Self-Advocacy; How To Help Without Hindering

About the Authors

mcgillLoryn McGill is a speech-language pathologist who specializes in treating people who stutter in her private practice. She is a member of faculty at Chapman University in Orange, California, where she is Professor of Fluency Disorders.  She has presented at the California Speech and Hearing Association (CSHA), FRIENDS and the National Stuttering Association (NSA).  She has developed and hosted CEU courses as well as annual one-day conferences.  Loryn has been involved with research, examining the use of medical intervention in stuttering and is currently involved in international research examining intervention in young children who stutter. You can learn more about her practice at www.OCfluency.com and contact her at 2900 Bristol St. B 103, Costa Mesa, CA 92626, USA. Phone: (949) 302-5681; E-Mail: lorynmcgill@gmail.com
oconnorNora A. O’Connor is a licensed clinical social worker and a person who stutters living in Los Angeles, California.  Nora facilitates counseling groups, in her private practice, for kids, teens and adults who stutter.  Nora treats the emotional response to stuttering.  She is on staff at the Successful Stuttering Management Program providing Cognitive Behavioral Treatment and Mindfulness.  She is in the process of developing a CBT and Mindfulness workbook for SLP and PWS.  Nora has been involved locally and nationally with stuttering self help organizations for almost 20 years. She is featured in two stuttering documentaries, Spit It Out (2004) and Right Here, Right Now (PBS, 2000).  She is an adviser to StutterTalk and author of the chapter Substance Abuse and Stuttering in the book Stuttering: Inspiring Stories and Professional Wisdom.  She holds additional training in addiction studies, trauma interventions, motivational engagement and walk & talk therapy.  You can learn more about her practice at www.NoraOConnorLCSW.com and contact her at 566 S. San Vicente, Suite 102, Los Angeles, CA 90048-4622, USA.  Phone: (011) 310-736-8623; E-Mail: NOConnorLCSW@gmail.com

Empowering a person who stutters (PWS) to advocate for themselves and explore self-determination are of interest for both Speech-Language Pathologist (SLP) and Licensed Clinical Social Workers (LCSW). Both groups of clinicians can learn how to help without hindering in their respective roles. The purpose of this paper is to explore self-advocacy from the perspective of an SLP and LCSW as they collaborate to achieve this goal with PWS. We will discuss self-advocacy within the dynamic transition from a therapy room to the day-to-day life; the role of community support, increasing a client’s self-esteem and helping without hindering. We will present literature review on self-advocacy. Lastly we will discuss tips and tools for SLPs and LCSWs

Introduction:

It is no surprise that when a person who stutters self-advocates an increase in communication is related to confident attitudes, high-self-esteem and better social skills. An individual willingness and desire to communicate is a critical predictor of positive peer relations and acceptance (Richmond & McCroskey, 1998). It is critical that clinician’s should, “help the child find a balance between modifying speech on the one hand and developing and maintaining healthier attitudes and feelings on the other” (Chmela & Reardon, 2001, p.1).

“Through the therapy process, the child will be faced with difficult situations.  The clinician can assist the child in dealing more effectively with problem situations by helping him develop problem-solving skills. Learning how to problem solve speaking situations will empower the child and help him see that he has communication choices “ (Walton, 2013, p. 117). The present state of stuttering therapy programs enables the clinician to render many PWS virtually stutter-free in the clinic. A major clinical problem, however, is the transfer of fluency to non-clinical situations and its maintenance over time (Altholz & Golensky, 2004). Learning self-advocacy skills within the therapy setting with structured practice outside the clinic will assist with long-term generalization and maintenance. “ There is an element of risk as well as the possibility of partial or complete failure.  In order to consider such challenges, we must reach some level of self-esteem and security” (Manning, 2001, p. 142). By directly addressing self-advocacy skills as part of a treatment plan for therapy, clinicians are better preparing their clients for long-term management of their stuttering.

