|About the presenters: Charleen M. Bloom, Ph. D., MSW, is an ASHA Fellow, a former member of SID #4's Steering Committee, and a professor of Communication Disorders at The College of Saint Rose in Albany, New York where she specializes in counseling and the treatment of fluency disorders in children and adults. Dr. Bloom has spent more than 35 years evaluating and treating individuals who stutter. She is the founder and director of the Capital District Council for Fluency, a support group and treatment program for people who stutter. She co-authored Synergistic Stuttering Therapy: A Holistic Approach (1999) and a NSSLHA monograph on the Clinical Interview with her co-presenter, Donna Cooperman.
Donna K. Cooperman, D.A., is an associate professor of Communication Disorders at The College of Saint Rose in Albany, New York where she specializes in the treatment of fluency disorders in children and adults. She is a clinical supervisor and directs the children and teen division of the St. Rose Council of Fluency. She has facilitated the parent counseling group meetings for the past several years. Dr. Cooperman has spent more than 35 years evaluating and treating individuals who stutter. She is a recognized mentor and a member of the fluency specialists of the American Speech-Language-Hearing Association's Special Interest Division on Fluency and Fluency Disorders.
There has been long-time agreement among speech-language pathologists (SLPs) that it is important to counsel the parents of children who stutter (Bloodstein, 1995; Bloom & Cooperman, 2003; Mallard, 1991; Rustin, 1987; Zebrowski and Schum, 1993). This view has been supported and mandated by The American Speech-Language and Hearing Association (ASHA) in its Preferred Practice Patterns (1997) and Scope of Practice in Speech-Language Pathology and Audiology (2001). ASHA states that we are responsible for both information counseling and adjustment counseling with our clients and their families. However, we have found that many SLPs, who work with the families of children who stutter, are much more comfortable with information counseling, and feel relatively insecure and in need of guidance for further issues in counseling. Luterman (2001) cites a study by McCarthy that demonstrates many SLPs receive no training in counseling. Flahive and White (1982) found that in a study of 226 audiologists, 90% of training focused on informational counseling and 10% on personal adjustment counseling. We do believe that information counseling is important and absolutely necessary for the parents of our children who stutter, and we will briefly examine some of the issues that are most frequently utilized in information counseling. However, the focus of this article is to assist the SLP in transitioning from the role of one who provides information only, to one who feels informed and motivated to learn more about, and to use the skills of counseling in the therapy process with parents.
Conture (1990) notes that a 30 to 60 minute information sharing session, after the initial interview, may be all that is necessary for parents, to relieve their fears and guilt. We agree that for some parents this is true. However, for the vast majority of parents, much more time is necessary to answer the questions of: "What causes stuttering?", "Did we do something wrong?", "Should my child be treated differently than my other children?", "Will my child outgrow this stuttering?" and other pertinent informational questions. Answering these questions can bring a great deal of relief to parents who have carried these concerns for years. We meet with parents weekly and spend one day of our Weekend Workshop providing information counseling for our parents (Bloom & Cooperman, 2002; Cooperman & Bloom, 2002). During this Weekend Workshop, we provide information sessions presented by both professionals and people who stutter. We provide literature from the Stuttering Foundation of America and connect the parents with information found on the Internet: The Stuttering Home Page (http://www.mnsu.edu/comdis/kuster/stutter.html), The National Stuttering Association (http://www.westutter.org/), and the Stuttering Foundation of America (http://www.stuttersfa.org/). We believe that all of these activities are important, and provide parents with valuable information about the cause of stuttering, methods of assessment and directions for families to provide a more stable and productive communicative environment for the person who stutters and the family. However, Luterman (2001) points out that there is a seductive side to counseling by informing. The clinician can appear to be one who has all the answers about the problem. Instead of empowering the parent, the parent comes to think that the clinician or the "doctor" knows best. "This mode of counseling assumes that parents are weak and incapable of effective decision making; people generally conform to our expectations" (Luterman, 2001, p.4). To facilitate the empowerment of parents, we believe it is important for the SLP to integrate the role of one who informs with the role of a "clinician/counselor" (Bloom and Cooperman, 1992).
Crowe asserted "...the question of whether counseling should be essential to the clinical practice of speech-language pathology and audiology is rhetorical. Counseling, in fact, does occur in almost every therapy encounter, whether it is intentionally employed by clinicians to achieve specific therapy goals, or whether it happens spontaneously and unguided toward any purpose." (Crowe, 1997, ix-108). Therefore, we urge SLPs to continue to broaden their thinking, studying and experience with counseling, so that their work with parents might include the guided and informed practice of both informational counseling and the integration of the skills of adjustment counseling. We have named the professional who integrates these roles a "clinician/counselor" (Bloom and Cooperman, 1992). We believe that this title allows us to maintain our primary identity as speech-language pathologists and yet adopt appropriate techniques of the counseling profession as they can assist us in providing holistic treatment to both our clients and the parents of children who stutter.
