Questions for an SLP

A few days ago I shared a guest post from Melissa James at Well Said: Toronto Speech Therapy. I sent her some questions, and she was nice enough to reply…

You run a speech therapy clinic for adults who want to work on their speech, social or communication skills. As this is a stuttering blog, how often do you work with clients who stutter?

As a speech therapist in a private practice, I work with clients who stutter nearly every day. More specifically, 40% of our caseload are adults who stutter. The other 60% of our clientele consists of vocal work, professional communication, accent, articulation and several other core speech therapies. Over the past five years, as a clinic, we’ve worked with approx. 300 adults who stutter who want to work with a therapist that truly grasps the unique challenges of being an adult who stutters.

Your clinic works to treat the physical and psychological parts of stuttering, how do you strike that balance with clients? Have most of them had therapy in the past? And-

This question touches on a very important commonality among adults who stutter; the vast majority of these adult clients received speech therapy in the past. Some individuals worked on their speech as children, and others, started working on their speech as adults. Adults who stutter frequently inform me that they find it difficult to utilize the speech exercises they’ve been taught (easy onsets, breathing, stretching, etc.) in real life. Most adults are looking for support with their stuttering at work and in high-pressure situations; consequently, if you are unable to implement your fluency tools in these settings, the stress compounds, and often worsens the outcome.

When you talk to a new client about the “burden” of stuttering, is it something they’ve thought about before? Or are they suddenly reflective, realizing more and more about themselves?

From my professional observations, most adults who stutter are know that many things in life are harder when you stutter, and moreover, recognize the pain associated all the while not taking time to process and reflect on the burden of stuttering. I also believe that most adults who stutter don’t openly discuss the struggle of stuttering in social and professional environments because most adults who stutter don’t know another peer who stutters. Online support groups have come a long way in building a community for adults who stutter and this is an excellent way to discuss the experience of stuttering with others who truly understand. Whether in an online group or a therapy setting, I feel that reflection and emotional exploration is an extremely important part of the speech-therapy journey, notably, engaging in and sharing thoughts, feelings and beliefs about yourself as someone who stutters. I think that most adults who work on their fluency find it incredibly liberating to work with a speech-language pathologist who acknowledges and respects the experience. Research shows the practice of reflection and mindfulness with regards to stuttering, known as ‘Acceptance and Commitment Therapy’, is helpful in reducing the severity of the stutter.

I would imagine that most adults who stutter who see you understand there’s no cure. So what do you do to help them understand that change is possible? How do you get them to move on from the mental state of, “it’s always going to be this way.”

In the traditional medical sense, there is no cure for a stutter. So to speak, there is no medication or surgery offered that will resolve stuttering; however, there are evidence-based treatment methods that reduce the frequency, duration and overall severity of the stuttering. I believe in full transparency in my work, therefore, I explain to my clients that the “cure” for stuttering is not external – an instantaneous solution does not exist. The client needs to engage in hard work in order to achieve stuttering improvement. In fact, during these sessions clients recognize the onus is on them, and they tend to work harder than I do. It’s also important to note that clients that are truly feeling hopeless don’t often seek help. The people who contact me have the readiness factor that is crucial in improving stuttering. If you want to improve and you are with the right clinician, you have a recipe for success.

How often do your clients visit? Are they given, for lack of a better term, homework assignments? I know as a kid we were told to go over sounds and practice breathing. How do you challenge an adult who stutters?

Clients usually visit once per week at the beginning of a therapy plan and less frequently towards the ends of a program. Therapy’s mandate is to build sustainable skills. Clients begin by learning the practices during an early stage, and later start to implement the tools in real life. The next step sees an increase in real life implementation, meanwhile reducing the frequency of sessions. The final goal is maximum fluency with maximum independence. Each week, we collaborate on a home plan. The best home plans are social exercises, (e.g., speak to three strangers or recording a new voicemail message) and mindset exercises (e.g., cognitive behavioral therapy exercises, mindfulness practices). A home practice strategy that adults who stutter like are time-of-day-challenges where you engage in a ten-minute long conversation, utilizing all the tools, during a specific time of day (e.g., following dinner every night). Daily, applied home practice is essential for success in a stuttering treatment program to allow for practice outside the clinical setting.

Is there a certain fear that you hear about over and over again with professionals? Something like a presentation to give at work, or having to interview, or something else?

