|About the presenter: Lynne Shields, Ph.D., CCC-SLP, is currently a Professor and Director of Graduate Studies in the Communication Disorders Dept. at Fontbonne University, St. Louis, MO. where she teaches undergraduate and graduate courses and supervises in on-campus clinic. She teaches in the areas of fluency, language disorders, and assessment. She holds Specialty Certification in fluency disorders from the Specialty Board on Fluency Disorders.|
What bothers you the most about your stuttering?
What do you want to do about your stuttering?
Do you think that this is a helpful way to manage your speech?
Tell me what you are best at doing?
Is this too big of a step to take today?
How did it make you feel when you were teased?
What might help you remember to stretch out the hard words?
These are some of the many questions I am learning to ask children, teens, and adults who stutter. Asking questions is the first step. More important is the second step, to listen, really listen, to the answer. When I pay attention, I learn a lot more about the client than I knew before. I learn what is important to them, whether or not they agree with the direction therapy is taking, and whether or not what we are doing in therapy is important to them. A third step is to truly value what the client tells you, meaning that you use the information to shape therapy.
It is so easy to assume that the ideas I have about treatment are both understood and agreed upon by the client. Therapy, at least in a one-on-one setting, is a relationship between two people. If two-way communication is not going on, then the relationship is not developing and (usually) the client is being left out of the process. The therapist prescribes methods and then persuades the client to use them. The client tries, but perhaps half-heartedly or without true understanding, and then little or no progress is made. That often translates into frustration on the part of both the SLP and the client and their family.
Luterman (2001) discusses the problems that occur as a result of therapy by persuasion. First, real change occurs when the client has decided to commit to an action, which requires ownership of the problem. A client who is making a change to please or appease a clinician is not really taking ownership of the problem and the process of solving the problem. Second, change works best when approached from the client's strengths. A client who is being persuaded to do something is less likely to feel truly adequate to make the changes.
I believe that good therapy isn't really about finding the right techniques for the client to learn. That is an "I can fix you" approach that is more likely than not to fail. Rather, good therapy is listening, really listening, and then taking it from there, as a partner with the client.
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