Attitudinal Changes

From: Pam Mertz

Comments

Hi Diane - I loved this article. It makes so much sense and to use the parallels with Carlin's piece is great. I was doing fluency shaping therapy for a while (in a teaching program with grad students) and became really frustrated with the fact that they, as students, had to focus on speech and language goals. That was way away from where I was, and am presently. I needed to explore the feelings that had been long buried - namely the shame that really unconsciously consumed me. I felt that it was seen that I had explored feelings long enough, and that I had to get on with learning fluency strategies. None of them worked for me, and needless to say, I no longer go! And thats OK. But I am so glad to see more and more a shift towards including the harder stuff - confronting deep feelings, actively working towards reframing attitudes, and acknowledging that it is ok. And I love the part of getting rid of "non-essential" numbers. I always hated sitting across from a clinician and seeing them count my stutters. This was an especially easy read, and very helpful. Thanks again!

 

Re: Attitudinal Changes

From: Diane Games

HI Pam...what a beautiful response! You are correct that a lot of programs focus on one aspect of stuttering. I do work on strategies to help with fluency, but find that most adults need to explore attitudes and feelings..plus do some thinking about communication....take care DG It was great to see you in Cleveland! take care..DG

 

Philosophy for Old Age!

From: Robert Benton

Comments

George Carlin did NOT write "Philosophy for Old Age". This is a common misattribution. It was probably written by another comedian named Larry Miller. The name of the author was changed because Carlin is more well known. See this website: http://www.snopes.com/glurge/aging.asp

 

Re: Philosophy for Old Age!

From: Diane Games

Comments

thanks for the reference...as I said in my article, a friend sent this powerpoint to me that was reportedly done by Carlin..with his picture, etc. Live and learn...I really found a couple of the comments in the PPT applied to the concepts I use in treatment. I am sorry for not knowing this was not his work and thanks for the reference.

 

Cognitive and Attitudinal Changes in Teens and Adults Who Stutter

From: Julie Gasway

Comments

Hi Diane, This is a wonderful article that addresses difficult goals. I appreciate the handouts on strategies to deal with stress, fearlessness etc., they look like great ways to help clients take a look at these things in a nonthreatening way. I think these would also be great for an adult group. I have always felt rude doing fluency counts and they aren't helpful...thanks for your useful activities and ideas!

 

Attitudinal Changes

From: Craig Stephenson

Comments

We are just as intimidated if not more so, when talking to you about our very personal problem. I admire any S.L.P. that chooses to go into stuttering. No two cases will ever be the same and it’s a long hard road. Thank God for those of you who do. Even if only one percent of the adult population stutters I am sure if you talk to anyone who dose stutter and finds fluency or is able deal better without fluency it changes their life forever.

 

Cognitive and Attitudinal Changes in Teens/Adults Who Stutter

From: Owusu-Yeboah - Ghana

Comments

Hi Diane, I am a stutterer undergraduate at the university for development studies, ghana. I have struggled with a stumbling tongue for the past 14-years to today. I hope and pray I don't want to carry it(stuttering) with me into the future. Stuttering has cost me alot-making me live under my capabilities everyday in life.I pray if and only if change is important for change I will witness this change with the help of your article. THANK YOU AND GOD BLESS YOU.

 

Stuttering Across the Ages

From: Abigail Cary

Comments

Professor Games- I really appreciate your contribution to the conference. It is accessible and easy to understand (which is very nice for me, a first-year SLP graduate student who knows little about stuttering), and I appreciate the concrete materials you’ve shared to help therapists. I wonder if you think that modified versions of the worksheets might be appropriate for children. I know that children-especially young ones-generally experience less self-consciousness and shame about stuttering than adults to, but I wonder if using confidence-boosting/balancing materials similar to the one’s you’ve included with “Cognitive and Attitudinal Changes in Teens/Adults who Stutter” might help alleviate some of psychological stress that those kids would face down the road? Do you have any experience working with the attitudes of children who stutter? Thanks, Abigail

 

Re: Stuttering Across the Ages

From: Diane Games

Comments

Hi...thanks for your comments. I do not use these specific activities with children and rarely with teems as they are cognitively too advanced. I do you simplified graphic organizers to talk about various situational variables and I use Power Point to have kids talk about different aspects of stuttering and communication...it is neat because they can share their thoughts with others.

