The Prof Is In

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

From: Ed Feuer
Date: 22 Oct 2010
Time: 10:38:52 -0500
Remote Name: 142.161.161.183

Comments

Mike, you have touched upon the very heart of the profession's failings in the treatment of stuttering. I am heartened to see some SLPs acknowledging the problem. I call it clinic room fraud. Here's basically what's happening: The practitioner gets a stuttering client relaxed in the clinic room, greatly reducing dysfluencies. This involves complete emphasis on speech production by the exclusion of factors causing communicative stress via the practitioner's total control of the environment (the clinic room). All signal, no noise. (As such it amounts to a parlour trick and that's what renowned skeptic/debunker James Randi would likely characterize what's going on if he ever turned his attention to claims of success based on clinic room fluency.) The practitioner then gives the client a "technique." The client leaves the clinic room for the real world and falls flat on his or her face. The client reports that to the practitioner back in the clinic room. The client is told: "Oh, you're just not working." The practitioner then collects from the bill-payer. Meanwhile, what's needed is known and has been known for many years. It's not secret knowledge found beyond the seas or the far side of the moon. What's needed is thorough, genuine, systematic (with hierarchies), in vivo, real-world desensitization — outside the clinic room. Charles Van Riper, in his classic, The Treatment of Stuttering, offers a pretty good guide in his chapter entitled Desensitization: The Reduction of Negative Emotion. Trouble is, the full regime of what's described there has never been done. Probably not even by Van Riper. Why? Because it's just way, way too much for the individual SLP in terms of both time and knowledge. One area in which I see hope is the inclusion of "multidisciplinary interaction" in the professional issues category of ASHA's Division 4, Fluency and Fluency Disorders group. (www.asha.org/members/divs/div_4.htm). To this PWS and non-SLP, that means multidisciplinary interaction with, and involvement of, experts outside the SLP profession in a treatment team, as needed — in this case psychologists with specialty in desensitization. What does multidisciplinary interaction mean to the experts here in general, and specifically relating to desensitization? Cordially, Ed. edfeuer@mts.net


Last changed: 10/23/10