Why are we so lost?

Hey there! I am currently a second year distance graduate student at SFA, and have also been an SLP-Assistant for  3 years now. My question today is broad, and subjective, but I see how many SLPs and people learning to become SLPs seem lost with stuttering. We grasp diagnosing and treating articulation and language, but when it comes to stuttering it seems as though most of us are lost.  Of course, not everyone seems to feel this way about fluency, but I know I do. I currently have an amazing professor, but if it were not for her or this class I would be going into this profession not feeling great about stuttering treatment. So my question is, why are we so lost with treatment of a disorder that falls in our scope of practice?

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Why are we so lost? — 2 Comments

  1. Dear Michella (is that correct, login name was michellak3),

    HI! It is great to hear from you! Can I guess you have Jaime Michise at SFA? If you so, it is nice to see you again. I’m Scott Palasik. John Gomez and I talked in your class a few weeks ago.

    You ask a great question, and you are right it is broad with many ideas and possible answers to it. All possible answers playing a role in the the uncomfortable history that SLPs have had (generally speaking).

    You brought up artic and language disorders being perhaps easier to “Grasp.” If we are looking at pure numbers, Stuttering is a lower incidence part of our job, so more time, energy, resources, and education have gone into these areas. That is true for any field. For example, Breast Cancer is a higher incidence than ALS, so more resources are put into Breast Cancer research, education, and such. So there that factor.

    I believe, though, one of the biggest factors is that stuttering is vastly different than language, artic, motor speech disorders and even dysphagia. All require counseling skills (to varying levels of degree and practice). However, stuttering requires actively practicing these skills to improve who we listen and communicate with PWS.

    Another factor is the variability of stuttering itself. When I say the following I’m not trying to simplify any other part of our field, so please don’t take it that way. When someone has an artic, phonological, language, motor speech, cognitive, aphasia, and dysphagia disorders, we can assess them and find a solid partner that we can see and count on the errors happening. Stuttering CAN (and often does) varY from day to day, hour to hour, week to week with little knowledge, at times, of what is influencing the changes, the swings, the eb and flows. So again, we are managing emotions, thoughts, and behaviors with an eb and flow of unknown influences. This all comes down to counseling skills.

    Speaking of counseling skills, students (in my humble opinion, and that is all it is, an opinion) do not get enough education with counseling SKILLS! As undergrads or in graduate school. Now there is a reason for this. Time! Look at how much graduate school NEEDS to teach a graduate student to get them the basics to be sent into the SLP world. It is a lot! So something has to give, and that usually is a designated counseling course. This is challenging. Graduate students need so much knowledge, and practice to be generalist. Between you and me, I would love to see our field go to a clinical doctorate model (like PT and OT).

    These are just a few thoughts to your great question. None are right or wrong. And, there is not just ONE factor that has historically had students feel lost, but many.

    What you can do is be proactive with your education. After school, do CEUs about stuttering. Contact experts and talk with them to learn more. Our education is our responsibility. So go out there after school and keep learning! You are doing it already by asking questions here at the ISAD Online Conference.

    Thanks for writing!
    With compassion and kindness,
    Scott

  2. @mitchellak3, I can really relate to your question. I heard someone say once that it feels like somewhat of a “crapshoot” – if you happen to land at a university with an instructor who is well-versed and passionate about stuttering, then the outcome is generally great for those students who come away really understanding the stuttering experience and feeling confident about working with people who stutter. Sadly, if that graduate program does not have such a person teaching the fluency disorders course and/or providing clinical supervision of practicum experiences with people who stutter, then a good number of graduate students leave grad school feeling ill-equipped to work with people who stutter.

    I would add to Scott’s thorough response that I believe this general sense of being lost when approached with stuttering treatment comes from the fact that there is no “cookbook program” for stuttering. There is no “Do XYZ in 1-2-3 order” to guarantee successful outcomes. As Scott mentioned, stuttering is highly variable, and the felt IMPACT of stuttering is also highly variable and often less visible, so working with people who stutter requires a different skill set than some of the other areas we “treat” that might be more clear-cut, sequential, or even intuitive. Learning to cope with stuttering is often counterintuitive. For example, you’ll often hear stories from people who stutter who say, “The more I tried to hide it, the more severe and impactful it became,” and alternatively, “The more I embraced my stutter and allowed myself to stutter, the easier talking became.” So working with stuttering requires a commitment to continual learning, particularly in areas such as counseling and cognitive restructuring.

    Ana Paula