SLP to be

Hi everyone! My name is Jana and I am currently a graduate student in speech-language pathology. My fluency professor is making sure we are becoming high-quality compassionate clinicians and take a holistic approach to help people who stutter. My question is, what advice do you have for us students preparing to work with people who stutter? Is there any specifics “Do’s/Dont’s? It’s heartbreaking to hear the countless stories in which SLPs are a disappointment to people who stutter, and I never want to be one of them. Thanks for reading!

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SLP to be — 10 Comments

  1. Thanks Jana!

    You have asked an important question. The list of “Do”s should include: DO…listen to the client, let your client educate you on their experience, remain flexible in the direction of therapy, incorporate the cognitive and emotional aspects of therapy, develop a therapeutic alliance, understand the complexities of this multifaceted disorder.

    The list of “Don’t” is lengthy. Don’t value fluency over communication. Don’t use language that is judgemental: “bad day, severe stuttering, good fluency!” Don’t simplify the experience or ever say: “all you need to do is…” Don’t compare your client to others–it is their experience. Don’t imply that you know that experience or compare it to something in your life. The worst thing you can say is: “oh I stutter sometimes, too.” In an attempt to relate to clients, young therapists often try to make it their experience (oh, I have social anxiety too, I get nervous during public speaking too) when this is done, the therapist minimizes the client’s experience and destroys hope in the process. Language like: “help me understand…” is better than: “I totally understand.”

    I love that you are proactive in finding ways to help, not harm!
    thank you!!

    • Hi Rita,

      I really appreciate your advice. You’ve brought up some points that I have not really thought about. I definitely think that my language and how I say things is something I have to pay close attention to. I can see how trying to relate to a client can be detrimental and take away from what they are feeling. You make so many valid points and I will utilize mindfulness when communicating with my clients in order to avoid theses types of situations. Thanks for your reply!

    • Hi, Destiny! Somehow your question got mushed in with the responses to this other question and I think you may have meant to ask your question to the PWS panel. 🙂 My brother grew up as a person who stutters since the age of 6, and I too stutter but not until the age of 36 due to a brain injury so personally I cannot comment on growing up with stuttering myself. I did witness my brother to have moments of less prevalent stuttering in adulthood, but this has been situational, depending on the context of the speaking situation or the audience he is speaking to. I hope this helps you some. 🙂

  2. Hi Jana,
    I have to say thank you for such an excellent question. I admire your reflective attitude!
    I couldn’t agree more with Rita’s advice. I will add that to my own professional practices as it is important to show our client that we SLPs are definitely not only specialists but also human beings. We are not perfect and we do not have answers to all of the questions; we make mistakes, but we are ready to learn from these mistakes and experience. Being able to show your clients that you are also ready to learn from them is extremely powerful. It could help to create a really meaningful relationship between an SLP and a client. I would repeat the last sentence from Rita’s post and I would recall a Latin phrase: primum non nocere (First, do no harm) which also applies to us SLPs. We should do our best so that our clients are not stigmatized (because of the communication disorders they experience). Unfortunately, sometimes we are the ones who stigmatize them.
    Together with K. O. St. Louis we mentioned about this in a paper on ISAD 2019: A Translatable Poster Pinpointing Cross-Cultural Findings on Stuttering Adult Preferences for Support and Assistance: (https://isad.isastutter.org/isad-2019/papers-presented-by/research-therapy-and-support/a-translatable-poster-pinpointing-cross-cultural-findings-on-stuttering-adult-preferences-for-support-and-assistance-katarzyna-wesierska-kenneth-st-louis).
    Once again, thank you for being so self-reflective and for sharing your thoughts with us!
    Kind regards, Katarzyna Węsierska

  3. Hello Jana!
    Thank you for your important question!
    I appreciate that you highlight a holistic approach in your future work. I would like to stress the important aspects of listening carefully to your clients and remaining flexible in therapy – which is so well expressed by Rita already.

    My best ‘personal’ advice is to consider all your work and shared considerations within a context-sensitive frame. For some, fluency might be important, and for others emotional or social aspects might be expressed by the clients as important. In my clinical practice, I experience that the descriptions of goals for therapy are mainly based on the person’s wish for better coping in real life settings. This is supported in research too (DOI: 10.1016/j.jcomdis.2019.105944), where the majority of the participants expressed goals of including both physical and psychological aspects of stuttering. Therefore, we have to listen carefully to each person. For many people who stutter, multiple aspects (ex. improved fluency (effortless speech), emotional-/social aspects) which are shared in therapy as important, should be regarded as important for you as a SLP as well. Hopefully the therapy elements which are shared and explored in daily life settings may influence the everyday functioning in a positive direction. Therefore, consider everything within the unique contexts of each person, and then you can start to consider do’s and dont’s within this particular context.

