The Prof Is In

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Re: the fallacy of clinical fluency vs. realistic outside situati...

From: Ken St. Louis
Date: 20 Oct 2010
Time: 16:58:30 -0500
Remote Name: 157.182.15.31

Comments

Hi Mike, I liked your post. This has always been one of my pet peeves as well. Aside from experiencing some initial relief and confidence building, what does the client ultimately care if he or she can come and talk to the SLP in the clinic with perfect fluency? Yes, a great deal of therapy must take place where stuttering occurs: in the real world. Why don't clinicians spend more of their time outside with their clients? I'm sure there are as many reasons as there are clinicians and clients, but here are a few. (1) Most speech therapy (with other disorders) does not need to occur so much outside the clinic room. The speech and language problems are learned, like long division maybe, and then automatically transfer to other situations quite readily. (2)If a clinician is on a tight schedule with lots of other clients, then it might take too much time to go outside. And if the client were paying by the hour, the cost would probably be 1 1/2 times higher with this addition. This is not unlike the fact that very few physicians now make house calls, something that was quite common two generations ago. (3) Most clinicians I know simply do not want to leave their clinic environment. They simply understand their role to be there--not on the street, on the playground, or on the job. (4) Most clinicians, as you indicated, are not trained in the view that taking a stuttering client into the real world is essential. Most see it as something nice but not required. (5) Some clinicians are lazy. Need I say more about that? (6) Many clinicians, like Roger Ingham wrote many year ago, "Train and hope" for transfer and maintenance rather than building in those components from the beginning. I agree that transfer should begin as soon as a client learns something. After that, the setting should be changed, even if talking from the other side of the table or without any chairs in the room. With this approach, transfer and maintenance are not left to chance. I hope this helps. Ken


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