Therapy Room:

Both the speech therapy room and the counseling room create a safe place for clients to increase vulnerability, learn new skills and develop self-esteem. The goal is to create safety in other areas of the client’s life and to transition and normalize the use of new skills. The therapy environment is frequently limiting, and fluency is often developed quickly. In the counseling office, a client can often master cognitive behavioral skills and anxiety management skills quickly. In both therapy settings, treatment goals are needed to the transfer of skills outside of therapy room, as well as introduce more real life situations to create the opportunity for greater success. An SLP and LCSW treating the same client together can develop a comprehensive plan to achieve the stated goals.

Introduction of challenging situations along a hierarchy is imperative to mastering higher-level skills of independence. Early in their treatment, the client determines the challenges, from mild to intense, they wish to undertake and in doing so, set their own goals. Situations may range from being able to talk with a neighbor over the fence, to speaking in large group situations

A LCSW would introduce Cognitive Behavior Therapy (CBT) skills, Mindfulness and Grounding skills. CBT skills you learn to, “change the way you think, the way you behave and the way you feel” (Burns, 1990, p. 5). Mindfulness skills guide you to be present in the moment to participate fully in life. Grounding is a set of strategies to detach from emotional pain, (i.e. racing thoughts, negative talk, worries, anger, and sadness), (Najavitis, 2002, p. 130-135). The LCSW would use ‘walk and talk therapy’ to practice skills outside of the therapy room.

A client would utilize these skills when practicing phone calls in speech therapy room or asking a question to a cashier clerk. With the hierarchy in place the client will understand how utilizing these coping skills will aid in increased self esteem to advocate for themselves. A client would be encouraged to analyze what it means to be a person who stutters and how that impacts successful communication.

Community Supports:

The clients’ immediate surroundings and support may send a conflicting message as the client takes more risk with their communication and deals with the emotions created by the challenging situations. This begins with communicating with the PWS that they are okay, even if they stutter. That what they have to say is worth listening to despite the fact that the words may not come out fluent. Shifting the focus in the clients’ immediate environment from focusing on fluent words to the content of the message is the shift that must take place to promote self-advocacy.

Finding a balance between doing and supporting can be challenging within a family or community unit. Watching a child or adult struggle to produce a sound, while people stare in confusion, can lead to a loved one having feelings of wanting to rescue. When the client’s self-confidence increases and they know that they are okay even if they stutter, they can better navigate these situations without rescue, and family members can also begin to relax. This will enhance the client’s success.

Self Esteem:

One of the ways to increase self-confidence is to allow the client to take chances. This starts in the controlled environment of the therapy or counseling room and gradually moves to situations that the client has determined to be of higher risk. Clients will typically take risks as they establish trust with the SLP or LCSW and feel that they are being helped and not hindered. Guiding a client to be prepared for setbacks allows “failures” to be learning experiences.

SLPs can prepare clients by doing speaking situation activities in the office (i.e. telephone calls).  Watching an SLP do tasks first can increase a client’s willingness to try. A client can choose how they want the therapist to voluntarily stutter and what they should say. This can be done through role-play in and out of the therapy room, then with trusted individuals, and then the actual trial situation. Prior to the actual task, the client can make predictions as to how the situation may go, and then discuss prediction vs. reality after the situation. Specific fluency strategies are discussed as well as how to react if asked to repeat a certain word or phrase. Whether to advertise, or mention stuttering, would be determined prior to engagement. A school or work presentation on stuttering would be an option to increase self-esteem through educating peers.

An LCSW will model positive affirmations in front of a mirror and then have the PWS do the same. A Daily Mood Log is taught to identify negative feelings, automatic thoughts and cognitive distortions (Burns, 1999 pg. 75). Grounding exercises and mindfulness techniques are led by an LCSW during the session, and then will be set up for PWS to do on their own. Client’s reality testing is measured by a “Prediction vs. Reality” worksheet to explore assumptions held before situation, and then discusses what actually happened afterwards. Lastly, Dr. Breitenfedlt explains in the Successful Stuttering Management Workbook, “Advertising is the most important technique that a stutterer can learn.” (Breitenfeldt & Lorenz, 1999, p.26). Advertising or being open about stuttering will most likely increase self-esteem and plays a role in self advocacy.

