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From: John Tetnowski
Date: 10/10/02
Time: 3:45:48 PM
Remote Name: 130.70.137.156
Gunars,
As you know, this is a loaded question, but I'll take a shot at based upon my own experiences. First of all "success" is a difficult concept because we all know that success can be measured in reduction of stuttering behaviors, elimination of the "handicapping" aspects of stuttering, reducing avoidance behaviors, improved speech naturalness, and many other ways. To use your examples, an air traffic controller would probably define success in therapy based on the observable speech characteristics, i.e., reduction of stuttering. For other vocations, success may be defined in a very different fashion, such as answering the telephone, or making your own introductions. At last year's NSA conference I was really touched by the story of Dennis Barsema (a highly successful business person). He viewed success as being able to be in the board room with investment bankers making a case for the IPO of his company. He also viewed success as having a great, supportive family (who came with him to Anaheim!!). Were those things (like being in board rooms) part of his success?......YES! Were they through a speech-language pathologist?....I don't think so (but I'm not really sure). So the question remains, did he achive "success" even though his speech behaiors didn't necessarily change? That is a personal decision. I think he achieved success. Therefore, successful outcomes in adults is a bit of a trick question. If you refer to Bob Quesal's paper in this ISAD conference, you can see that some influential people view success in only one way. I think that we should view success in a wide variety of ways that meet the needs of the client.
Now to get to the failure part. Of course failure is also based on a person's definition about "success". Not all measures of success respond to experimental, reproduceable methodologies. This results because we still don't all agree on a definition of what stuttering is, or what are the handicapping conditions are. In Walt manning's text he refers to a quote from Bannister (1966) that states humans are "notoriously nonsensical and unfit subjects for scientific scrutiny". All humans are different, and "success" or "failure" is different for each one of us.
In my own experiences, I have referred people to the appropriate professional, and this ranges from physicain, to psychologist/counselor, and even once to a person highly trained in pain management (and thus hypnosis!). Sometimes these referrals are made before therapy begins, sometimes in conjunction with active speech therapy, and sometimes after failure in speech therapy. It is obvious to me that not all people who stutter should be in speech therapy at a specific time in their life journey. Sometimes they need services outside our scope of practice. Again, it is obvious to me that we can not meet all the needs of all of clients, all the time.
OK, Final Answer. YES, I DO REFER TO OTHER PROFESSIONALS.......WHENEVER IT IS NEEDED!
Thanks (and good luck in your doctorate)!
John Tetnowski
P.S. In your studies, please also read studies in some of the other social sciences, such as sociology, anthropology, applied linguistics, etc. They sometimes look at other methodologies that can be very appropriate for understanding the human condition.