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From: J. Scott Yaruss
Date: 10/9/01
Time: 3:41:15 PM
Remote Name: 136.142.142.98
HI Gunars Thanks for the post...I'm afraid I haven't been pulling my weight on this list, but I've sure been enjoying everybody else's responses... Since my name was mentioned in your post, I thought I'd take a stab at it ;-)
For me, the ultimate goal of therapy for a school-age child, adolescent, or adult, is that the person will be able to do what needs to be done to manage communication effectively...This will be different for each person -- for some people, this will mean the ability to monitor speaking situations and use techniques learned in treatment to reduce stuttering on a situation-by-situation basis; for others, it will mean maintaining acceptance of stuttering, handling teasing, or focusing on improving overall communication attitudes on an ongoing basis. The goal is for the client to "become his own therapist," determining not only what he needs at a given point in time, but also how to accomplish that, then evaluating the success of the endeavor while preparing to do it all again...it is a very active process...
Now, can an 11 year old do this? To varying degrees of success...an 11 year old who is working on modifying tension during stuttering can certainly assess whether he had a hard block or an easy one and evaluate whether the pullout he tried was successful and what he might need to do in the next similar situation. He can also assess whether his easier beginnings, or whatever, are working...Kids need to learn how to do this...and when they have learned, they are ready to "go it on their own" for a while until they need to learn a new set of strategies (or get better at the strategies they've already explored) as they move on to the next level...
Note that my goal is not a certain percentage of fluency or a quantified increase in attitudes...rather, I want the person's goals to be flexibly defined based on what they need -- the older the person is, the more sense this makes, but I believe it even starts in childhood...
An example...I'm in the process of finishing treatment with a 9-year-old boy...he's learned to manage his stuttering and gotten quite good at using speaking techniques to improve fluency when reading and in selected situations. Is he perfectly fluent? No...does he use the techniques all the time? no...but, he is aware of the techniques, he knows how to use them, and he knows how to figure out WHEN to use them. Is he always successful at those times? No...But still, he's about ready for dismissal because: (a) he's been in treatment for a long time already, (b) he is starting to self-correct and manage on his own, and (c) he feels like he's met the goals he has for now...he'll come back to therapy in time when he's ready for additional goals, but for now, he's accomplished what he's going to accomplish...he won't practice at a higher level than he is already (he's already doing pretty well), and he's very comfortable with his speech, confident about his ability to manage stuttering, and completely unconcerned about being teased, etc., about his speech. In essence, he's communicating freely and the stuttering isn't getting in his way (I don't want to force him into additional therapy at this point because I don't want to make stuttering a central focus in his life again, like it was before...there will come a time for that, and I'll be available for him when that happens)...
In terms of the instrument you mentioned (now it its third and nearly final version, termed "CASES: Comprehensive Assessment of the Speaker's Experience of Stuttering") -- the goal of that project is to develop an instrument for documenting progress in treatment that is based on more than just the observable characteristics of stuttering...the instrument combines information about the stuttering behaviors, with a detailed analysis of the affective, behavioral, and cognitive reactions the speaker has to the stuttering, an assessment of the impact of stuttering on the speaker's functional communication abilities, and an evaluation of the impact of stuttering on the speaker's overall quality of life. Together, these measures help to show what changes the person might have experienced as a part of therapy, and highlight several of the areas that are addressed in a comprehensive treatment program.
As to whether the instrument could be used to set criteria for dismissal -- that's difficult to say because the criteria would be different for each person...I think the instrument could be used to document change, but I don't think there would be a set number that we should work toward...the whole point of the cognitive therapy approaches, and this type of assessment in general, is to move away from pure numbers as either a mode of treatment or as an indicator of success....
Hope this helps, and sorry for the length (HIH and SFTL), ;-) S