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.