Helping Without Hindering:

SLP:  Parents in particular will ask what to do if their child is stuttering. First, the home environment has to evoke support for communication. Second, the child has to believe that they are good communicators. Third, trust between the child and the parent needs to be strong enough that the child feels that the parent believes they can communicate. That being said, the child needs to know they can turn to the parent when they are really struggling and ask for help without solely relying on the parent (i.e. on a particularly rough day). If the child is continually looking for the parent to speak for them it is because they do not believe they are able to communicate effectively. The parent needs to assist in increasing the child’s self-esteem by increasing praise.

LCSW: In order to help and not hinder, do not make assumptions. Ask clients what they need.  At times, the client may not be interested in self-advocacy or increasing self-esteem, instead their goal is to be fluent. Or other times they want to reduce anxiety and let a few people know they stutter. Therapy begins where the client is at – honor the client’s journey, establish achievable goals and treatment plan. Treatment plans will be updated often to reflect current needs.

Self-Advocacy Tips and Tools:

SLP:  So much is lost when one is not able to speak. The long-term effect on an individual who is not able to communicate in risky situations is damaging. When you ask a person who stutters, “ How would your life be different if you did not stutter?” you get a wide range of responses. For some people the answer is that it would not be all that different, just easier to talk. For others they may have chosen completely different career paths, had different personal relationships and overall feel that they would be happier. That the life they currently have does not resemble the life they feel they would have if they did not stutter. For those individuals the risk was always too high and the chance of stuttering was always too great to do the things that they wanted. So often in therapy the primary focus is on fluency. When the shift is made away from the fluency of a word to the value of a message then the client will gain the confidence they need to speak on their own behalf. This being said, it cannot be done unless the client is systematically introduced to more challenging situations as their skills increase and they are participating in well structured avoidance reduction therapy.

LCSW: When you get the opportunity to work with a PWS you may have much to learn. Most often the client will be your best resource about his or her own stuttering. You must also be willing to learn more on your own. Begin by contacting the Stuttering Foundation of America, National Stuttering Association or Friends to obtain educational material. You may learn of a local workshop or a support group that’s near you and decide to attend. You may consider reading memoirs such as “Out with It: How Stuttering Helped Me Find My Voice” by Katherine Preston (2013), Stuttering: A Life Bound up in Words by Marty Jezer (1997) or Voices: A Stutterers Odyssey, by Scott Damian (2013). You may view a movie discussing stuttering such as, The King’s Speech and Rocket Science. You can subscribe to StutterTalk Podcast, and browse the archives for interesting topics.

Conclusion:

Joseph Sheehan’s “Giant in Chains” complex discusses the stuttering puzzle of “if only he did not stutter, then there could be no limit to his accomplishments.” (Sheehan, 2013, p. 33). What we have discussed is how a PWS can be successful while stuttering with support from an SLP, and/or LCSW and the community. As a PWS learns to advocate and develop self-esteem it is hoped that they will believe that there is no limit to their accomplishments, even when they stutter. In this paper, we have explored what both a SLP and a LCSW are doing together to help the PWS to advocate for themselves and increase their self-esteem. We have discussed our personal and professional experiences that demonstrate a variety of approaches to guide people who stutter into a lifestyle of self-advocacy and self-confidence.

References

Altholz, S. & Golensky, M. (2004). Counseling, support, and advocacy for clients who stutter. Health & Social Work 29.3.

Burns, D. (1999). The Feeling Good Handbook, (2nd ed.) (p. 5, 75).  New York, NY: Penguin Group.

Breitenfeldt, D., & Lorenz, D. (1999), Successful Stuttering Management Program ( Second Edition, p. 26). Cheney, WA.

Chmela, K., & Reardon, N. (2001). The School-Age Child Who Stutters: Working Effectively with Attitudes and Emotions (p.1). Memphis, TN, Stuttering Foundation of America. & Reardon, N. (200. Memphis, TN: Stuttering Foundation of America

Manning, W. (2001) Clinical Decision Making in Fluency Disorders (2nd ed.) (p. 142). San Diego, CA: Singular.

