counseling in there.
I didn’t need fluency shaping or stuttering modification or really any of what student clinicians were being taught back in that time. I just needed someone to tell me it was OK to stutter. When I finally heard that, I felt comfortable enough to realize I wasn’t broken and didn’t need therapy to “fix” me. It was then that I quit therapy after only 9 months. I didn’t feel bad – it wasn’t working for me, in fact, I think it was hurting me. Having fluency shaping skills drilled into me made me “feel” broken and I needed to run as far away from that as I could. So I did.
My therapy became using my voice to help others. It was soon after that unfortunate therapy experience that I found the NSA, went to my first conference, and then started my podcast, using my voice to lift up the voices of other women who stutter, who may have felt voiceless.
Thank you for sharing your journey with this- and while I am so sorry to hear of your unfortunate therapy experience (the not even looking at you part really got me, too!) I am amazed and always in awe of your work, Pam. You really used that experience to help folks try to do different- so thank you for using your voice for so much advocacy, education and awareness.
Pam,
Thanks for sharing! As a therapist, it’s really hard to hear that our work can be harmful. And we hear it time and time again. I’m sorry that you weren’t heard, that you experienced what you did and that it made you feel that you weren’t an ‘easy client’. Your story is an important one to hear. I really appreciate you sharing what you did need too – to hear the words that it is okay to stutter, to connect with others who stutter and to feel a sense of belonging in that community and to give back. I hope that students and therapists alike hear these words, Nic
Hi Pam, great to see you here! To your comment/question about stuttering being one of the most challenging and intimidating speech issues that SLPs face, besides all the reasons that Nic and Steff listed (limited training, small numbers on caseloads, conflicting therapy approaches, limited counseling skills), 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 that 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.
In regard to more female than male SLPs, I’m sure there are studies out there with theories and explanations about female-dominated fields, but what I do appreciate is that there are many MALE SLPs who stutter in our field, not to discount of course the many amazing female SLPs who stutter. -Ana Paula Mumy