|Ken St. Louis , is a professor of speech-language pathology at West Virginia University (WVU). In his 40-year career, he has taught courses in fluency disorders to prospective speech-language pathologists, carried out research related to stuttering and cluttering, treated adults and children with fluency disorders, and participated in self-help activities, and was co-founder of both the International Fluency Association and the International Cluttering Association. Ken's current research focuses on public attitudes toward stuttering worldwide.|
Imagine you went to your doctor for unexplained chronic headaches. Your general practitioner told you to take aspirin, ibuprofen, or acetaminophen. You try that and it does not really help very much. After a month, with the headaches still persisting, you try another doctor, who doesn't ask about your previous medication history but diagnoses you with tension headaches. The doctor recommends yoga, walking, and better nutrition. You try that. After a few more months, you lose weight and feel more energetic, but you still have the headaches. Then, you try a headache specialist, who after a cursory history, diagnoses you with Migraine headache, and prescribes BOTOX treatments. This helps initially but not very much. And so it goes from one failure to the next, you seeking help from other medical specialists, chiropractors, psychiatrists, aroma therapists, massage therapists, and the like. Each of them administers the standard evaluation and then recommends the standard treatment.
What would you conclude about doctors and other headache specialists after all of this? If you are like me, you would be quite convinced that these medical and other specialists don't know anything about headaches. And unless the pain was excruciating, you might stop trying to get treatment altogether. According to The National Migraine Association, "It has been reported that over 60% of Migraine sufferers have had bad experiences with doctors, and many never return. In addition, diagnosis of Migraine can be difficult, as the symptoms and triggers vary from person to person, as do responses to treatments" (MAGNUM, 2012).
I submit that, although this example might be extreme, it is not unlike the experience of many of our stutterers or parents of school-aged children who stutter. Too many of them have seen several or numerous speech-language pathologists (SLPs) with little lasting benefit. Some of their SLPs, just as some physicians in the previous example, will consider carefully the client's past treatment and, given that it did not work, recommend something other than what they might have tried if that information had not been unavailable. Sadly, however, far too many of these SLPs have carried out their standard case history and evaluation procedures and then recommended their standard treatments, without asking or knowing much of anything about previous treatments and why they were recommended.
I try to learn from all of my stuttering clients, and feedback from individuals who stutter or parents of stuttering youngsters who have failed to find the kind of help they sought has informed this "clinical nugget." One of the things I have learned is always to try in that initial phone call with a parent or person who stutters is to ask the person to give me a chronology, as best as they can remember it, about exactly what advice, help, or therapy they have received and how effective it was. I do the same thing in formal evaluations, usually beginning the session by recording the client's individual "story of stuttering" (see an earlier ISAD conference presentation on that http://www.mnsu.edu/comdis/isad4/papers/kuster4.html [Kuster, St. Louis, & Sielen, 2001]). My goal is two-fold. First, I try very hard to listen carefully to the person and "hear past" some of the common frustration and anger with previous clinicians who did not or could not help. I try to probe why the stutterer or parent believes the approach did not work or why it worked initially but did not continue to work. I also try to probe about what specific procedures did work and why that might have been the case. The feedback I alluded to above is what has often been offered voluntarily to me at this point. I hear comments like, "[So and so] did not take the time to listen to me like this" or "I'm really glad you asked me these questions."
What I learned from these clients is that they need to have an opportunity right from the outset to express their frustration and anger from past disappointments. They need someone who is knowledgeable (as many of their previous clinicians probably were) to take perhaps an entire session simply to listen.
Then people who stutter or parents of stuttering children need something else that is extremely important. They need a sensitive clinician who begins by admitting that nobody has all the answers for stuttering and that there are many different treatments that have been effective with some stutterers, but unfortunately, not with all. They need a clinician who will then do her or his very best to explore with them why these various previous treatments worked, worked temporarily, or did not work. Often clients will discover that they themselves, and sometimes even the family support system, were partly responsible for the failures. Not uncommonly, they will now understand why a previous clinician recommended what she did. And sometimes, clients will discover that a previous clinician simply was not well enough equipped to deal with their unusually difficult problem. Taking the time to interpret all of this with and for the client has, in my experience, done wonders to re-instill hope and to help clients come to terms with the fact that past SLPs could not treat every case of stuttering as they might have wished. It also sets the stage for future treatment with an unspoken understanding that therapy will proceed with honestly and candor and that the client and clinician must work as a team, each listening to the other.
Kuster, J. M., St. Louis, K. O., & Sielen, R. J. (2001). A story is worth a thousand pictures: Your story can and should be told. Paper presented at the 4th International Stuttering Awareness Day Conference. http://www.mnsu.edu/comdis/isad4/papers/kuster4.html.
MAGNUM (2012). About MAGNUM. http://www.migraines.org/about/.