Najavatis, L. (2002).  Detaching from Emotional Pain (Grounding). In H. T. Blane and T. R. Kosten (Eds), Seeking Safety: A Treatment for PTSD and Substance Abuse (First Edition, p. 130-135) New York, NY, The Guilford Press.

Richmond, V. P., & McCroskey, J. C. (1998). Communication: Apprehension, Avoidance, and Effectiveness, 5th edition. Needham Heights, MA: Allyn and Bacon.

Sheehan, J. (2013). Stuttering Foundation of America, Effective Counseling in Stuttering Therapy, Publication No. 0018 (3rd Printing)(p.33) , Memphis, TN: Stuttering Foundation of America.

Walton, P. (2013). Fun with Fluency for the School-Age Child (p. 117) Austin, TX: PRO-ED.

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Comments

Self-Advocacy; How To Help Without Hindering — 45 Comments

  1. awesome! Looking forward to reading more in the years to come about your collaboration.

    Warmly, michael

  2. Hi loryn,
    There is an association of people who stutter in Mali. from support today we need to conduct a study among stutterers people of Mali to determine the factors of stuttering and have a stuttering evaluation Support

  3. Hello! I enjoyed reading this paper! My question is if an SLP is presented with a stuttering client but has no access to a LCSW, would it be appropriate for the SLP to introduce cognitive behavior therapy, mindfulness, and grounding skills? Thank you.

    • Hi, Genevieve, Thanks for reading article and making a comment. Loryn will follow up with this answer as well. I encourage you to build a relationship with a few LCSWs in your area. Where do you live? I feel this is a “win-win.” To have more LCSWs become educated about stuttering, and then having more PWS working with qualified mental health professionals.

      With that said, yes – I would encourage you to take a course on CBT that also discusses mindfulness. I can definitely help you to locate a workshop, class or online course. I would also ask you to order the Stuttering Foundation of America, Effective Counseling in Stuttering Therapy book. This book is a great resource to SLPs.

      Keep in touch.
      All the best.

      • Hi Genevieve,
        I agree with what Nora has said. I feel that as SLP’s it is important to act within our scope of practice and council as we are educated to do as it pertains to communicative disorders. Attending courses to learn more, reading and consulting with other professionals allows us to provide the best care for our clients. Although I feel I am educated on CBT I know when outside professional are needed and when the therapy that needs to be provided is outside what I know/am able to do. With tele -therapy being utilized more often it is easier to access professionals than ever before. This may be an option for you as well. Thank you for reading.

  4. Hi Loryn and Nora,
    Thank you for taking the time to write this paper, as it is extremely helpful for future SLPs like me! One of the aspects that I most enjoyed about your paper was advice and ideas for both SLPs and LCSWs. Sharing ideas for both of those professions really helps to promote interdisciplinary teams and collaboration to work with a PWS. Self advocacy and self acceptance are two metacognitive features that I want to know more about as an SLP student. One part of your paper that really stood out to me was,”When you get the opportunity to work with a PWS you may have much to learn. Most often the client will be your best resource about his or her own stuttering.” Our fluency disorders professor emphasizes often how a PWS has their own story to tell. My questions for you are, does creating an environment for self acceptance and advocacy, and the sharing of a PWS’s story differ for child clients and adult clients. If so, how?

    • Hello, Heather,
      I really enjoyed reading your comments. Im excited to hear that you are pursuing a career as a speech language pathologist.

      We cannot forget who is our most important resource – the client !

      Loryn can definitely do a better job of answering your question towards children ad teens who stutter in the “speech therapy” room. My belief, as a stutterer and a social worker, is that creating self affirming environments results in more success (in both counseling and therapy office). When a child / teen who stutters understands that he or she didn’t do anything wrong when they stutter, and they are not “bad” when they stutter – its going to create a safe environment for them to learn techniques for fluency and/or manage stuttering, as well as advocacy. For adults who stutter, you’d probably focus a lot more on self acceptance and confidence.

      Also, keep in mind that every client is different. I treated a young women in her 20s (for counseling) and she had little interest in self acceptance, and was determined to achieve fluency.

