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From: Charlie Healey
Date: 14 Oct 2008
Time: 19:45:52 -0500
Remote Name: 76.84.69.211
Wandie: Thanks for your question about when to stop therapy if there aren't any improvements being made. My initial reaction to your question is to ask who the therapy is for...the client, the client's parents, or the slp? As a clinician, I don't know that I have the right to tell someone that we should should stop therapy because they aren't becoming more fluent. Maybe the client is getting something from therapy even the speech is not changing. Perhaps it is an emotional support or spending time talking to someone who really understands stuttering and what the client is going through. I try not to be the judge as to whether therapy should continue and I certainly don't rely only on speech change as the only criterion for continuation or termination from therapy. If the therapy is not working or the client is not satisfied, he will let you know that by missing appointments, not doing home practice assignments, not being engaged in treatment, etc. I have had clients in therapy for years who simply want the feedback I can provide them and the emotional support or advice I can provide. However, I always ask if it's time to stop therapy or is the therapy helping. Children won't have a good answer for this but adults will. Sometimes children tell me or convey non-verbally that therapy is becoming a waste of time. In that case, I talk with the parents and the child about if the therapy should continue or not and if it does continue, what the expectations will be for everyone concerned. So, don't be quick to judge the effectiveness or failure of therapy simply by speech changes or lack thereof. There is more to therapy than working on stuttering behaviors. It could be the cognitive, affective, or social support they get from coming to therapy. But, the bottom line is to keep asking if therapy is helping and if not, then discuss with the client what they want from treatment if is discontinued. Sometimes a break in treatment helps the client see that they need to do what is being worked on in therapy and by not having therapy, they now see the value of what therapy is all about.