OASES incongruence

Fluency Professionals, 

I am a second-year SLP grad student, and I was curious if you had any recommendations for approaching inconguencies between OASES results and behaviors and emotions that you observe (i.e. the client demonstrates significant negative self-talk and a negative view of being a PWS, but reports no emotional impact of being a PWS.)

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OASES incongruence — 4 Comments

  1. Dear Mswagerty (sorry, there was not name signed on to your message),

    HI! Thanks for writing and asking questions. Welcome to the conference. Where are you at graduate school? Just curious.

    I believe what you are describing, and help me out because I do not want to assume what I’m saying is correct, is the client is verbally saying negative self-talk and showing you negative perspectives but did not report an emotional impact on the OASES? Is that correct?

    I guess my first question would be, when did the client take the OASES? Was it before they got to know the clinician and open up more? I ask these questions because it may not be the scale that is incongruent but the client did not exactly answer the questions the way they might truly feel. What do I mean by this, well, I have had several clients whom at the eval will say things like, “My stuttering doesn’t impact me at all.” “I pretty much say what I want.” “I can’t remember being teased.” “I like to talk.” We as humans try to put our best foot forward, especially meeting new people. That makes sense, right? Eventually, as the client and clinician get to know each other, they share more and their perspectives might come out and become clearer. These same clients I referred to above would eventually describe moments that contradict what they told me on the first day. This is a human need for survival and to look as if we don’t need help. Again, putting our best selves forward until we can be vulnerable and show our true self at that moment.

    Vulnerability is a challenging thing, especially with people we don’t know (strangers). In essence when we start with clients we are a stranger to them.

    What I’m saying is that what we see on a survey, or even the answers that clients may give verbally when we first meet them might not be the WHOLE story. Not yet. In order to really know people, we need time. We can’t learn everything about a person based on one interaction or one survey. It takes time.

    Also, surveys are hard. We know that what we are writing down is going to be analyzed so we might not want to tell the whole story, in that moment. What I do is use surveys (the OASES) to probe questions further. This is an activity to facilitate counseling moments and deeper conversations. That is where the learning and therapy really happens.

    Did that make sense?
    Thanks for asking questions.
    With compassion and kindness,
    Scott

  2. Matt,

    Hello! I second what my colleague Scott says, in that surveys are tough and often may not be the whole story. I have more often seen it the opposite way, where a person says they are not bothered by their stuttering but ends up scoring in the moderate range re: the effect of stuttering on activities of daily living. I also agree about Scott’s comment re: time.

    A couple of thoughts. First, there are different ways that people cope, and those ways have been found to be “variable”. These are the same studies that I attached in class, but I will attach them here again because they are just that good (for anyone else looking at this response) that are part 1 and part 2 of Plexico, Manning and Levitt’s work on stuttering and coping:

    Plexico, L. W., Manning, W. H., & Levitt, H. (2009). Coping responses by adults who stutter: part I. Protecting the self and others. Journal of fluency disorders, 34(2), 87–107. https://doi.org/10.1016/j.jfludis.2009.06.001

    Plexico, L., Manning, W. H., & Levitt, H. (2009). Coping responses by adults who stutter: part II. Approaching the problem and achieving agency. Journal of fluency disorders, 34(2), 108–126. https://doi.org/10.1016/j.jfludis.2009.06.003

    Secondly, It’s easy while we are coping to say one thing and do another, or say something and feel like we are backed in a corner and try to take it back. It has at times taken months for a person who stutters within our therapeutic alliance, for that person to really come out with how they feel about their stuttering and how it has an impact on their life. What I would take from an OASES and verbal report that are mis-matched is that, the person isn’t quite ready to disclose all of it quite yet. You may have pieces of the puzzle, but don’t pry too much in your client interview questions and let the person you are serving lead the discussion regarding what they want to tell you within their own stuttering journey. Utilize the active listening skills and strategies that you have learned when communicating with a person who stutters, and within that, apply learned counseling skills to help this person within their expressed wants and needs in their stuttering journey. You’ll do great! 🙂 PS- see you in class.
    Thanks,
    Steff

  3. Scott,

    I am currently studying at Idaho State University with a couple excellent fluency experts that I am sure you are familiar with, I really appreciate your willingness to spend time spreading knowledge and sharing your incredible insight in this setting.
    You hit the nail on the head with your assumptions, I apologize my question was not entirely clear. I really like the idea of utilizing surveys as a tool to determine questions and areas that we should take a deeper dive into. It seems as if outcomes and client experiences might improve if we had the ability to spend 2-3 sessions building rapport and gaining an understanding of who the client is before diving into assessment. Alas, that is not the option for many SLPs.

    Steff,

    As always, wonderful person-centered approach to therapy that we all need to remember! It’s a hard line to walk between encouraging growth but also letting them set the pace for their stuttering journey. Sometimes it is easy to forget the variability in responses to a communication disorder, especially for newer SLPs! Our class would not be the same without you!

    Scott and Steff,

    Thank you again for taking time to respond to my question, I am excited to utilize the OASES along with your insight to better serve future PWS!!

  4. Dear Matt,

    HI! I assume you are studying with Dan Huddock? If so, tell him hi from Scott. I miss him.

    Keep asking questions and being willing to evolve. Those two qualities will take you far in your life and career.
    With compassion and kindness,
    Scott