Building the Therapeutic Relationship – Karissa Colbrunn, Susannah Parkin, Chad Yates

About the Authors:

About the Author: Karissa Colbrunn, M.S., CCC-SLP is a school-based speech-language pathologist at the Lakeland Joint School District in Northern Idaho. She graduated from the Master’s program in Speech-Language Pathology at Idaho State University in Pocatello, Idaho in 2017. Her specialty focus areas include stuttering and functional language therapy at the secondary level. She has presented at the Intermountain Speech and Hearing Convention and the National Stuttering Association conferences about Acceptance and Commitment Therapy and small talk skills in relation to stuttering. Karissa enjoys spending time outdoors hiking and swimming with her fiancé Jim and dog Lefty.
Susannah Parkin is a person who stutters. She graduated from Hamilton College in 2013 with a BA in psychology. She worked as the program coordinator for the Depression Clinical and Research Program at Massachusetts General Hospital after graduation. She spent some time in Joshua Swift, PhD’s Psychotherapy Process and Outcome Lab at Idaho State University. She’s currently living in Austin, TX and she’s planning on pursuing a master’s degree in social work.
Dr. Chad Yates joined the ISU Department of Counseling in the fall of 2013. He received his Ph.D. in Counselor Education and Supervision from Kent State University and his M.A. in Community Counseling from the University of Toledo. Before coming to ISU, Chad worked as a mental health and substance abuse counselor in Kent, Ohio. He also was a part-time instructor at Kent State University, Indiana University of Pennsylvania, and Youngstown State University. Chad has served as the Mental Health Coordinator for the Northwest Center for Fluency Disorders at ISU over several years.  His counseling experience includes working with individuals with substance abuse disorders, batterers and survivors of domestic violence, families, and as a generalist treating many diverse client issues His research interests include evidence-based practice in counseling, client-focused outcome evaluation, and the treatment of individuals with substance abuse and co-occurring disorders. His personal interests include hiking, camping, skiing, and golfing.

Lily’s task in this afternoon’s stuttering therapy session was clear – walk up to strangers, advertise her stuttering, and ask them a few questions about stuttering. She was hesitating though and was resistant to interrupt a student at a table working. Her therapist intervened and pulled her aside. He acknowledged her fear and told her that her words were worth hearing. He told her that she was important and that it didn’t matter if she stuttered during the dialogue. These words and the therapeutic relationship they were built on enabled her to walk across the room and engage with the student. Lily was able to achieve her therapeutic goals by speaking her mind in a supportive environment.

Stuttering therapy can be intimidating. Stuttering training, although getting more comprehensive, tends to be lacking in graduate programs as a whole (Yaruss & Quesal, 2002).  Many people who stutter have had negative experiences with therapy which they bring to the table. What we do in therapy matters, but how we do it is just as important, and can greatly impact outcomes. People who stutter report feeling less than human due to their stuttering, and are more likely to experience bullying, depression, and anxiety than the general population (Beilby, 2014). Therefore it is especially important to implement strategies to increase a sense of connectedness and support in session. In psychotherapy and counseling, the therapeutic relationship has been long studied and the importance of it cannot be denied. Stuttering therapy is no different regarding the role of the relationship. Three skills that can be used to form and enhance the therapeutic relationship are unconditional positive regard, paraphrasing, and feeling reflection (Egan, 2010).

The Skills

Unconditional positive regard is accepting and respecting your clients without judgment or criticism. It does not mean that you always agree with your clients, but rather you accept and value your clients as individuals you respect. Stuttering is a stigmatized disorder and can impact how people see themselves. It is important for your clients to feel that they are supported in their communicative decisions no matter what.

In an experience with strangers, people who stutter could have the option to disclose their stuttering and finish their sentences or switch into survival mode and get through the experience as fast as possible by letting the speaking partner finish what they are saying. While professionals could pick a side and argue their point and encourage their client to make a better choice in the next experience, that can convey the idea that the person did something wrong or bad. Using empathy to understand why someone would choose not to advocate for themselves in that situation could foster a sense of support and collaboration and allow the client the opportunity to explore his or her feelings and choices.

Paraphrasing is restating what the client says in such a way that the basic message is similar, but more concrete. The main purpose is to convey understanding to the client, and to communicate that you are trying to understand the client’s world. It is a tool that shows the therapist is actively listening without adding in his or her two cents. When a client is telling a story of something that happened outside of therapy, paraphrasing can be used to make sure the listener is following along and understanding the important details of what happened.

A feeling reflection is an attempt to portray an accurate understanding of a client’s emotional state. Emotion is critical to understanding what motivates behavior. This skill can help clients to see the relationship between their thoughts, behaviors, and feelings. There is also the bonus that the therapist is conveying that he or she hears what the client is saying and build empathy. Five basic emotions that can be used for this skill are happiness, sadness, anger, fear, and loneliness. As this skill is developed, a feeling chart can be introduced to expand these terms.


Putting it together

These skills are demonstrated below in an example of a therapy session.

Therapist – Did anything come up this week that you want to talk through?

Client – I went to eat at a restaurant with Greg and Tyler and let the waiter finish my order.

