Counseling

Hi, I’m a second year graduate student at the University of Minnesota Duluth. I am currently in an advanced fluency disorders course and a counseling course. I was was wondering, for fluency disorders specifically, when it is appropriate to counsel clients and when it would be most appropriate to refer a client to see a counselor. Also, when working with PWS are there specific counseling techniques that have been more successful than others?

Thanks!

Rachel

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Comments

Counseling — 4 Comments

  1. Hi Rachel,

    I am happy that you have had the opportunity for both advanced training in fluency disorders and a course in counseling. As you probably know, many SLPs report feeling inadequately prepared by their undergraduate or graduate studies for working with people who stutter. Many also report lacking comfort in working with this population. I trust that this will not be the case for you.

    Counseling is such a crucial aspect of working with people who stutter. The surface behaviors of stuttering are more easily observed, but the underlying features of stuttering (e.g., emotional and cognitive reactions, attitudes, and communicative avoidance) also affect the speaker’s life – sometimes as much, or more so, than the surface behaviors themselves.

    Because the underlying features of stuttering so often have adverse effects on people’s lives, I believe that every clinician working with people who stutter should become a competent counselor. However, it is important to recognize our own limitations. You ask an important question about when we should make an outside referral to a psychologist or counselor.

    The short answer is that we should refer clients for counseling when their needs go beyond our professional scope of practice. Personally, I feel comfortable counseling people about problems clearly related to communication and stuttering, such as fear of saying certain words, frustrations with perceived lack of progress in therapy, or anxiety about certain speaking situations. Problems beyond the boundaries of communication and stuttering, such as persistent feelings of low self-worth, may exceed our scope of practice and necessitate a referral.

    While we should not hesitate to make a referral when problems are beyond our scope of practice, I would caution you not to be too quick to refer, either. I was once the client of a well-known stuttering therapist. Early in the treatment process, I observed that while I had made a lot of progress in previous therapy, I was afraid that there may never be a real solution to the problems of stuttering for me. In a perfect world, this therapist might have replied, “I don’t know. Why don’t we work together for a while and see?” Instead, I was immediately referred to a counselor for making “inconsistent statements” in speech therapy. I remember feeling shocked and embarrassed, and later, rejected and even betrayed. The therapeutic alliance had been broken. It took me quite a while to recover from that unnecessary setback. In stuttering therapy, it is not uncommon for people to experience strong and mixed emotions. We are often just the right professionals to help.

    I hope these musings prove helpful to you. Wishing you the best in your studies and career,

    Rob Dellinger

  2. Hi Rachel,
    I agree with Rob’s insightful reply, and wanted to add that when we refer to a counselor or psychologist, we need to make sure that this professional holds current beliefs about stuttering and/or is open to hear what we have to share on this topic. I once was quite taken aback when I was in a conversation with a psychologist about stuttering. She said she’d like to work together on stuttering cases. When I said I thought this was a great idea to collaborate, and asked how she saw her role, she replied, “I’d love to get in there and see what happened in their family dynamics to make them stutter.” I was shocked at the “old school” thinking, and it made me ponder the fact that we are the ones to best understand stuttering. I still would love to collaborate with these professionals on cases where there are issues beyond our scope (like self esteem, abuse, etc.), but would be cautious about who I refer to, and caution families and clients to ask about these professionals’ perceptions of stuttering before signing on with them.

  3. Thanks for your post – I don’t have much to add beyond the excellent responses of my colleagues. I just want to pick up on the last bit of the question, “are there specific counseling techniques that have been more successful than others?”

    To me the answer would be, “lots of different things work for different people, so there is no specific technique that is better specifically for people who stutter.” Of course, we all have our preferences, and some approaches do seem to have some nice efficacy (e.g., ACT and mindfulness work is extremely exciting, CBT is well-established). One of the key aspects of the process is building rapport with the client and developing a strong therapeutic alliance to help the client through the challenges of coping with stuttering.

    Regardless of the specific counseling approach you favor, I would strongly encourage you to develop your counseling and client/clinician interaction skills, for this will help you with any condition you treat.

    Thanks again for reaching out and for caring about people who stutter!
    – J Scott Yaruss

  4. Hi Rachel,

    I am currently a graduate student going for speech-language pathology. In my stuttering class, we learn about the iceberg effect that plays a part in a person who stutters’ life. It explains how the small part of the ‘iceberg’ showing above water contain the physical features of the person who stutters that you can see and hear, like the part-word repetitions, blocks, and prolongations or their physical behaviors while stuttering. The majority of the ‘iceberg’ that is underwater is the hidden emotions and attitudes the person battles within themselves. This part can often overwhelm the person who stutters and plays the biggest impact in their life. Even if their stutter is ‘cured’, it is likely that these hidden emotions still exist and bring up issues and possibly undo any progress that was made. My suggestion would be to wait and see how the client handles their situation. If they seem to be handling their disfluency well, counseling may not be necessary. If it appears that they are struggling with coming to terms with their speech disorder, it would likely be beneficial to suggest therapy. Not all people will be open to this suggestion and they may need time to process it on their own, but simply suggesting it when you believe it is in their best interest likely will not hurt.

    This is a great question. Thank you for asking it and for all others who have responded!

    Elizabeth