    I thank you for your open mind, and wish you a meaningful and enjoyable future.

    Best wishes from
    Hilda

    • Hello, Jana. I tell my graduate students about times when I was still being trained to do modified barium swallow studies, and the medical pager at the hospital I used to work at would go off in my pocket for a MBSS, and I would get a chill down my spine- but now, I have done so many solo, my oh my do I love to do them! You have got this, dear one. Your question, alone, shows so much empathy and compassion. You are already being an effective clinician in not wanting to hurt/hinder people. Wow, that speaks volumes to your character. Yes, there are some people who stutter that have stories of negative experiences of speech therapy by dare to be different… dare to be part of the change, and an educator. I don’t tend to blame the SLP’s that just weren’t taught better or truly didn’t know better…. but our profession, is getting better at it. So many that “get it” are teaching others to “get it” as much as possible. Immerse yourself in the stuttering community, and listen to people’s stories.. that’s how I learned so much- and two people who stutter are not the same. You cannot put stuttering therapy in a “fluency box” and if you do use a “fluency box” for therapy, you must individualize it to the person sitting in front of you or they won’t come back for therapy (or they will, but it will be forced by their parent.. and hence starts the possible trauma process.) You are already being a world changer by participating in this conference and asking this question. And remember, not all people who stutter have had negative experiences either. The person sitting in front of you in that therapy room is a person just like you are. Ask them what they like and don’t like in their journey and world and be sensitive to that. LISTEN. Soak in their story. Learn from it. And teach other clinicians to do the same. Best wishes in your studies.

  4. Hi, my name Sierra, I am a future SLP, I was wondering has there ever been a time in your career when a patient was not progressing no matter what technique was being tried. If so, what was your next steps with the patient and how did you feel about the experience?

    Thank you

    • Hi, Sierra. 🙂 First of all, super congrats to you as a future SLP! Somehow your question got smashed in with responses to another question. This is a really great question and it really depends on your goal writing process, the measurability and appropriateness of your goals, and so forth. We just talked about goal writing in the graduate class I teach, and I addressed this very thing, and it really goes along with any communication entity that we treat.When you write goals and your student, for example, isn’t making progress, you look at the goals first to see if they are truly attainable based on the person’s want/needs/level of function etc. We want to set realistic goals and make sure the parent (if it is a student in a public school, for example) is involved in the goal writing process. If the child is over the age of 6 I typically involve the child in the goal writing process too and have a talk with the parent and child together to see what they both want therapy to look like, especially with kids who stutter (if this is an option with parent or guardian… if parent or guardian is available, sometimes this isn’t an option and most of your info comes from teacher.) When writing goals for therapy, you don’t want to write a goal that has six parts to it.. that’s not attainable. For example, “By December of 2020, the student will complete the following stuttering strategies to include: a.) light contacts b.) pull-outs c.) cancellations d.) prolongations e.) decreasing of secondary characteristics f.) easy onsets g.) painting of nails h.) brushing of teeth i.) combing of hair… ok, you get the point (the last part was just for dramatic effect.. those are not truly- as you should know- research-based strategies taught in therapy.) First of all, not all of those strategies will more than likely be ones the person who stutters ends up using and liking/ends up working for them.. so don’t list them all in a goal, because the therapy goal will not get met. So defining “not progressing” is tough. The same goes for how we write our goals. If we write a goal that says that our person who stutter is going to be “98% fluent”….. do you think we will reach this goal in “30 days in the outpatient setting” as stated in the evaluation report based on the evaluation, and based on the nature of stuttering using the therapy methodologies in place? What are our thoughts on that? Some SLP’s write goals with a fluency percentage attached to it. If the person who stutters comes that comes to me for therapy prefers for me to do that once I have explained the nature of stuttering to them (stuttering can change on a daily basis regarding prominence of overt characteristics) then I will write it as such… however, think about a goal written like that. We are expecting a person to be “98% fluent”…. that’s not something that a person is “fluent” can even do by definition, right? (first of all.) So ok, let’s change the goal for the person to be “90% fluent across three consecutive sessions in structured contexts.” but let’s say that the person coming in your office that day for stuttering therapy didn’t sleep well the night before and might be emotional about something at work from that day… it’s session three and they were not “90% fluent” that day.. goal wasn’t met. Are you following? This is again a response based on my personal practice, but when a person who stutters wishes to work on speaking techniques in the therapy room to modify or reduce disfluencies in some way, I tend to write the therapy goals to state that the individual will demonstrate usage of strategies during “structured and unstructured contexts 8 our of 10 trials across two consecutive sessions” for example. Then we aren’t focusing on the fluency. 🙂 We are honoring the true nature of stuttering even in our goal writing, and we are honoring the person in front of us by showing them it’s ok to stutter, while still helping them reach their personal goal of learning the fluency strategies… does that make sense/help? SO it’s all about the goal writing/mutual process of it. Then also, having good normal basis talks with individuals in the therapy room about progress, about how therapy is going, making sure everyone is on the same page…. so it takes a LOT for a client to “not progress” in my book.. because we not only look at what our student or individual we are seeing in the therapy room is doing, but we really must look at what we are doing too. Long answer, sorry but I hope it was helpful! Keep up the good work in your studies!

