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From: Ken Logan
Date: 21 Oct 2010
Time: 07:55:43 -0500
Remote Name: 98.70.132.210
You're exactly right that speaking in the clinic can be extremely different from speaking out of the clinic. I've seen this many times in my role as a clinician and I experienced it many times (in spades!) when I was in fluency therapy years ago. I just wanted to add a few thoughts to the good points that all of you have made so far: (1) I've done a fair amount of therapy activities where I accompany a person who stutters out to real world sites. One main benefit of these activities, I think, is that it allows the clinician to see, first hand, the situational dynamics that affect the person's ability to manage stuttering. Such information can be helpful in tweaking whatever implementation plan is already in place so that the client has a better chance of succeeding. Another benefit of these activities is that they provide an opportunity for the clinician to model the use of a particular behavior. I think it's important for clients to see models of real live people doing whatever fluency management strategy they are trying to implement. ("It CAN be done...here's what it looks like".) As the others have pointed, it can be logistically difficult for clinicians to do these real world activities in some work settings. So, variations of this include: (a) doing the modeling during telephone calls or (b) having a client to go out into real settings with another client, to try new skills and support and encourage one another in the process. (2) I’ve found that another big component of successful “transfer of fluency skills” is setting realistic (i.e., incremental) goals. I’ve seen the following happen many times (and experienced it to some extent myself when I was in fluency therapy): the client is able to speak with little or no stuttering in clinic and then wants to speak that EXACT same way beyond the clinic. It is a pretty tall order (it’s a little like: would a quarterback be expected to throw passes with the same accuracy in front of 90,000 screaming fans and a tough defense as he does in practice with no defenders on the field?). It is much more realistic and productive, I think, to set very modest speech goals as one attempts to implement newly learned skills in real situations. For example,” I will use the “cancellation” technique on ONE word during my 5-minute conversation with the eye doctor.” A goal like that is very realistic and, if met, offers the client a “toehold” on gradually changing speech in that situation. Incremental goals often don’t sit well with clients (I know they didn’t sit well with me!) because it means that you are still doing some stuttering in front of someone else, and many times, people are very reluctant to do that. (This gets into attitudes about stuttering, risk taking, and so forth. Sooner or later these issues have to be dealt with, though). Anyway, the main point is that change usually occurs gradually, and as with fitness training, weight loss, etc., it is requires lots of work. There lot’s more to say about this, but I’ve probably said enough already! Thanks for the interesting post.