Advice for new clinicians

Hello experts!

I am a 2nd year graduate student, and I was wondering what you think is most important for new SLPs to know about PWS. I am taking an advanced fluency course right now, so what is one piece of advice regarding working with PWS that I won’t learn in a textbook??

Thank you!


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Advice for new clinicians — 8 Comments

  1. My advice would be to immerse yourself in the self-help community. Attend NSA and FRIENDS conferences (Friends also provide grad student training). PWS are an incredibly diverse group and there is no one-size-fits-all in terms of characteristics and best treatment. Be an active listener- if you are not a PWS, you will need to listen a lot, as I have.
    Make sure you learn as much as you can about conflicting points of view. Some things- like just working on helping a child speak fluently and praising as such- can actually cause more tension than relief in some contexts.
    Choose your therapies by considering rationales very carefully.
    Ask clients (including children) what THEY want to work on and achieve. Their goals (not ours) should drive treatment. And make sure you get OUT of the clinic setting as much as you can with your clients (and bring their significant others in).
    I could go on and on but will let others chime in!
    Best of luck

  2. Hi, Kellie,

    A good, probing question . . .

    I’ll be emphasizing what Dr. Grossman stated, namely that therapy is a partnership, and that clients and the people in their lives who care about them are your partners in any professional relationship you may choose to fashion to help them speak and communicate more as they wish.

    That means you each need to know at the outset the reason you will be joining into such a goal-focused relationship and each of your roles in it

    In such a relationship, you and the client each need to know what the purpose is for working together, not just you. For example, to become aware of the various components of the fear of stuttering and of the actual stuttering itself. You both need to “sign-on” to the work in the same language and in the same spirit of colleagues or of team members.

    And, in such a collegial relationship, which is the one most likely to bear fruit as compared to, say, an authoritarian one where the clinician assumes the role of “boss,” the clinician/therapist needs to becomes guide or mentor to help establish a useful experience for the client that continues beyond the termination of the clinical relationship which includes knowing when and how to safely let go.

    I also believe that participating in some form of personal growth activity, such as therapy or maintaining a meditation practice or personal journaling, etc., is very important for the clinician to develop insight and perspective and empathy and compassion for the bravery, perseverance, and patience required for the client to choose to take a course leading to desired, personal growth.

    And, “Yes.” This can be a way to approach therapy with clients who are children, with appropriate modification.

    You may be interested in reading a very practical book I wrote, “Mind Matters. Setting the Stage for Satisfying Clinical Service.”

    Best wishes to you, Kellie.

    Ellen-Marie Silverman

  3. Hello Kellie, you’ve asked a great question and the responses by Dr. Grossman and Ms. Silverman are excellent answers that can get you started on your path to helpful therapy for people who stutter. In my graduate class in stuttering, I also strive to increase awareness about stuttering through entering the world of people who stutter. If they don’t know someone who stutters, they can listen to podcasts, such as those on StutterTalk, and watch YouTube videos of people who stutter. Attending NSA or Friends meetings, as Dr. Grossman suggested, are two other wonderful ways to learn about stuttering and connect with those who stutter.

    Best wishes to you in graduate school, Kellie.

    Jean Sawyer

    • Hello, Jean,

      Nice to hear from you here.

      I feel I need to say for all those who may be affected one way or another by not realizing that it was possible for a woman of my age to earn a Ph.D. in Speech Pathology, that I did and so did others, less then than now certainly. But, at any rate, I, too, have earned the title Doctor as a form of address. And in professional exchanges such as the ones here, it is the title I prefer.

      Best wishes,

      Ellen-Marie Silverman

      • Oh, my goodness, Dr. Silverman, I do apologize! Thank you for setting me straight, as I didn’t realize you had earned a doctoral degree. I appreciate your post.

        Kind regards,
        Jean Sawyer

  4. Hello Kellie,
    Great advice so far, so I will take a different road here….
    Keep in mind that disfluency is a surface feature that can manifest for a variety of reasons. It can represent stuttering (of course), but it can also be a symptom of language learning (think about English language learners), language formulation, anxiety, motor speech difficulties, cluttering, etc.
    For children especially, take time during the evaluation process to consider differential diagnosis. New clinicians may observe disfluency and assume stuttering, without a closer look. The time you put into differential diagnosis will pay off in time saved in treatment: A more targeted therapy will lead to better outcomes.
    Good luck to you!

  5. Hi Kellie,
    Speaking is the expression of one’s inner self. It involves all the principles of speech science, brain function, neuro-plasticity, the mind/body connections. In short the way we speak reflects, thinking, feeling, behaving, attention and intention. I believe, as in so many others areas that we treat as SLP’s, we have to focus not only on the problematic issue, the stuttering, but also on the way the system can best function. Therefore, in addition to the text books on stuttering and fluency per se, I would suggest learning as much as you can about the neuro-physiology of speaking, the way people can make changes through cognitive behavioral approaches, meditation and counseling strategies. In short, all that you can learn about human nature will serve you well as a clinician treating people who stutter.

  6. Hi Kellie,
    Along with the great advice already given I think it is helpful t to realize how difficult it is to implement speech techniques into every day conversations. Many people think that PWS could improve their speech if they would “just try harder”. This idea is reinforced when we see our clients using speech techniques in the therapy room but not in other situations. So I challenge you try this for yourself: There are two ways to produce the “s” sound (1) tongue tip up or (2) tongue tip down, they both result in the same sound people just prefer one method over the other. Say the “s” sound and figure out how you say it. Then, for the rest of the day, try to articulate the “s” sound in the opposite way that is natural to you. You will find that you may be able to use it when taking alone using simple sentences but once you have to use it in a conversation, at work, or during an interview it is not easy.
    This exercise will give you an idea of how difficult it is to modify the way you speak. Now, add to that the emotional related aspects of stuttering and it becomes even more difficult.
    Good luck to you Kellie,
    Thales De Nardo