How Listening to Clients’ Experiences and Preferences May Help with SMART Evidence-Based Practice (EBP) Holistic Goal Writing and Treatment – Steff Lebsack, Dan Hudock

Steff LebsackAbout the Authors:

Steff Lebsack, MS, CCC-SLP (PWS), became a speech-language pathologist because she has an older brother, Jasper, who is a person who stutters. Steff also began to stutter at the age of 37 due to a hypoxic brain injury. Steff is a PhD student at Idaho State University, with her attention on research in stuttering. Steff focuses on the treatment of stuttering and cluttering within her private practice and is the current course designer/instructor for the graduate Fluency Disorders course for the Baylor University online Master’s Degree Program. Steff has completed many invited guest lecture talks and international poster presentations, with her recent meta-analysis on language sensitivity in chronically-ill pediatric patients being accepted by the American Academy of Pediatrics. She lives with her husband Kevin, her two beautiful young children Mary and Karter and a pug named Ritchie. When she isn’t playing with her kids or catching up on stuttering current events, she can be found baking, writing or reading.

Dan Hudock

Dan Hudock, PhD., CCC-SLP (PWS), a person who stutters himself, is an Associate Professor of Communication Sciences and Disorders at Idaho State University. He is also the Founding Director of the Northwest Center for Fluency Disorders that offers a two-week interprofessional intensive stuttering clinic (NWCFD-IISC) with Speech Language Pathologists collaboratively working with Counselors and Psychologists to treat adolescent and adult clients who stutter through Acceptance and Commitment Therapy (ACT) informed frameworks. His areas of research include psychological, emotional, and social factors of fluency disorders, interprofessional collaborations with mental health professionals, and the neuroscience of speech perception and production in people who stutter using high-density EEG. He has over 30 peer-reviewed publications, 80 international through local presentations with several recent ones being invited keynote and full day talks, and one TEDx Talk entitled “Please don’t finish my sentence” about the experience of living with a communication disorder.

Stuttering is so much more than just the overt speech disfluencies of repeating sounds, syllables, words, and phrases, and getting stuck, either prolonging or blocking on sounds and words that one may observe. For someone who stutters, their lived experiences with their communication disorder, be it internalized emotions, thoughts, and perceptions, or the perception of other negative social consequences imposed by communication partners can impact their emotional, psychological, and social well-being along with their beliefs about their functional abilities, skills, and limitations. For example, the apprehension someone who stutters may feel when making a phone call or talking to a stranger may act to exacerbate their outward stuttering behaviors, including self-perception, tension, and effort-filled struggle, to the extent that the moment of stuttering has frequently been described as experiencing a tidal wave of anxiety causing a dissociative freezing-like response in the individual. More recently, since about the early 2000’s, much of the field of speech language pathology, especially in the United States of America, have experienced a major paradigm shift going from being focused on the listeners’ observations and perspectives of stuttering to focusing and emphasizing the lived experiences of the individual, including the psychological, emotional, social, linguistic, behavioral, and functional domains, which are all within our scope of practice, in terms of relation to communication or impact on communication. This is wonderful for so many reasons, but it also presents unique challenges. A growing body of literature is continuing to accumulate supporting the many long-term positive outcomes that come from holistic-based assessment and treatment for clients who stutter. Some of the challenges that come along with this new focus are that people in general typically aren’t directly exposed to sitting with, understanding, or identifying the physicality and/or motivation(s) to them AND that students in Speech-Language Pathology programs/Speech-Language Pathologists seldom receive adequate direct training on counseling theories or application. 

Our presentation focuses on how engaging, and listening to, our clients may help frame holistic evidence-based practices and goal-writing for clients who stutter. During our presentation, we introduce a reframing of stuttering-focused to more holistic-communication focused experience that walks you through how to use clients’ statements to create meaningfully-holistic evidence-based goals and activities for clients who stutter, along with what outcome(s), represented by client statements, may occur. We hope this presentation helps you, as the person who stutters, advocate for taking a more active role in therapy and goal planning, and the student/SLP to reframe and plan for holistic EBP therapy in stuttering therapy.    

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How Listening to Clients’ Experiences and Preferences May Help with SMART Evidence-Based Practice (EBP) Holistic Goal Writing and Treatment – Steff Lebsack, Dan Hudock — 18 Comments

  1. Hi Dan and Steff!

    Great video. I like how you rewrote goals to make them measurable and clearly achievable, AND related to engagement in conversation. This can be confusing for many SLPs so it is nice to see how others go about doing it. Well done! Love it!!!


    • Thank you so much for your kinds comments and compliments, Tricia. This is a really important area and so easy to confuse as you said, so I am glad it is helpful. 🙂 -Steff Lebsack

  2. Dear Steff and Dan

    Thank for this wonderful and enlightening paper. It’s wonderful to see how you folks are educating us on the sea change in approach to stuttering.