      All the best,
      nora

      To answer to your question:

    • Hi Heather,
      Your Professor was correct in saying that everyone has their own story to tell. Children see the world differently than adults because they have limited experiences by comparison. The goals between an adult and child will look different as the environments and people they interact with are different. The communication demands in these environments will vary as well.
      Thank you for reading

  5. Hi Ladies,

    I really enjoyed reading your paper! I am a first year graduate student in speech – language pathology and am currently taking a course in fluency. My professor emphasizes the importance of addressing the client’s emotions and self-concept throughout the process of speech intervention. I have not heard of CBT before but I am very interested in learning more about it! Based on your paper it sounds like it is useful not only for PWS but for individuals with generalized anxiety as well.

    Nora I have a couple questions for you about your practice and personal experiences as a PWS.
    Do you use CBT only with clients that are PWS or is CBT a type of intervention that can be used in a variety of different scenarios?
    As a PWS how were your experiences in speech therapy and how did that shape your practice today?

    Look forward to hearing from you!

    Best

    Katrina

    • Hi, Katrina,
      Thank you for taking the time to read our paper. All the best as you move though grad school. What school are you attending? How do you like your Fluency class?

      Cognitive Behavioral Therapy is used for many disorders including depression, anxiety, trauma, behavioral, self esteem, etc, etc. As i learned CBT in undergrad I began using the treatment modalities with all populations. Over the years I realized how much I benefit from what I was learning and teaching. I began applying the skills to myself, and then recognized how important it would be for people who stutter to understand and utilize CBT skills as needed. I now treat PWS in my private practice and from my experience most clients have responded really well to these new skills along with any handling techniques they may (or may not) be using.

      I had a variety of experiences with speech therapy. My elementary school speech teacher was the best. She was very caring and loving, and tried many treatment approaches. This was the 80s so there was still much to learned about stuttering treatment. I used the DAF (slow, smooth connected speech), which was very difficult to transfer out of the speech therapy room. My Junior High speech therapist seemed ill prepared to treat stuttering, which was common then and now. I recognized her uncomfortablenss, but also I was a teenager and I wanted to be normal – I “dropped” out of speech therapy. The most significant treatment occurred when I attened the Successful Stuttering Management Program in my mid 20s. This program focused on both acceptance and managing stuttering. Check out the program at http://www.ssmpmanual.com

      All the best,
      nora

      http://www.NoraOConnorLCSW.com

  6. Your paper has encouraged me to keep finding ways to help my 2nd grade client who really isn’t interested in overt treatment and not concerned with his stutter to address covert aspects. I am a 1st year grad student with limited experience and knowledge on how to work with CWS. My client has a beautiful and outgoing personality that I would like to encourage and preserve as he grows older. I believe I can do this by asking my client what he wants to take away from our time together. It’s a starting point. Do you have any other suggestions? What are your feelings about sharing a recording of himself talking? Would that damage his self-esteem? I am hesitant to do so and I would appreciate your advice. Thank you!
    Correne

    • Hi Correne,
      Thank you for reading our paper. It is hard to comment specifically on what to do with a client that I have not personally seen. It is important to establish a, ‘buy in’ with therapy. The client needs to feel that the intervention that they are receiving is important and helpful. Have you tested his feelings towards his speech? The OASES would be a good starting point if you haven’t yet, it would give you insight into how he feels about his speech.
      Loryn

    • Hi, Correne,

      Thank you for taking the time to respond. Loryn can speak to your questions about speech therapy.

      I am glad to hear your 2nd grader has such a great spirit. You can continue to foster that by talking about what he likes about himself; what are his interests and hobbies. Showing him that you care about him is the first avenue to establish rapport and a good relationship. . Often kids love to read about the professional athletes who stutter. You can read articles together. http://www.stutteringhelp.org/famous-people-who-stutter
      Id encourage you to order a couple posters from both the National Stuttering Association or Stuttering Foundation of America. http://secure.stutteringhelp.org/Merchant5/merchant.mvc?Screen=CTGY&Store_Code=SFA&Category_Code=W
      You can let him know that organizations like FRIENDS exist, whether he’s interested in this now or later – at least he knows other kids who stutter hang out with each other and have a good time. Id encourage you to attend a FRIENDS one day workshop. They are held all over the country. http://www.friendswhostutter.org

      Also, let his family know about these resources too.

