Emerging Clinicians’ Questions

Dear stuttering professional,

       We are graduate speech-language pathology students who are currently enrolled in a course that covers stuttering. As we are learning more about stuttering and interacting more with people who stutter, a few questions have come up. First, in your experience, what is the best way to interact with individuals who stutter while remaining sensitive, but still addressing the stutter? How do these individuals typically react or want you to react? How have your interactions changed as you have become more experienced within the field? Thanks so much for your time. We appreciate any tips or suggestions you can share J

Best,

Rosi, Sarah, Maggie

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Emerging Clinicians’ Questions — 9 Comments

  1. Rosi, Sarah and Maggie,

    Thank you for your question! I certainly hope you are enjoying your stuttering course. From my perspective, the best way to communicate with people who stutter (PWS) is to engage with that person like you would with any other speaker. Specifically, focus on the content of their message vs. how they are producing it, maintaining good eye contact and waiting for the speaker to finish his or her message before responding. As far as their reaction, my experience is that PWS are more appreciative when these things occur. They are not communicating only to be told to breathe, slow down or relax. As I have become more experienced, my interactions have indeed changed. I have become more empathetic to the difficulty tat PWS can have in communicating their thoughts and feelings. I have also become more cognizant of what I am doing and my own behaviors when talking with someone who stutters.

  2. Hi Rosi, Sarah, and Maggie,

    Thanks for your great questions. I work mostly with school-age children, so I will have this population primarily in mind when I answer your first question. Regarding how best to interact with people who stutter while remaining sensitive, but still addressing whatever needs to be addressed regarding stuttering, I would say that there is no one best way. Everyone is an individual, with a unique genetic history and biological makeup, and unique life experiences. It is important to start with a Differential Evaluation (which is ongoing) that assesses not only the motor aspects of speech and the fluency breakdowns, but also reactions to stuttering and anticipated stuttering, and contributing factors within the child and within the child’s environment, such as the development of negative attitudes toward communicating and stuttering, avoidance behaviors, and concomitant or co-occurring conditions. This leads to Differential Treatment, which is highly individualized for each child, and which targets more than just speech skills, addressing social and emotional needs and helping to evolve overall communication competence, while reflecting the desires of the child and key stakeholders, such as parents.

    Kristin Chmela put it beautifully when she said, “Helping a child who stutters begins with a conversation.” This conversation “shows interest in what the child is interested in and creates relationship.” And we know what a critical role relationship and the therapeutic alliance play in treatment outcomes. Some important guiding questions include, Are the relationships among all parties positive? Does the child enjoy coming to therapy? Is the child’s relationship with himself or herself positive? Are we exploring feelings and validating them? Are we listening and valuing? Are we providing the right amount of information? Are we assisting in developing or maintaining healthy attitudes and feelings regarding communication and stuttering? I hope this is helpful as you think about and explore how to interact with children who stutter. Best,

    Rob Dellinger

  3. Hello,
    Thanks for your question and interest! I agree with what has been discussed so far. I wanted to add that each speaker is unique in what they prefer in terms of listener reactions, etc. So the best way I have found is to ask the speaker what they prefer. Although I always thought that no person who stutters wants another to finish a word or sentence for them, over my career I’ve learned that some may want this in specific situations. So I’ve learned to not assume or generalize, but rather to ask each person I am working with and follow their lead. Best of luck with your course!

  4. As graduate students, you have probably had very little interaction, if any, with individuals who stutter.
    I am happy to tell you that people who stutter (PWS) are just like the rest of us. They will display variations in preferences and responses. Your interaction will be slightly different if you are meeting a person who stutters in a social situation versus being assigned to see them as a therapist in the clinic.

    I’ll address the therapy situation first. As a new therapist, I remember being very worried about whether or not I would react the correct way.

    In terms of your physical and verbal reactions, treat the PWS as if they didn‘t stutter. Keep natural eye contact. If the person has a hard block or long prolongation or significant facial movement, you may be tempted to show your surprise. This will be less likely if you have desensitized yourself to seeing and hearing stuttering. Watch lots of videotapes of PWS so you’ll be used to it and you won’t be shocked by anything you see or hear. Your face and your heart should be calm and reflect a normal expression. If PWS are talking, just keep quiet and wait. Don’t interrupt. Wait until they are finished talking. Then you talk. It’s simple common courtesy not to talk until your conversational partner is finished sharing their idea, so don’t treat a person who stutters any differently. Just wait. I can’t emphasize that enough. You will be tempted to talk too soon. Stop. Don’t do it. Wait. Think of how rude it would be if someone talked before you were finished or they finished your sentence for you! You’d be insulted. What if they finished it with the wrong word? Then you’d have to start your thought again and you’d be frustrated they didn’t give you time to finish your idea. If you need help waiting then practice silently counting to three before you talk. Tap your fingers silently in your palm to stop yourself from talking too soon. Practice waiting and pacing your speech with another therapist before you conduct your first session.

