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Practical Thoughts Blog

Increasing Our Confidence as Stuttering Therapists

Increasing Our Confidence as Stuttering Therapists

A colleague mentioned that she wasn’t feeling confident about working with a new child who stutters on her caseload. This prompted me to think a bit… Actually, I spend quite a lot of time thinking and writing about the confidence challenges that speech-language pathologists face when working with children who stutter. I have long wondered about how we can help to increase clinicians' sense of self-confidence and self-efficacy surrounding stuttering, because I think that this will ultimately lead to better treatment for our clients who stutter.

This is also a topic that Nina Reeves and I have written about quite a bit in our books. For example, the chapter headings for both our early childhood and school-age stuttering therapy books are drawn from the questions and comments we have heard from clinicians who are working through their fears about stuttering (e.g., "Oh no! This child is stuttering!" "Why are there so many techniques?" "What do you  mean, 'Working with feelings?'" "It sounds good on paper, but what about in the real world?" "What do I do next?" "What if I need help?")

Of course, our use of these chapter headings in a bit tongue-in-cheek, but we are trying to address a real and pervasive sentiment amongst the many clinicians with whom we have worked: Many people—even people with significant experiencejust aren't comfortable working with people who stutter.

I bring this up today for three reasons: One, to highlight the fact that clinicians are not alone in feeling uncertain about stuttering… Many feel the same thing, and many of us can benefit from a confidence booster from time to time. Two, to highlight the fact that we, as stuttering specialists and people who care about the treatment of those who stutter, have a lot of work yet to do if we are to improve the situation. And, three, to give myself an opening to talk about a couple of ways that clinicians can work to improve their self-confidence about stuttering therapy. (They may seem somewhat obvious, but whenever I'm feeling uncertain about something, I try to go back to the basics or fundamentals to rebuild my strengths…)

First, remember that it's okay to stutter. Many clinicians tell me that they feel a tremendous weight of responsibility when working with children who stutter. They believe that it is their duty to "fix" the child and make him stop stuttering. Certainly, the parents want that, the child wants that, and the teachers want that. Heck, even we as speech-language pathologists want that. The problem is that when we're talking about a school-age child who stutters, the likelihood of achieving a full, 100% recovery from stuttering is rather slim. This is not to say that there's nothing that we can do (and we're certainly not, dare I say it, "throwing in the towel"). There is, in fact, a tremendous amount that we can do to help school-age children who stutter to address stuttering. A cure may not be one of those things, but we can still help them improve their understanding of stuttering so they have a greater sense of control in their speech and in their lives as a whole, reduce their concerns about stuttering, increase their acceptance of the fact that their speech is different, minimize the burden they experience as a result of stuttering, reduce the likelihood of adverse consequences such as bullying, diminish the negative impact of stuttering on their ability to succeed in school or have friends, and ensure that stuttering does not have a negative effect on their quality of life. Oh yes, and we can do all of that in addition to helping them improve their speech fluency and reduce the frequency and severity of their stuttering behaviors. So, that's not half bad (far from it), but often clinicians feel that they are inadequate because they can't offer a cure. (I often wonder why some people can accept the fact that we can't cure other neurodevelopmental conditions such as autism spectrum disorder but can't accept the fact that we can't cure stuttering…) Bottom line: it's not our job to fix kids who stutter; it's our job to help them, and we can do thatand quite successfully!

Second, just as it's okay to stutter, it's also okay to talk about stuttering. Our field has a long history of trying not to talk about stutteringmuch of it based more or less on various interpretations of the diagnosogenic theory. Fortunately, we have learned that it is okay to talk to children about stutteringand that it can in fact be very helpful for us to do so (even with very young children). Talking about stuttering openly and in a matter-of-fact, accepting way helps children learn that they are not doing anything wrong when they stutter. Stuttering is just a characteristic of their speech; it's not a mistake, something that they're doing that's bad, or something that they need to hide. Talking about stuttering in this way can help to reduce the likelihood that they will develop negative attitudes about themselves and their speaking abilities, and that can reduce their sense of embarrassment and shame.

Oh, there's so much more I could write. (That's why Nina and I write books that are 300 pages long!!!) But, that's probably enough for today…