Conversations About Stuttering

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Re: Question

From: Judy
Date: 11 Oct 2007
Time: 15:26:22 -0500
Remote Name: 70.22.163.191

Comments

I wish I had to worry about this issue! :) Nine times out of 10, a student begins speech therapy with me simply to stop stuttering. Very rarely does a student say, "I want to accomplish _____ and therefore I wnat to improve my speech." In fact, I think this is the single most challanging part of being an SLP in this field - helping students discover specific goals that would make it worth their effort to do the work of speech therapy. There are the standard goals along a hierarchy of linguistic complexity. I use this hierarchy for fluency shaping and stuttering modification. This is the easy part. The hard part is designing endless games to practice at each level and in a variety of contexts that contain "fluency disrupters." OK, so, if you have a child who has bought into speech therapy = school and he is going to practice speech-motor skills in a bunch of fun games, then you've at least begun to build a therapeutic relationship. In conversation during these games, you will learn about the child's life and you will be keeping your ears open for potential real-world goals the child might be interested in pursuing. Recently, I had a teen begin with the explicit goal of improving his oral reports in school. What a pleasure! When I would suggest skills to practice, he would ask how the activity related to oral presentations. In a case like this, the SLP needs to teach the student how to look at a large goal (oral presentations) and figure out the many small skills that are needed which will culminate into the larger success. Then the SLP needs to teach the idea of hierarchies. I make specific suggestions, but I make sure to leave lots of space for the student to offer steps along his hierarchy. (What I would love to do is brainstorm with a group of teachers what the speaking skills are that make a child successful in school.) So, some goals are small steps to a larger goal. The child always needs to contribute to the hierarchy, but, the SLP needs to suggest how additional steps may need to be added based on her knowledge of linguistic complexity, narrative structure, public speaking, desensitization, family support, executive skills, the child's personality, etc. Kristen Chmela gives an example of how to achieve samll goals in her 2006 ISAD paper, "Self & Double Charting: A Self-Monitoring Strategy for School-Age Children Who Stutter." Lastly, there are the huge goals. This is where my interest lies at the moment. In Michael Sugarman's 2006 ISAD paper, "Changing the World for People Who Stutter," he talks about a "metamorphosis" that people who stutter go through. He says,"When I was younger, I had gone to speech therapy, but I was not open or ready for change. Now I was." So my goals for chldren are in a sense always short term. Their goals are intended to help them discover their own locus of control (empowerment) and nurture a sense of hope that the future can be bright for them, despite stuttering. For the child, I am a cheerleader. For the older teen with specific goals, I can tone it down and be more like a coach. Discovering and honoring the client's goals at all times is what will keep his feeling heard.


Last changed: 10/22/07