Advice for a future SLP

Hi Everyone!

I am a graduate student studying speech-language pathology. Our class had a great experience in which a speech-language pathologist who stutters came to speak to us. She explained that she wished her speech-language pathologists she had as a child would have explained stuttering more clearly to her. I am wondering what therapy techniques have been the most successful and meaningful to you and what advice you would give as I prepare to enter the field of speech-language pathology.

Thank you!

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Advice for a future SLP — 5 Comments

  1. Many factors have contributed to the shortfall in the preparation of speech-language pathologists to prevent, assess, and treat pediatric stuttering. Some of these factors may be related to the inherent complexities involved with this disability or university training programs’ challenges with changing accreditation standards. For most SLPs, training in the area of fluency began with graduate school, and for a long time, many academic programs may have reduced or eliminated required course work in fluency disorders and the minimum clinical practicum hours in stuttering in accordance with standards. These changes have resulted in an unknown, but what must be a significant, number of graduates of professional programs entering the profession with little or no formal academic training or clinical experience in the assessment or treatment of fluency disorders in children. In 2005, ASHA released a new set of academic and clinical education standards which do not specify requirements about the courses or clinical experiences students must complete, but instead, focus on the competencies students are expected to achieve. These competencies include: the ability to demonstrate specific knowledge and skills about the nature, assessment, and treatment of nine major disorder areas (including fluency disorders), as well as knowledge about research, ethics, and professional issues. This focus on the outcome rather than the process of preparing competent clinicians may be seen by some as a positive step for improving students’ training. However, it is still incumbent on university training programs to develop educational and clinical training for students in order to meet minimum knowledge and skills competencies in the area of stuttering. Given the complexity of stuttering and the repeated finding that many practicing clinicians already lack sufficient comfort and competence with fluency disorders, it would seem that more training and experience, not less, is needed to prepare clinicians to help people who stutter. Training programs, and indeed, the profession as a whole, must work to identify unique and alternative ways of preparing student clinicians to appropriately and effectively evaluate and treat fluency disorders. The fact that stuttering is a low-incidence disorder also contributes to the breakdown of best practice services for children who stutter, as it often creates a small number of available clients who stutter in many academic training programs. Many universities, particularly (but not only) those in less populated areas, may be unable to find a sufficient client base to allow all students to gain face-to-face clinical experience with children who stutter. All of this is to say that academic training institutions must be intentional in providing coursework and clinical experiences for students in this area, in an effort to increase the confidence of the clinicians working with PWS.
    Best,
    Brent Gregg

  2. I’m so glad to have graduate students participating in this conference. This is one great way to begin to learn more about stuttering, and to build your knowledge base in the area of fluency disorders. As Brent stated, there are a number of reasons why people who stutter do not all have therapy that helped them understand their stuttering or manage it in ways that are helpful to them. I don’t have a therapy ‘technique’ that is ‘best’. Rather, I think that putting in the time to learn about fluency and stuttering, as well as learning ways to work with people that are valid and supportive are both great ways to prepare to serve clients who stutter and their families.

    So, a few areas to think about as you prepare to enter the professions and that will prepare you to better serve clients with any type of disorder:
    1) learn to listen to your client’s story; what they see as the problem; what goals they want to work on; what bugs them the most about their stuttering; how it feels to be a person who stutters and what that means in their everyday life–all of this information will lead you to have a better understanding of the problem from the client’s point of view;

    2) Establish goals based on what you learned from point 1, rather than on what you think is important, what a supervisor, teacher or parent thinks they should work on, or what you read in a ‘how to’ book on therapy–clients are much more motivated to do the hard work of change if it is toward a goal that is important to them;
    3) take a course in counseling, and once you graduate, engage in continuing education in this area–learn all you can about how people change, why change is difficult, and how you can best support change that is authentic to the client;

    4) Make your therapy very functional, so that what you do in therapy generalizes more readily outside of the therapy room;

    5) Regardless of the age of your client, engage them in their therapy from the beginning. I already mentioned setting goals that are those of the client. They can also participate in choosing specific skills to work on, selecting when and where they would like to practice a new skill outside of therapy, and learning how to obtain verification that they did what they agreed to do.

    6) Embrace your clinical mistakes–they are great teachers!

    Certainly, there are many continuing education opportunities available to learn more about fluency disorders once you have completed your graduate training. Looking for these opportunities is a great way to learn more and to develop a network of colleagues with and from whom you will be able to learn.

    I wish you all the best as you move forward!