      All the best!
      nora

      http://www.NoraOConnorLCSW.com

  7. Hi,
    As a graduate student studying to be a Speech Language Pathologist I found your article to be very interesting.It is so interesting to see how beneficial the collaboration of a SLP and LCSW can be for a PWS. By giving them the self confidence in their communicative abilities they will be able to speak in a greater amount of situations. Loryn, do you always refer you clients who stutter to a Social worker to help them with their self esteem and confidence in their communication? Or do you try to address these areas and if the client needs additional support you then refer to an LCSW?
    Libby

    • Hi Libby,
      It depends. I see PWS of all ages ranging from preschool to adult. Adults will often tell you if they have anxiety, depression, are on medication, etc. Although I am a speech therapist with experience in CBT and avoidance reduction therapy; if the anxiety and depression are present in other areas of the clients life, I like to seek outside support. For example, if a client is socially isolating themselves by not leaving the house on the weekend and only going to and from school and withdrawing from all other non-required activities, then perhaps consulting with a LCSW would be helpful in identifying anxiety triggers that may or may not be speech related. Although part of that problem may be the stuttering, it goes beyond what I as a therapist feel I should be doing on my own.
      Loryn

    • Thank you for your reply, Libby. All the best in grad school. Thank you for choosing this profession.

      Nora

  8. Hello, I am an aspiring speech language pathologist and in my master’s program. I have a question, what would you suggest if you have a non-compliant child, to the point that he is oppositional and that just does not want to help himself?

    • Hi Rebecca,
      I have to ask more questions first about age, stuttering characteristics, how long he has been in therapy? You can contact me on my website at OCfluency.com
      Loryn

  9. Hi Loryn and Nora,

    I really enjoyed reading your paper! I am a graduate student studying to be an SLP so I found this really interesting. I think it would be really beneficial to improve their self-esteem so that there is more generalization outside of the therapy room. You mentioned the family of a PWS and how they can help without hindering and I am wondering how you would go about helping build the trust between the parents and child? I think this is really important, but I’m not sure what advice I would give to a family on how to go about doing this. Thanks!

    • Hi,
      It starts with educating the parents. Giving them handouts from the NSA, FRIENDS and local support groups. If they do not understand stuttering and the treatment you are providing, they may have difficulty providing the support that needs to be provided at home. You can have them observe you interacting with the client, providing positive communication comments. For example, ” that was great story, I like the way you look at me when you talk, that was a really big word you used.” Assist them in focusing on all the things the child IS doing. You can also have them keep a log at home of comments they said during the week and have them bring it to you. Acknowledge that the parents may be having a hard time with their child’s stuttering and provide support for them through counseling and meeting parents of other children who stutter and adults who stutter.
      Loryn

    • Thank you for taking the time to read our article and commenting. Where do you attend grad school?

      Id encourage you to attend a FRIENDS one day conference for young people who stutter, families and professionals. This will provide you an understanding of how other parents deal with their child’s stuttering and give you an arena to talk about your experiences also.
      http://www.friendswhostutter.org/one-day-conferences/

      All the best,
      Nora

      http://www.NoraOConnorLCSW.com

  10. Hello,

    I currently have a client in my program’s fluency disorders clinic who is reported to be non-compliant at home. His mother told us that during the Summer she was constantly reminding him to “use his tools.” Now he does not want to participate during clinic and gets uncomfortable when he is asked about stuttering. This is a major step back from previous semesters. The other day we had a great session. When his mother was told what a great session we had she just said that she doesn’t see that at home.

    Can you recommend anything for us to help create a more “helping and not hindering” home environment?