 

Question

From: Tara

Comments

How would you respond if a client simply "shut down" in the middle of a therapy session (they were so discouraged that they refused to go on).

 

Re: Question

From: Diane Games

Comments

Fortunately, I have not had this happen..but when a client is upset or an activity is not going well, I stop the session and talk about what I observe..something like "I can see that this is difficult" or "I can see that you are upset". I then listen or sometimes sit quietly with them. I never force an activity....and will remove it and move onto something less emotional. Hope this helps...sometimes a client is not ready to talk about certain issues.

 

The Inner Voice

From: Alyssa Saunders

Comments

This is a wonderful article. I especially like the article about the "inner" game of tennis. I deal primarily with voice disorders. I myself have had a voice disorder and know that one must change the inner voice before he/she changes the outer voice. Learning to TRUST oneself is the hardest thing to do, but the most important when it comes to any speech disorder, be it fluency or voice. Thank you for the great article.

 

Cog & Att. Changes in Teens/Adults

From: Janet Skotko

Comments

I have read that generally with teens and adults, the search for tx or return to tx is due to a more mature acknowledgement of the need for some help due to an upcoming event in life; they also are more motivated and simultaneously want a faster 'fix'. Do you see that?

 

Re: Cog & Att. Changes in Teens/Adults

From: Diane Games

Comments

Janet...I have seen that with some clients, but often adults who stutter are just "tired" of avoiding, changing words, or dealing with the management of speaking...but, no matter what brings a client in the door, they need to examine how stuttering impacts their life....and to work on change. the process is different with every client..there is no one way, activity, etc..thanks for your comments..DG

 

Attitudes of Success

From: Rachael A.

Comments

Professor Games, I appreciate your contribution to this event. Your paper reminded me of a class discussion in my fluency class this week. I am a first-year graduate student in Speech-Language Pathology and this semester is my first experience with stuttering. We’ve been discussing “success” and how to help clients realize their own success both in and out of the therapy session. I believe the difficulty with adults and older teens is that they are aware of the goals they have set, and thus are much more likely to adopt a discouraged attitude when they do not reach their goals in the time they had expected. I think it is important for clinicians to help their clients realize that success is possible without achieving a long term goal or even a short term objective. There can be success in each session. I thought your handouts/worksheets would be very useful in helping clients see and experience their own success. It seems as though this counseling aspect of fluency therapy would be very beneficial. In your experience, do you find that people respond better to therapy when they have a positive attitude and understanding of success? Thank you for your time. Rachael A.

 

Re: Attitudes of Success

From: Diane Games

Comments

Hi! You have targeted the main reason so many people get discouraged in treatment...as a therapist you need to prepare your client for the various aspects of change..and when changing any behavior, it is a process..and with people who have stuttered a long time, it takes time to work through these issues. This is my problem re:programs that deal only with the surface features of fluency..thanks again for your thoughtful comment.

 

Great paper - I have a question

From: Emily and Alicia

Comments

We were wondering what advice you offer to your clients when they tell you their family and friends give them unwanted advice about their stuttering? Thanks!

 

Re: Great paper - I have a question

From: Diane Games
Date: 24 Oct 2010
Time: 21:49:28 -0500
Remote Name: 76.17.183.48

Comments

Hi to both of you! As with many things, family and friends are often the first to offer advice about stuttering...and someetimes the advice is not "evidenced based"!! I always do an educational piece with my clients..usually over several sessions. I also give them articles to read thoughout treatment..this helps to counter the "advice" from others which is usually given to help, but not always accurate!

