How to Stand on Elephants (Susannah Parkin, Karissa Colbrunn, Tanner Saxton)


About the authors: 
Susannah Parkin:  My name is Susannah Parkin. I’m a person who stutters and a first-year clinical psychology PhD student at Idaho State University. I’m originally from Boston, MA and I received my bachelor’s degree from Hamilton College in Clinton, NY in 2013. For the past few years, I have been working as the program coordinator at the Depression Clinical and Research Program at Massachusetts General Hospital. I interned at the Stuttering Foundation in 2011 and was interviewed on Episode 400 (Public Speaking, Stuttering and Doing What You Fear) of the StutterTalk Podcast.
About the authors: Karissa Colbrunn: I’m beginning my second and final year in the Speech-Language Pathology Master’s Program at Idaho State University. I’m originally from Southern California. I received a Bachelor’s degree from San Diego State University in 2015 with a major in Speech, Language, and Hearing Sciences and a minor in Psychology. I love spending time outdoors, especially near the water, and exploring new places with open-minded and curious people. I have recently become extremely passionate about how an acceptance approach can be taken in speech therapy when treating individuals who stutter, especially in an intensive setting. I’m also interested in raising stuttering awareness and knowledge, both generally in the world and specifically within the field of speech-language pathology.
About the authors: Tanner Saxton: Hello! My name is Tanner Saxton and I am a second year Master’s student in the Counseling Program at Idaho State University (ISU). I was raised on a farm just outside Paris, Idaho. In 2015, I completed a Bachelor’s of Arts degree in Anthropology at ISU and the following fall I entered graduate school, declaring as a school counseling major. I have many areas of interests within counseling that include trauma work, cultural counseling, career counseling, and addictions. As I prepare to enter my final months of the program, I look forward to working as a school counselor in a secondary education setting and to continue my career in coaching as well.

elephants-bioOur clinic experience this summer underscored to us the importance of this year’s ISAD conference theme, Stuttering Pride: Respect. Dignity. Recognition. We approached stuttering from a strengths-based perspective while simultaneously leaning into the challenges, fears, and anxieties that come along with stuttering. Paired with an emphasis on forward flowing speech and stuttering well, this holistic approach allowed us to move beyond acceptance into a stuttering pride and advocacy perspective. In our discussions and activities, we explored and experienced the power of having pride in the entire person, confidently talking about stuttering with friends and strangers alike, and maintaining our own dignity regardless of listener reactions.

How to Stand on Elephants

Susannah

This summer I participated in the Northwest Center for Fluency Disorders Interprofessional Intensive Stuttering Clinic (NWCFD-IISC) at Idaho State University. A collaboration between the Departments of Communication Sciences and Disorders and Counseling, it is the first and only clinic of its kind to simultaneously target overt stuttering and the covert emotional and cognitive processes associated with stuttering. The clinic takes an individualized approach in which each client is assigned one Speech-Language Pathology (SLP) Graduate Student and one Counseling Graduate Student to work with them as a collaborative three-member team (client, SLP, counselor) throughout the two-week clinic. The clinic uses an Acceptance and Commitment Therapy (ACT) framework to promote a positive self-perception and includes individual and group therapy, generalization activities in the community, and a high ropes course. Below you will find a description of the clinic experience from three distinct but interrelated perspectives: my own, my SLP, and my counselor.

At the beginning of the clinic, I described my stuttering as an elephant. It was a big presence in my life and my relationship with it was complicated. Sometimes my stuttering was an elephant standing next to me – it was always there and on my mind, but I could live in peace with it. Other times, I was standing on top of the elephant embracing the gifts that stuttering brought me such as empathy, perseverance, courage, and an ability to connect with others. And other times, the elephant was standing on top of me. It was heavy and suffocating and it stopped me from doing what I wanted to do. I vacillated between these frameworks and I spent more time than I wanted feeling paralyzed under the weight of the elephant not knowing how to stand back up.

My overt speech reflected the insecurity that I felt. I repeated phrases and used filler words because I wanted to avoid or at least postpone the moment of stuttering. I was afraid of stuttering because it made me feel helpless about my ability to say what I wanted to say. Even though I was moving forward in my life, I lived in fear that the elephant would suffocate me. As a result, I inhibited my words. I weighed the importance of what I wanted to say with the understanding that I would probably say it with a stutter – I held myself back.

Past mixed experiences with speech therapy made me somewhat wary of participating in this intensive clinic. I was afraid that I would be able to apply the speech techniques in the clinic room, but not in my real life and that I would blame myself for my failings, leaving the clinic feeling worse than I did at the beginning. The difference that this clinic brought to me, though, was that it changed my perspective on how I view situations and so-called “failures.” Stuttering is not a failure. Struggling to apply speech techniques is not a failure. Secondary behaviors are not failures. Someone interrupting you or hanging up on you or laughing at you are not failures. They are moments to be mindful and have self-compassion and keep going. They are learning experiences.

The connection and collaboration I felt with my team in addition to the positive environment promoted by the clinic as a whole facilitated my shift in perspective during the two-week period as well as in the time since the clinic has ended. My team made me feel accepted and empowered while simultaneously pushing me to my growth edge. I talked to them about my fears and struggles and with their support, I felt safe approaching challenging situations. We took each interaction as a learning experience and we debriefed about what took place.

As the clinic went on, I began to feel free. I started to break my habits of phrase repetition and using filler words. I experienced less fear when I spoke and said what I wanted to say without avoiding. I let go of my tendency to focus on what the listener might be thinking. I self-advocated and I talked about stuttering confidently and without apologizing. Now that the clinic is over and I am facing the new challenges of graduate school, I know that my journey with stuttering is far from finished. However, I also know that I have a solid foundation from which to move forward.

My clinic experience is not about fluency. It is about communication. It is about forward flowing speech and stuttering well. It is about accepting myself as a whole person just the way I am. Through this clinic, I learned how to stand on top of my stuttering elephant through realizing that my words are worth saying, I am important, and I am enough.

Karissa

Prior to beginning the IISC, I was extremely nervous but excited about treating stuttering. I found that my biggest tool at the IISC was not knowledge of speech techniques, but teamwork. I was worried after initially meeting Susannah and hearing about her negative experiences with fluency shaping that I was going to be the bad guy and wagging my finger telling her to use her techniques, but our team worked cohesively as a unit to address overt, covert, and secondary behaviors related to stuttering.  Susannah was so motivated and determined throughout the clinic and made my job as an SLP such an enjoyable experience.

I learned so many things from this immersive experience, three of which stand out in this reflection. 1) Think of your client as a member of your team, and treat them as the expert regarding their communication. I would not have gained as much valuable insight regarding Susannah’s treatment if we wouldn’t have taken the time to explore, process, and debrief following speech activities. 2) Keep an overall goal in mind and explain how tasks are feeding into this goal throughout treatment. My initial goal as an SLP was to teach Susannah how to use techniques so she could use these on her own. This later shifted into using techniques as a way to self-advocate and approach situations confidently and encourage my client to say what she wants to say in all situations and not be held back by her stuttering. I made an effort throughout the clinic to explain how each task led into our overall goal. 3) Enjoy the journey while working toward a goal! The process is just as important as reaching goals, and I would have missed out on once-in-a-lifetime experiences if I would have been entirely focused on accuracy percentages and techniques during the clinic.

Tanner

For me, this was a journey of risk-taking, self-discovery, team cohesion, and of course, an increased understanding and awareness of stuttering. To say that stuttering is EXTREMELY challenging in terms of emotional, mental and spiritual stamina is an understatement. I never could have prepared for where this journey would take me as an emerging counselor. The trust that our team was able to build throughout the process was vital to our work and served as motivation for us to work together in the face of so many unforeseen (at least to me) obstacles. Each of us was committed to the process and brought with us unique perspectives as professionals and as people.  Susannah was the expert on herself as a person who stutters; she could describe her stutter in both a beautiful and profound way; yet to an outsider of stuttering like myself-my conceptualization of the elephant was lacking.  My conceptualization was that it was the one in the room that I wasn’t clear about how to talk about. We became empowered together to converse about and explore stuttering. For me, the entire clinical experience was a reflection of Susannah standing on that elephant and I was lucky enough to ride alongside.

One of the things I loved most about this experience was the way in which we were able to collaboratively investigate covert aspects of stuttering and apply creative approaches to our exploration. We used play therapy, music therapy, art therapy, talk therapy, recreational therapy and brought in various metaphors and applications of these mediums to help us understand more about the individual experience of stuttering. I even had to pseudo-stutter in public as well as use techniques throughout the clinical experience which in and of itself was a way for us to gain some common ground. Although it was a far cry from understanding what it’s like to live with a stutter, I certainly gained more empathy in these experiments. I found that the wide-range of activities and approaches allowed for creativity in therapy in a way that maximized our growth as a working unit and that led to incredible insight.

Throughout the therapeutic experience, we each held space for moments of self-awareness and growth and it was both exceedingly exhausting and deeply rewarding to me! I developed a more acute sense of the lifelong challenges of stuttering; it’s hard!  The strengths of the individual were of such a profound nature that building on these was intrinsically related to the presenting challenge of stuttering itself. Resiliency, empathy, courage, intelligence, selflessness, and many other qualities struck me as being reflective of the belief that the PERSON truly comes first; the person comes before the stutter. The success that I believed we had as a team came from a willing client, one who “leaned into discomfort” and one who shared her experience freely and openly. I am grateful to have embarked on such a unique inter-professional experience, one in which I never would have thought I’d be riding elephants in Idaho.

