Sunday, October 25, 2009
Being Around People Who Stutter
I remember one time she commented to me (and prefaced it with, "no offense intended"), after being with you for a while, I notice that I stutter a little bit for a day or two afterwards. It also reminded me of when I myself have visited Southern states - Louisiana or Texas - that for a day or two afterwards, I find myself speaking with a bit of a southern drawl! What's up with that?
At first, I didn't know what to make of her mentioning that my stuttering was "rubbing off on her", but then I just laughed, because it was kind of funny. And I actually noticed her stutter a bit sometimes after hanging out with me.
What do you think? Do you think its possible that someone can "pick up"another's stuttering? Do you think a person who stutters might be offended by this? Or think they are being made fun of?
Wednesday, October 21, 2009
Addressing Fear Through Meditation: Zen and Stuttering
The question that I presented to him was whether or not Zen meditation had a direct or indirect effect on his fluency. In other words, because of a reduced fear of speaking, was he fluent or was it that it helped him with the covert phase of stuttering? He responded that meditation allowed him to focus on mindfulness and on the whole self which is a long term process. He also talks about how it helps reduce fears that a block may occur when producing a /t/ or /p/ sound. As we talked about in class, the covert theory states that an individual has difficulty with the monitoring of sounds before the articulation phase. I also wanted to get his thoughts on interactions with other kids in Bulgaria. He responded that they were understanding and he was not teased. He also does believe that more efforts and attention should to meditation as part of an SLP education.
This article is very interesting and offers another perspective for treatment. However, there are many forms of meditation so I am not sure how convincing this form of meditation is with removing fear and anxiety. Also, interestingly he indicates in the end of the paper that he still has some fear with public speaking and that stuttering may occur. This is a form of behavioral management that helped him to some degree but may not necessarily be effective for others.
Tuesday, October 20, 2009
Changing Attitudes in Children and Teens who Stutter
I chose to read an article about changing the attitudes of those who stutter. With in the field of stutter is an area of concern that continues to grow. Many children and teens who stutter have been discouraged by comments from their peers. Often when they experience difficulty communicating this helps contribute to the negative attitudes. No two clients move through the process the same way, but several types of treatment activities appear to help facilitate attitude change. Five of these activities were discussed in this article.
1. Learn the vocabulary to describe stuttering
2. Learn to analyze and problem solve approaches to various speaking situations, ie. what happens during these difficult speaking situations.
3. Understand the impact of negative thinking on attitudes while speaking in different situations and transfer negative thoughts into positive ones
4. Tell your story
5. Meet other people who stutter
This article talks about using these techniques and creating a powerpoint presentation to describe and talk about their stutter. Using these powerpoints to then share with other people who stutter, their family and even their friends has been found helpful to everyone involved.
I asked the author: “I found your article both interesting and informative. I found, as a Speech language pathologist, your ideas for ways to help children not only realize and express their attitudes/feelings about stuttering were not only helpful, but also easy enough to put into therapy sessions, as I have not yet worked with a person who stutters. I am wondering at what age you suggest these techniques would work? and do you think sharing the information the child develops with his or her guardians may also be helpful to everyone involved (with the child's consent of course). Thank you for you time :)”
And receive the answer back: “Thanks for the great questions...however,every client is an individual. I try to listen to what the kids are telling me about their speech and also what the parents are saying. The general edcuation about talking/stuttering often starts the diaglogue. My students are used to sharing ppts with other students...this is also a learning component. As for the age, it really depends on the child...and I do share these ppts with parents as part of the education process. I have never had a student refuse to share..in fact, students feel empowered to give add ideas and comments, to alter the slides and to update their thoughts/information. Good luck...:)”
I found this article very helpful and full of wonderful ideas that can be easily implemented into therapy.
Monday, October 19, 2009
Voluntary Service to Help People Who Stutter in Cameroon, Africa
This article focuses mostly on Canadian Speech Language Pathologist (SLP), Mr. Gordon Skinner and his contribution to the stuttering community in Cameroon. In the country of Cameroon, with a population of 16 million people and given that one percent of any given population is made up of People who Stutter (PWS), it would be expected that approximately 160,000 people stutter. However, the prevalence rate in Cameroon may be as high as 5 percent. The Speak Clear Association of Cameroon (SCAC) was created to bring hope to the people who stutter in Cameroon and this is a national self-help movement.
