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From: Lynne
Date: 11 Oct 2007
Time: 21:18:47 -0500
Remote Name: 70.237.227.11
Heidi, I'm glad you asked that question. You're quite right in that simply following the guidelines I suggest won't get you through to the end. There are a number of ways to approach deciding on the treatment goals. But, it doesn't have to be an either/or situation--you get to choose or the child gets to choose. When you both work together, the important problems can be addressed. But, as the old saying goes, the customer is always right—if you address the child’s concerns, you’re much more likely to make real progress. In the example you gave, the child wants to work on talking on the phone with her friend. That is a great goal, and with her motivation being high for this, a good place to begin. You could begin by talking about what makes a good phone conversation—what are the communication skills that make it work? Which of these skills does the client think she is good at, and which are challenges? You are addressing the goal of learning about speech and communication, which is a good, basic foundation for managing stuttering. You can also talk about desensitization and different ways to increase her comfort level with the telephone: voluntary stuttering at the beginning of a phone call, starting by making phone calls within the clinic to you and progressing to making calls to her friend that are prearranged (so her friend knows she will be calling at 4:00 pm), and so forth. Addressing the goal of phone calls can accomplish much for the client, and she is focused on something that is a real problem for her. If monitoring or shaping her stuttering is not important to her right now, then it isn't going to happen, whether or not you target it in therapy. However, you may find that the client notices when she is more at ease on the phone, her stuttering is less tense. She may become interested in other aspects of stuttering management, once her primary concern has been addressed. I hope this is helpful, and encourages you to think of working with clients as partners, no matter what your client’s age. Best wishes in your studies, Lynne