Advice for SLPs working with PWS?

As a future speech therapist, I would enjoy nothing more than to hear first hand from people who stutter about their experiences working with speech pathologists. Do you have any tips for an SLP working with a PWS for the first time? Thanks in advance for your time!

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Advice for SLPs working with PWS? — 7 Comments

  1. To assure some level of success as a SLP working with a PWS for the first time, I would start out by asking why the client is there and what outcome does the person hope for. I think that has to be the basis for a therapeutic alliance, whether the person who stutters is a child, teen or adult. A therapist should never assume that you have an expertise that the client needs or wants. You could discover that you are treating the wrong thing.

    I tried therapy for the first time as an adult in my early 40’s. I realized very quickly into the relationship that the clinician seemed to feel that she should set the structure for the time we would spend together and I just let her. Until it became too uncomfortable with me. She as a student clinician worked hard on trying to get me to be successful with several fluency shaping techniques, which just did not work and I strongly resisted. As it was a student clinician I was seeing, I’d only just start feeling comfortable with what she wanted to try (and realize the goals she needed to meet in order to be in compliance with her class) the semester would end and I’d get a new clinician. Nothing changed until I spoke up (finally!) and expressed that these things weren’t working for me.

    Things like sitting across from me and “ticking off” on some chart the number of stutters I was reading from this rather elementary passage about Rainbows. She would not look at me as I read because she had to focus to get all of the % stuttered syllables. I finally said something – to the effect “hey, I really hate this, you sitting across from me yet are far from present with me, as you are only concentrating on errors I was making.” I challenged her and others who came after her to work with me to find some way to capture the data, just don’t do in front of me. It made me feel like nothing but apiece of data, no longer a person. From that point on, any SLP clinician working with me had to use the old VHS tapes and record my sessions so that we could engage by looking at each other and have a back-and forth conversation, as they should have been.

    Those clinicians had to take their video recorder up to their room and review my reading samples on her own time, which created more equal footing in the therapy room.

    Ultimately I wound up leaving therapy after just a year and a half. It just wasn’t meeting my needs. I had just come out of a big loss in my life and I had been work hard all my life to keep my stutter completely hidden. So I didn’t need to be taught some techniques. I needed to stutter the way I had always had and have someone tell me that it was OK.

    I was trying to “awaken” real Pam, as “fake” Pam had guarded the Covert stuttering for 30 years, yet fake Pam was getting sloppy and messy and stutters were escaping all the time anyway. When I realized I didn’t want to learn strategies to “cover up my stuttering” because I had been covering it up all my life. I left that therapy and became involved in the social aspects of finding my tribe, which work. I wrote an earlier paper on “Things I learned In Therapy” I think back in 2009. I believe every tip I offered then are all still relevant today, 10 years later. Here’s the link to that paper:

    http://www.mnsu.edu/comdis/isad12/papers/mertz122.html

    Thank you for your questions – hopefully you will take a little from this, and some from another and another and try suggestions from us as applied to the approach you wish to use.

    Pam

    • Thank you for this Pam! I am a grad student and have not had any experience with fluency clients at any of my placements. I just received news that at my school placement we will be gaining a new student who stutters. This information has been so helpful for me and help ease some anxiety that I have about the assessment and treatment process. I think it is so important that clinicians and clients are transparent on what the goals and outcomes of therapy will likely be. I appreciate you sharing your perspective on this topic!

  2. Wow Pam! such a powerful message behind your comment. I think you made a very valid point about asking why the patient is there and what their goals are for therapy. As a future SLP and the SLPs out there, we as the professionals should be catering to our clients needs and wants.

    I also never thought about how client’s would feel having a student clinician. I am a graduate student myself and see clients now. Of course during our interviews and evaluations we are trying to obtain valuable information but not at the expense of our client’s comfort. I would never want a client to feel like a piece of data rather than human. My sole purpose of choosing this profession was to help others and make them feel heard and to assure them that they do matter. So thank you for sharing your perspective on having student clinicians. Moving forward I will be more empathetic to my client and self aware to ensure they don’t feel less than or that they don’t matter. I will also share this information with my colleagues because I’m sure like myself, many don’t think about it from perspectives like yours and is something that shouldn’t be overlooked or dismissed.

    I think what you did, advocating for yourself, was amazing! These small breakthroughs is what is going to help us as SLPs provide exceptional care for clients in hopes to have an optimal outcome. I find your experience with therapy very insightful and appreciate you sharing. Thank you Pam for helping me become a better student clinician and future SLP. I wish you the best in your future endeavors!

    -Edwinna

  3. Thanks for the post, Pam.

    2nd year grad student here who is holding a weekly clinic for a school-aged client who stutters, and I really appreciate your input regarding “being present” during therapy. I have tried to perform online data collection during therapy sessions and, just as you said, I noticed that I have my head down trying to focus on percentages instead of being an active listener.

    I’ll be using an audio recorder from now on for data collection and focusing on being a good conversation partner, which is likely what my client needs.

    If you have any other suggestions on promoting acceptance or engaging in meaningful conversation for 10-12 year old children who stutter, I can always use more feedback!

    Thanks again,

    Trevor

  4. Ms. Mertz,

    I am a graduate student as well. I have recently started working in my school clinic with a CWS. I have been nervous and very unconfident about my therapy approach.My client is 11 years old. He ask questions for everything and every time I am taking data he is observing what I am writing and how I am writing it down too. It makes me feel uncomfortable that I can not look at his eyes or all the sudden we are both quiet waiting for me to be done writing. I will definitely request a recording player my therapy session, so I can be more involved while working with client.

    • Maria – that makes me so happy that you can see the benefit of being “present” with your client and making eye contact rather than looking down trying to capture all of the speech errors.

      I am glad that I’ve been able to offer some practical advice on best practices in therapy. I’ve often heard and read that stuttering intimidates many student SLPs and even seasoned SLPs, because stuttering is so complex, multi-layered and variable. There is no quick “fix” for stuttering, like there often is for articulation or lisps. For many people who stutter, managing stuttering turns out to be a lifelong journey.

      I bet your very inquisitive 11 year old client does make your heart race. I am glad to hear he feels comfortable asking tons of questions. It means he feels safe enough to do so, beyond being inquisitive.

      Best of luck in your journey as a therapist. The field needs practitioners who “get it.”

      Pam

  5. So happy to find SLPs asking for advice, as communicating with the client is the key to success. Pamela Mertz has already provided a lot of great advice. I’ve replied to similar questions from SLP students to my paper that you might like to read, so please take a look at http://isad.isastutter.org/isad-2019/papers-presented-by/stories-and-experiences-with-stuttering-by-pws/sure-i-stutter-what-are-you-good-at-anita-blom/comment-page-1/#comment-13861

    Anita
    Sure I stutter. What are you good at?

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