    Also, well done for using the S.M.A.R.T. model for defining goals/objectives. This is so important, and makes all the difference in setting and achieving goals. If I may suggest, perhaps a Lessons Learned might be helpful at the end. Sometimes we don’t manage to meet our (therapy) goals, and there are may possible reasons for that. Sometimes I may simply not be up the challenge. Blame-free “Lessons Learned” helps me process that.

    Thank you

    • Hello, Hanan and thank you for your kind comments on our paper. I love your suggestion of the “lessons learned” at the end. I know all too many times the person we are serving blames themselves for not achieving a goal in therapy, and that should absolutely not be the case for so many reasons. As a clinician, when a person doesn’t reach a goal, I always survey the goal and my practices and see what I can first adjust in what I am doing as a clinician or if the goal is properly written to fit where the client is at or to truly meet the person’s needs. Thank you so much for this suggestion, and for the reminder for clinicians that people we serve so often blame themselves for this and we need to really be mindful of that. -Steff

  3. Dear Steff and Dan,

    Thank you for sharing this paper! It is very informative and enlightening. I am in my master’s program for speech language pathology and I thought this video was very helpful for writing goals/objectives for people who stutter. Also thought it was great to point to only move forward increasing difficulty in task if the patient is ready for it.

    • Erin,
      Thank you for your comments and for reading our paper. I am glad that you found this video helpful, and best wishes in your graduate studies! You are entering an absolutely amazing and rewarding profession.

    • Fernanda- thank you so much for your kind comments! I do agree- writing SMART goals as such is something that cannot wait for the benefit of people who stutter in speech therapy services. Thank you! Be well, Steff

  4. Hi Steff and Dan,
    Thank you for presenting this information! I am currently a second year master’s student in speech-language pathology, and I thought that your presentation provided great information about holistic goal-writing for people who stutter! I also think these same principles can be applied to many other patient populations, and I’m sure I’ll use this information about holistic goal-writing with many future clients. -Lily

    • Lily,
      Thank you so very much for watching our video and for your kind comment. I am so glad that this information was helpful for you and this for sure can be applied to other people that we serve. Take care, and best wishes in your studies.

  5. Hi Steff and Dan,
    Thank you for sharing this information! I am currently getting my master’s degree in speech-language pathology and I thought that this presentation really spoke on the importance of focusing on the patient’s experiences and perspectives and applying them to the goal-writing process. Taking a patient-centered approach, rather than listener-centered, allows the patient to become an active member of their therapy process.

    Thank you!

    • Anna,
      Thank you so much for your kind comment on our paper. Yes, I fully agree that a holistic approach truly allows for the person we are serving to be an active member of the therapeutic process; just as it should be. Be well, and take care!

    • Ana Paula,
      Thank you for your kind comment and for reading our paper! Yes, it is so important to meet the people that we have the honor to serve where they are at within the therapeutic alliance and journey. Take care. 🙂

  6. hi staff and dan,

    I really enjoyed reading and watching your presentation!
    I am in my last semester of undergrad for comm disorders and we recently had a PWS panel in my fluency class. one of the speakers spoke about holistic approaches in speech therapy and i never had thought about it that way until then. seeing how much more in depth you went really feels like this is the way it should always be!! i hope that throughout my grad school experience, i can practice this approach 🙂

    my question to you is how do you feel about voluntary stuttering as a technique used? we just recently learned about this in my fluency class and i would love to hear your opinions on it and its alignment with holistic approach 🙂

    thank you so much for your time,
    Annika Paz

    • Annika,
      Thank you so much for watching out video and for your kind comments. A holistic approach to goal writing is ever-so important to hold client involvement paramount. 🙂 You ask such a great question regarding voluntary stuttering! Voluntary stuttering (or pseudo stuttering) can for sure be an effective technique when used in the therapy room. Voluntary stuttering is often times used as an assignment within a graduate course and some students who do not stutter feel very uncomfortable going out in public or speaking to a friend or family member and voluntarily stuttering perhaps because the student may feel like they are pretending to be someone they aren’t or a “faking” a “disability” so to speak (I say this- but I will clarify that although stuttering is defined as a disability by the Americans with Disabilities Act, not all people who stutter consider themselves to be “disabled” within their own individualized stuttering journey). I will say, however, that for the graduate student learning about stuttering and attempting to put themselves in the shoes of someone who stutters as much as possible, the experience of voluntary stuttering can be one of learning, empathy instilling and very enthralling. With that, as SLPs we utilize voluntary stuttering a lot in the therapy room when demonstrating things to people who stutter. I always preface to the person I am serving to say, “I am going to show you an example of something, and voluntarily stutter to show you this, are you ok with that?” so that the person knows I am not doing this to mock them in any way. On the flip side, using pseudo-stuttering as a person who stutters can be empowering as well. I have had people who stutter tell me that the turning/pivotal point for them in their journey therapeutically with their stuttering was when they became confident enough to pseudo-stutter in public themselves because it was the first time they ever truly gelt agency (ownership) and control over their stuttering behaviors.
      Does that help with your question? Thanks so much again, for commenting. 🙂

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