Susannah

As a person who stutters, I have the opportunity to expose my greatest vulnerability every time I speak. Revealing myself in this way is scary because I don’t have control over how others react. And people do not always react well to stuttering – they may express discomfort or mock or turn away. Anticipating and dealing with listener reactions has been one of my greatest challenges because I’ve always felt like those reactions said something about me and my worth. However, through the collaboration and trust that I developed with my team during this clinic, I have begun to realize that I and I alone have the power to define my worth. By leaning into my fears, I’ve experienced the incredible power that comes with being vulnerable. I’ve also learned that by stuttering well with openness and confidence, I can communicate my self-worth to others, perhaps showing them that they have the power to do the same.

elephants

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Comments

How to Stand on Elephants (Susannah Parkin, Karissa Colbrunn, Tanner Saxton) — 75 Comments

  1. Greetings Susannah, Karissa, and Tanner,
    Susannah, thank you so much for expressing so eloquently how being a PWS has made you feel throughout your life. Your description of stuttering as an elephant in the room is not only poetic, but really provides a channel to the reader to be able to empathize with your experience. As a second year graduate student in speech-language pathology at Idaho State University, I am proud that our university is host to the NWCFD-IISC and has made such a powerful and positive impact on the lives of PWS. From what I can gather, the most important aspect of the clinic is how it shifted your perspective on situations and behaviors that you previously would have labeled as “failures.” It also seems to have shifted your perspective and perception of self, which is priceless. I appreciate how during the camp, you were able to let go of listener expectations and worries about what the listener might be thinking, and instead, focus more on forward speech, stuttering well, and the artful exchange of communication; not fluency. Your ability to be vulnerable and share your story is inspiring. Thank you. Also, thank you Karissa and Tanner for sharing your own journeys in regard to participation in the camp. What an outstanding experience it must have been!
    Joanna

    • Hi Joanna,

      Thank you for your thoughtful note. I agree that the most important aspect of my clinic experience was how it changed my perspective on what I would have previously labeled “failures.” I think that this shift in perspective has been especially helpful to me since the clinic has ended. It’s one thing to be able to feel stuttering pride and focus on forward moving speech in a clinic setting and it’s something completely different to transfer those things into everyday life. I think that the integration of ACT with this clinic is unique and has given me something to fall back on when I do find myself labeling things as failures. It helps me to re-focus on accepting the present and keep a growth mindset.

      Thanks again for your kind words and good luck with the rest of your program.

      Best,
      Susannah

    • Joanna,

      Thank you Joanna, and it truly was an outstanding experience, for sure. It was an honor to be able to participate in the NWCFD-IISC, and I’m glad I got the chance to participate in this reflection!

  2. Hi Susannah, Karissa, and Tanner,

    This was such an inspiring read. Susannah, I absolutely love your standing on elephants metaphor. I am a graduate student relatively new to the field of speech-language pathology and stuttering in particular, and I thought this metaphor was such a beautiful and meaningful expression of what stuttering means to you. Tanner, you mentioned that the “elephant” was something in the room that you were unclear of how to talk about. I think this is a sentiment that a lot of people have when they encounter stuttering, and I imagine it can contribute to some of the feelings Susannah describes regarding worrying about listener reactions. I am curious as to how all of you became empowered to openly facilitate dialogue among each other during your time in the clinic. What barriers did you have to overcome, and how did you establish an open environment to function as a collaborative team?
    Thank you for sharing your experience!

    Regards,

    Alex

    • Hi Alex,

      Thanks for your note and your thoughtful question – I think that it’s a very important one. I don’t want to speak for Tanner and Karissa, but I’d be happy to share my perspective and they can add in their own.

      As Tanner wrote in his reflection (and as you pointed out), I think the main barrier we had to overcome was that at first Tanner and Karissa were perhaps not sure how to best talk about stuttering because they were not extremely familiar with it. As people who don’t stutter, it was something that they had never personally experienced. I think that a few things helped us in overcoming this. For one, the clinic environment gave us a lot of time to spend with each other and talk about stuttering. Having this time gave us the freedom to explore stuttering to a deeper level than we would have been able to otherwise. Also, from the start Tanner and Karissa conveyed to me that they were truly interested in hearing my personal perspective and experiences. They listened to me thoughtfully and non-judgmentally and they asked me questions that showed they truly cared about me and wanted to better understand my personal experience. This allowed me to trust them and feel comfortable opening up to them.

      I think that the clinic’s integration of counseling and speech therapy was also beneficial. Although some sessions were more focused on counseling and others were more focused on speech, both Tanner and Karissa were involved in all sessions. I think that this allowed Tanner to better understand the speech side of things and Karissa to better understand the counseling side of things – which consequently allowed them both to better understand the full picture of stuttering and get us all on the same page. Finally, I think that our involvement in community activities was also beneficial. Through out the clinic, we went into the community to face real world challenging situations (e.g., ordering at a restaurant, asking store clerks questions, advertising stuttering). In some of our experiences, the listener did not react to stuttering in the most positive way and I think that it may have been helpful for Tanner and Karissa to see these “real world” reactions in person, as it allowed them to better understand stuttering and its associated daily challenges from the perspective of someone who stutters.

      I hope that was helpful and thanks again for your note!

      Best,
      Susannah

    • Hi Alex,

      I agree with Susannah, that the clinic allowed plenty of time for us to get to know one another and start having a dialogue about stuttering. Of course, for me having some of the vocabulary and education on what stuttering is and what it is not, helped a lot. We as counselors and SLPs spent an entire week before the clinic learning more about stuttering and the main therapy framework we would be working from (Acceptance and Commitment Theory). Personally, this gave me some context to work from. Some of the barriers we faced were miscommunication, misunderstandings on some of the activities and overall, time pressures and exhaustion. There were the many generalization activities that we did in the community that opened my eyes to some of the challenges that people who stutter face. Laughing, cutting off, looking away, and in the worst cases, offering inappropriate advice or “fixing stuttering” solutions and in some cases, mocking, were all part of listener reactions that I would not have anticipated even when I pseudo-stuttered myself. Of course, there were friendly or “good” reactions too, but I think I needed to see more of the spectrum to understand a little more (though I never will understand it fully) how challenging stuttering can be.
      Alex, I think you hit it right on when you say that people who are unfamiliar with stuttering often add to a person’s trepidation with listener reactions. It is my hope that we treated Susannah as the expert on herself, the expert on her stuttering; and this is one way I think we joined together in talking about it. I also feel that we were lucky in that Susannah knew we were “in-training,” 🙂 and there was a lot of acceptance and patience on her part that allowed us all to kind of laugh at our mistakes and move forward the closer for it. Self-disclosure I believe was a key aspect in open communication. I spoke of this in my reflection piece, but I truly believe that we had a lot of opportunities to try connecting with stuttering and the covert aspects through different activities. Some worked better than others, but each brought a little bit more insight into the process of therapy, both speech and counseling work. We watched each other climb the tower in the ropes course and do the swing and encouraged each other along the way. We were the belayers for one another, and I think these activities fostered trust and collaboration in a big way. Truly, the clinic itself had built into it the accommodations needed to build a supportive, collaborative team and I have to add that the clinic leaders and supervisors modeled this exceptionally well. Dr. Chad Yates and Dr. Huddock were right there to help us in these barriers and I felt supported the entire time. Thank you for your thoughts and questions!

      Tanner

  3. I really liked your description of how you felt about your stuttering. As a future SLP, understanding the feelings behind stuttering could be beneficial to my future work. Your “elephant” description really helped me picture all the different emotions that come with stuttering. After going through this experience, what would your advice to someone who feels that the elephant is on top of them?

    • Dear Nicole,

      That’s a great question and one that I don’t have a perfect answer to. I’ll admit that despite the positive experience I had during the clinic, I sometimes still feel like the elephant is on top of me. And when I feel this way, I try to remember that dealing with stuttering is a journey – it involves a lot of ups and downs. I’ve found solace in Acceptance and Commitment Therapy (ACT) – particularly acceptance, thought defusion and mindfulness. I try to accept that I am feeling the way that I am and have self-compassion with myself for feeling that way. Stuttering can be exhausting (mentally, emotionally, and physically) and it can lead to some very challenging situations. It’s fair to expect that my relationship with stuttering won’t always be positive. I’ve also found help in talking to others about stuttering. During most of my life, stuttering is something that I thought about a lot but did not often talk about with others. All too often there is a stigma surrounding talking about stuttering and I think that not talking about stuttering often makes everything feel worse for the PWS because on top of all the negative feelings that someone may have regarding stuttering, there’s also an overriding sense of loneliness. Talking about stuttering can begin to open up that feeling of loneliness. I’d also recommend the StutterTalk Podcast (a podcast about stuttering, hosted by PWS) and becoming involved with the National Stuttering Association. Connecting with other PWS is very powerful – there is nothing else quite like it. Hearing others’ stories, sharing my own story, and hearing other people audibly stutter are all things that I’ve found very therapeutic. I hope that helps!

      Best,
      Susannah

  4. Thank you Susannah, Karissa, and Tanner for each sharing your own unique experiences with participating in this intensive stuttering clinic. As a second year graduate student who also participated in this clinic, I still feel like I learned so much from reading this presentation. Susannah, I love the way you wrote about your personal experiences with stuttering with the elephant description. I think you painted a great picture of the many aspects of stuttering. I love how you said your clinic experience is not about fluency, but about communication. I think this is something so important for others to hear. Thank you for sharing your story with us.

    • Dear Allie,

      Thanks for your note! I’m so happy that you participated in the clinic this summer and I’m honored to hear that you got something out of our presentation. Yes, I think that a focus on communication rather than fluency is key. Throughout my life, whenever I’ve had a goal that involves fluency, it’s brought me much more harm than good. When my goal is fluency, my thinking becomes wrapped around the conception of fluency as a success and stuttering as a failure. This line of thinking often draws me to not say what I want to say because I don’t want to stutter. When my goal is communication, though, I’m less preoccupied by how my speech comes out and more focused on what I’m saying. Further, stuttering doesn’t prevent me from communicating effectively – if I say what I want to say and that message gets across to my listener, then that’s a success.

