How Can SLPs Best Help Empower PWS?

I am a future SLP taking a class on stuttering and I was wondering, for those of you who met with a speech-language pathologist to work on fluency, if you could give me your perspective on the impact your SLP had on you, positively and negatively. Specifically, what were some ways that your SLP helped you to feel positively (or empowered) about your stutter? What were some ways that your SLP influenced negative feelings about your stutter?

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How Can SLPs Best Help Empower PWS? — 3 Comments

  1. Dear Haley,
    HI! What a neat question! Thank you for asking questions to learn more for yourself and your future as an SLP which will ultimately serve those who stutter and those with other communication disorders.

    As a PWS, and now a professional in Speech Language Pathology, I can clearly remember most of my therapists. I had one at 8 years old (until I was 9). That experience was mostly not empowering, except I had the confidence to go into the SLP’s office at the great and wisdom filled age of 9 and quit therapy because I thought it was not helpful. The therapy consisted of me reading every session as slow as I could for about 30 minutes. This lead to decreased confidence and negative reactions to reading out loud and reading in general (again, in hide sight).

    My next SLP was completely different. She let did not focus on any stuttering enhancement skills. Instead she just let me talk. She seemed to genuinely want to hear anything I said. Whether it be good, bad, muddy, happy, or sad, she just listened. This basic counseling skill of active listening empowered me with the thoughts that I had some worthy thoughts to share with the world and that people might listen to those thoughts. She started the road (started, because the road is still continuing now) to empower me to speak focusing on what matters to me, and that my words had value. And that I was valuable. Something that my suicidal mind(at the time) did not see fully, but in time this was clear to me and that due to her just listening intently.

    The student clinicians I had in college empowered me with knowledge about stuttering so I knew what how my speech mechanism worked so I could begin to develop awareness of this system in order to think about adjusting speaking, voice, posture, or anything physical and mental to modify this system. Empowerment of education is a great asset that SLPs can provide clients and families.

    Finally, with the education I received from all of the SLPs (and counselors I had), they empowered me to keep learning and to remember that there is not just one way to think or act. That my actions were related to what was best for me.

    Thanks for the question. That is just a few things that the SLPs I have had contact with as a PWS have empowered me.

    With compassion and kindness,
    Scott

  2. Hi Haley,

    Thanks for your post. I’d be happy to share some of my experiences as a client in stuttering therapy during my 52 years on the planet. It will be a welcome change of pace from my usual perspective from the clinician’s chair.

    I’ll frame my story within the context of 11 basic principles of stuttering therapy developed by Hugo Gregory in the 1960’s, refined through decades of collaboration, and redefined by Kristin Chmela and June Campbell in their manual, Working with School-Age Children Who Stutter: Basic Principle Problem Solving (2014). These 11 basic principles, and an ongoing problem-solving model informed by them, guide my stuttering therapy for school-age children and the consulting work that I do in the public schools.

    The basic principles are as follows: 1) DIFFERENTIAL EVALUATION-DIFFERENTIAL TREATMENT (individualized, comprehensive, and ongoing for each child); 2) RELATIONSHIP (positive relationships cultivated among all parties – the child, parents, siblings, teachers, SLPs, and relevant others); 3) COUNTERCONDITIONING, DECONDITIONING, & DESENSITIZATION (of tense speech responses and maladaptive attitudes and behaviors to more adaptive ones); 4) MODELING (of exemplary communicative skills, including actions of assertiveness, confidence, and effectiveness, and ease of communication); 5) GUIDED PRACTICE (by manipulating child and environmental variables during treatment activities and home assignments); 6) REINFORCEMENT (of desired behaviors, attitudes, and communication skills; 7) SELF-MONITORING, SELF-REINFORCEMENT (of desired behaviors, attitudes, and communication skills); 8) TRANSFER (of more adaptive behaviors, attitudes and communication patterns through systematically planned and conducted treatment activities); 9) GENERALIZATION (of more adaptive behaviors, attitudes, and communication patterns); 10) GRADUAL DISMISSAL, FOLLOW-THROUGH, & MAINTENANCE (of positive treatment gains); and 11) INTEGRATION OF CHILD-RELATED & ENVIRONMENT-RELATED FACTORS (throughout evaluation, treatment, dismissal, and maintenance processes).

