|About the presenter: Michael Susca, Ph.D., is an assistant professor at the University of the Pacific. Dr. Susca is an ASHA Board Recognized Specialist in Fluency Disorders, a member of the Special Interest Division Four*Fluency and Fluency Disorders steering committee, and has over thirty years experience in treating people who stutter. Dr. Susca has published in national and international journals, presented at state, national, and international conventions, and is a former stutterer himself. He also continues a small private practice primarily for people who stutter.|
Organic Therapy? Where else but in California where speech therapy might blend with organic gardening in some way. Actually, there are many parallels between organic gardening and good speech therapy. Challenges and joys abound in each. This article will share some gardening principles as metaphors that beginning clinicians and consumers of speech therapy for stuttering might find useful (or, at the very least, worth considering.) After all, many people prefer quick techno-fixes in gardening just as they do in speech therapy. Rather than seeking a "magic fix", gardening teaches us how investing time, care, and effort may result in quality outcomes.
Preparing the soil
Many gardeners recognize the importance of quality soil for their plants, but different plants do relatively better or worse in different soils. The general soil sought is called "loamy", which is a combination of sand, clay, and silt. It is sought because it has the properties of holding water and nutrients well while also providing spaces for roots to grow. However, different plants need different soils so it is important to know the soil your particular plant does best in and how to best prepare that soil. People are like plants needing particularly prepared soils.
Consumer preparation for therapy includes seeking information regarding clinician qualifications and preparation for issues the consumer will bring to therapy. It means self-education through resources such as the American Speech and Hearing Association, the Stuttering Homepage, the Specialty Board on Fluency Disorders, the Stuttering Foundation of America, support groups such as the National Stuttering Association, and (of course) this International Stuttering Awareness Day conference! Consumers also need to do some introspection: understanding one's own needs, values, and goals will help a consumer find a "best fit" with the clinician of choice.
Clinicians need to be prepared and regularly educated as well. Clinicians should build from a fundamental base of knowledge regarding the disorder and consistently develop their skills and experiences. This means reading journals of the profession, attending conferences, and engaging in other continuing education activities to supplement experiences, knowledge and skills. Like the good gardener recognizing different soil conditions for different plants, the good clinician will recognized different treatment conditions for different consumers. Thus, before therapy can be successfully planted it would be wise for potential clinicians and consumers to interview each other to help understand the needs and conditions each brings to the therapeutic process. Mutual understanding of what is expected from therapy, how treatment might be developed, and what outcomes might be harvested can help each party sow the beginnings of a fruitful therapeutic relationship.
Some planting variables
Beyond knowing the appropriate soil conditions, a good gardener knows what to plant, how to plant it, and when and where to do the planting. There are good times and bad times to plant certain crops: peas grow great in the coolness of spring and fall but die during the summer heat, when beans, peppers, and tomatoes do quite well. Some crops need full southern exposure while others need cooler soil. Some plants are fine crowded together, others need "their space"; some plants have short life cycles, others have long ones. Knowing the variables affecting a particular plant's best growth pattern aids good gardening.
Likewise, clinicians and consumers need to discuss and "best fit" treatment philosophies. Agreements need to be made regarding the right time, place, and kind of therapy. All parties should consider frequency, duration, and character of meetings (i.e.: one-on-one versus group, direct versus indirect), and recognize if current conditions are right for therapy to begin. Other issues to consider include: Is the consumer ready for change, committed to change, and recognizing the issues that must be addressed for change to occur? How much time and for how long a duration is one willing to commit to change? What kinds of change and what kinds of therapeutic targets are anticipated and reasonable? Is the consumer seeking or learning a technique to manage stuttering, enhance fluency, change a perception, and/or enhance effective communication--or some combination of these or other targets? How comfortable is the consumer with making and internalizing these new changes in functioning? Are there extraneous issues affecting the decision to start therapy (such as school or work commitments, vacations, or meeting medical or social issues) in the first place? Sometimes it is best to postpone the start of therapy to a different time in a consumer's life, or negating therapy because the desired change is not possible in the time commitment allowed. For example, a short and infrequent summer therapy program towards major changes in communication fluency may not be warranted for the severely stuttering college-bound student moving out-of-state before the fall. Perhaps an intervention aimed at a shorter-termed objective or strategy would be an alternative for such a consumer. Just as garden planting decisions may be affected because radishes take a few weeks to harvest but pumpkins take a few months, speech treatment frequency or duration may need to be modified by the imposition of extraneous issues. Some extraneous issues may include availability of child or clinician in a school setting, reimbursement costs or insurance coverage in a private setting, or known dates when a consumer will be relocated due to vocational requirements. Any of these issues may affect therapeutic effectiveness.