      Best,
      Susannah

  5. Hi Susannah, Karissa, and Tanner,

    Thank you so much for sharing this and for being so honest and open. I think the team idea with the collaboration of the CSD and counseling programs is brilliant. I also loved reading each of your own personal experiences with the clinic. Currently, I am a first year graduate student in speech-pathology, and aside from classes, I have not had much experience with stuttering. I loved the idea of the elephant metaphor because it helped me grasp a better understanding of the different perspectives that a person who stutters may have. Susannah, I also really appreciated your honesty and explanations of how listener’s reactions affected you. I love how you said that you learned how to stand on top of your stuttering elephant through realizing that your words are worth saying, you are important, and you are enough. That is incredibly powerful, and so many people could benefit from hearing those words said to them. I was wondering if there was a distinct moment you remember feeling empowered by those words and if so, what was the instance or thing someone said that happened for you to feel a change? Karissa, I also really liked your 3 points to remember in therapy, and those will be very helpful for me as a beginning clinician. Tanner, I really enjoyed your perspective and input from a counseling point of view, it was fascinating to me. My question is, based off your own personal experience in the clinic and the creative ways you mentioned that you were able to approach the aspects of stuttering, could you mention some more specifics on the recreational therapy and art therapy techniques you used? I love creative ideas and learning from other people’s success stories.

    Thank you all again for sharing your story, it was so powerful to me.

    -Devan Carter

    • Hi Devan!

      I’m glad you liked the reflection and found value in my perspective! So to me, one of the most insightful days we had in the clinic is when we went a high ropes course. We first played several team building exercises with ropes, etc. and it was a lot of fun. We were able to do a climbing wall and then also a rope swing that were both super fun and a little scary :). We all got to participate in these and I thought it was a great rapport building exercise, especially since we all went into it as a group; every person there, including SLPs and and counselors, had to come up with something that we have held on to (that has held us back) and then state it to the swing operator before we could get pulled up to the top. We then could think about letting go of it as we pulled the release on the swing. This was very powerful! And having all of us do it really put us on common ground. We also went to Jackson Hole, Wyoming, and several people went on the Alpine slide, a sort of luge like recreational activity. There was also some volleyball playing and hiking around the Snake River in Idaho Falls as we generalized and practiced, all done with an eye akin to the boundaries needed to create a safe atmosphere. And although some of these may sound like just normal everyday activities, I do believe they were very intentional in the therapy process, especially the ropes course. I think that therapy is such hard work as it is, and integrating some of these recreational components was a way in which wellness was brought to the forefront. Many people, clinicians and PWS alike, had never done some of these activities, and I think though some of these were challenging and were part of the in-process work that we were doing, others were ways of connecting with others, celebrating successes along the way, and also just enjoying the many opportunities we have in front of us everyday to take part in. We visited Jenny Lake in Wyoming and also took a very short hike to a waterfall, both of which, again, were part of the finding joy in the journey, at least for me. We did do the art metaphor, in which there was a comparison made of stuttering to some entity through a drawing. We also did some paint work in better understanding techniques, and lastly, we also did something not totally art related but of similar nature in doing sandtray therapy. This also allowed for creative expression and awareness of one’s own subconscious patterns. There are, of course, many other specific art-related interventions, such as house-tree-person drawings or kinetic family drawings that unfortunately we did not have time for, but that are considered great tools for counseling. I appreciate your interest and hope you find this answered your questions on creative therapies.

    • Hi Devan,

      Thanks for kind words! I’m glad that you found our reflection so powerful – it was fun to write. I like your question about whether there was a moment in which I remember feeling empowered by the concepts that my words are worth saying, I am important, and I am enough. There is in fact a distinct moment that I remember feeling empowered. One activity we did during the clinic was complete stuttering surveys. These involved walking up to strangers and asking them questions about stuttering (e.g., what they know about stuttering, if they’ve ever talked to someone who stutters, etc). My team identified a student who for me to ask, but I was resistant because she was wearing headphones and doing work and I did not want to interrupt her. At that moment, Tanner challenged me to walk up to her. He told me that I was important, what I have to say is important, and that it was ok if I interrupted her. Hearing those words gave me the confidence to walk over to the student and ask her the survey. Ironically enough, she was taking an exam and was not able to participate in the survey, but I felt proud of myself that I had put myself out there and asked her.

      Best,
      Susannah

  6. Susannah,
    What are some of the techniques that you tried for addressing the overt aspects and how do you decide which ones work best for you? What is your favorite technique for addressing the covert aspects?

    • Dear Jennifer,

      Thanks for your questions. In terms of overt techniques, I’ve found that pull-outs and light contacts are helpful for me. I’m currently working on feeling more comfortable using these techniques in my everyday life (which is much more difficult than feeling comfortable using them in the context of the clinic). In terms of covert techniques, I’ve gained a lot from Acceptance and Commitment Therapy (ACT), which was integrated with this clinic. The concepts of thought defusion (seeing your thoughts as thoughts rather than “real things”) and contact with the present moment (as experienced through practices such as mindfulness) are two techniques that I found particularly useful in dealing with those covert aspects.

      Best,
      Susannah

  7. Susannah, Karissa, and Tanner,
    Thank you all for your thoughts and candor! What a great experience to be a part of a collaboration of that kind. As a graduate student, I’ve noticed how interprofessional collaboration is talked about so frequently yet how few opportunities exist to put it into practice while in school. Very neat idea for a clinic.

    Susannah, your elephant metaphor is really a great way for beginning clinicians and counselors to visualize what people who stutter may be going through! I was struck by your description of how it felt to be on top of the elephant – “embracing the gifts that stuttering brought me such as empathy, perseverance, courage, and an ability to connect with others.” I feel so often we (future clinicians) hear the negatives sides of stuttering, but I love this list of special gifts that you possess. Also, you said you were concerned you would not be able to generalize what you were learning in clinic to the outside world – were there any treatments or strategies that really “clicked” for you regarding applying techniques outside of therapy?

    Karissa, I really appreciated your advice to “treat (your client) as the expert regarding their communication.” This is such an important reminder! As SLPs we feel like the communication experts, but it’s so important to remember that everyone has different experiences, especially people who stutter. Thanks for that reminder! All of your 3 reflection pieces are so useful for me as a beginning clinician.

    Thank you all for an inspiring read!
    – Andrea

    • Hi Andrea,

      You definitely picked up on my experience learning about stuttering and working with Susannah as an SLP. It was really challenging to step outside of the medical model of “fixing” a stutter and instead use acceptance, awareness/mindfulness activities. in coordination with speech techniques (such as prolongations, light contact, pull outs, and easy onsets) to give Susannah tools to manage her stuttering. Every person who stutters is going to have a completely different experience and components they want to work on, so it’s super important to take a step back and let them guide the process first and foremost. An open mind and compassion are your biggest tools as an SLP when treating fluency disorders.

      Thanks for your thoughtful comment!
      Karissa

    • Hi Andrea,

      Thanks for your comment and for your question about generalizing techniques outside of therapy. To be honest, it’s something that I’m still trying to figure out and it’s involving a lot of trial and error. I think part of why I have a difficult time transferring techniques to the real world is that I have a habit of getting caught up in thinking about what the other person is thinking and that leads to an increased feeling of time pressure. Grounding and mindfulness techniques are both things that we explored in the clinic and that I’m coming back to now and finding help in. Something else that I find helpful is trying to remember to have self-compassion for myself in my journey. I can be very self-critical and will easily get frustrated with myself for “failing” to implement skills that I got use out of in the clinic. These judgmental thoughts are not helpful to me and lead to increased feelings of shame, so I’ve also been trying to remember to think of everything as a learning experience. I hope that was helpful!

      Best,
      Susannah

  8. This article gives insight to me as a person studying to be a speech-language pathologist that I can’t get through a text book or a class. Thank you all for your openness for me to learn from. When I think of working with a person who stutters, I think that I always want them to say whatever they want to say and to not let anything hold them back. What do you think are the most important things I should keep in perspective while working with someone who stutters? What can I do to best benefit them as a future SLP?

    Thank you!
    Erin

    • Hi Erin,

      I’m glad that you enjoyed our reflection. Thanks for reading it and writing to us. I really like what you said about always wanting a PWS to say whatever they want to say and to not let anything hold them back. I think that this ties in nicely to what you asked about the most important things to keep in perspective while working with someone sho stutters/what you can do to benefit them as a future SLP. I think one of the most powerful things you can do in your role as an SLP is to simply convey this to them – that your hope for them is that they say what they want to say and not let anything hold them back. Having the focus be on communication/saying what they want to say rather than fluency is something to always keep in mind. On a similar note, I think that conveying to the client that you care about them as a whole person rather than just focusing on their speech is vital. For many people who stutter, stuttering is so intertwined with complex thought processes and emotions and if your focus is only on speech, you’re going to miss a lot of the stuttering experience. Lastly, I’d recommend always remembering that each person who stutters is unique. Every PWS that walks into your office is coming in with a lifetime of individual experiences regarding stuttering whether that’s previous speech therapy experiences (positive, negative, or neutral), avoidance habits, coping mechanisms, ways of thinking about stuttering, etc. It’s important to listen to your client and ask questions about their personal experiences and then meet them where they are at to start building that alliance. Good luck in your career and I hope that’s helpful!

      Best,
      Susannah

  9. Hi Susannah, Karissa and Tanner,

    Thank you for sharing your experience. I am a first year graduate student taking a fluency course this semester. I have had little experience with stuttering this far. A couple evaluations that I have been a part of on a team were with children who stuttered. The experiences have all been different which is intriguing to me. I enjoy the idea of the collaborative team. Susannah, I really enjoyed reading your description of your stutter being an elephant. I never really thought of the three options that stuttering can bring to a person. I also enjoyed you describing secondary behaviors, other’s reactions and struggling to apply speech techniques as learning experiences rather than failures. Karissa, I like the advice of thinking of the client as being a part of the team. Also, the advice to enjoy the journey through therapy. I agree that the process is just as important. Tanner, I really like the idea of using so many therapies to understand the individual experience of stuttering. All of your experiences of this process are inspiring as I begin my career as an SLP. Do you mind sharing your opinion of how working as a team has created a better outcome in therapy rather than one-on-one therapy?

    Thank you!

    • Hi Andrea,

      Thanks very much for your thoughtful message. I’m so happy to hear that you found our reflection inspiring. I like your question about how our experience of working as a team perhaps created a better outcome than one-on-one therapy. I’m interested for Tanner and Karissa to share their perspectives on this, but I’m happy to share my initial thoughts.

      I think Tanner touched on this in his reflection, but I think a big component of our team success was that we each brought with us unique perspectives – Karissa and Tanner as professionals and all three of us as people. I think that our individual perspectives were able to complement each other and allowed us to explore facets of stuttering to a deeper level than we would have otherwise. I think our multiple perspectives were also particularly helpful when we faced challenges throughout the clinic because we were able to problem solve collaboratively and effectively.

      Another thing is that I think having three people allowed us to really think of ourselves as a team. Ideally, in any therapeutic relationship, the client and therapist will work as a team but with only two people, I think it’s probably easier to stay in those defined roles of client and therapist. In our clinic experience, it’s true that I was the client and Karissa and Tanner were the therapists but I think in a way we were able to move beyond those roles. Throughout the clinic, we explicitly referred to ourselves as a team – we respected each other, saw ourselves as equal contributors, and were consciously working toward the same overarching goals and I think that was a powerful force.

      Thanks again for your note!

      Best,
      Susannah

    • Hi Andrea,

      Thanks for reading, and for your comment! I really like your interpretation of our paper! Working as a team was a great experience. Susannah touched on this, but it was awesome to have the extra support throughout the process and working with a professional who has a different perspective than mine was great. SLPs definitely operate from more of a medical model, and this isn’t totally conducive with the acceptance approach that we took at the clinic. The counseling really helped me to fully understand person-first treatment, and it was awesome to have extra support during our sessions. It was really helpful to have a third perspective when I was doing individual treatment, but our counseling and speech sessions definitely blended together toward the end. Also, I loved what Susannah said about our experience as a team, as equal contributors working toward overarching goals.

      Thanks,
      Karissa

  10. Hi Susannah, Karissa, and Tanner,

    Thank you for sharing about his experience! As a first year communication disorders graduate student, the bulk of my experience with stuttering comes from a book and videos. However, we have discussed the idea of adding counseling to speech therapy and now I have seen the result! Karissa and Tanner, I am wondering how you two worked together during sessions. Were the two therapies joined together? Were they more separate entities? Did therapy activities incorporate ideas from both?

    Between the three of you, what would you change or add to the program?

    Thank you!
    Caitlin

    • Hi Caitlin,

      Thanks for your comment and a great question. Karissa and Tanner explain the general clinic structure in response to the comment from Lauren below. There were typically 3 individual sessions every day (1 speech, 1 counseling, and 1 session of choice). One of the things that I really liked about the clinic’s structure was that all three of us were present for all of the individual sessions, so Karissa was there for the counseling sessions and Tanner was there for the speech sessions. I think that this structure really helped us to bond as a team and gain common ground in what we did/talked about. In regard to your question about how separate/combined the speech and counseling therapies were — I think that this structure of having all three of us in the room allowed for appropriate flexibility during the sessions. Some sessions were definitely more directed at speech and others were more directed at counseling, but there was a lot of integration of the two in the same session as things naturally came up (and especially as the clinic went on). For example, in a speech session after we practiced a specific technique or watched a video recording, we might open up space to talk about how the activity went and as we did that, more counseling components played in. Similarly, as the clinic went on I was encouraged (alongside the clinicians) to practice speech techniques as much as possible to gain comfort in them, so speech techniques were incorporated in some counseling sessions as appropriate. I hope that explanation helps in your understanding.

      Best,
      Susannah

  11. Susannah, Karissa, Tanner,

    Thank you for sharing your experience; I loved the metaphor that stuttering is an elephant, as it beautifully broke down the many cycles that a person who stutters may feel. I think it is so cool that there is a clinic that integrates counseling, as well as speech-language pathology. You said that the Northwest Center for Fluency Disorders Interprofessional Intensive Stuttering Clinic (NWCFD-IISC) was one of the first clinics of its kind. Did you find that this integrated approach was beneficial to all partners involved and how?
    Personally, I believe this is a direction that many clinics should begin taking. Why do you believe that many speech clinics focus solely on fluency shaping methods (where goal is perfect speech) versus an integrated approach, such as stuttering modification, where the person is first and foremost the goal?

    Thank you!

    • Hi Audra,

      Thanks for writing to us and for sharing such kind words. Yes, as far as I know the NWCFD-IISC is currently the only clinic that has this model of fully integrating counseling with speech-language pathology. Drs. Dan Hudock (SLP) and Chad Yates (counselor) at Idaho State deserve all the credit for making this clinic what it is. I’m honestly not sure why so many speech clinics focus solely on fluency shaping rather than taking a more integrated approach. I’m not an SLP myself so my knowledge of the field is limited to my own experiences in therapy and interacting with the stuttering community, but it’s seemed to me that the field of stuttering is often overly focused on fluency — fluency is seen as the goal so fluency shaping approaches make sense and are perhaps the obvious answer in that respect. However, narrowly focusing on fluency undervalues the complexity of stuttering as it disregards the bottom of the iceberg. Based on my own personal experience and values, I think that focusing too narrowly on fluency shaping is less effective than an integrated approach and my hope is that other clinics take note of the NWCFD-IISC’s approach and apply a similar model.

      Regarding your question about whether the integrated approach was beneficial to all partners involved and how — I believe it was. As far as the other clients, we all came in with different experiences and at different points in our stuttering journeys, but I think that the integrated approach allowed us all to be met (and meet each other) where we were at. The clinic environment as a whole felt exceptionally safe and throughout the two weeks, we opened up to each other and learned from each other. We supported each other through challenges and took pride in each other’s accomplishments. Further, the structure of the clinic encouraged a close connection to form between the clients – the majority of us were living in dorms on campus during the two weeks. This allowed us to spend a lot of time together and bond as a group.

      I’m interested for Karissa and Tanner to share their thoughts on the benefits to the participating SLPs and counselors as they are more familiar with this area. However, I do believe that the SLP and counseling grad students found participation in the clinic to be a positive experience. For one, I think that the interprofessional nature of the clinic allowed SLPs and counselors to expand their professional knowledge base (SLPs learned about counseling, counselors learned about speech language pathology). I also felt that the clinic was unique in its full involvement of SLPs and counselors in the experience as a whole — SLPs and counselors were encouraged to participate in the activities alongside the clients and lean into their own discomforts (following an ACT approach). I think that these shared experiences were beneficial in that they allowed SLPS, counselors, and clients to gain common ground, thus helping in the therapeutic process as a whole, and they were also beneficial because I think that many of the SLPs and counselors were able to gain their own personal insights through participation.

      Thanks again!

      Best,
      Susannah

    • Hi Audra,

      Prior to the clinic, we had a four day training learning about each other’s fields first and foremost. After that we learned about stuttering through the SLP lens and through the ACT and Counseling perspective. There was an ongoing process throughout the clinic about learning about each other’s fields and how to gain ongoing perspective and insight to the holistic/big picture of the person who stutters— so we weren’t shoving the bottom of the iceberg away, but talking about things right then and there as they came up. As we implemented awareness and speech techniques (overt aspects- the tip of the iceberg), we had the resources, time, and expertise available to explore the feelings and thoughts that came up as well.

      Having the vocabulary and knowledge of stuttering through working with SLPs helped me from a counseling lens. It was invaluable to be able to implement techniques and strategies and debrief every experience together. Not only is having the professional knowledge and expertise from each field so great, but having the third-person perspective when we were doing interventions and brainstorm together was awesome. We received professional insight from our fellow student clinicians working as integrated team.

      Ultimately, collaboration and consultation were the most beneficial components of the integrated treatment approach.

      Thanks,
      Karissa and Tanner

  12. Hi Karissa, Tanner and Susannah,

    Thank you so much for sharing your experiences. It was fascinating to read about the program from the perspective of a PWS, as well as from people who are providing the counseling aspect. While they are technically “outside” of the field of speech-language pathology, they are such an integral part of how we can provide the best therapy to PWS.

    It was very interesting for me to read about stuttering as an “elephant”. I work at a fluency clinic doing therapy with PWS, and it made me view how they perhaps feel about stuttering differently. It also made me wonder if many PWS have some sort of metaphor that they use to characterize stuttering in their lives.

    Thank you so much for your thoughtful stories, they were very enlightening to read!

    Katie

    • Hi Katie,

      Thanks for your message. As perhaps conveyed in this reflection, I definitely agree that the counseling aspect is integral to consider/focus on for PWS. That’s a good thought about different people who stutter having different metaphors for stuttering. As you’e probably learned from your experience working at your clinic, stuttering is such a personal experience and means different things to different people/has impacted people in different ways. I’d very much agree that different people who stutter have different metaphors for it, each relating to their own unique experience.

