Your Experience with Speech Therapy
Hi everyone,
My name is Ireland Hookstra, and I’m a second-year graduate student in speech-language pathology at Stephen F. Austin State University. I’m currently taking a course on fluency, and it’s been eye-opening to learn about stuttering and all the factors that can influence it.
As a future SLP, I’m really interested in hearing from People Who Stutter about your perspectives on therapy. I’d love to learn about your experiences (both positive and not-so-positive), what approaches or interactions have helped or made an impact, and if you have any advice for new SLPs who will work with people who stutter in the future.
Thank you so much in advance for sharing your thoughts and experiences. I appreciate your time and insight!
Thanks, Ireland
Hi Ireland!
My experience with speech therapy would fall under the not-so-positive category as the therapy I have always done was fluency based. I found that the strategies I was being taught never worked in my case of stuttering and this type of therapy left me with a negative connotation around stuttering. I thought if I stuttered I was doing something “wrong” or “bad”, making the fear of stuttering even worse. The last program I was in was back in 2019, which was a 3 week intensive fluency program that basically taught us a whole new way of speaking and to be honest, I was not a fan of it at all. I had gone into it with a lot of hope that it would “cure” or “fix” my stutter, but after realizing it was not for me, it left me pretty hopeless. It made the fear of stuttering even worse. It wasn’t until I found an online stuttering community in late 2022 that I finally had been told that it was ok to stutter and I felt like I had an “ah ha” moment and helped me realize that I did not have a part of me that was broken, only a difference. It made me much less fearful to stutter.
The biggest piece of advice I can offer is to always keep the stuttering iceberg in mind. Stuttering is so much more than what you hear and see and affects everyone differently. I would also find out what the stutterer wants out of speech therapy and set goals based off of what they want. I remember being very young in speech therapy and just doing what I was told without really being asked what I wanted out of it.
Matt
Hi Ireland, I was a covert stutterer for years, which meant therapy that focused solely on the mechanics of speech didn’t work well for me. When all we addressed was how I spoke rather than the fear, shame, and avoidance patterns driving my behavior, I missed the deeper work that could have been transformative.
My advice: remember that stuttering isn’t just a speech issue but it’s often wrapped in layers of emotion, identity, and self-perception. The most impactful therapy addresses both the surface behaviors and what lies beneath them.
I’m grateful you’re asking these questions early in your journey. Wishing you the best,
Gina
Hi Ireland
Adding to the important messages from Matt and Gina:
Fluency-focused therapy was an abusive experience for me. Myself a few other people I know, who went to the same intensive fluency shaping course, refer to ourselves as “survivors” of that course.
I did not pursue other formal therapy after that. I did (eventually) start to learn for myself about stuttering, and after researching stuttering for about 15 years, lecturing extensively, and publishing a book about stuttering, I offer the following advice:
1) If you’ve seen 1 PWS, you’ve seen 1 person. Treat every PWS individually; practice patient-centric therapy
2) Always be mindful, and in particular non-judgmental and compassionate
3) Understand for yourself and educate the PWS on stuttering, specifically on
(a) the knowns (and unknowns) of the neurobiology of stuttering
(b) differentiating between primary and secondary characteristics of stuttering. Understanding the difference between stuttering and the struggle (to avoid stuttering)
(c) the affective and cognitive aspects that be present in the experience of the client. Most importantly, teach that stuttering is not a defect, that it’s OK to stutter, that stuttering is a difference, not a defect
4) Help the client identify the characteristics of their stuttering – the primary and the secondary.
5) Help the client practice mindfulness, i.e. non-judgmental awareness of their stuttering, in the moment of stuttering. Help them identify their experience in terms of physical sensations, feelings, and beliefs.
6) Help the client identify struggle behavior, and then the “letting go” of that struggle.
6) Define steps to practice non-avoidance of stuttering and desensitization to the experience of stuttering
Of course, much more can be written. Feel free to reach out if you need a more in-depth discussion.
Wishing you much success and fulfillment
Hanan
Hi Ireland
I truly hope the course was not on fluency, but on assisting a PWS to find a way to speak that fits the client. What I’d like from SLPs is to loose the word “fluency”. Fluency is a goal that can be more hurtful than helpful, as expecting fluency can be the same as expecting PWS to climb the Mt Everest. Not everyone can, not everyone even wants to.
That said, I’m truly happy the course was an eye opener. As yes, we’re all individuals, bring different things to the table, such as background, culture, experiences, religion and many more, and want different things. So start by getting to know your client. What is he there for. What is his goal. And is it his goal, or someone else’s. Is that goal within reach?
You see, we’re often told by society, and sometimes even by an SLP, that fluency is the holy grail. THE way to get a job, to get accepted, to get good grades, to not “disturb” the listener. All this turns stuttering from a neurological issue with physical outcomes, into fear, shame, and other mental health issues. So we hide, become covert, stop talking, or even worse… Not because of stuttering itself, but people society’s demands.
Sure, stuttering is hard. It’s exhausting and frustrating to not get the words out. So I myself have learned to get rid of my tics and not close my eyes so I can drive my car ;-), relax my shoulders and my chest to not get hiccups, get out of a block to say the words I want to say no matter how they sound, I’ve learned mindfulness to simply enjoy life, and learned presentation techniques that got me a job as a (stuttering) teacher. Ask questions. Listen. Don’t start focusing on the stutter, but on the person behind the stutter. Who is s/he. What does s/he want, not only from therapy, but also from life. How are relationships with family, friends, school etc. Tell him/her that you’re not judging, not counting syllables, just finding out where s/he is, and where s/he wants to be.