Common fears include meeting new professionals, giving presentations and being interviewed. Adults who stutter fear that colleagues or contacts think they are incompetent if they stutter openly. At the same time, these adults don’t want others to pity or patronize them. Meanwhile, they tend to be highly ambitious, intelligent and want to progress in their careers, yet feel bound by a constant fear of exposing their stutter during one-on-one interactions. Adults who stutter also fear, or feel nervous about, speaking on the telephone, and specifically being hung-up on. Other common concerns include introducing themselves ex. saying their name while checking into a hotel and speaking on a conference call. Almost always, these fears get in the way of the client practicing these skills which in turn reinforces the anxiety and the stuttering. Through a slow exposure approach, we can start to practice these situations, thereby reducing the anxiety through exposure, which in turn reduces the frequency of stuttering.

 

Do we have to talk?

The other day I was at a Starbucks, and there were two men outside speaking Arabic. I wanted to sit outside. I passed them on the way in, obviously, so in addition to thinking about having to say my name for my coffee, I also got to think about going up to them and telling them about my Saudi experience.

I shoved my name out to the barista, whatever, that was done. I wanted to sit outside and read since it was a nice day. There was a table near these two gentlemen. I went outside.

As those of you who stutter know, there’s timing with all of this, and things “expire” pretty quickly. If you don’t go up to them when you first get out there, the window closes pretty quickly. Then you’re just being creepy and weird.

I thought about this. I thought about the stuttering. I thought about what I wanted to say. Then I thought, am I just being too hard on myself?

Yes, I’ve been getting better about speaking up. At work, at basketball practices, whatever. Do I have to do this everywhere? Am I obligated to practice? Aren’t I allowed to look at it form a non-stuttering perspective — maybe they just want to be left alone, my experience was boring, and really, are we somehow going to become best friends if I go up to them?

I didn’t talk to them. Yes, the stuttering did have something to do with it. But it was also about picking my battles. Challenges? And also the social picture. Maybe sometimes you just don’t want to talk to someone else.

Well Said: Toronto Speech Therapy

One of the things I wanted to try to do a long time ago was to have guest posts and interviews with SLPs. So! Finally after a few years, here we are.

Melissa James, B.A., M.H.Sc. (Reg. CASLPO), was nice enough to send along a post. She is the director at Well Said: Toronto Speech Therapy.

From their site:

We are Toronto’s speech therapy clinic for adults where you can work with registered speech-language pathologists to improve your speech, social or communication skills. Our work focuses on practical, real-world outcomes. From a lisp to social skills, our registered professionals help you develop the confidence that you need. Our services are always founded in research-based approaches that have helped thousands of others.

From Well Said: Toronto Speech Therapy:

Top 6 Tips for Letting Go of Your Feelings About Stuttering

Stuttering is painful, not in the stub your toe kind of painful, but a deep, chronic worry and frustration, emotional kind of painful. This leads many adults who stutter to a speech therapist’s office to help reduce their stuttering. In the past, you would expect to work on slowing down, using voicing, breathing, and other tricks to help you speak more fluently. While this type of therapy has research efficacy, a significant proportion of adults find that this therapy works only as a temporary fix. And another common complaint with this type of tools therapy is that people feel like they’re putting on a mask. Masking the disfluencies can be a great thing for someone who feels neutral about their stuttering. Unfortunately, most adults who have an emotional history with their stuttering that is far from neutral. For someone who has struggled with stuttering their entire life the feeling about their stuttering: the anxiety, negative thoughts, avoidance of situations are worse to cope with than the actual stuttering.

For these people who stutter a new approach to stuttering treatment has been developing steam in the speech therapy community. This type of treatment focuses on healing the psychosocial and emotional aspects of stuttering. Years of coping with stuttering certainly does take a psychological toll and this approach to new stuttering treatment is designed to alleviate the emotional pain rather that the stuttering itself. This new approach (let’s call it a counseling approach) to stuttering therapy has some good research behind it. Research has shown that not only were people who stutter feeling more accepting of their stutter and positive about themselves after working with a speech-language pathologist who used this approach AND –  the frequency of stuttering decreased and gains were still evident three months later. This means that working on your stuttering with a speech therapist who uses the counseling approach will help you feel better and decrease the number of stuttering moments at the same time. Are you surprised to hear this? Probably not. As someone who stutters, you know that when you are having a bad day when your mind is cluttered with worry and negative thoughts, your speech is less fluent. And, when you are feeling care-free, like during a relaxing vacation, your speech becomes your most fluent. This research does well at capturing something you already knew: your mood affects your fluency. And so, now speech therapist’s can work with you on helping you reduce anxiety, increase vulnerability, feel more positive, and more accepting of your stuttering which together will reduce the stuttering.