      During the NWCFD-IISC, we had an activity in which we were given art supplies (markers, paper, play doh, etc) and asked to create something to represent our stuttering. The SLPs and counselors participated in the activity too and they were asked to create something that represented something challenging they’ve dealt with/are dealing with in their own lives. It was very interesting to see and hear about the various representations/metaphors that people came up with. Some of them turned out to be similar to one another, but they were very different as well and represented a range of experiences, emotions, and thought processes. It was during this activity that I sculpted an elephant out of the play doh and it wasn’t until it was my turn to share that I fully articulated my metaphor even to myself (in all of the relations it demonstrated between me and my stuttering). As in, it was through the activity (creating the symbol and then explaining it) that I really conceptualized the entirety of the metaphor. If you wanted to and it made sense, it might be interesting to ask your clients to create some type of representation of how they see their stuttering as I think it might be a good self-reflection activity for the client and a good learning experience for you to gain more insight into how that particular client views stuttering. Thanks for your thoughts!

      Best,
      Susannah

  13. Hi Karissa! I am a speech pathology student and I really appreciate you taking the time to mention what you learned during this collaborative therapy experience. I have not had much experience working with people who stutter as I am just now in a fluency class. Were the therapy activities determined as a group? Susannah, do you have any suggestions for how to get clients to participate to the fullest extent possible when determining activities? If I was the client I might be reluctant to participate in the selection of activities because I might feel like I am lacking the knowledge about what needs to be done. Thank you!

    Jessica

    • Hi Jessica,

      That’s a good question about how to get clients to participate to the fullest extent possible in terms of activities. I think it’s helpful for the client to understand the purpose of the activity as a way to get him/her on board with it. Before activities, Karissa and Tanner both explained why we were doing that activity and I think that this made me feel more invested. We also debriefed after activities (discussing our experience, whether it was challenging, etc) and I think this was helpful as well in terms of maximizing the activities.

      Additionally, I came into the clinic already having several speech therapy experiences. Karissa and Tanner took the time to ask me about these previous experiences and what I felt had been helpful vs. not helpful. They then took my input (both my previous experiences and current goals) into account when planning activities throughout the clinic. I felt like this gave me a voice into what we did, thus increasing my investment.

      Lastly, the SLPs and counselors were asked to employ various speech techniques alongside the clients (e.g., pseudostuttering, tallying, freezing, light contacts) both in the clinic and outside of the clinic as we participated in generalization activities. I felt like this was helpful because with the clinicians modeling techniques, it encouraged clients to more fully participate in using the techniques and it also gave us all a sense of common ground. I hope that was helpful!

      Thanks,
      Susannah

  14. Hello Susannah, Karissa, and Tanner,
    Thank you for sharing such and interesting experience. I am a first year graduate in an SLP program. I was really pleasantly surprised when you first mention the three of you working together. I thought “that’s perfect!” My stuttering class has just begun talking about counseling as part of therapy because there is such a significant emotional component with stuttering.Tanner, do you have any advice for an SLP student in the approach to counseling in speech/fluency therapy?

    • Hi LeoBean,
      Thank you for your response, I too was excited when I learned about the collaboration of SLP and Counseling fields, particularly because I think interprofessional experiences add so much layer to one’s own understanding of his/her field. So its hard to say what advice I would give to an SLP from a counseling perspective just because it would most likely vary to person to person. However, I love what Karissa said in her paper about attending to the client in a way that treats them as the expert and to be open to the process more as opposed to outcomes. I think people receiving therapy (of any kind) in general often feel unsafe or at the very least, not as trusting, when they feel that someone is not as concerned with how they feel as they do getting “the job done.” I know I feel most connected to my own clients when I address my own personalizations, or things that are coming up for me that aren’t helpful to the therapeutic relationship, and strive to meet the client where they are at. This experience was great because we had several opportunities to debrief together as SLPs and counselors after activities, therapies and other meetings and this gave us insight into one another’s perspectives. I know one thing that a lot of counselors and SLPs talked about that was challenging to the SLPs, is silence and feeling expression in therapy. I believe it is normal for a lot of people to be uncomfortable with silence, and I think it is especially difficult for some of the world’s best communicators, (SLPs), but my advice would be to pay attention to nonverbals, to the things a client communicates to you through other ways, and don’t be afraid of silence. Often, a client will give you a ton of insight into their world through less threatening ways, such as practicing a technique with an art metaphor, etc. It’s my belief that people deserve to be heard, especially in my experience, that what they feel is even more important in many cases than an expectation that I have for them in therapy. Really listening to what PWS have experienced in their life is at the heart of trust, acceptance and progress in therapy, and I believe the more you truly listen, the more clearer it will become (for you together with your client) to know what directions in therapy will be of the greatest benefit to the client. Hope this helps, and thank you again for your great question!

  15. Hi Karissa!

    I am a grad student and am currently enrolled in a Fluency course. I have not had too much experience in working with PWS. I find counseling to be just as important as teaching stuttering techniques. I love the idea of working together with a counselor, but if it is not possible to have a counseling team member I was wondering what the best approach would be to start tapping into the hidden negative emotions that come along with stuttering. What approaches would be best in having the client feel comfortable enough to open up and share the emotional impact their stuttering has had on them?

    Thank you for the insight!

    Rachel

    • Hi Rachel!

      I totally understand this challenge as an emerging SLP. I think the first part of this is to take a step back from techniques and be truly interested in understanding your client. Some good ways to do this is by incorporate some counseling techniques, such as active listening, feeling reflections, and paraphrasing. Motivational interviewing is also really cool. I’ve found a foundation for emotional work is to push yourself to be open-minded and understanding as possible and recognize that everything you do is through your own lens. The better you are able to put yourself in your client’s shoes, the better your therapy and its outcomes will be. On that note, if you are in a state of avoiding your emotions, that can carry over and disrupt the process so I recommend working on yourself as well, because things will come up! We were pushed really hard to apply ACT to ourselves before using it during the IISC and I found it extremely helpful to this experience and my life in general.

      Best of luck,
      Karissa

  16. I appreciated your processing of the experience of stuttering as an adult, and I’m confident that you will find that as you lean into your fear(s), you will find them shrink and, perhaps, melt away and open doorways into your increasing awareness that you are stronger than you think and safer in this world than you thought. “Leaning in” to the scary places is a doorway to liberation of all sorts as you are discovering.

    One suggestion, if I might be so bold: Consider “leaning in” not so much a willingness to be vulnerable, which might escalate fears and create barriers to moving into spaces you might wish to know, but curiosity, which generates excitement and can be tempered with cautionary judgment to cultivate a safety net as needed. I have found that the very word “vulnerable” elicits a slight fear that ripples through my being and generates contraction of it and the desire to recede rather than to move forward and beyond. Saying to myself “I wonder what that will be like” with genuine interest raises my energy level and helps propel me forward. Something to consider. Words are powerful!

    Thank-you for this paper. It is honest and thoughtful and, I’m sure, helpful to many.

    Best,

    Ellen-Marie Silverman

    • Hi Ellen-Marie,

      Thank you very much for your thoughtful response. I really like the idea of re-framing “leaning in” from a willingness to be vulnerable to a curiosity. I’m thinking of it as moving from a passive stance to a more active stance — moving from “opening oneself up” to “proactive exploration.” I find this idea of shifting perspectives to especially echo with me where I am right now, as I’ve been experiencing a surge in stuttering-related fears in the past few weeks as I move forward in my graduate program. May I ask you how you moved into this curiosity mindset? Do you have any advice about how to do this?

      Thank you again for sharing!

      Best,
      Susannah

      • Hello, Susannah,

        The short answer to how I chose to approach life from a curious perspective is through the practice of mindfulness meditation, which I have been doing since 1996. This practice highlights non-judgmental observation of our own thinking, emotions, and body sensations, which is a fundamental aspect of establishing or returning to shamatha, or “calm-abiding.” Once the mind has been settled, then attention can be directed toward “vipassana,” or deep looking, i.e., curiosity, to encourage insight. Together, this mindfulness practice, i.e., “shamatha-vipassana,” is something I wrote a bit about in the book I authored, “Mindfulness & Stuttering.”

        Surrendering, or, as one might saying “being vulnerable,” I think is most effective in all its fullness when one first develops a sense of one’s own personal strength and of the fairness of the Universe.

        Best,

        Ellen-Marie Silverman

        • Hi Ellen-Marie,

          Thank you very much for your insights. I’ve recently begun to practice mindfulness, and I have found it beneficial. I look forward to continuing my practice.

          All the best,
          Susannah

  17. Susannah, Karissa & Tanner (also known as the Dream Team),
    I am so lucky that I got to see this progress first hand! During the camp I loved this elephant analogy you shared. I think this analogy really puts stuttering in a light that a lot more of us can try to understand since we all have an elephant we are constantly dealing with. But I like what you said Susannah, “I have the opportunity to expose my greatest vulnerability every time I speak”. This really helped me think of my elephants I live with and how brave you are that you don’t let this vulnerability hold you back! I am so glad I got to experience this camp. I think the take home of this camp for me was another great part you hit on which was that people’s negative reactions are not failures and all the negative things that come from stuttering are not necessarily failures, the only failure that can happen is if you let it hold you back and don’t say what you want to say. Thank you for sharing your experience with everyone I think the dream team was a prime example of the effectiveness of this interprofessional collaboration between SLP, Counselor and (awesome) clients like Susannah!

    • Brooke,

      Thank you for your reply, it was awesome to get so many perspectives from all of the SLPs and in working with you all! Thank you for sharing your reflection, what a neat experience the stuttering clinic was and I’m grateful that we had so many opportunities to learn from one another; I have to confess, I think the clinic in and of itself was the dream team, with all of its phenomenal components and I think every triad was a dream team! You all modeled things so well for us counselors and were super open and curious to our field and that made a HUGE difference. Thank you,

      Tanner

  18. Susannah, Karissa, and Tanner,

    Thank you for providing me and other readers with such an inspirational story. I am mesmerized by your self-motivation and drive to overcome the vulnerable states that stuttering has put you through in the past. I thought that it was amazing how three people working together could make such a huge impact on someone’s life. After reading your article, I did additional research on motivational interviewing. As a future speech-language-pathologist, I will definitely incorporate this into my therapy sessions. It seems as though the motivational interviewing brings out the PWS own desires and enhances their confidence in taking action in therapy.

