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From: Lynne
Date: 10 Oct 2007
Time: 21:59:36 -0500
Remote Name: 70.237.227.11
Dear Christina, I appreciate your comments, as well as your questions. Thanks for reading my clinical nugget! Your first question asks about strategies that I use to insure that I am listening to my clients. First, if I find that I am doing most of the talking during a session, I'm pretty sure that I haven't been doing much listening. So, after each session, I think back and evaluate the quality of my listening. If necessary, I jot down a few questions that I can use to refocus therapy on the client at our next session. Another strategy is to get in the habit of consulting the client about their experience, their opinion about a suggested therapy method, their evaluation of their home practice, etc. So, rather than always telling the client, "nice pull out", I might sometimes ask, "how do you rate that pull out you just used?" or "I wonder how it feels to you when you decided to say that word instead of avoid it?" Kristen Chmela and Nina Reardon wrote a book entitled "The school age child who stutters: Working with attitudes and emotions"(published by the Stuttering Foundation), and one of the chapter focuses on ways to talk with kids so that they know that you are listening, and that you are really paying attention to them and what they are accomplishing relative to their stuttering. If you do not have a copy of that, I highly recommend it. Your second question asks whether clients are reluctant to suggest strategies and whether or not this might stem from fear of failure. What a good question. I suspect that if a client feels that everything depends on what they suggest, they might be reluctant. However, the best therapy relationship, in my mind, is one in which the therapist and client are partners in the therapy, and therapy is viewed as experimentation: let's try out some techniques, figure out how they fit you, and test them out. If they work, great; if not, let's tweak them and try again, or throw them out if they 'stink'. I'm not leaving them to their own devices; neither am I dictating what they must do. I hope this makes sense. To give one example, let's say that you are working with a child who finds talking in class to be very anxiety-producing, yet he really would like to participate in class. I might ask him to think about all of the kinds of talking that happen in his classroom, and then rate each of those on a scale of: 1-I don't mind talking then, 2-I'd rather not do that, but I can see myself doing that some day, 3-that's pretty hard to do, and 4-NO WAY would I ever talk in that situation. This gets the child breaking "talking in class" into chunks, some of which he is more willing to participate in than others. He can see that, perhaps, he actually does find some talking situation do-able. So, I might then ask him if he'd like to try to increase the amount of times he talks in the #1 rated situation, or if he'd like to choose one of the #2 rated situations and challenge himself to talk once each day at school this week in that situation. Whatever he chooses, we can talk about how he wants to approach it: telling the teacher ahead of time that he plans to do this, using voluntary stuttering while he talks in class, use one of his fluency techniques, or some other idea he may suggest. The client and I are engaged in a problem-solving activity, an experiment, if you will. Once he has decided how he wants to approach the problem, we write it down as a plan, and he can come back next session for a debriefing session, when I can find out how things went from his perspective, and see where he wants to go from there. I hope this addresses your questions sufficiently. Do let me know if you have other questions. Best wishes, Lynne