Here are the top 6 tips for letting go of your feeling about stuttering:

1. Journal – Journalling has life-changing powers to develop your self-reflection, emotional processing, and insight. When you journal about your experience with stuttering, you are reorganizing your feelings into thoughts and confronting them in a safe way which will allow you to get all the “feels” out and down on paper rather than ruminating over how you should or could have said it better.

2. Practicing Gratitude –  Getting into the habit of noticing why you are lucky or what you are grateful for has been demonstrated in research to improve one’s wellness. For adults who stutter taking a few minutes to take perspective on what you have going for you can be very helpful in improving your feeling about stuttering.

3. Mindfulness – Mindfulness is a hot topic in the psychology disciplines right now. Several articles are written on a daily basis on the benefits of mindfulness from depression to anxiety, to anger management to stuttering. Mindfulness is essentially taking time out of our modern 2017 lives to disconnect and focus gently on our being without judgment. I personally like yoga as a mindfulness practice. Some people really like guided relaxations. You can find guided relaxations on the internet here.

4. Envisioning your goals realized – I often ask clients to collect images and put them together in a collage that represents how they want their lives to look in 5-10 years. This task of visualizing the future for my clients who stutter has been helpful in shifting the focus away from speech and on to the real values. By focusing on how you want your life to look in five years, we can at a glance see what is important to you. And from there, we can work backward and formulate a plan for how we get there with stuttering.

5. Checking the evidence – See if you can challenge your own thinking when you notice a negative thought passing through your internal dialogue. For example, did you just think to yourself – oh, she probably thinks I am incompetent – stop yourself and ask ok, wait a minute this thought is unhelpful and what evidence do I have to prove this is true? You may want to read more about unhelpful thoughts if you think this strategy would work well for you.

6. Most importantly, you shouldn’t feel bad about stuttering and you shouldn’t call your a dysfluency a “mistake” or a “mess up” We have to change our language about our stuttering to make it neutral. When we describe something using neutral language, our minds are less likely to associate it with a negative emotion.

Do you have any strategies that you used to deal with the unhelpful feelings and thoughts around stuttering?

Moving on quickly

I had to make a phone call first thing Monday morning at work. I thought about what I wanted to say, what point I wanted to get across. The good news was that I was calling someone at our own company. I’m pretty sure my name showed up on her phone. But still. Basically a cold call.

I was a stuttering mess. She didn’t say anything about the stuttering at all. I slowly made my way through the information. I tried not to get frustrated since I was doing so badly. But the good thing was that she remained professional about everything.

I needed a minute after to just take a deep breath. I consciously decided not to let it affect the rest of my day. I knew it was just a bad moment — cold call, phone, etc.,

Then someone came by my cubicle.

I had to ask him something about the same project. This is someone who I talk to frequently and have a friendly rapport with. I was still feeling the hangover from stuttering and having a hard time with my words. But I kept talking, and he kept listening. I slowed down a little to catch my breath. And thought about breathing. I took a breath and then let the words run out. And I did it again. And again. And the stuttering started to melt away, and I got back to what I’m used to with closer associates.

By the time we were done, I once again had gotten my point across. And I had completely forgotten about the phone call from earlier.

Forgetting the pressure

My wife and I had an appointment earlier last week with an immigration officer. It was an official interview, something that would decide status. We knew about this for several weeks, so I had time to gather all the necessary documents.

I didn’t know exactly what to expect other than maybe having to tell the story of what we had been doing overseas and how the status had changed.

I consciously decided not to worry about my speech. In the past, I would have gone through every thing that could have been said, everything that I could have said, thought about all the words, all the combinations, all the avoidances …This time, no. Just deal with it when it came.

I was a stuttering mess. It was on camera and all that. It was official and in a small office.  But of course it was on the usual stuff — name, DOB, kids and their DOBs. Stuttered through it all. The immigration guy didn’t say anything, simply smiled and continued on. I got through my part, and she got through hers, and things were approved.

I’m glad I didn’t waste energy worrying. Sure, I stuttered a lot, but I didn’t die. I got the information across.

<span>%d</span> bloggers like this: