Reluctance to work with stuttering

Many people who stutter and SLPs have heard that stuttering is complex and often SLPs are reluctant to work with individuals who stutter. What are some of the reasons why SLPs and graduate student SLPs seem reluctant to work with stuttering? 

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Reluctance to work with stuttering — 7 Comments

  1. Thanks Pam! You ask a great question.

    Stuttering IS complex and an SLP (Speech Language Pathologist) working with stuttering needs extensive knowledge, which is not always accomplished at an academic level. Some graduate programs have little or no courses in stuttering. So, the first challenge becomes obtaining appropriate training.

    Unlike other speech and language differences that SLPs treat, stuttering has a cognitive and emotional component; requiring expertise in counseling and behavior therapies. This becomes the second challenge…an understanding of the multi-factorial components.

    The final challenge is the dynamic, individualized nature of evaluation and treatment. Each person who stutters is unique and each day of their life can present different challenges. That variability in the experience is often the hardest area to grasp for new SLPs and is best learned by involvement in support groups and listening to/understanding the lived experience.

    Yes! Stuttering is complex and fascinating. What a boring life it would be if we shy away from every challenge. If we slay all the dragons, there can be no heroes! AND, we have a wonderful support network to help you learn more about stuttering and travel that journey to be an effective clinician: NSA, Friends, SFA, SIG4, the American Board of Fluency and Fluency Disorders and more. Thanks again for a great question to kick off the ISAD!

  2. Your question gave me interesting insights into how professionals in countries other than mine view stuttering. In India, on the contrary, I find that SLPs are very willing to work with stuttering. Most student SLPs or relatively less experienced therapists, however, tend to reach a dead end at two points:
    1. When fluency as well as natural sounding speech need to be carried over to situations outside the clinic.
    2. When relapse occurs.
    In my opinion, encouraging student clinicians to go beyond the “core behaviors” and stay abreast of recent encouraging evidence about cognitive approaches to intervention and counseling might make them more competent to work with stuttering.

    Therapists (and consequently persons who stutter) often feel disillusioned with therapy because they expect therapy to make the stuttering disappear in every person who stutters. Acceptance, disclosure, easy stuttering and the fact that we do not intend to ‘get stuttering out of their system’ through therapy is what I try and emphasize in my classes, hoping that it might translate to more competent therapists working with stuttering in future.

  3. To add to Rita’s and Dr. Kelkar’s responses, I would just add that for SLPs in school settings, when your caseload is predominantly made up of students with other communication challenges, I believe that SLPs tend to choose continuing education in other areas of our practice (e.g., articulation disorders, autism, language), which perpetuates the problem of having so many SLPs feel uncomfortable or reluctant to work with stuttering. School budgets have also dwindled, so I also believe it gets trickier to set aside time and money to further their education in stuttering. That is why Spero Stuttering, Inc. has developed the Continuing Education and Traineeship (CEAT) stipend, to encourage and fund more SLPs to obtain the additional training they need.

    Pam, I am so thankful for people like you and others who invest in the training of graduate students by being willing to share your story, which helps us combat this problem. I know that my students have gleaned SO MUCH from hearing the stories of people who stutter and getting an insider glimpse into their lived experiences. Thank you for participating in the “Stuttering Café” at the University of Kansas as I teach and train future SLPs!

  4. Pam,
    Thank you so much for your question to the professional panel and I fully concur with my colleagues, Rita, Dr. Kelkar and Ana Paula who have answered thus far. Additionally, some SLPs here in the United States have spoken of a reluctancy to treat stuttering specifically because, sadly, of a lack of patience in the therapy room. For example, we can treat an articulation error with an /s/ sound and correct that. With stuttering treatment, this is different- and the therapeutic outcome looks differently, presents differently and requires a different skill set on behalf of the clinician including counseling skills, etc. Stuttering isn’t something that is to want to be “fixed”. Neither is an articulation difficulty, for that matter, but it is oftentimes looked at that way, and SLPs think of articulation therapy as a method of “seeing results” versus stuttering therapy. This is very unfortunate, and in my opinion, goes back to what Rita said regarding a lack of education at the graduate school level and isn’t necessarily the fault of the SLP. Stuttering therapy is very rewarding for the clinician, and has marked results; the SLP that doesn’t see that just doesn’t have the education, and doesn’t understand the nature of stuttering nor the individualized stuttering experience itself. Stuttering is so fun and exciting to treat, and one of the most amongst one of the heartfelt areas we can treat if you know how to go about it properly. I hope that helps. 🙂
    -Steff Lebsack

