In the accompanying piece "Odyssey's End", Gary Dunham traces his journey of stuttering across the decades, exposing the cache of intense emotions, cultural influences, memories and workaround strategies associated with a lifetime of disfluency.
When someone like Dunham, with all this accumulated history, comes to you, the speech-language pathologist, seeking treatment for stuttering after all these years, where do you even start?
In the following pieces, Jill Douglass and Glenn Weybright share strategies for approaching these unique clients—and lessons learned from them.
Working With Adults Who Stutter: Challenge and Inspiration Abound
By Jill Douglass
An adult who stutters enters into your treatment room. After talking for a few minutes, you feel more comfortable with him. You ask him the million-dollar question, "What is your goal for treatment?" and he succinctly states, "I want to stop stuttering." Pause! Some challenges arise.
- Remind yourself to breathe. You can do this.
- How is your active listening? Active listening is far beyond nodding when a person is talking. Active listening involves empathy, lack of judgment and no agenda. As SLPs, we may find active listening a challenge because, let's face it, we like to talk. The reality is, active listening is essential to work with adults who stutter. Provide them with the space to elaborate on their goals. You may be surprised as the client unveils a message filled with details regarding his anxiety, communication difficulties, the drive-you-mad-reality of having a predictably unpredictable stutter, and so on.
- The client's current goal may not be as obvious as you think. As noted in my opening scenario, an adult who stutters may feel the goal is to gain complete fluency. This may be due to social pressure, a lifelong aspiration or a core feeling that he truly believes is possible. With your clients, attempt to find out: Do they instead think their goal should be fluency? Find the middle ground between (a) their overt goal of total fluency and (b) their needs based on what they have disclosed. By using their words, you increase their awareness of other goals that they have covertly suggested. These additional goals can possibly provide them with great satisfaction along the way to developing more fluent speech.
- They are experienced; this isn't their first rodeo. Working with adults who stutter includes working with their history of stuttering experiences, including therapies. Those in the 40-plus age range may have first-hand experience of growing up in Johnson's diagnosogenic generation. If they received treatment as a child, the adults in their life may have been warned that openly discussing stuttering only increased its persistence. For many adults who stutter, this (debunked) theory may perpetuate the mindset: stuttering is "bad" and fluency is "good." Again, this is possibly another layer of understanding the root of their "stutter-free" goal. Once trust is established, then it is time to gradually chip away at that shame barrier, building empowering stuttering experiences instead.
The noted challenges only scratch the surface of the big picture of working with adults who stutter. Presenting these elements as "challenges" should be perceived as paths in sharpening your clinical skills. These challenges are well worth the effort as you develop the professional friendship with the adult who enters your treatment room. You will find that seeing your client empowered in speaking situations feeds into your sense of gratitude at having the opportunity to work with such an inspirational individual.
What Adults Who Stutter Have Taught Me
By Glenn Weybright
Adults who stutter and who have successful speech treatment outcomes are my teachers.
- Successful treatment begins with a discussion of what the client wants from therapy. I need to listen, for example, when "Todd" tells me he is considering changing his name because he can't say it.
- Successful treatment happens when I model openness and honesty, including pointing out my own stuttering. Todd embraced openness and began inviting friends to treatment sessions.
- Successful treatment happens when I demonstrate a willingness to learn from my client. I had never attended the National Stuttering Association's annual summer conference until my client "James," who had tried to ignore stuttering for 20 years, told me he was going.I signed up the next day. "Kathy" is a young professional who quickly grasped the importance of letting others know about her stuttering. She began referring to this practice as FYI-ing, a term that I immediately adopted.
- Success happens when we target and applaud small changes. As a woman told me, "Small steps are big steps.'
- Success in treatment is enhanced when the client is willing to educate people about stuttering. "Emily" is a college student who agreed to interact with a fifth-grade girl who stuttered. "Nora" and "Matt" faced their fears and spoke to college classes about stuttering.
- Success in treatment happens when the client is courageous. James, a person with covert stuttering, quit his job, spent months at home researching stuttering, started speech treatment, and as a self-generated assignment, sent an e-mail to family and friends disclosing his stuttering. Nora approached me during a break in a college lecture and through tears told me she was a person who stuttered and had never met anyone else who stuttered. "Jennifer" is a person with covert stuttering. To help her fourth-grade daughter who stutters, Jennifer was willing to point out her hidden stutters during conversation, deliberately calling attention to something she hated.
- Success in treatment can happen when the clinician establishes a relationship and allows himself or herself to be vulnerable. "Jordan" was a young man in prison for a serious offense. He and his two clinicians formed a solid friendship and Jordan made significant progress in treatment. He was released from jail and almost immediately taken into custody again, losing contact with the clinicians, who grieved for their friend.
- Success in treatment happens when the client can put stuttering in perspective. "Beth" is a person who stutters and who has multiple sclerosis. For her, stuttering is not the overwhelming dark cloud that it might be for someone else.
- Success in stuttering treatment happens when the client begins to view weakness as strength or even a gift. As she began interviewing for jobs, Kathy realized that people were remembering her because she stuttered and still successfully communicated.
- Successful treatment involves support from friends and family. Nora's husband calls our local support group "a cool club" and wishes he could belong.
I have learned from my teachers.