    I started speech therapy in the 1st grade. While I don’t remember much about it, I will never forget how the SLP made me feel: Singled out for humiliation. I remember having to stand in front of the group and recite the Pledge of Allegiance. I knew I was supposed to speak fluently, but I didn’t know how not to stutter. I got as far as standing up on wobbly legs before I panicked, sat down, and refused to say a word. I also remember taking proactive steps to avoid this kind of humiliation in the future. On subsequent therapy days, I would lock myself inside the bathroom in the classroom, turn off the lights, and try to hold my breath so that the sound of my breathing wouldn’t give my location away. I remember my teacher calling out to my classmates, “Has anybody seen Rob?” It didn’t matter how much trouble I might be in; I kept the door locked until it was too late to go to “speech.” If I were consulting with my old SLP now, I’d advise investing (much) more effort into learning about the nature of stuttering and Basic Principle #1, Differential Evaluation and Treatment; #2 Relationship; #3 (systematic, gradual) Desensitization; #4 Modeling; #5 Guided Practice; and #11 Integration of Child-Related and Environment-Related Factors). I’d teach my SLP to focus on all the ways – not just fluency – that a child can become a better, more confident communicator.

    Private therapy followed in the 3rd or 4th grade. My SLP was kind, encouraging, gentle, and patient. I remember laughing a lot in therapy. I remember his magic tricks, and my astonishment as he would pull a quarter from behind my ear, only to make it disappear. I liked him and trusted him (#2 Relationship). In retrospect, I realize that in every fun activity we did, he was trying to chip away at the emotional walls that stuttering had built (#2 Relationship; #3 Counterconditioning, Deconditioning, Desensitization). In the end, however, the therapeutic alliance was no match for the many contributing factors (personal and environmental) that complicated my stuttering problem, and the (unintended) negative messages and unhelpful reactions I was still getting at home. If I were to advise him now, I might encourage more emphasis on family dynamics and getting my parents fully on board with the program (#11 Integration of Child-Related and Environment-Related Factors).

    During my junior year in college, following an embarrassing class presentation, I reached the stark realization that trying to conceal my stuttering – my top priority in life at the time – just wasn’t working. Although I had carefully avoided all courses with a public speaking component, my professor departed from the syllabus and sprung one on the class anyway. While presenting my paper, I panicked. Flooded with fear, embarrassment, and adrenaline, I couldn’t help but stutter openly. I felt raw and exposed. Soon after, I scheduled an appointment at the campus speech and language clinic. During my evaluation (Basic Principle #1), I talked about the emotional toll of trying to conceal my stuttering at all costs. The clinician cautioned me that not only speech therapy, but even getting through the evaluation could prove to be an emotional challenge (#2 Relationship, #11 Integration of Factors). She was right. Despite her understanding and encouragement, I read aloud the first few words of “The Rainbow Passage” before apologizing, thanking her, and walking out the door. I’d have no advice for my clinician; the timing simply wasn’t right.

    After graduation, I worked as a newspaper reporter. I had imagined that writing for a living would somehow compensate for my lifelong struggle to express myself verbally. I had envisioned a career spent quietly in front of a keyboard. Instead, I was using my voice all day long, interviewing sources in person and – gasp – on the phone. Following a panic attack in the newsroom, I sought out my old SLP from the 4th grade. He was working in the public schools but invited me to weekly group therapy sessions he was holding for young adults. Speech therapy was like an undergraduate course in communication disorders. I learned what our profession knew at the time about the nature of stuttering, what may cause it, and the various ways to treat it. I learned all about the key components of the speech mechanism and how they worked together for stuttered and non-stuttered speech. I even learned to identify the place, manner and voicing of the consonants; name the cognate pairs; and tell which vowels were high or low, round or unrounded, tense or lax. Therapy was integrated (#3 Counterconditioning, Deconditioning, and Desensitization); I learned to identify and work with unwanted thoughts and emotions; reduce avoidances; pseudostutter; modify stuttering; and use fluency-enhancing behaviors (#3 Modeling; #4 Guided Practice; #6 Reinforcement; #7 Self-Monitoring, Self-Reinforcement). Everything I learned in therapy was practiced during regular outings in the community (#8 Transfer, Generalization). It was a wonderful community of support. I decided to leave my profession of journalism and go to graduate school to become an SLP.

    Graduate school was not the paradise for a person who stuttered that I had expected it to be. Under academic and other life pressures, my stuttering symptoms (overt and covert) increased, and most of my peers and professors seemed no more understanding of my problem than the general public. Feeling pressure to be fluent, I enrolled at the campus speech and language clinic. A sizable rotation of my gradate-clinician peers did not know what to do with me (#1 Differential Evaluation-Differential Treatment). They rarely heard me stutter, did not recognize my avoidances, and could not understand how stuttering could be such as problem for me (#11 Integration of Client-Related and Environment-Related Factors). When a well-meaning clinician finally brought a copy of Dr. Seuss’s “Oh, the Places You’ll Go!” into the therapy room, and suggested that we read it together, I thought it was a sweet gesture, But I knew it was time to go. If I could advise those clinicians now, I would teach them about the nature of stuttering (chronic, variable, and complex) and the patterns of avoidance and complicated emotions and attitudes that people who stutter can exhibit. I’d advise the graduate supervisor to take a larger role in a complicated case involving a student in the program and to focus on the role of counseling in stuttering therapy.

    In my mid-40’s, while working as an SLP in the public schools, my insecurities about stuttering resurfaced with a vengeance. I treated myself like I would never treat one of my students: I became preoccupied with obliterating those last few percentage points of stuttered syllables. I sought the help of a friend whom I consider one of the best stuttering therapists in the business. I wanted to optimize my fluency. Fluency, she replied, was not the problem. Or the solution. I already knew how to be fluent, she said; what I needed was to learn how to stutter (#1 Differential Evaluation-Differential Treatment; #3 Counterconditioning, Deconditioning, and Desensitization; #11 Integration of Factors). Fortunately, I took her advice and rediscovered the value of acceptance, and of allowing stuttering to exist, right alongside my efforts to work through it and speak with greater ease. I also recommitted to mindfulness practices and began to embrace Acceptance and Commitment Therapy (ACT), which helps me to remember the value of saying what I want to say, whether stuttering or not, in the service of living the kind of life I want to live.

    In my early 50’s, I can reflect on what has been quite a journey so far. I’m grateful for the help I have received, and that stuttering is in a workable place for me most of the time. I hope this has been helpful to you! Wishing you the best in your studies and career,

    Rob Dellinger

  3. Interesting question, Haley. I remember 4 SLPs. Two worked together and when I was first brought in, one asked if I knew why I was there. I said stuttering. They both immediately said no, that I was there to work on artic. That therapy was 2 sessions & out. The next SLP only evaluated me and said she couldn’t see any reason for my stuttering, as I had friends, a stable family life, and was doing well in school. Finally in junior high, I was seen by somebody who actually knew something about stuttering. A lot of the attitudes therapy we did meant little to me at the time, but when I was in my 20s, I remembered much of what we talked about and began confronting my stuttering. It’s interesting—when I had the opportunity to participate in the Voices: Past and Present panel discussion (http://www.mnsu.edu/comdis/voices/voices.html, 2011), I heard others also note that early therapy kicked in when they were young adults. Unfortunately, sometimes the empowerment takes a while and the SLP is no longer around when it’s time to give thanks.