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From: Mike
Date: 20 Oct 2010
Time: 14:20:30 -0500
Remote Name: 128.95.140.129
I always thought it was weird/strange the emphasis on fluency in the clinic (and stuttering performance is always 98% of the time measured inside a clinical room) and the clinicians reluctance to do any therapy outside the clinic...Because inside the clinic, it is not realistic. Often, the clinician will give out homework assignments and tell the client to use the "technique" outside on the telephone, while doing a presentation, or use it during a job interview. Easier said than done... This is like telling someone with a limp training for a marathon or 10k race to just train inside the gym and never run outside. As long as the stutterer is running fine inside the gym on a treadmill using the "new technique" everything is rosy...if the client fails, then he/she is not using his/her technique that was taught... Many people who stutter, their stuttering can vary from situation to situation. Another problem is that many people who stutter stutter way less when inside the clinic, 1 on 1 with a clinician... How come student clinicians are not trained to conduct therapy outside the clinic? Does therapy outside the clinic (called transfer activities) make sense? Sure, a stuttering treatment program usually incorporate some transfer activities towards the end, but why not start from the very beginning. Why not do therapy 50% inside the clinic and 50% outside the clinic. My opinion is that fluency/no stuttering inside the clinic is Useless unless the person who stutters is able to stutter less outside in real world situations. So measurements of stuttering treatment efficacy should be measured in real world situations and not in the clinic or videotaped in the clinic. Impromptu telephone calls are good...but that is just one way to reliably measure treatment efficiacy. And then what about the Hawthorne Effect? I really think speech therapists need to do a better job transferring the skill or the technique to real world job interviews, graded presentations. And please less focus on fluency inside the clinic, because the clinical room is not realistic. Killing your enemy in your dreams is meaningless just like reducing your stuttering inside the clinical room is meaningless. Often, the client feels guilty and the clinician is frustrated....how come (you are/I am) fluent in the clinic, but stutter so much when I leave the clinic...it is all my fault!!!