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From: Charlie Healey
Date: 02 Oct 2008
Time: 10:12:17 -0500
Remote Name: 129.93.99.57
Dale and Walt have offered some great suggestions but I would like to offer a couple of others. First, be sure he is able to use the Easy Onset strategy or another technique you are working on in therapy in a variety of ways. That is, help him use a strategy in an obvious way and then help him learn to produce variations of an easy onset such that it gradually becomes hard to detect but it's still being used. At that level, I ask the client to use a strategy while reading something, underline words where is going to use the strategy without me looking, and then I can count the number of times he used the strategy while he reads. If the strategy use is subtle, it will be hard to detect but hopefully the client knew he was using it. Second, I would role play the use of the strategy as Walt and Dale suggested but be sure you gradually increase the amount of information he is talking about. For example, if you are working on strategies in simple sentences, you might want to move to picture description, then reading and retelling stories, and then move to discussing a topic that he is familiar with as a way to mirror conversational speech. If he is able to move through those linguistic levels with some ease and use of a strategy, then you have helped prepare him for unstructured conversation. Self monitoring is also important in the early stages before any client can expect to use strategies or modify stuttering in conversation. So, help him improve or maintain good self-monitoring skills while speaking along a continuum of easy to difficult topics and have him tell you what he is focusing on when he talks. That might give you some clues as to why transfer is not working so well. Bear in mind though that all of us clinicians have problems with transfer so you are not alone. Hope my suggestions are helpful.