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From: Ken St. Louis
Date: 10/3/03
Time: 2:49:39 PM
Remote Name: 157.182.12.31
Dear Bernie,
You bring up a topic that has occupied a good bit of my attention over the years. Actually, Wingate wrote an article in 1971 entitled "The Fear of Stuttering" that dealt with clinicians' fear of working with people who stutter. I have written a fair amount about the issue, most notably an article in Asha 10 years ago. Here is the reference:
St. Louis, K. O., & Durrenberger, C. H. (1993). What communication disorders do experienced clinicians prefer to manage? Asha, 12/35, 23-31, 35.
I also did a followup study of that which I presume most of my colleagues have not seen. It was published in 1997 in the Bulgarian Journal of Special Education (in Bulgarian). Since that is unavailable, let me quote extensively from the discussion section of that article (in English of course).
"This survey of [86] practitioners confirmed earlier results that the majority of clinicians definitely prefer not to manage fluency disorders. There was no ambiguity in this finding. The St. Louis and Durrenberger (1993) study asked respondents to select their three favorite and least favorite disorders after rating 30 different disorders on a 1-9 scale. In that study, stuttering emerged as one of the least favorite but its selection may have been influenced by the categories provided. The questionnaire used in this study began directly with the open-ended questions, “What are your favorite and least favorite disorders to manage clinically?” Stuttering (as least favorite) was the most frequently identified disorder for either question (49%).
Training in fluency disorders continues to be a problem. St. Louis and Lass (1980) reported that 43% of master's students had never had a course devoted entirely to stuttering; 44% reported having one course. While not being entirely comparable, the results here for practicing clinicians are not quite so grim. Only 12% of the 42 clinicians identifying stuttering as their least favorite disorder to manage had not taken at least one full course in stuttering. There were none who reported no coursework at all.
In summary, experienced clinicians from West Virginia and surrounding states echo national trends indicating that stuttering and other fluency disorders are unpopular among clinicians, compared especially to language and phonological disorders. Training and experience in fluency disorders (and other disorders that clinicians prefer not to manage, such as voice disorders) is more limited than in their favorite disorders. Nevertheless, it would be hard to argue that lack of training and experience, per se, is responsible for the fact that nearly half of a sample of clinicians identified stuttering as their least favorite disorder. Other factors, many no addressed by this study, are likely important as well."
At the end of that article, I listed six hypothesed reasons why speech-language clinicians might be reluctant to treat stuttering. (These were also published in the ASHA Special Interest Divsion 4 (on Fluency and Fluency Disorders) Newsletter in 1997
"(1) Competence Problem: Clinicians perceive a lack of academic training and clinical practicum experience with stuttering. The current study suggests that this is, indeed, one important reason why clinicians identify or rate stuttering or cluttering as their least favorite disorders to manage. As noted earlier, the St. Louis and Durrenberger (1993) survey identified lack of training and experience as the most common reasons why stuttering was listed as a “least favorite” disorder.
(2) Psychologists' Problem: Clinicians perceive stuttering as a psychological problem which they believe is either not within their clinical expertise or their scope of practice. In a nationwide survey of speech-language pathology and audiology students, St. Louis and Lass (1981) found that psychological problems were expected among most stutterers. Surprisingly this attitude was not affected very much by training.
(3) Diagnosogenic Problem: Clinicians fear that by treating stuttering (especially in children), it might or will get worse. Wingate (1971) reported that clinicians fear managing stuttering clients. Johnson (1958) theorized that it is the parents over-critical ear and reaction--not the child’s type or frequency of disfluency--that is responsible for stuttering. And the prevailing treatment for child stutterers for an entire generation in the USA was to “ignore it, and it will go away.” Although, this diagnosogenic theory is no longer regarded as valid in most cases, its influence is still felt, especially among clinicians who would rather not risk intervention with a young stutterer for fear he or she might become worse.
(4) Responsibility Problem: Clinicians are reticent to accept the responsibility for treating a person who might either become essentially "normal" or remain significantly speech impaired, depending on the clinician’s "correct" administration of therapeutic experiences. To the author’s knowledge, there is no data to support or refute this hypothesis. Nevertheless, the reasoning for it’s inclusion as part of the explanation for the unpopularity of stuttering is a follows. Clinicians often enjoy the challenge of working with very severe physiological disorders, such as Alzheimer’s disease, severe or profound mental retardation, cerebral palsy, and so on. It is accepted fact that these individuals will not “get well” or “recover” from therapy, i.e., return to normalcy. Whatever the clinician might be able to do to help is seen as a positive step, but no one would seriously “blame” the clinician if the client did not improve a great deal. By contrast, with stuttering, it is likely that the clinician sees the potential for immense improvement--even to becoming a normal speaker--if only the “right” therapy could be provided. This places tremendous responsibility on the clinician to do the “right” thing. Many clinicians, especially those who are uncertain of their skills in the first place, may simply not wish to place themselves in the situation of having to be “responsible.”
(5) Prognosis Problem: Clinicians are pessimistic about the outcome of stuttering therapy. Reports by St. Louis and Lass (1981) and St. Louis and Durrenberger (1993) provide evidence that clinicians are not optimistic about the outcome of stuttering therapy. This is so in spite of evidence that most stutterers actually do quite well in therapy (Bloodstein, 1995; St. Louis & Westbrook, 1987).
(6) Stereotype Problem: Clinicians (and others) have negative connotations of stuttering and persons who stutter. Numerous recent investigations support this assertion (e.g., Lass, Ruscello, Pannbacker, Schmitt, & Everly-Myers, 1989; Doody, Kalinowski, Armson, & Stuart, 1993; Ruscello, Lass, Schmitt, & Pannbacker, 1994). It is possible that clinicians simply may not want to be around stutterers since it makes them uncomfortable.
It would be naive to assume that complete and satisfactory answers to the question “Why clinicians are reluctant to treat stutterers?” will be forthcoming due to the inherent complexities in human personalities."
I don't know if this sheds any light on your question or simply buries it deeper into the inevitable complexities that science seems to uncover. There is some good work going on in this area in the UK and Ireland just now, so maybe some additional revelations of how we might combat this fear of stuttering by SLPs will be forthcoming.
Thank you for your post.
Ken