 

Fluency Counts

From: Lindsay Chargois

Comments

I really liked your comment about focusing more on the positive (strategies the client uses to minimize his or her stuttering) instead of the negative (how often the client stutters). Do you think that fluency counts are completely nonessential for the adult population or that they just shouldn’t be used as much?

 

Re: Fluency Counts

From: Diane Games

Comments

thanks for your comments..I work on fluency shaping/stuttering modification strategies in every session! This article is on one aspect of my therapy. I do fluency counts at different times based on the client..the need/amount of time in treatment/the difficulty he has in using the strategies. These counts are very important in treatment and I do them regularly! This article is about another aspect of treatment that I do simultaneously with the target work. I will add that the amount of strategy work depends on the client.

 

Teen Attitudinal Changes

From: June Sultan

Comments

Hello. I am currently a first year graduate student at NYU taking a course in fluency disorders as well as adolescent development, so I would first like to say that I found your paper extremely interesting! In my fluency class we talk a lot about the idea that we do not know if we can ever completely "cure" a client's stuttering. I was just wondering what you do in a situation where your adolescent client is set on "curing" his or her stuttering. Do you work on changing his or her attitude about stuttering first? Or do you go along with the idea that the stuttering can be "cured" so that their commitment to therapy won't become diminished?

 

Re: Teen Attitudinal Changes

From: Diane Games

Comments

Jane, I accept the beliefs of each client..nothing is presented as the wrong/right way of doing things!! Therefore, often the client problem solves many of the issues...with my guidance. I never tell an adult client that they are "dismissed" from treatment and I keep the door open for a return to treatment..making the transition easier for them...thanks for your nice comments.. DG

 

Quick Question

From: Monica Johnson
Date: 24 Oct 2010
Time: 22:01:39 -0500
Remote Name: 76.17.183.48

Comments

I really enjoyed this article and appreciate you writing it for everyone to read. I have a quick question: Trying to address long-standing emotions and thoughts about communication in therapy activities, do you ever feel that dealing with emotions is out of our scope of practice? How and where do you draw the line from speech therapy to referral to seek counseling?

 

Re: Quick Question

From: Diane Games

Comments

I do think about ethical practice with all of my treatment and have served as chair of Ethical Practice Committee for the state of Ohio. To treat stuttering, a clinician must deal with the motor, attitudinal and affective parts of stuttering. I have studied with some of the best clinicians in our country and a comprehensive program of treatment is not seen as un-ethical and is used in many centers To answer your question, I also would not hesitate to refer a client for counseling if needed. I feel that an approach that only deals with the motor aspect of stuttering is sorely lacking from the emotional aspects along with cognitive aspects of the disorder. SLPs are trained to do this type of treatment..though it takes practice and study with other professionals which I have done...hope this answers your question.

 

quick questions

From: Allison Fontenot

Comments

I really enjoyed your article and would like to ask you a quick question. As a Speech- Language Pathologist, do you agree with the third point discussed in Shapiro’s book? I understand how important it is to address the feelings of the person who stutters, but I was wondering if you ever tend to see the complexity of behaviors, beliefs, and thoughts decrease with time? I ask this because I think of those who, over time become more familiar with the factors that often trigger the stutter and find ways to compensate for these factors and gain the motivation needed to help with the changes they are hoping to make.

 

Re: quick questions

From: Diane Games

Comments

What a great question!! Not a quick one..:) Every client is different and certainly with clients who stutter, there are a lot of variables. I do therapy that is individualized to meet the needs of the clients. What you are seeing in this article is a compilation of activities that have been successful with several clients...but no client does these in the same order and some so not do them at all. No one therapy is workable for all clients...as for working on the cognitive and emotional aspects of stuttering along with the motor aspects...all of my clients get a dose of all three!! I have studied with some wonderful therapists, but the ideas and my approach is a compilation of several types of therapies. in my experience, no two clients do things in the same way and I do not going into therapy expecting that...I am constantly developing new worksheets to address issues...as for the motor part of treatment...this happens every session!!!! Thanks for your great question.