    Lynne Shields

  3. Thank you for your question and your interest in stuttering! Brent Gregg and Lynne Shields have already done a terrific job in highlighting shortfalls in the preparation of SLPs for working with people who stutter, and in making specific, practical recommendations for a young clinician. Therefore, I will offer another perspective on a “way of thinking” about stuttering, and people who stutter, that I hope will also be useful to you as you move forward in your studies.

    While it is perfectly understandable for a graduate student to wonder what techniques have been the most successful for a person who stutters, your question begs further questions. Successful for what? Improving fluency? Improving one’s ability to modify stuttering? Reducing avoidances? Shifting negative attitudes? Improving overall communication competence? And so on. As you learn more about stuttering and the various evaluation and treatment options, I’d encourage you to start reframing your question towards, “How can I think differentially and critically around the complexities of stuttering, at any given age?”

    Thinking “differentially” refers to approaching people who stutter differently based on individual circumstances and relevant personal and environmental factors. Thinking “critically” about stuttering refers to the intellectually disciplined process of actively and skillfully conceptualizing, analyzing, synthesizing, evaluating and applying information gathered from, or generated by, observation, experience, reflection, reasoning, and communication, as a guide to clinical problem solving, and action.

    In my school district, I am fortunate to serve as a stuttering consultant. Through our workshops and remote and on-site consultations, I am encouraging my colleagues to embrace the “way of thinking” that I am describing to you, a framework to facilitate critical thinking and navigate ongoing challenges within the evaluation and treatment process for children who stutter. The framework in our district is Basic Principle Problem Solving (based on the book “Working with School-Age Children Who Stutter: Basic Principle Problem Solving,” by Chmela & Campbell, 2014). Basic Principle Problem Solving incorporates treatment evidence, desires of all relevant parties, clinical knowledge and expertise, and work-setting rules and regulations into an ongoing clinical problem-solving model. The focus on ongoing challenges is essential due to the complexity, variability, and chronic nature of school-age stuttering. In case you are interested, I wrote about this model in a paper submitted to last year’s ISAD conference entitled, “Fluency Consulting in a Metropolitan School District: Helping School SLPs Understand Stuttering.”

    As you move forward, I would encourage you to take this kind of ongoing, problem solving-based approach to stuttering that incorporates what we know about stuttering at any given age, and that regards each person who stutters as a unique individual with a unique set of needs. Wishing you all the best in your studies and your career!

    Rob Dellinger

  4. Every year, I invite participants from our support group to talk to the graduate fluency disorders class. The question of what new SLPs should know always comes up and the most common advice, by far, is to think of stuttering as more than just speech breakdowns and be prepared to tackle the entire experience. With that in mind, Lynne’s list is very valid.

    Just a quick note on Brent’s post: After grad school training (with all the barriers he outlines), many SLPs have caseloads at their work sites that are heavy on language and phonology. Thus, when it comes time for continuing education, those are, quite logically, the topics in which the SLPs focus their efforts. It becomes easy to fall behind in other areas. I know that if I had to start treatment with, say, a dysphagia client today, my initial ideas would be based on the last such client I had. In other words, they’d be several decades out of date.

  5. Hi, First of all, let me express my admiration for both you and your fluency disorders course lecturer. Arranging a meeting for Speech Pathology students with an SLP who has personal experience,
    as a person who stutters, is a brilliant idea. Based on my own experience, I can confirm how deeply touched my students and my SLP Polish colleagues were by such meetings I had arranged
    in the past. I am also full of admiration for you, so actively looking for ways to become a professional clinician. It is not necessary for me to recommend specific methods or techniques since you
    have already learned them at university. All of us are continuously learning and developing them throughout our professional careers.
    My advice to a young therapist is to be ready not only for constant learning of theoretical knowledge and therapeutic skills but also for self-reflection and improving interpersonal skills.
    Essentially, therapists have to achieve an attitude of openness to the client’s needs and environment and to the realization that the client may possess
    the actual key to his/her own aspirations. In other words, we, as therapists and clinicians, enter a process of building a mutual bond of trust and confidence for
    the purpose of reaching meaningful goals. This process entails a working relationship, an interdependence, in the spirit of learning together. The more we can strengthen the clients’ confidence
    and independence, the closer we can come to helping them to realize their inherent potential, rather than demonstrating our professional proficiency. It is far more useful to become facilitators than
    ‘all-knowing experts.’ Of course, this requires an attitude of humility, modesty,and capacity to confront our own imperfections.
    However, this approach has been shown to give our clients the inspiration and strength to pursue their goals. I believe the therapy process is not about us being
    appreciated and valued. On the contrary, it is about our clients becoming fully aware of their potential and fully capable of enjoying the beauty of communication.
    I hope you will find my thoughts useful.

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