Your Insights on Therapy
Hi, everyone! My name is Megan Berry, and I am a graduate student in Speech-Language Pathology at Stephen F. Austin State University, as well as an SLP-Assistant in the private clinic setting. I’m new to working with individuals who stutter, and I really want to learn from your experiences so I can be the best support for my future students and clients. I’m especially curious about your preferences and goals in therapy. If you participated in speech therapy, what worked well for you? What did you enjoy? What did you not enjoy? What would your ideal therapy experience look like? Hearing your perspective will really help me understand how to make therapy more helpful, meaningful, and personalized for the people I’m serving.
Thank you!
Thank you for your question, Megan.
When I was young SLPs didn’t really know how to treat stuttering. I was told to say the days of the week in one breath. (I played the saxophone, so air wasn’t the issue.) I’ve had SLPs telling me to breath properly. (Again breathing.) I’ve had an SLP who became my psychologist, but when I told her my story, she threw it back in my face. All of this made me feel less, incapable, a failure. Today most SLPs understand that fluency is not the one and only goal, but for a client to say what s/he wants to say, the way s/he feels comfortable with. Whether that’s with some help to get out of a block, to gain more self-esteem, to expend comfort zones or even to help explain stuttering to others or to find the answers to raise awareness. A good SLP works together with the client, listens, asks questions, and together find a way to set up baby step goals, while stepping out of the box and see what this very client wants and needs. S/he is maybe asking for something that’s not in your textbook, and you may have a suggestion that your client never heard of. So work together. As you have the tools, but we have the experience. 😉
There are some things I wish SLPs would do.
1. Listen and ask questions. Don’t just listen to the stuttered syllables, but listen to the story. The background. The goals. The culture, religion, anything that makes the person the way s/he is. As stuttering is so much more than what comes out of the mouth. Also listen to the parents and maybe even a friend, a partner. If a PWS doesn’t feel heard or safe, s/he will not give you the information you need.
2. Think out of the book, or box. One size does NOT fit all. One client (or the parent) might want to be fluent. Tell them fluency might not be for all. That climbing the Mount Everest is too hard for most people. So to set up reachable goals. Maybe tools to get out of a block. Maybe working on acceptance and self-worth. Maybe by giving them the knowledge to learn more about stuttering and explain to others. Maybe by suggesting something else but speech therapy. F ex presentation techniques, yoga, a choir. Or all of the above!
By listening, asking questions and providing a smörgåsbord of things to try, TOGETHER you might find something that fits that very client to reach acchievable goals.
As we’re all different, want and need different approaches. Some might want total fluency. If so, make sure they understand that this might not be an obtainable goal, but that there are many steps in between. Some might want help to accept and live with stuttering. Some might simply want some techniques to get out of a block. Some might want to know more about stuttering. Some might want help to get family members to understand. And therapy can be a full smörgåsbord with different things to try, of which some are maybe completely different than speech therapy. F ex yoga, singing, art. Also bring your clients to support groups, camps and online places where PWS meet. This has been life changing for me.
I also gave some advice in my paper in this conference, so feel free to have a read. 🙂
Keep them talking
Anita
Hi Megan!
I have done a decent amount of speech therapy in my life which was heavily focused on breathing and teaching fluency techniques. I found that they were not helpful in my case of stuttering and did not find out later on that this can actually be harmful. It teaches you that you have something that needs to be fixed and in my mind I created a negative connotation around stuttering. I thought I was doing something wrong and avoided it as much as I could to hide it. I wouldn’t use techniques, it was more so intuition and waiting until I knew I would not stutter when saying something. It wasn’t until I found an online stuttering support group that helped me to start my acceptance of my stutter and learn how to embrace it and advocate for myself. I no longer felt like I had to hide it.
I wanted to share this before going into what my ideal therapy experience would look like because as Anita said, stuttering is so much more than what you hear and see. Ideally I would want an experience that helps me to understand what stuttering is. I did not know much about it growing up and avoided addressing it for the most part. I think it’s hard for all of us to open up and talk about something we are going through but it’s so important that we do and have a better understanding as to what is going on. Having someone to help me better understand myself and listen to what I had going on would have been beneficial.
Matt
Hi, Megan, and thank you for your important questions!
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.
Best of luck to you in your career!