Stuttering, Self-Harm, and Counseling

Hello,

I am graduate student at Illinois State University. I had attended ASHA last Fall in Chicago and saw a presentation on “Stuttering and Suicide”. It was both moving and intriguing, as I do not believe there was a dry eye in the entire presentation. I never truly understand the emotional difficulties that an individual would face when dealing with a stutter. My question is: as a speech-language pathologist, how can you provide the most beneficial therapy to an individual who is struggling to the point of thoughts of self-harm? Also, where would one draw the line between what our scope of practice says to do and referring the patient elsewhere? I believe that as a speech-language pathologist, it is critical to be aware of situations such as these and how to handle them. Thanks!

502 total views, 1 views today

Comments

Stuttering, Self-Harm, and Counseling — 12 Comments

  1. Speech-language pathologists, unless they have qualifications also in clinical psychology or psychiatry, do not have the skills or the health care resources to deal with self harm ideation. Such cases need priority referral to appropriate health services. Indeed, those who stutter are at considerable risk of mental health problems. This is a challenge because clinical psychology is not the domain of speech-language pathologists. However, it is possible to obtain post-graduate qualifications in cognitive behaviour therapy, and standalone Internet mental health intervention for stuttering seems viable according to recent publications.

  2. There was a great article in the ASHA Leader a couple months ago about this very topic, and it may give you some insight into the best ways SLPs can respond if this issue comes up.

  3. I agree with Mark Onslow that most SLPs, unless specifically trained in psychopathology and its treatment would not want to work alone with a client who appears to be suicidal, either because of his/her stuttering or something else. That said, it is often possible to work as a co-therapist with a mental health professional who knows about managing patients with suicidal tendencies but who knows little about stuttering. This arrangement requires a great deal of careful coordination and clear communication, but it can be helpful. (See Cox, 1986.)

    I am not sure that Mark meant to imply that a large percentage of those who stutter are at “considerable risk of mental health problems.” There is a large body of literature that suggests that most serious mental health problems occur in stuttering populations at about the same rate as the nonstuttering population. Of course, recent evidence, especially in Austraiia, has shown that clinically measurable social anxiety is more common in those who stutter that previously thought. That may be true, but minimal social anxiety is very, very far from being suicidal in most cases. In all my years of treating adults who stutter, I have only had a handful whom I believed were at risk for suicide.

    This, in my mind, is similar to the recent evidence of measurable language problems in stutterers. Yes, subtle language problems do exist at greater rates than previously thought, but to consider people who stutter similar to most “language disorders” would be to confuse very mild problems with very significant problems.

    This is my “two bits” worth. I hope it helps. Ken St. Louis

    • Hi, Ken,
      What has been your experience with collaborating with mental health professionals in your practice ? How often do you refer clients to a psychologist or LCSW?
      Nora

      • Nora,

        I have rarely collaborated with mental health professionals in treatment, especially in recent years when I have spent more and more of my time in research. The few times, however, that I did work as a “co-therapist,” I found it useful. In one instance, the stutterer did not want to actually go to see a counselor because that would imply he was “crazy.” In this case, the graduate student clinician and I met with the counselor every week to discuss what we would do in “speech” therapy that would serve both our purpose and that of the mental health professional. In a few other cases, the client saw both of us at different schedules during the week.

        I have referred to mental health professionals either through past experience with them or, a few times, by simply asking colleagues who they thought might be both good and open to a co-therapist arrangement.

        I’m guessing that others have had more experience in the area of serious psychpathology and stuttering than I have. Nevertheless, I have run an NSA or related group therapy experience for adults who stutter for more than 15 years. In this weekly group we deal with all sorts of “issues” that surround stuttering: anxiety, avoidance, self-esteem, relapse, family/friend connection, etc. etc. As we all know, stuttering is so much more than getting stuck on words.

        Ken

    • I think there is miscommunication here. Ken seems to to talking about suicide and I am talking about mental health problems. For example, social anxiety disorder has been shown with independent reports to occur in 30-60 percent of clinically presenting cases of stuttering, which is way above the population prevalence.

      • Mark,
        The questioner asked about referrals for suicide and then went on to mention self harm. In my mind, stuttering associated with social anxiety is very different in the vast majority of cases from stuttering associated with suicide. That is what I questioned in my earlier post. Yes, I see that you were talking about all “mental health problems” of which social anxiety certainly is one. I thought that the original question may have been lost in this change of focus.
        Ken St. Louis

  4. The panel members from the ASHA presentation last year were amazed at the size of the audience for the session on suicide and stuttering! A similar session is on the ASHA convention program this year, only expanding it to all disorder areas covered in our disciplines (speech, language, swallowing, and hearing).

    Certainly the majority of people we serve are not suicidal. There is actually peer-reviewed research evidence of suicide ideation and even completion in other disorder areas we serve than there is in stuttering (where no actual research evidence is reported in peer-reviewed literature).

    ASHA lists “counseling” as part of our “scope of practice.” We provide service to many clients who are dealing with life changing events in their lives that involve loss. Although there are several in our field who also have degrees in counseling, psychology, and related fields, I suspect most have never had a course in counseling. Personally I believe all people entering our field should have at least one required course in counseling somewhere along the way. I congratulate many programs that already require such a course. Some universities offer an elective in their counseling programs that students could take advantage of.

    And everyone should know out professional boundaries as well as referral resources for when our “counseling role” is not adequate. If you are interested, a stripped down PPT and handout from the ASHA session least year with many resources is available online at
    http://www.mnsu.edu/comdis/kuster/asha2013presentation/suicidepanel.pdf

  5. I very much believe in combined approaches. When it is needed, I have positive experiences by including clinical psychologists in the collaborative working process. Some psychologists have also approached me for support, because their clients hardly are able to talk at all because of severe stuttering. Psychological therapy might therefore be difficult to handle (both for the Client and clinician) if a person hardly is not able to share thoughts and feelings because of severe and longlasting blockings. Hilda Sønsterud

  6. Thanks for asking this question, and, thanks for coming to the presentation in Chicago. The members of the panel greatly appreciated your attendance and interest in looking out for your clients.

    I agree with the previous replies. Yes, counseling is part of our scope of practice, and, there are several SLPs that have specific or extensive training in counseling, psychotherapy, and/or other aspects of clinical psychology. Ultimately, the lines drawn are individual to each SLP. If one has training in psychotherapy and are comfortable in counseling, they might go further with the conversation of suicide with clients. That being said, all SLPs would benefit from having a list of clinical psychologist or psychiatrists, for those clients who might express suicidal thoughts.

    Bottom line is we need to do and practice what is in the best interest of our clients without ego and judgments.

    With compassion and kindness,
    Scott