  5. Hi, Sierra. 🙂 First of all, super congrats to you as a future SLP! Somehow your question got smashed in with responses to another question. This is a really great question and it really depends on your goal writing process, the measurability and appropriateness of your goals, and so forth. We just talked about goal writing in the graduate class I teach, and I addressed this very thing, and it really goes along with any communication entity that we treat.When you write goals and your student, for example, isn’t making progress, you look at the goals first to see if they are truly attainable based on the person’s want/needs/level of function etc. We want to set realistic goals and make sure the parent (if it is a student in a public school, for example) is involved in the goal writing process. If the child is over the age of 6 I typically involve the child in the goal writing process too and have a talk with the parent and child together to see what they both want therapy to look like, especially with kids who stutter (if this is an option with parent or guardian… if parent or guardian is available, sometimes this isn’t an option and most of your info comes from teacher.) When writing goals for therapy, you don’t want to write a goal that has six parts to it.. that’s not attainable. For example, “By December of 2020, the student will complete the following stuttering strategies to include: a.) light contacts b.) pull-outs c.) cancellations d.) prolongations e.) decreasing of secondary characteristics f.) easy onsets g.) painting of nails h.) brushing of teeth i.) combing of hair… ok, you get the point (the last part was just for dramatic effect.. those are not truly- as you should know- research-based strategies taught in therapy.) First of all, not all of those strategies will more than likely be ones the person who stutters ends up using and liking/ends up working for them.. so don’t list them all in a goal, because the therapy goal will not get met. So defining “not progressing” is tough. The same goes for how we write our goals. If we write a goal that says that our person who stutter is going to be “98% fluent”….. do you think we will reach this goal in “30 days in the outpatient setting” as stated in the evaluation report based on the evaluation, and based on the nature of stuttering using the therapy methodologies in place? What are our thoughts on that? Some SLP’s write goals with a fluency percentage attached to it. If the person who stutters comes that comes to me for therapy prefers for me to do that once I have explained the nature of stuttering to them (stuttering can change on a daily basis regarding prominence of overt characteristics) then I will write it as such… however, think about a goal written like that. We are expecting a person to be “98% fluent”…. that’s not something that a person is “fluent” can even do by definition, right? (first of all.) So ok, let’s change the goal for the person to be “90% fluent across three consecutive sessions in structured contexts.” but let’s say that the person coming in your office that day for stuttering therapy didn’t sleep well the night before and might be emotional about something at work from that day… it’s session three and they were not “90% fluent” that day.. goal wasn’t met. Are you following? This is again a response based on my personal practice, but when a person who stutters wishes to work on speaking techniques in the therapy room to modify or reduce disfluencies in some way, I tend to write the therapy goals to state that the individual will demonstrate usage of strategies during “structured and unstructured contexts 8 our of 10 trials across two consecutive sessions” for example. Then we aren’t focusing on the fluency. 🙂 We are honoring the true nature of stuttering even in our goal writing, and we are honoring the person in front of us by showing them it’s ok to stutter, while still helping them reach their personal goal of learning the fluency strategies… does that make sense/help? SO it’s all about the goal writing/mutual process of it. Then also, having good normal basis talks with individuals in the therapy room about progress, about how therapy is going, making sure everyone is on the same page…. so it takes a LOT for a client to “not progress” in my book.. because we not only look at what our student or individual we are seeing in the therapy room is doing, but we really must look at what we are doing too. Long answer, sorry but I hope it was helpful! Keep up the good work in your studies!

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