I have had consumers who came to me with "treatment didn't work" comments. Often, I learn the treatments did work but did not stay with the consumer for various reasons, many having to do with time, costs, or environmental/social/personal issues. By knowing the consumer's and clinician's intervention goals, the timing of the intervention in the consumer's life cycle, the available time allotment for intervention, and the environmental conditions affecting intervention, on can determine the right time and place to "plant" an effective therapy program.
The growing process
One can not put a seed in the ground, add a little water, and expect to pick a fruit or vegetable the next day. Growth is a process and therapy is the process of growth and change. It simply does not happen overnight.
Basic gardening requires regular sun, periodic but consistent watering, occasional fertilizer, sometimes weeding, and always time. Similarly, good therapy requires a consistent relationship with regular attendance and clear, supportive communication. Growth will be stimulated by counseling suggestions, specific techniques, and the suggestion of alternative strategies to deal with idiosyncrasies a consumer may present. Like water, it takes persistent application of therapeutic suggestions to keep the process growing. A good therapist knows when to hold back or apply these suggestions, just as holding back or delivering more water might stimulate flowering or fruit production in a garden plant. There are some plants that need lots of fertilizer or particular kinds of fertilizer to keep the growth process moving in the direction desired, while other plants do well with no fertilizer whatsoever. So, too, are different consumer needs: some will need special therapeutic enhancements, embellishments, or experimentation while others will do well without extra or unusual interventions or supports. When extra supports are used, it is important to deconstruct these supports as soon as possible so consumers may flourish on their own. Once established, a healthy plant will seek its own nourishment just as knowledgeable and growing consumers will learn what is best for them.
Weeds in the garden compete for nutrients and are removed. Consumers may have weeds affecting their growth when confronted with distractions such as false notions (mother caused the stuttering), fringe treatments (acupuncture, hypnosis, aroma therapy, herbal use), or unproven media-hyped cures come to their attention. Such distractions need to be dispelled immediately. The quick-fix is rarely a long-term fix. Good therapy is a process requiring time for change to occur and become inculcated. The clinician is instrumental in guiding positive change in the behaviors, thoughts and feelings of the consumer. Ultimately, consumers are developing self-reliance and independent communicative functioning. The process may require modifications to the therapeutic plan, changes in hierarchies, or guidance into insights of self-empowermentŠ. processes that require time. The persistent application of effective clinical intervention allows growth and change that the consumer may integrate into daily communicative functioning.
Generations of farmers have discovered some plant combinations may aid or deter the growth of other nearby plants. For example, dill and nasturtium are beneficial plants for cucumbers, melons, and squashes if planted nearby. Although potatoes do not grow well with tomatoes, planting onions and carrots together has the effect of confusing the respective flies that would attack either plant if grown alone. Garlic prevents blackspot on roses and inhibits many fungal diseases. So, an interactive effect sometimes occurs with the presence of some plants in proximity to others.
There are many different kinds of companion planting effects. Some help or hinder the growth of others by depositing nutrients or chemicals in the soil. Some prevent pests or diseases while others attract pollinators and predators. Some simply complement each other for various but poorly understood reasons.
In the school system, planting a "speech buddy" may help a child who stutters use techniques, engage in conversations, or enhance effective communicative interaction in some other way. Having children teach others about stuttering, giving strategies to deal with bullies, or encouraging reports/projects about stuttering in a school environment are other forms of companion planting. Adults who stutter may also benefit from such companion planting by involving a supportive "significant other", whether it is a spouse, partner, or friend in the therapeutic process. Involving other individuals through education, demonstration, or connection to additional resources are companion planting ideas that help enrich the environment and enhance a consumer's communicative competence. The clinician or consumer who educates a parent, teacher, or boss regarding a client's treatment, communicative, or functional needs is involved in companion planting. All forms of companion planting help the therapist and consumer in the process of transferring and generalizing various therapeutic practices, strategies and goals. Thus, companion planting is a smart therapeutic component to any therapy plan.
As noted, the fruits and vegetables of one's labor do not come overnight. Through careful preparation, management of timing and environmental conditions, consistent care, application of supplements, and the involvement of various supports across time one may enjoy a garden harvest. Similarly, good timing, the right match of consumer to clinician, a readiness for change, the regular application of strategies and skills, and encouragement of a supportive environment will result in harvesting communicative competence previously not experienced. For example, an individual may respond with his/her name without anticipatory fear, with easier motor actions, or without secondary behaviors. Communicative harvests may also include a child who asks questions in class, an adolescent willing to seek a date regardless of (dis)fluency, or an adult making a first time oral presentation at a job site. In each case, the individual is gaining communicative independence and confidence. A garden harvest may include some misshaped fruits and vegetables, just as there will always be communicative exchanges that are less than perfect (regardless of fluency.) That is nature. Whether the harvest is a shared fruit or a shared comment, the communicative connection is just as sweet.
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