For a more complete description of counseling and its role in communication disorders and stuttering therapy with parents, the reader is urged to consult any of the following: Andrews and Andrews(1990), Schum (1986), Rollin (2000), The Stuttering Foundation of America (2003), and chapters in Bloom and Cooperman (1999) and Manning (2001).
The work of the clinician/counselor is about helping people to change the way they think, feel and behave in regard to their communication disorder. As SLPs, we must become students of the change process, and professionals who facilitate our clients' inward journey. Our hope is that parents will find the internal and external strengths and personal resources to help them change how they feel about themselves, when necessary, and to accept and relate more fully to their children who stutter. We will highlight, here, some aspects of counseling principles that might enrich the interaction and productivity of SLPs when working with the parents of children who stutter:
ASHA (1997; 2001) mandates that we provide both informational and adjustment counseling in our service delivery model. In order to respond to this mandate, we must abandon the security of only providing information to parents, and venture into the world of the clinician/counselor. The transition from information giver to clinician/counselor relies upon the commitment on the part of the SLP to develop a new set of skills. We hope that our colleagues will join us in exploring and implementing the counseling literature which must be incorporated into our work with children who stutter and their families.
ASHA (2001). Scope of practice, speech-language pathology. Rockville, MD: Author.
ASHA (1997) Preferred practice patterns for the profession of speech-language pathology. Rockville, MD: author.
Bloodstein, O. (1995). A Handbook on Stuttering, 5th ed. San Diego, CA: Singular Publishing Group.
Bloom, C.M. & Cooperman, D.K. (2003) Counseling and disorders of fluency: An overview. Perspectives, December, pp. 2-6.
Bloom, C. & Cooperman, D. (2002). Innovative approaches in service delivery for children who stutter. Perspectives, December, pp. 6-7.
Bloom, C. & Cooperman, D. (1999). Synergistic stuttering therapy: A holistic approach. Woburn: MA: Butterworth-Heinemann.
Bloom, C. & Cooperman, D. The Clinical Interview: A Guide for Speech-Language Pathologists and Audiologists (2nd ed.). Rockville,MD; NSSLHA, 1992.
Caldwell, C. (2004). Caring for the caregiver: The art of oscillating attention. Psychotherapy Networker. July-August, pp. 34-35.
Conture, E.G. (1990). Stuttering (2nd ed.). Englewood Cliffs: Prentice-Hall.
Cooperman, D.K. & Bloom, C.M. (2002). Point-counterpoint: Synergistic stuttering therapy: holistic treatment for people who stutter. Perspectives, April, pp. 5-8.
Corey, G. (2001). Theory and practice of counseling and psychotherapy. Belmont, CA: Wadsworth Thompson Learning.
Crowe, T. (1997). Applications of counseling in speech-language pathology and audiology. Baltimore: Williams & Wilkins.
Eagen, G. (2001). The skilled helper. Monterey, CA: Brooks/Cole.
Flahive, M. & White, S. (1982). Audiologists and Counseling. Journal of the Academy of Rehabilitative Audiology, 10, 275-287.
Ivey, A. (2001). Intentional interviewing in counseling (4th ed.). Belmont, CA: Brooks/Cole.
Luterman, D. (2003). Helping the helper Perspectives, December, pp. 19-20.
Luterman, D. (2001). Counseling Persons With Communication Disorders and Their Families, (4th ed.). Austin, TX: Pro-Ed.
Mallard, A. R. (1991) Family intervention in stuttering therapy. In R.F. Curlee (Ed.) Seminars in Speech and Language, 12. NY: Thieme Medical Publishers, pp. 265-278.
Manning, W.H. (2001). Clinical decision making in the diagnosis and treatment of fluency disorders. Albany, NY: Delmar.
Rogers, C. (1961). On becoming a person. Boston: Houghton Mifflin.
Rustin, L. Ed. (1991). Parents, families and the stuttering child. San Diego, CA: Singular Publishing Group.
Rustin, L. (1987). The treatment of childhood disfluency through active parent involvement. In L. Rustin, H. Purser, & H. Rowley (Eds.), Progress in the treatment of fluency disorders. London: Taylor and Francis.
Schum, R.L. (1986). Counseling in speech and hearing practice. Rockville, MD: National Student Speech-Language-Hearing Association. Clin. Series #9.
Stuttering Foundation of America, ((2003). Effective counseling in stuttering therapy. Memphis, TN: SFA publication #0018.
Zebrowski, P. & Schum, R. (1993). Counseling parents of children who stutter, American Journal of Speech- Language Pathology, 2 (2), 65 -73.
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