T– You were out with friends and the waiter finished your order. (Paraphrase)

C– Yeah, that’s what happened. I thought about advertising and telling them that I stutter, but in the moment I had a hard time. I didn’t want to bring attention to my stutter.

T– You were scared. (Feeling reflection)

C– Yes. I want them to like me.

T– Would you still like being around them if they stuttered?

C– Of course. They’re my friends and I have fun and care about them.

T– I wonder if they feel the same way. Everything you say is important and matters, whether or not you stutter. (Unconditional positive regard)

C– If I advertised my stuttering next time and asked the listener to be patient, it could eliminate the guessing game.

T– It sounds like situations where you don’t disclose can get awkward. Does advertising help with this?

C– Yeah, it can feel weird at first. Especially leading up to telling them. But once I do, I feel relieved and stuttering doesn’t seem like as big of a deal.

T– What are some ways you could practice to make this easier for you?

C– What if we went out and tried out a couple of situations and talk about them after?

T– Sounds great. Let’s try it.


This is an example of how these skills can be used, however these services should only be delivered by skilled therapists who have received adequate training and are qualified in their field.

These three skills are simple and with practice, can make a large impact into building a supportive relationship in therapy. Using counseling skills can increase active listening, support, and create an environment where a client can feel supported in making the vulnerable changes that can lead into the overall achievement of effective communication where it matters: In the real world (Egan, 2010). The theme for this year’s ISAD Conference is “Speak Your Mind”. It is so important to build a therapeutic relationship where a person feels they can truly express themselves and feels comfortable speaking their mind.


References

Beilby, J. (2014). Psychosocial impact of living with a stuttering disorder: Knowing is not enough. Seminars in Speech and Language, 35, 2, 132-143. doi: 10.1055/s00034-1371756.

Egan, G. (2010). The skilled helper: A problem management and opportunity development approach to helping (9th ed.). Belmont, CA: Brooks/Cole

Yaruss, J. S. & Quesal R. W. (2002). Academic and clinical education in fluency disorders: an update. Journal of Fluency Disorders, 27, 43-63. doi: 10.1016/S0094-730X(01)00112-7

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Comments

Building the Therapeutic Relationship – Karissa Colbrunn, Susannah Parkin, Chad Yates — 9 Comments

  1. I am really glad that you made this presentation. The ‘unconditional positive regard’ is what we always have for our clients, but don’t really express. I didnt realize that I havent showed the positive regard to my clients that much. It was great to read this presentation and learn with the example! But the client in the example seems older than preschool or elementary school-age children. If you would use those 3 skills with children younger than 10 years old, how would you deliver your thoughts and feelings using those 3 skills?

  2. Thank you so much for your presentation. These skills are not something I was previously familiar with and appreciate learning them and having an example of how to use them. I imagine that clients sometimes don’t wish to discuss the emotional aspect of stuttering. Do you have suggestions for conversing with individuals who don’t desire to speak about the emotional aspect of stuttering? Would you use these same skills to build rapport or are there other techniques you could suggest?

  3. I really enjoyed this presentation and examples of responses when delving into the emotional side of stuttering. I was wondering if you had any suggestions or examples of how to begin the conversation about emotions/attitudes towards stuttering for school age children?

  4. Thank you so much for this post and for including examples of how these techniques may be used. You made it clear that these services should only be delivered by skilled therapists with training. I wonder if you thought it might be beneficial to train parents of children who stutter on some of these supportive techniques to be used in conjunction with therapy. Is there is any type of program that focuses on training the family units in some of these skills and techniques that you think would be beneficial and appropriate? It seems like giving them the skills and ability to support their children through their every-day emotional and communication struggles could have some benefit.

  5. I really appreciate this paper. As a future Speech Therapist, I am constantly looking for tips and tricks to be able to connect and understand clients better. I think this article can help current Speech Therapist’s and future ones studying. Thank You!

  6. This was an awesome and clear explanation of how to promote a compassionate therapeutic relationship. I love how you’ve outlined the three components and gave such a clear example of how to use these in a real life scenario. I agree that not all therapy techniques are taught clearly, at least not until a clinical application arises. It’s clear that these techniques should be practiced and given attention in the academic level, yet you mention that this is not currently the case. Do you have suggestions on how to promote these further outside of a conference setting?

  7. I really enjoyed learning about this presentation. These skills are very important for not only the client but the therapist as well. It is beneficial for both individuals to understand the importance of unconditional positive regard, paraphrasing, and a feeling reflection. Support is what many individuals need and I believe these skills give a client just that. This presentation was laid out great and was very informational. How would you show these skills on young children and can these skills be taught to families and caregivers to help promote compassionate therapeutic relationship?

  8. Hello,
    I am a second year SLP major and I very much enjoyed reading this passage. Sometimes we can get so focused on the task at hand that we can forget about the therapeutic aspect of this field.
    I hope that as I enter the field this will stay with me. Although I am sure that building relationships with each client is different and will take a different amount of time.
    Thank you,
    Katelyn

  9. I really appreciate how this paper was outlined. I am a graduate SLP student and reading different skills like this is so important for learning how to connect with clients who stutter to help support them. Thank you!