I’d so wish for SLPs to understand that therapy can be so much! After getting to know your client and what he wants, start offering a smörgåsbord with lots of different options, according to what your clients wants, and likes. As if you offer therapy that doesn’t fit your client, it’s like being forced to eat something you don’t like.
Show the way to meet others who stutter, like camps, meetings, chat groups (check out Penny’s paper on playing video games with other kids who stutter). But also group therapy to proof they are not alone and can support each other. Let him/meet other adults who stutter. Bring a friend into the therapy room and let them do homework together. But… add fun!! When it’s fun, it’s more likely to continue, and to open up. And when giving assignments, do them yourself too. Don’t give assignments you’re not willing to do. Also offer help to speak to the classroom, you or your client, or maybe someone from a local support group. To talk to the class and/or the teachers (but decide that together).
Therapy is not one option. It should be a full smörgåsbord with different things to try, of which some are maybe completely different than speech therapy. F ex ACT, Mindfulness, yoga, singing, theatre, public speaking, art. Meeting other PWS. And should be adjusted as we go along. As we change along the way, physically, mentally, our place in life, goals, dreams, job options, partners, etc. What didn’t work at first might work later on, and vice versa. While to others, consistency is the key. And that’s why your job is challenging, but also creative! So keep listening, asking questions and stay creative. And work together. As you have the tools, but your client can give you the information you need to find new “recipees” for your smörgåsbord. 🙂
I also gave some advice in my paper in this conference, so feel free to have a read. 🙂
Keep them talking
Anita
Hi, Ireland, and thank you for these interesting questions!
I will repeat here a response I gave to someone else, since the topic is very similar.
I had tons of speech therapy, beginning at age 4 (or possibly earlier), and continuing throughout my childhood, teenage years, and early adulthood. I also had much fluency shaping therapy in my 30’s.
I estimate I have seen about 35 different therapists for my speech, with varying approaches. Some were speech-language pathologists (although that phrase wasn’t around until my adult years); some were professional psychologists who specialized in stuttering treatment.
Of all those therapists, there were only 7 who provided me with significant help; and of those seven, only 5 provided me with substantial help.
I will provide examples here of an outstanding clinician I had, and also of a very poor clinician I had, to provide a helpful contrast.
Of all the therapists I have had, I believe the most helpful was a speech-language pathologist who stutters himself, and who is a master at using techniques of the Precision Fluency Shaping Program. When I was 30, I enrolled in a three-week Precision Fluency program at the Hollins Communications Research Institute, Roanoke, Virginia. (Today the institute is gone, and I don’t think Precision Fluency Shaping is still around.)
Precision Fluency techniques were very helpful to me when I engaged in intensive daily practice of techniques (for an hour or more!), and carefully monitored every conversation. I should mention that I no longer practice such techniques; about a quarter-century ago I decided to simply and calmly accept myself as a person who happens to stutter.
The clinician I’m referring to, R.B. (now retired), ran a fluency shaping clinic in Norfolk, Virginia. This was largely based on the Hollins program – in which he was trained – but had some small differences.
R. incorporated his own experiences as a person who stutters, and as one well practiced in these techniques. Hollins emphasized and analyzed tiny aspects of these targets (as they were called); R. preferred to look at all the targets as a whole, put together as a unit. To me, this was a more useful approach. Hollins considered HOW one spoke to be the only point of importance in therapy, and placed no emphasis on content at all; R. emphasized content as well as techniques.
And R.’s therapy was dynamic. In his therapy he was friendly, informative, and helpful; and he also had caring, compassion, and understanding. R. to me was the ideal speech clinician, helping clients with knowledge, wisdom, personal experience, and deep understanding. I had many fluency refreshers with R. during a four-year period.
Now, for contrast, here is an example of a bad clinician:
One summer, when I was 19, I attended a university speech clinic several times a week. I had therapy with a student clinician (under supervision), who I found to be really ignorant about stuttering. I found that I was teaching her more than she was teaching me. In fact, I recognized the text she was basing her therapy on, and I always knew exactly what she would say next.
No, this is not the example of a bad clinician I’m referring to, as I realized her shortcomings were due to lack of knowledge, training, and experience.
But this is what happened next:
On the last day of therapy, she called in her supervisor to take over.
He was a tough-looking guy, and for an hour, he berated me, insulting me, harshly criticizing me, yelling at me. He told me I had made no progress whatever that summer, and the only reason why was ME. He told me I did not work hard enough, that I was not motivated to “improve” myself, that it was obvious I did not want to “get better”. He told me that my attitude was all wrong, and that with my attitude, I would never make any “progress”. He told me that I was entirely to blame for this “failed” therapy.
Now that is an example of a terrible clinician. And he was a supervisor of a university clinic, a position he should never have held.
He was the classic example of what a clinician should NOT be.
And here is something important for all future SLP’s to keep in mind.
Every person who stutters is different, and the best therapeutic approach (or approaches) for stuttering therapy vary from individual to individual.
Too often I have encountered clinicians who believe that “one size fits all” in stuttering therapy. Speech clinicians need to mold a therapy program individually for each client, based on the needs and desires of that individual client.
It’s important to never blame the client for a relapse or for what appears to be a lack of progress. In other words, it’s important not to be like that clinical supervisor I mentioned above.
And alos it’s important to be caring, compassionate, and friendly to all – as well as knowledgeable. That is, clinicians should have the qualities that I mentioned above, that my clinician R. had when doing therapy.