  11. Hello,

    I am currently a graduate student in a speech pathology program and I found your article insightful. It was interesting to learn how much professional overlap can exist between the field of speech pathology and social work. I do agree that it is important to give the client the opportunity to personally decide the appropriate starting point for therapy and goal-setting because he/she has to truly believe in the therapy and be willing to internalize the skills in order for proper generalization to occur. How would you go about addressing a client who may have personal goals which you feel may be too lofty or not realistic for the amount of sessions you are prescribed? I would not want to discourage the client or make him/her feel like they are not being acknowledged.

    • Hi Toni,
      The goals that the client sets are for them. Although you may have limited time with this client, it does not mean that they are necessarily stoping therapy with you. Clients often go in and out of therapy and the goals that the develop with you, they might take to another therapist down the road. How great that they have high goals and want you to support them in reaching it!
      Loryn

    • Toni, Thanks for visiting the ISAD 2015 conference. You are well on your way to being a dynamic and understanding SLP. All the best in your studies.

      Loryn answered your questions wonderfully. Let us know if there’s any other questions you have.

      Id encourage you to attend FRIENDS workshop in your area – This will help further your toolbox with great resources and establish colleagues in the field !
      FRIENDS website
      http://www.friendswhostutter.org/one-day-conferences/

      All the best,
      Nora

      http://www.NoraOConnorLCSW.com

  12. Thank you for posting on this topic. This is a question that I constantly find myself asking and have read conflicting viewpoints. I agree that it varies depending on the individual and that the most beneficial thing to do is to ask. Some individuals may want help and others may refuse it. In your experience, is it more beneficial to have family members involved in the therapy room from the start or do you find the child has greater success when the child masters the skills on their own and then carryover strategies are taught to the family to implement outside the therapy room? Would this maybe depend on the client as well? Do you also find that working on mindfulness and disfluency simultaneously is successful or is it better to work on disfluency intervention and then progress to mindfulness? I think that the timing of teaching mindfulness depends on when the client is ready to accept their stutter. Overall, this article provided unique insight into an area that does not have a lot of existing research.

    • Hi,
      It is such a ‘as case’ decision. For the younger kids I like parents in the room because they see change first hand and often will mimic your interaction style at home which is very important. My school age kids kick their parents out but I have them explain to the parents after what we are working on and towards so they are included. I believe that you can work on both mindfulness and fluency at the same time because when you are more in touch with your reactions to your stuttering then fluency will come as a byproduct. The goal for any client is to ‘stutter well’ and to be willing to communicate in all situations. Every client’s fluency will look different.
      Thank you for your comments,
      Loryn

    • Thank you for your comments. I agree that his area does not more research!

      You are correct that some people may want help and others may refuse it – The most important is for you to stay consistent, so you’re available when the client shows a desire for help.

      Id encourage you to order a couple posters from both the National Stuttering Association or Stuttering Foundation of America. The posters may peak his curiosity when he does come to the speech room.
      http://secure.stutteringhelp.org/Merchant5/merchant.mvc?Screen=CTGY&Store_Code=SFA&Category_Code=W

      All the best in your studies. Thank you for choosing this profession.
      Keep in touch !
      Nora

      http://www.NoraOConnorLCSW.com

  13. Nora and Loryn,

    Thank you for bringing the issue of transferring learned skills into real life situations to light. This is probably one of the harder concepts to grasp for me as I am in my second year of graduate school. I think the best things we can do for our potential clients are to teach them self-advocacy skills more so than teaching them how to speak more fluently. While it is critical for us to train the client in new skills that will increase fluency, we should also teach the client to become a self advocate and to also focus on not being ashamed of their stutter. If we focus on how their fluency is “not normal” compared to their peers, this can hinder any possible development of self advocacy. I also appreciate that you allow the client to have control over the challenges they will be given; because even though they have difficulty controlling their stutter, they at least have control in the situations that they practice in order to build up their confidence level. I think including an LCSW is a great idea when working on treatment with a client. Given my knowledge of stuttering therapy is limited, I’m wondering if this is common practice in a majority of stuttering therapy? I think introducing a collaborative and comprehensive treatment approach between these two professions has the potential to show dramatic changes in clients.