    Thank you again sharing your personal experience with everyone.

    Amber

    • Hi Amber,

      Thanks so much for reading our reflection and for your kind comments. It was definitely an incredible experience, which I believe was highly facilitated by our team working together very well (alongside all of the other teams who participated). I’m glad to hear that you’ve done some research looking into motivational interviewing (MI). From my perspective as a client in this summer clinic and as a clinical psychology graduate student, I think that MI can be an excellent tool. A related topic that we discussed a lot during the clinic is the idea of stages of change – basically that people are cyclically moving through various stages of change (precontemplation, contemplation, preparation, action, and maintenance). I think that it’s important for both the client and the therapist to realize these stages of change whether the therapy is in context of stuttering or anything else – it’s important for the therapist so that he/she can meet the client where the client is at and it’s important for the client so the client can expect his/her own stages of change to cycle and to not take this as something negative. Personally, I think my own speech therapy experience has been highly related to my own stages of change and it can be beneficial for me to take that into account in the experience as a whole.

      Thanks again for your note!

      Best,
      Susannah

  19. Dear Susannah, Tanner, and Karissa,

    Thanks so much for giving us insight in all three perspectives of stuttering therapy. In our graduate studies, we have found that intensive therapy can be effective at reducing stuttering behaviors and the negative attitudes and beliefs it is associated with. As future SLP’s, we love that a counselor was actively involved in therapy and that Susannah was the expert in the whole process. The way you explained stuttering as the elephant in the room is very insightful! What advice would any of you give to a person who stutters who feels apprehensive about the counseling aspect of therapy? Do any of you worry about relapse due to the program being so short? Thank you so much for your bravery and willingness to share with others!

    -Sarah Lawson and Veronica Stout

    • Hi Sarah and Veronica,

      Thanks so much for your comment. I’m glad to hear that you enjoyed our reflection. You bring up great questions.

      Your first question asks what advice we would give to a PWS who feels apprehensive about the counseling aspect of therapy. I think both Tanner and Karissa would have good insight here from each of their professional backgrounds so I’m interested for them to add in, but I’ll share my own personal thoughts as well. Speaking from my own experience, the counseling aspect of stuttering therapy felt like the beginnings of a weight being lifted off of me. Throughout my life, stuttering has always been something that I’ve thought a lot about/had a lot of shame about, but did not often talk about and these thoughts and feelings really ate away at me. Every PWS will of course be different and bring with them their own personal life experiences, but I do feel like this build up of negative thoughts/feelings regarding stuttering is a relatively common experience. In this sense, counseling has the power to be extremely beneficial and come with a feeling of relief to finally open up and explore all of those things. In contrast, the process of initially opening up and dealing with thoughts/feelings that you’ve hidden away for years — especially if it’s something that you feel incredible shame in — is beyond scary so I would think that it would be quite normal for PWS to be apprehensive about or even resistant to counseling. I think my advice for the process there would be to first focus on the client/clinician relationship — develop a strong and positive alliance where the client trusts the clinician and feels safe. If the client is apprehensive about exploring counseling components, I would encourage the clinician to talk about those feelings of apprehensive — what is the client scared might happen? I think that exploring and normalizing those thoughts and feelings will help pave the way for a collaborative and respectful therapeutic relationship, thus encouraging the client to engage more actively in the counseling. (And regarding further advice to the clinician in this area, I really like what Tanner wrote above in reply to the comment from LeoBean – I think he hit some very important points).

      Regarding whether I worry about relapse due to the program being so short — yes and no. I would answer yes because I feel like “relapse” often and easily occurs after intensive programs and I’ve experienced it after other intensive programs I’ve participated in. I think that at the end of an intensive program (especially one that has been very supportive and the client feels safe in) many people feel like they are on a high of sorts. I’ll be the first to say that transitioning from that safe and supportive environment where everyone understands stuttering and stuttering is ok (promoted in fact!) to the real world where stuttering does not always feel ok can be extremely scary.

      However, given this reality, I feel like the NWCFD-IISC does a good job at minimizing “relapse” as much as possible. For one, towards the end of the clinic, there is a lot of discussion about the fact that the clinic is ending. We talked openly about the fears/feelings we had about the clinic ending and the fact that these fears/feelings were ok and expected. We also proactively planned for life after the clinic. Each team collaboratively made a maintenance plan for the client that involves regular homework/challenge activities in addition to times when we are encouraged to check in with clinic staff regarding how everything is going. And finally, throughout the clinic and especially toward the end, there is a lot of discussion of one’s stuttering journey — the idea that one’s relationship with stuttering is always changing. Drs. Hudock and Yates (directors of the clinic) are clear in communicating that the end of the clinic does not mean an end to one’s stuttering journey and that we should not expect to have resolved our relationship with stuttering by the end of the clinic. Rather, they frame the end of the clinic as a “launching” – we are now going out into the real world to begin to implement the various strategies we have learned to deal with covert and overt stuttering when and to the degree we want to. We talk about how we are constantly learning and that we always have the option to take negative experiences and allow them to inform how we want to handle things moving forward (which relates to the reframing of failure I discussed in my reflection). And regarding overt stuttering, they talk a lot about how speech strategies are difficult to implement and require immense concentration and we need to find our own balance in using them in our real worlds — as in, they don’t set an unrealistic expectation that by the end of the clinic we “should” be using these strategies reliably/efficiently all of the time. Rather the hope is that we will feel comfortable and confident using them at the times that we choose to.

      I hope that was helpful! Thanks again for your note.

      Best,
      Susannah

  20. Susannah, Karissa, and Tanner,

    I really enjoyed reading about your experience and how much you all learned from working together. What was the biggest challenge you faced while working together and what advice would you give to other graduate students that may come across a time when they work in a similar team format?

    Thanks for sharing,
    Christina

    • Hi Christina,

      Thanks for your comment and question. Tanner and I discuss some of the barriers that we faced throughout the clinic in reply to Alexandra’s comment above so I’d encourage you to read our responses there. In terms of what advice to give graduate students who may come across a time when they are working in a similar team format, I think that I would say to be as open as possible to understanding the perspectives of the other team members involved whether that be professional knowledge/approaches or personal strengths. I think that one of the reasons that our team was able to develop a strong working relationship was that we really did our best to learn from each other (especially Karissa and Tanner in terms of their professional backgrounds/viewpoints) and I think that this was truly important and allowed us to maximize the experience. Thanks again!

      Best,
      Susannah

  21. Hi Susannah, Karissa, and Tanner,

    I am so excited to hear about such a collaborative effort for treating the behaviors, feelings, and thoughts associated with stuttering. I am currently taking a fluency course in my graduate studies to be a SLP. What are some suggestions to me as a future SLP that you can offer so that I can be a better informal counselor and help make my treatment a success? I fully embrace the idea of having a co-counseling aspect to fluency treatment and I wonder how you started this effort.

    Thank you so much for your insight and openness,
    Katey

    • Hi Katey,

      Thanks for your comment. I’m very happy to hear that you embrace the counseling role in the context of your work as an SLP — I think that it’s a very important piece to take into account for stuttering (and I’d imagine for other communication disorders as well). Tanner gives a really great answer to this question in response to LeoBean’s comment above so I’d encourage you to read that.

      Thank you!
      Susannah

  22. Hi Susannah, Karissa, and Tanner,
    Thank you for sharing this! I’m a first year Speech and Language Therapy student, and I really enjoyed reading your different perspectives. Susannah, I love your elephant analogy, and your description of realising that what you have to say is important, and that you are enough. It’s definitely something I’ll remember going forward.
    Thank you again!
    Alice

    • Hi Alice,

      Thanks for reading our reflection and commenting. I’m so happy to hear the you enjoyed reading our different perspectives as well as what I had to say about my experience and I’m glad that it gave you something to think about and remember moving forward. Good luck with your program and career!

      Best,
      Susannah

  23. Hi Susannah, Karissa, and Tanner,

    Thank you all for sharing your experiences from the NWCFD-IISC. I found this paper to be very profound and informative. What a wonderful idea for interprofessional collaboration. I am a first year graduate student for speech-language pathology, and I’m currently enrolled in a fluency course. Susannah, I appreciated your candidness and insight to what it has been like for you to stutter. I felt that your analogy of the elephant was brilliant. I’m glad that you have found empowerment in this experience and have been able to feel free of your fears. Karissa, I really valued your advice for clinicians who want to create a mutual partnership and build confidence with their clients. As a beginning clinician, these tools will help me to better serve clients in the future. Tanner, I loved how you spoke about using collaborative creativity to promote growth and understanding of stuttering within your team. It seemed to be both challenging and worthwhile. A question for you all is, how will this experience carry over in your future clinical practices and how will you use what you’ve learned to promote empowerment with clients you work with?

    Thank you again for your story,
    Kristin

    • Hi Kristin,

      Thank you for your thoughtful, kind comment and GREAT question.

      Karissa: Empowerment is such an important idea when working with people with communication disorders. This is a big component of ACT therapy and our clinic really revolved around this idea. Effective communication, not fluency, was our main goal and I hope the field of speech pathology continues in this direction. This clinic made functional, person-first treatment a reality and that experiences are what you make them. This clinic showed me that it is possible for clients to experience life and be the best version of themselves and I definitely see myself using ACT in the future.