 

Question

From: Teela Faircloth

Comments

I really enjoyed your article and found it extremely important to know that negative emotions are sometimes associated with stuttering and should be dealt with. However not all PWS will have these negative emotions and treatment should only focus on what the client needs. I like that you included the importance of educating family members on the emotional state of the teen/adult who stutters. As a current graduate student, I would like to pose a quick question, when is providing counseling for a client outside our realm of work and when should outside referrals be appropriate? I guess what I am asking is where do SLP draw the line when counseling clients? Also in your opinion do you think there should be classes in college that teach/inform this type of counseling for individuals with communication disorders? Thank you.

 

Re: Question

From: Diane Games
Date: 24 Oct 2010
Time: 22:14:08 -0500
Remote Name: 76.17.183.48

Comments

SLPs counsel in every session...i.e. when you tell a mother what to do with regard to handling various treatment disorders. I did a lot of training with slps who are very talented in treating stuttering..yes, this type of treatment is within our scope of practice, but if ever I am uncomfortable re: a client's need for counseling, then I do refer out.

 

Communication?

From: Erin

Comments

I appreciate your post and found it interesting to read. The materials you provided at the end of the article were great to think about how they would be implemented in therapy. You mentioned the importance of working with the family and maintaining positive relationships. I was wondering if you would recommend similar handouts for parents/family/friends to discus their perspectives? It appears the attitudes of listeners in the individuals environment are also important. Especially at the beginning of intervention, are there ways for them to break down their thoughts and how they want to help the person who stutters?

 

Re: Communication?

Comments

Erin...this is a great idea. I usually have family members attend some sessions, but it would be great to have some feedback from them..it also might open some dialogue about important issues.

 

Adult Therapy

From: Kassie Lawson

Comments

I am a current Graduate student in Speech Language Pathology and really enjoyed reading your paper because it went along with what I learned in a counseling class this summer. When adults come to therapy they are usually coming on their own, they dont have someone making them come so I have a question pertaining to that. At the initial meeting with the adult would you kind of lay out everything or just take things as they go. For instance would you tell them about the 'causes' of stuttering, ask them about emotions, feelings, or problems with others, and those things? or would you just let them express emotions, guilt, problems with family members, and things on their own? Thank you for your time.

 

Re: Adult Therapy

From: Diane Games

Comments

Kassie, First I do a complete evaluation that includes Attitudinal, Cognitive and Motor assessments. After the assessment, I schedule a meeting to "go over" the information that I observed in the dx. Listening during this entire process is the best advice that I could give. I learn so much during this process. I always set up each session with the reasons why I am doing an activity and this relates to the dx information. I don't treat any two adults in the same way...but I do have some activities that I like to use with all adults when they are ready.

 

Question regarding carryover of skills

From: Kayleigh Barton

Comments

Diane: Thanks for the great article, I loved how holistic and simple your tips were. The last point about "keeping it simple" to help increase carryover is very powerful. I know you only mentioned carryover briefly, but I was wondering in general what your thoughts were about how well stuttering therapy does carryover with adults. Does there have to be some kind of "acceptance" by the PWS before you see that carryover? Or does the drive to improve work for some? Thanks for you time.

 

Re: Question regarding carryover of skills

From: Diane Games

Comments

Concerning your question about carryover with adults who stutter: in my experience, adults are variable in all of the areas that we see variability in children/teens..but they have been stuttering longer which does often impact confidence and expectations for success. There is also an issue of motivation..once some people realize the amount of work and effort needed to make change, they become less interested. On the other hand, many adults make excellent changes in their speech....finding that having some problem solving strategies really helps them.

