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From: Gunars
Date: 14 Oct 2004
Time: 11:30:32 -0500
Remote Name: 134.29.30.89
Dear Tami, I am writing from my own experience as well as from studying psychology and reading about stuttering therapy. There were sixteen therapies so I will name some things a speech therapist should NOT and SHOULD do: 1) Therapists who do not have the proper training should NOT practice stuttering therapy without getting consultation from a speech therapist who is a certified American Speech and Hearing Association fluency and disfluency specialist. Some so called stuttering therapists encourage word substitution and starter words without understanding that this in the long run makes stuttering worse, because it tells the person who stutters that there is something terrible, horrible, awful or dishonorable about stuttering. A small re-repetition or eeelongation is much better. 2) NO therapist should encourage avoidance of speaking situation where the person would experience stuttering. Again the fear of stuttering only makes more stuttering. 3) The stuttering therapist SHOULD talk about feelings of shame, guilt, anxiety, fear, desperation, and other feelings concerning stuttering. Also the stuttering therapist best investigate the self-talk that a client has. For example, “I am no good if I stutter.” Such self-talk best be talked about in therapy and changed to “Even though I do not like to stutter, and some types of stuttering if it is severe can cause me practical disadvantages, I can still like myself.” Good material can be gotten from Rational Emotive Behavior Therapy (REBT) Literature that is found on www.rebt.org. Also consultation with psychologists who use REBT is recommended. 4) Therapists should NOT say that they can guarantee perfect speech for all of their clients. First, nobody ever talks perfectly, even people who are fluent. Second, not everybody is helped equally. The consequence is that the client who does not benefit is totally demoralized and he is de-motivated to find any other therapy that might work. The appropriate statement is “Most clients who come to this therapy learn how to stutter easier. So much so that they can do anything that they want to do. We also teach the clients to like themselves whether they stutter or not. Some clients do become so fluent that an outside person cannot tell whether they stutter of not.” 5) Therapists who build conditional self-esteem instead of unconditional self acceptance are not really helping the client. Conditional self-esteem is based on doing something else well and therefore feeling good about your self. Or talking better and therefore feeling better. This is like pouring perfume over a dead skunk in the back yard. You have to keep on buying and pouring more perfume on the dead skunk. Even then the smell is there. Unconditional self acceptance, often come by changing self-talk and doing voluntary pseudo stu-stuttering may be more obnoxious at the start, but it is like holding the nose and throwing the dead skunk away. :-) 6) The therapist best learn also to be a counselor. I prefer REBT, but Cognitive Behavior Therapy (CBT) is also good. There are many courses where you can learn either. Start with www.rebt.org. Other psychology techniques have not helped out in stuttering as much. 7) The therapist should be willing and able to take the client and demonstrate the assignments such as voluntary pseudo stuttering outside of the clinic. I fail to see how therapy done strictly in the counseling center can be transferred to the outside world situations. 8) Although some therapies start with a non-normal rhythm and tone of the speech (the technical term is prosody), if they persist that the person cannot use normal flow of the speech even when they are bound to fail. I see normal speech peppered with small di-disfluencies much more acceptable to the persons who stutter as well as the listener. 9) Demanding unreasonable home work activities from a client without having an assistant or a former client helping them to do them is plain ridiculous. These will never be done. Either the client will openly refuse to do them, will lie about doing them, or will try to do them and be totally demoralized. 10) The therapist should explain to the client, even if he is a child, what the treatment plan is. What will be the steps and what will be the possible outcomes. 11) The therapist should also explain that sometimes a client will take two steps forward and one back. 12) It helps if the therapist establishes a good open communication with the client (good rapport). I do hope that all stuttering therapists either get their specialty in stuttering therapy from ASHA or use a consultant who has one. Best wishes, Gunars