    • Hi Danielle,
      As far as I know it is not ‘common practice’ but I would like to see it become it. It is important as a professional to know your scope of practice and know when to refer out. We do a disservice for our clients when we think we can do it all when in reality, there are other professionals that are more qualified to assist. Dr. Gerald Maguire at UC Riverside and Nora are trained professionals in their fields who also understand stuttering and I know that when my clients see them, they are in good hands.
      Loryn

    • Hello, Danielle, Thank you for attending the ISAD 2015 online conference. Your participation is invaluable as we continue to find better and more effective ways to treat people who stutter and support the family.

      Your comments are wonderful. Speech therapy techniques are very important for young people who stutter to learn, and they need to feel good about themselves to utilize these tools. Working on self esteem and encouraging self advocacy will create a more grounded person who is willing to take risks in life to not be ashamed of his/her stutter.

      All the best,
      Nora

      http://www.NoraOConnorLCSW.com

  14. Hello,

    As a graduate student studying to be an SLP, it never occurred to me that a person who stutters could benefit from working with an LCSW. I really appreciate your insight into how SLPs and LCSWs can work together to provide a stronger, more well-rounded support system for people who stutter. It was also interesting that you mentioned the client should indicate their own challenges and set their own goals. This notion seems like common sense, as speech therapy in general is never a “one size fits all” undertaking, but it seems this is more true for disfluency therapy. Thank you for increasing awareness of better supports for people who stutter.

    Justine

    • Hello, Justine,

      Thank you for reading our paper and responding. What grad school do you attend? I applaud you for choosing this profession. Thank you.

      As a person who stutters, in hindsight I really needed more focus on thoughts and feelings as the years went by. Eventually the intense emotions got in the way of me using speech handling techniques. When I did see an LCSW I felt that she knew nothing about stuttering or how to create a safe place for me to stutter openly.

      Id encourage you to attend a FRIENDS one day workshop. They are held all over the country. http://www.friendswhostutter.org

      All the best,
      nora

      http://www.NoraOConnorLCSW.com

  15. Hi,
    I am a SLP grad student and in my practicum there is a boy who stutters who shuts down during therapy and sometimes refuses to go to therapy with the SLP that I am working with. I enjoyed many aspects of your paper of increasing confidence in difficult situations by role playing with the clinician pseudo-stuttering the situation first, asking what the client would like to work on, and backing off in areas needed. I am trying to get any ideas about how to help the little boy and thought it sounded beneficial to ask him what he would like to accomplish. Do you have any other suggestions about how to work with him? Thanks.

    • Thank you so much for reading our article and responding. You care about your young client, and that’s where the therapy starts !!!

      How old is your client?

      You can continue to foster the relationship by talking about what he likes about himself; what are his interests and hobbies. Showing him that you care about him is the first avenue to establish rapport and a good relationship. Id encourage you to get to ask your shared client about himself. Get him to talk about what he likes; his interests, etc. You can take a walk with him. Sometimes getting out of the therapy room is most important.

      When he is ready – often kids love to read about the professional athletes who stutter. You can read articles together. http://www.stutteringhelp.org/famous-people-who-stutter

      Id encourage you to order a couple posters from both the National Stuttering Association or Stuttering Foundation of America. The posters may peak his curiosity when he does come to the speech room.
      http://secure.stutteringhelp.org/Merchant5/merchant.mvc?Screen=CTGY&Store_Code=SFA&Category_Code=W

      You can be familiar with support organizations so your prepared to provide this info as needed. Id encourage you to attend a FRIENDS one day workshop. They are held all over the country. http://www.friendswhostutter.org

      Provide his parents with these resources too.

      All the best,
      Nora

      http://www.NoraOConnorLCSW.com

  16. Happy ISAD, Loryn,
    I just re-read our paper. Good job ! I enjoyed your part on how the parents have to back off and let the child take risks AND they also need to be there when the child is having a hard day. We don’t always have to be super brave. It can be mentally exhausting to live as a PWS. Sometimes its okay to let someone else order for you !! Just as long as you know that person is confident you can speak on your own! The same with the SLP and PWS relationship, or LCSW and SLP. Needed to build trust.

    Looking forward to working more together this year.