    I will share some of the key components of a successful first session as a new therapist. Be sincere and honest. Share that you’d love to learn more about stuttering. You’ve read a lot about the topic and now you’d like to hear about stuttering from an expert-the person who stutters. You might ask them some of the following questions: If you’ve been in therapy before what did you like or dislike? What worked and what didn’t? Are there techniques they really want to avoid or ones they’d like to practice more? What techniques do they remember and what were the techniques labeled? (Some people call the same technique by various labels; easy onset, soft starts…). After they list the names of techniques then ask them to demonstrate the techniques and teach you. You imitate their models and then they provide feedback about how well you are doing or provide you with additional instruction. Share that you are just learning the skills and they will need to help you. This places them in a position of not only explaining techniques to you so you see what they know but it also provides insight into their ability to demonstrate what they know in theory. You will also experience what it’s like to apply the techniques and you’ll understand a little bit about how difficult it is to concentrate on changing motor skills. If the person likes some techniques then ask them when and where they use them. do they only use with a few people or with large groups? What are their goals for therapy? Why did they decide to get help now? Plan your session so no matter what their response you have at least one goal and one specific home activity to use before their next session. Involve them in writing a realistic goal.

    Now my answer to talking to PWS in a social situation. Respond to what the person says not how they say it. We all want to be accepted, loved and valued.

    In social situations, we all have our own definition of what a successful interaction entails. Ask 100 people what annoys them about social events and you’ll get a variety of answers. One person says they get annoyed if people at a party are quiet. They love talking, asking lots of questions and learning details about everyone’s life at the party. Another person prefers to find a quiet corner and talk to one or two people all night and hold in-depth discussions. Just like all of us, individuals who stutter have a range of comfort levels in social situations.

    If you’re interested in learning more about stuttering, ask people who stutter. Ask them what it feels like to stutter, how they wish people would react and what they wish everyone knew about stuttering. If you are truly passionate about stuttering, then spend time researching, interviewing and enjoying your time with PWS. I am a bit biased because I have found individuals who stutter to be some of the most incredibly kind, sensitive, compassionate, intelligent and insightful human beings I have ever met. It has been a wonderful honor to share the journey with people who stutter for nearly 40 years. I encourage more SLP’s to specialize in stuttering because it’s a wonderful journey.

  5. I completely agree with and second all the above comments. I do want to share a change that I underwent as a therapist. Compared to earlier, I now find myself simultaneously observing the interaction more as a third person, being alert to any micro expressions- of the PWS or myself- that I might otherwise miss, in my quest to give an get information. This has not only helped me to read between the lines, but also to decide the flow of the initial interview, and most importantly to understand the person beyond the stutter.

  6. Hi,

    I am a recovered PWS and Practicing Clinical Psychologist who works with clients who stutter. What you have asked are indeed important questions, but they only have partial answers that are frequently disputed even by the most erudite scholars.

    What we are dealing here is with the counseling aspect much more than with thera

  7. Rosi, Sarah, and Maggie,
    The best advice I can give is to just talk, have a conversation like any other. Over the years being involved with the NSA and also running my own intensive clinic every summer where I teach, I have realized it is best to just hold a natural conversation. At times, with some clients or friends who have more severe stuttering and might get stuck in a rather long block with lots of tension, I look for how they are responding to it. If they show frustration or embarrassment, I will acknowledge it with a comment like, “that was a tough one” and open the door to talking about it. Focus on the person always, hard to go wrong with that 🙂

    • Rosi, Sarah, and Maggie

      I am to a graduate student and I believe those were great questions. Having conversation colleagues and family who stutters, I’ve learned to be sensitive in the conversation. Allow them to finish and/or make sure they are done before interrupting or finishing their statements for them. Be as natural as possible. Be aware of your body language, because although we make not verbalize our thoughts; they can be easily seen through non verbal communication.

  8. Dear Rosi, Sarah and Maggie,

    You have had some really fine answers to your good questions. I will add to the answers regarding how my practice has changed over the years. I began, as others above have shared, by trying so hard to do the ‘right’ thing in terms of therapy. Over the years, I’ve come to understand that talking with clients to find out their preferred goals is by far the best way to develop a treatment plan that will work for the client. Trying to force goals on a client, simply because they are “typical” goals, tends to get you and the client nowhere fast. I now have clients select their own goals (written in their wording, not mine. Note: you can always write ‘formal’ goals that match the client’s goals for the files!). In addition, I no longer assign ‘homework’; I have them choose home practice (what, how often, how long, when and where), and move on from there.

    In addition to this, I include some education about stuttering and communication in most of my sessions, so that the client becomes knowledgeable about stuttering and other aspects of communication. This not only helps them understand their disorder, but also puts it in the broader perspective of communication. When fluency is the focus, and everything revolves around that, several consequences are likely. First, this tends to further add to their negative feelings and attitudes about stuttering and themselves (e.g., when you focus on reinforcing fluency in a session, that is seen as the only measure of success by the client). Second, many clients will be more successful when they understand that, as my good friend Kristin Chmela wisely says, becoming a good communicator, rather than someone who does not stutter, is what it’s all about. When a client is focused on NOT stuttering, increased tension is much more likely than when they begin to let go of trying to control their speech/stuttering and learn how to use their speech mechanism in a more relaxed manner. They begin to understand that much of what we do in stuttering therapy is really learning how to become a really great communicator. One example is eye contact. I focused on working on eye contact for years from the point of view of eliminating one type of avoidance. Now, I talk with my clients about how people who are good communicators use eye contact to connect with their listeners, to show confidence, and to let others know that they are listening or, conversely, are still talking when they have a block or other disruption.

    Hope this is helpful. I wish you all the best as you continue your education!

    Regards,

    Lynne

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