      Tanner: I’m really excited about this idea of interprofessional collaboration. This was my first experience so I didn’t know what it would look like or how it would work. Interprofessional experience added to my understanding of my own personal field and I learned skills from speech-language pathology that I can apply with future clients who stutter and communication disorders. I’m also excited because I think there are other areas I hope to collaborate with, such as global leadership and social anthropology. I also see myself using ACT with future clients.

      Susannah, what are your thoughts on ACT going forward from the clinic?

      Thanks,
      Karissa and Tanner

    • Hi Kristin,

      Thank you for your generous comment and thoughtful question. I really like what Karissa and Tanner said above about how this experience will carry over into their future clinical practices. For me, I guess thinking about this question is a little different because I was in the role of the client for this clinic, but as a clinical psychology grad student I will soon take on the role of a clinician myself.

      Prior to the NWCFD-IISC I had heard of ACT in terms of its theoretical principles, but this clinic was the first time that I had experienced it put into practice. I feel that I have gotten (and will continue to get) a lot out of applying ACT to my life and I look forward to using it with my future clients. I also think that ACT is more than a therapeutic technique – it’s more a way of approaching the world and I think that having been on the other side will hopefully help me in introducing it to clients. Additionally, I was able to see the benefits of interprofessional collaboration from the viewpoint of the client. It was inspiring to see my two clinicians work together in the way that they did (in addition to the collaborations in the clinic as a whole) and it encouraged me to put my best effort forward every day. This clinic will definitely make me seek out interprofessional collaborations in my career going forward as I now know from experience the positive impact they can have on all parties involved.

      Best,
      Susannah

  24. Susannah, Karissa, and Tanner,

    Thank you so much for sharing about your experience with this interdisciplinary model of fluency therapy. I loved hearing Tanner’s perspective from a counseling background! It makes so much sense to involve a counselor in this process because of the thoughts and feelings that come along with the experience of stuttering. I am a graduate student getting my degree in speech-language pathology, and I want to know more about addressing the covert aspects of stuttering in therapy.

    With that being said, Tanner what are some activities you all did to address specifically Susannah’s thoughts and feelings about stuttering? Susannah you mentioned the survey being a powerful activity for you, was it the most impactful? Why or why not? What were some other activities that were very powerful for you as a person who stutters to help you “stand on your elephant?” 🙂

    Thanks again! This was a very helpful read!
    Taylor

    • Hi Taylor,

      Thanks for reading our reflection and for your great comment and questions. In terms of Tanner’s role as a counselor throughout the clinic, I’d recommend that you read his response to LeoBean’s comment above to begin to get a sense of his approach as well as possible advice. And yes, I did feel that stuttering surveys were a powerful tool in the clinic (particularly the specific example I give in reply to Devan’s comment above). However, I probably wouldn’t say that stuttering surveys as a whole were the most impactful activity for me personally that we did throughout these two weeks. One reason is that our team focused more on some of the other activities, so we did not do too many stuttering surveys. Another reason is that I’ve done a lot of stuttering surveys in other speech therapy programs I’ve participated in, so I don’t think that in this clinic they had as much impact on me as they would have if I had never done them before. I would say that some of the more natural generalization activities we did toward the end of the clinic were particularly impactful to me (e.g., pseudostuttering, advertising, transferring other techniques, etc in the real world doing every day activities like talking to store clerks). Although not ideal, there were a few times in these activities in which the listener did not react in the most positive way (e.g., interrupting me, giving me “advice” about stuttering) and because of that they felt very familiar to other experiences I’ve had throughout my life. What was different here, though, was that I was able to process and debrief with my team immediately following these interactions. This helped me to change the emotional reaction/thought patterns that I was having and begin to look at these “negative” interactions in a new (and less personalizing) light. Thanks again for your comment and questions.

      Best,
      Susannah

  25. Hello Susannah, Karissa, and Tanner,

    Wow. Reading this really addressed so many aspects related to stuttering. As an SLP graduate student, I have learned that there are so many different obstacles people who stutter face, and many of them are not easy to understand for someone who does not stutter. I really liked when Karissa mentioned how important it is to keep the client in mind as an active member of the team, and as an expert in his/her communication. I agree in that treatment is so meaningful when the client is being acknowledged appropriately. I really enjoyed reading about how Tanner went out to experience stuttering himself. I have heard of people doing this before, and seems as though when a person does not experience stuttering first hand, pretending to stutter and experiencing it that way helps to understand it better. I absolutely loved reading about the successes Susannah shared, in which she is able to stutter well, with openness and confidence. This made me feel comfort in that I have a great deal of social anxiety, and although the anxiety may never go away completely, I can relate to a person who stutters in which my anxiety can be handled positively when interacting with others.

    Susannah, have there been times since this therapy with Karissa and Tanner that you have felt extreme negative emotions related to stuttering? Or have the coping methods you explained, such as openness and confidence worked fairly well for you? If you have experienced negative emotions, what have you done to remind yourself to “stand on the elephant?”

    Thanks,

    Jaclyn

    • Hi Jaclyn,

      Thanks very much for your thoughtful comments and for sharing about your own experience with anxiety. I like the point that you make about how the anxiety may never go away but that it can be handled positively when interacting with others. I think that this phrasing really gets at the heart of acceptance and commitment therapy (ACT): that you can feel the anxiety AND have positive interactions with others. I feel like so often when we have negative emotions or thoughts, we struggle with them – we feel anxious and we don’t want to feel anxious so we fight the anxiety, which often (and ironically) ends up escalating it even further and maybe even adds on extra layers to it (guilt, shame, etc). And there’s also often a mindset that we can’t be anxious (or experiencing whatever unwanted emotion/thought we’re having) AND be happy – that we need to “conquer” this unwanted emotion/thought in order to be happy/successful. I like the ACT framework in presenting the idea that we don’t need to fight against our unwanted experiences. If we are feeling anxious, we can acknowledge that we are feeling anxious and experience the anxiety AND simultaneously move forward and follow our values. Through out the clinic we had a theme of “leaning into” whatever was presently happening mentally, emotionally, or physically. If we were experiencing negative emotions surrounding a challenging interaction, we were encouraged to “lean into” those emotions rather than hide from them. I think that this emphasis (though challenging because it goes against our instincts) is very rewarding as we followed through.

      To answer your question about whether there have been times since the clinic that I have felt extreme negative emotions related to stuttering — yes, I certainly have. I’ve stuttered for over 20 years and those negative thought and emotion patterns relating to stuttering are deeply engrained. I think it would have been unrealistic to have had the expectation that a 2 week clinic (however positive the experience is) would completely change how I think/feel about my stuttering by the time it was over. However, I believe that the clinic was a life changing experience for me in the sense that it has given me a more adaptive way of handling those negative emotions and thoughts related to stuttering when I do have them.

      This leads to your second question of what do I do to remind myself to ‘stand on the elephant’ when I am having those negative emotions/thoughts. First, I think the structure of the clinic was helpful in framing us to think about the clinic as the start to a new phase in our stuttering journeys rather than the end of it (I discuss this idea in the above comments in reply to Sarah Lawson). I’ve found it helpful to try to reframe experiences/interactions that I would have previously labeled as “failures” (that are bringing up my negative thoughts/feelings) and think about them instead as learning experiences. This helps me to separate myself a bit from the thoughts and feelings that I’m having (the ACT principle of cognitive defusion). Along those same lines, I’ve been trying to continue to apply ACT principles to my life such as continuing to practice mindfulness. I’ve also maintained contact with some of the other people who were involved in the summer clinic and continuing to feel that support has been super beneficial. I hope this answered your question and was helpful! I’ll admit that I’m still trying to figure all this out for myself 🙂

      Best,
      Susannah

  26. Susannah, Karissa, and Tanner,

    Thank you all for sharing your experiences and your different perspectives after being involved in NWCFD-IISC. It was really interesting reading all of your perspectives since the three of you come from different educational backgrounds. I am a first year grad student and I am taking a fluency class. In our class, we are discussing the client-clinician relationship and how this greatly impacts therapy success. This relationship plays a major role in therapy. Our professor also had us go into the public and pseudo-stutter. This opened my eyes and gave me a better insight into what it is like to deal with observable and unobservable aspects of stuttering.
    Thanks again for sharing!
    Sarah

    • Hi Sarah,

      Thanks for reading our reflection and sharing your experience. I completely agree that the client-clinician relationship is incredibly important and really sets the stage for how a therapy progresses. I’m also happy to hear that you have tried out pseudo-stuttering and that that this experience added to your insight about both the observable and unobservable aspects of stuttering. I think that all too often an emphasis on the observable aspects of stuttering precludes a discussion of the more unobservable aspects, which in my experience are often more challenging to deal with. There’s a quote from Malcolm Fraser (the founder of the Stuttering Foundation) that I think explains it well: “Stuttering is largely what the stutterer does trying not to stutter.”

      Best,
      Susannah

  27. Susannah, Karissa, and Tanner,

    First and foremost thank you all for sharing your experiences with us all! I have learned about interdisciplinary approaches in class, however I have not been apart of one so this gave great insight into how each member of the team played a part in therapy. I loved that you all used an acceptance approach because I feel as though that allows all aspects (overt and covert) of stuttering to be addressed. I also appreciate the elephant metaphor. This is a great way to explain the different feelings a PWS may encounter with their stuttering experience. I believe my favorite part is how all three of you were equally a part of the therapy session. You were all truly a team and learned from one another.

    I see that you all used many variations of therapy, such a play therapy, music therapy, etc. Could you given an example of how a session would go with this kind of approach? Also, you all seem to have worked together for a relatively short period of time. Have you still worked together after the conference came to an end? And lastly, was this your first time working with an interdisciplinary team, and if so what pros and cons do you see and how did this experience effect how you will practice in the future?