 

Grief

From: Jennifer Cosentino

Comments

You speak about letting the client handle any grief he may have during therapy. When a client begins to talk about guilt and the emotional aspects of stuttering during therapy, how do you personally determine between what is within the scope of practice and what needs to be referred out? Where does the line get drawn between helping a client work through grief to move forward in treatment and discussing grief to the point where it might be a psychological issue that SLPs are not adept in handling?

 

Re: Grief

Comments

this is a great question that probably does not have an exact answer...some clients come to treatment for stuttering while in counseling...other have been in counseling for periods of time. Some adults do not need counseling! I keep discussions focused on the issues related to stuttering and when the client keeps moving to discussions emotional/attitudinal issues not related to stuttering, then I refer them for general counseling. Discussions of grief and emotions related to stuttering are welcomed..i.e. not speaking in various situations, or feelings from past difficult interactions, or negative reactions from close family members, etc.

 

Reducing Guilt and Shame

From: Courtney Sacco

Comments

I have come to learn that a beneficial part of therapy in relation to stuttering is the idea of increasing a person's acceptance of their stuttering through reducing feelings of shame, guilt, and embarrassment. I know you touched on the aspect of reducing the guilty feelings within one of your clients, but I was curious in connection to working towards this goal with a client, have you experienced any challenging escape behaviors that are occurring due to the negative affect and what type of therapy methods did you find most sufficient in addressing the behaviors?

 

Re: Reducing Guilt and Shame

From: Diane Games

Comments

I have had some clients use some escape behaviors and to be honest, I feel that this will continue for some people despite making good progress in treatment. I approach this type of discussion with 1) defining escape behaviors, 2) making a general list of these types of behaviors, and 3) what does escaping vs. not escaping accomplish for the speaker..or something along that line. I know that it is not an easy behavior to manage and I respect that issue for my clients...I approach it as a problem that will be addressed over a long period of time.

 

Treatment Concepts

From: Katara Tabaa

Comments

I appreciate the treatment concepts that were adapted from "Philosophy for Old Age!" I agree that counts should focus on the positives. As a general rule, we all like to hear what we did well (vs. where we could have improved). Focusing on the positives is much more empowering. I also agree that the client should learn about stuttering, I feel this would empower the client (i.e., because they are involved and understand stuttering). Laughter is the best medicine! If a client feels comfortable to laugh and smile in therapy, we are doing something right :) I think listening in a non-judgmental manner is always important, not only for the clinician. It is important to address guilt. Guilt may arise with individuals who stutter (and with other individuals). I feel it is important to address the guilt because this will help the individual to form a more positive relationship with their clinician. I find it very important to teach others about stuttering. There are many stereotypes associated with stuttering. As a future SLP I feel it is part of my job to dispell these stereotypes. And lastly, I agree 100% that a client should leave therapy feeling empowered to make change. Knowing that a client is empowered is the most positive feeling an SLP can have. Thank you for sharing these points. These are things that I have never thought about directly...and sometimes we need things pointed out for us :)

 

Working with Teens

From: Abby Waller

Comments

Professor Games, I am a first year graduate student in WCU's Communication Sciences and Disorders program. Before entering this new field I had been working in the mental/behavioral health field. Much of my past professional experience has been working with teenagers who have become overwhelmed with the pressures of growing up without adequate coping skills. As a mental health clinician building rapport and making progress with a teenager can be very different, and often more challenging, than with adults. Interventions that work with adults may not be effective for teens and there is often more resistance to treatment. I'm wondering about your experience as a SLP in working with teenagers as opposed to adults and the differences you've encountered. Thanks!

 

Re: Working with Teens

From: Diane Games
Date: 30 Oct 2010
Time: 22:15:42 -0500
Remote Name: 98.28.157.96

Comments

Abby..what a great question! My experiences with teens is generally they want a "quicker" fix..not all of them but some. I also vary my presentation of concepts with teens...focusing on motor issues initially and then generally problem solving situations and then more into the attitudinal/cognitive aspects of treatment. BUT every client is different and I feel that treatment needs to be varied based on a number of client issues.