  5. Pam – that is a good question and I concur with the responses from all my esteemed colleagues above. One aspect that I would like mention one factor that is not often discussed: simply human nature. As a professor, I have been teaching graduate level stuttering courses for ~12 years now. My focus with the graduate students is to de-emphasize focusing solely on fluency, rather focus on functional change as emphasized by the ICF model. As such, I focus on the benefits of Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy (ACT) in helping clients address the “ice-berg” of stuttering. At the end of each semester I feel I have made a change and accomplished something – till I read my teaching evaluations. Inevitably, I have a few students comment that, “the class was interesting and we learned a lot about stuttering, but it was not helpful since we still do not know how to make out clients fluent.” My immediate/instinctive reaction is, “Who’s class did they attend????”. However, after reading your question, I think I understand what is happening. Despite my best efforts and training, human nature gets in the way. They see something is not “normal” and they ask, how do we make it “normal”. Couple the fact that even training does not always have the intended impact on one’s mindset, with the factors listed by those above me – and it makes sense why so many SLPs are reluctant to work with clients who stutter. Thank you for the question and thank you to those who have already responded for their insights.

    Farzan

  6. Thank you everyone.

    Wow! These responses are amazing – you all dug deep and I really appreciate the thought each of you gave to answering this question and offering your insights.

    I’ve been around for a while as an adult who stutters, but I still hear this sentiment – that stuttering is too difficult or too challenging for students (or even some seasoned clinicians) to work with. That it’s too frustrating because there is not a readily seen “quick fix”.

    [As an aside, I remember doing a 2 hour workshop a few years ago here locally at our state ASHA conference. It was about covert to overt. I remember two SLPs, one woman and one man, both in their late 50’s, I’d guess. Both of them mentioned or questioned during the session something along the lines of – “some people who stutter don’t seem to understand the goals of speech therapy”. Or close to that. I remember saying in my head, “Wow, really?” but of course I didn’t react).

    I know that is not the case with all of you, some of who we are good friends, who clearly get it and choose to hold hands with the stuttering community to both help and learn.

    I had therapy for about 18 months as an adult, and I exited relatively soon, I think. I saw that the students really only knew how to offer fluency shaping techniques (this was in 2006-2007) and that’s not what I needed or wanted. I wanted affirmation that it was OK to shed my covert skin and to be affirmed that stuttering was OK and I was Ok to just want to stutter naturally. Unfortunately, the student clinicians didn’t seem to know what to do with that. 😊 I was pro-acceptance and they needed to set fluency goals and count stutters and didn’t seem to care that I didn’t care about those goals. I understood it was a requirement for their class. In fact, I stuck around as long as I did to “help”, LOL, as there was not enough PWS to go around.

    When I saw that my goals clashed with theirs and there didn’t seem to be any wiggle room, I left at the time that was right for me to leave.

    I really hope that others, especially students, will look at this question and the “point on” responses and learn something just from reading. And maybe further discussion will evolve.

    Again, thank you all for giving such thoughtful responses and insights. I think some SLPs would get defensive with this thought. You cannot learn this stuff in a book – it comes from joining hands and seeing the value we offer to each other.

    Pam

  7. Hi Pam!

    When reading your response above, I consider the year’s topic ‘speak the change you wish to see’ even more important. To consider the first-person perspective as the most relevant perspective, may be the most important perspective to consider in the collaboration between SLPS and persons who stutter. We cannot always expect that the persons themselves share their goals and wishes or speak the changes they wish to see on their own initiative. Therefore, we as SLPs (and researchers) need to create necessary and useful spaces or rooms for these dialogues. These dialogues or first-person perspectives need to be taken into account not only in speech-language therapy, but also in stuttering therapy research.

    Thank you for all the good work you are doing!

    With all the best wishes from
    Hilda

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