    Thanks again for allowing insight to an interdisciplinary approach!

    Best,

    Tori

    • Hi Tori,

      Thank you very much for your kind words! I’m happy to hear that our teamwork and how we learned from each other came across in our reflection because that was a central part of our clinic experience. In terms of what sessions would like like, Karissa and Tanner give a good description of the overall clinic structure in reply to Lauren’s comment below. As they explain, days typically included three individual sessions (1 speech, 1 counseling, and 1 session of choice). These different sessions used different approaches. In terms of the counseling sessions, the majority involved at least a component of talk therapy, but we had one session that revolved around play therapy (sand tray), one that revolved around music therapy, one that involved around art therapy, etc. And the recreational therapy was distributed throughout the clinic (Tanner gives a more thorough description in response to Devan’s comment above). I’ll also say that even though some sessions were more targeted toward speech and others were more targeted toward counseling, there was a lot of integration of the two in the same session, especially as the clinic went on. In terms of whether we have continued to work together after the clinic has ended – we haven’t continued to work together in the same team format, but we have maintained contact for follow-up, etc. And regarding working together as an interdisciplinary team, I’d direct your attention to our response to Kristin’s comment above. Thanks very much for your great questions!!

      Best,
      Susannah

  28. Susannah, Karissa, and Tanner,

    Thank you for sharing your wonderful experience. Susannah; your elephant metaphor was wonderful. This summer program sounds amazing, I wish more colleges and universities did a collaborative program like this. It seems as though you three developed a strong relationship and communication skills among each other, and it seems beneficial. Do you think incorporating aspects of this communication, art therapy, and other modalities that you used would be beneficial for a client who stutters who may also have receptive language or cognitive issues? In other words, do you think the experience or journey would be beneficial for someone who may not cognitively grasp the bigger concept of ‘finding oneself’?

    • Hi Jodi,

      Thanks for your comment and thoughtful question. I’ll be honest in that this is not my area of expertise, but I would think that a client who stutters and who also has receptive language/cognitive issues could definitely benefit from an approach/activities similar to those that we did in this clinic. I think that as long as the activities and explanations were modified as necessary to make them accessible to the client, the client could benefit. Although this isn’t the same as receptive language/cognitive differences, the client group who participated in the clinic this summer did have a relatively diverse background in terms of age, speech therapy experience, counseling experience, viewpoints about stuttering, etc. With this diversity, I think that we all benefited from the clinic experience in our own way and took different lessons home with us. Similarly, I think that a client with receptive language/cognitive issues may take away different lessons from these activities as compared to a client who does not have receptive language/cognitive issues, but I wouldn’t see these differences in lessons as either positive or negative – just different. In any type of therapeutic experience, clients will bring with them their own individual strengths, viewpoints, and life experiences and I think that the clinician can always maximize these in an effort to work toward a positive outcome. Thanks again for a great question.

      Best,
      Susannah

  29. Hi Susannah, Karissa, and Tanner,

    Much of what I want to say has been said by the comments above, but I, too, just wanted to add: WOW. And THANK YOU. Thank you Susannah for leaning into your fears, for so candidly and openly working with this mighty elephant, and for beautifully demonstrating how courage trumps fear. The iceberg and elephant metaphors really helped conceptualize the experience of stuttering. I love how you were able to reconsider past notions of so-called stuttering “failures”, and no longer viewed them as such. So so powerful (beyond words) to share how as clinic went on you began to feel free. That’s what this all comes down to I think: this idea of communication freedom. I love how you write that you alone have the power to define your worth, (taking it away from listener’s reactions) and that this is a story about communication, not about fluency. Thank you for your vulnerability. Almost brought me to tears. I feel much closer to the stuttering experience through your words (and Karissa’s and Tanner’s.)
    Thank you Tanner and Karissa for embarking on this journey collaboratively with her– what a beautiful example of interdisciplinary collaboration!–for your wise and caring words, and for bringing us all that much closer the experience of someone who stutters.
    Karissa, I love how you write that we must enjoy the journey, not just have our heads set on the outcome. As others have written above me, I too, am curious to hear more about the specificites of your therapy techniques and what you actually did. (I am an SLP graduate student currently engaged in a group-therapy/self-help group with people who stutter.)
    Tanner, thank you for sharing how the person must always comes first, and, through your pseudo-stuttering and this collaborative experience, showing how utterly exhausting and all-encompassing it is to stutter!

    Thanks you all for sharing your experiences so openly and honestly. I know I really benefitted from reading this and I’m sure others did as well. –Lauren

    • Hi Lauren,

      We received a manual that structured our days but allowed us the flexibility to adapt sessions to our needs. There was no typical day, but we often had three individual sessions– One speech, one counseling, and a session of our choice. There was a group session every day and we had opportunities to take notes, debrief and plan future sessions. We worked on specific speech techniques/strategies at the beginning of the clinic and more generalization/community activities toward the end.

      The clinic was broken down into three phases: I. Understanding Yourself and Stuttering: Awareness (Mirror work, tallying, freezing, pseudo stuttering). II. The Process of Change: Techniques (Prolongations, light contacts, disclosing, pull outs). III. Planning for Long-Term Success: Maintenance (Follow-up plan, application of techniques without as much support).

      Hope this gave you more of a picture of what the clinic was like!

      Karissa and Tanner

    • Hi Lauren,

      Thank you for reading our reflection and for your very generous comment. I’m humbled by your words and very happy to hear that you got so much out of this paper. I’m especially happy to hear that you feel closer to the stuttering experience through our words. Through your comment, it’s clear that you have a curiosity to want to understand your clients’ experience/viewpoint and I think that this is a wonderful asset that will serve you well in grad school and in your future career as an SLP. Thanks again!

      Best,
      Susannah

  30. Hello Susannah, Karissa and Tanner,
    Thank you so much for sharing your experiences. It was really great to hear three different perspectives on stuttering and how these three perspectives can come together to have such a powerful impact. The idea of relating elephants to stuttering really opened my eyes to how stuttering really influences a person’s life in many ways. In addition, it was also interesting to see how the idea of the elephant and stuttering could be relatable for speech language pathologists and counselors too. I am a speech-language pathology grad student and I gained a perspective that I could not have obtained from any textbook. The ending really stood out to me, as it showed such empowerment and perseverance through finally being able to stand on top of the elephant. I learned a lot about collaboration and understanding through your story. It was truly inspiring.
    Thank you,
    Michaela

    • Hi Michaela,

      Thank you for reading our reflection and for your thoughtful comment. I’m so happy to hear that you gained something from what we wrote that as you say “could not have [been] obtained from any textbook” – that’s quite humbling to hear. Good luck with the rest of your program and in your career.

      Best,
      Susannah

  31. Dear Susannah, Karissa, and Tanner,
    Thank you for sharing your story! I found your description of the therapy model at Idaho State University to be very interesting. It’s an innovative idea for speech language pathologists and counselors to collaborate in stuttering intervention, but also kind of a “no brainer” approach considering what we know about the internal or covert aspects of stuttering. In relation to this, I also really enjoyed the graphic at the end of your paper. I am a first year SLP graduate student and am currently learning about fluency disorders. We’ve learned about the iceberg theory of stuttering and your iceberg interpretation helped me better understand my role with future clients. While I am exploring the unseen portions of the iceberg, trying to better understand and help my clients, I will simultaneously be supporting my clients as they climb to the top of the iceberg. What a complex situation!

    Thanks again for sharing your experiences!

    Breanna Helminski

    • Hi Breanna,

      Thanks very much. I completely agree in that after you hear about the collaboration between SLPs and counselors for stuttering therapy, it really makes sense and it’s surprising that the idea is not more widespread in terms of clinical practice. I feel very fortunate that Drs. Dan Hudock and Chad Yates made it a reality at ISU.

      And I’m glad that you got something out of our graphic! When Karissa, Tanner, and I were first talking about submitting something for this conference we agreed that we wanted to submit some type of visual to go alongside our reflection. The iceberg analogy seemed logical as it came up time and time again during the clinic (and I think it truly does a great job at communicating the whole picture of stuttering). We came up with the idea of a client climbing the iceberg with the clinicians belaying from the high ropes course activity we did during the clinic. As the clients and clinicians took turns climbing the tower, we were each other’s belayers and I think that this was a cool way of really demonstrating the trust that we had developed (and were continuing to develop) with each other in a very concrete way. I also think that the illustration demonstrates a strong therapeutic relationship/experience — clients need to face their own challenges for themselves, but the clinicians are there to support and facilitate the process, ready to ‘catch’ the client and guide them back up as needed.

      Best,
      Susannah

      • I really liked the illustration also. It makes me think about how many times, as a developing SLP clinician, I just toss my clients in the air, hoping they’ll catch the top of the iceberg on their own. It makes me realize the responsibility that I have to support them while letting them go on their own and define their own path.

        Thanks for sharing such personal feelings and experiences with us!

        • Hi Becky,

          Thanks very much for sharing that reflection/realization with us. The role of a clinician is certainly complex and involves a lot of responsibility. Good luck with the rest of your program and future career!

          Best,
          Susannah

  32. Everyone,
    Thank you for sharing your experiences throughout treatment! This is unique to see various perspectives in one paper and especially from those involved together! Susannah, I love the honesty you have in regards to your experiences – those both good and bad. Your perspective made me wonder what it would be like if all collaborating teams were to share their experiences as you all did in this situation. If this had been done in past scenarios, I also wondered how the experiences would have changed.
    Furthermore, it’s apparent that this team had a cooperative approach that worked in everyone’s favor. As a graduate student in a speech-language pathology program, I would hope to have similar collaboration with my teams and clients in the future. Thank you again for sharing your experiences! I enjoyed seeing each of your points in this paper.
    Sincerely,
    Erika