Mr. Skinner began his visit by organizing intensive therapy sessions for 12 adults who stutter, with a focus on slow easy talking (set). Remarkable progress was made that was recorded during the sessions as some of the participants who had difficulties saying their names at the start of the sessions could speak without much stuttering at the end of the sessions. In addition to offering speech therapy for PWS, workshops for teachers and health professionals were offered. Mr. Skinner also spoke on a television broadcast, where he spoke out against making fun of people who stutter because comedians on the television show were poking fun at stuttering right before he went on air.
I initially wanted to know why the author, Joseph Lukong, thought the prevalence rates were higher in Cameroon. This question had been answered previously, but I would still like to share the author’s explanation. He stated that it “was difficult to say,” but that “higher rates of stuttering have also been reported in some of the tribes in West Africa.” Therefore, it is not only in Cameroon that prevalence is higher in Africa. He felt that this may be an important subject for research and speculated that it may have something to do with ethnic origin, culture, climate or the food they eat. The question I asked Mr. Lukong was if there were other therapy techniques used besides the slow easy talking. He responded by saying other techniques were taught, although he didn’t mention which kinds. However, he stated that most of the emphasis was placed on slow easy talking, as the time was relatively short to cover all techniques in detail. They also used support group meetings when practicing their tools.
I believe that this article is relevant to our fluency class because it helps us to understand how diverse stuttering is and shows the influence that therapy can have in just a short amount of time. This article also provides encouragement to those who wish to work or volunteer abroad in countries that do not have a great amount of access to therapy.
What Marty Jezer Taught Me About Counseling
I recently read the article, What Marty Jezer Taught Me About Counseling People Who Stutter by Lisa Vadnie (Minnesota, USA) and Marty Jezer (deceased). The article was all about Marty Jezer and his opinion as a person who stuttered about the emotional side of stuttering and what he would want from a therapist to help him the most. Ms Vadnie chose special excerpts from Marty Jezer’s book that best highlighted the feelings and emotions that a speech pathologist may need to address during therapy. In his book Mr. Jezer spoke about when he would use avoidance to steer clear of having to stutter when saying a word he thought he might stutter on, or taking a long time to talk to a girl that he had an interest in. Mr. Jezer also believed that his stuttering impacted his ability to get a job. He let his stuttering impact him when getting a job because he limited his possibilities when he thought that the job he had in mind would not be suitable for a person who stutters. He also talked about how he thought that employment agencies did not want to provide him with employment. He made the statement, “ I went through the motions of job hunting with no confidence that I'd ever land a job.” He brought up the feeling of denial that he would tell people that his stuttering did not bother him but after lying he would feel ashamed. Mr. Jezer brought up the feeling of fear. His fear of talking and fear of what a communication partner might think of him. Perhaps the most interesting point that he brought up was that he did not like to voluntarily stutter because he knew who he was when he was stuttering but not when he was trying to stutter.
The article went on to discuss the critical clinical attributes that clinicians should have when working with people who stutter. This article was wonderful because it gave the reader another person’s opinion on the important factors of stuttering therapy. Reading about Marty Jezer’s experience was a great way to see what the client wants when providing therapy for a person who stutters. The article made crystal clear to the reader that there is so much more to fluency therapy than helping an individual to be more fluent. The needs of the client must be first and foremost in the therapy along with attitudes and feelings.
I asked the author, “I was just wondering in your professional opinion which of Mr. Jezer's important clinician attributes is the most important, which is the most helpful for clients?” She has yet to respond to me but the one that I felt was the most important was that the therapy be client centered.
Stuttering: Falling through a hole in the academic web?
Grant Meredith is studying engagements of stuttering students in Australian universities with the schools’ disability services. At this point he is focusing on the accessibility and content of the information that potential students are able to find on the websites of 39 universities that can support them into and through academia. One point of his was to find out whether each site contained the direct contact details for the disability liaison officers. He found that each site offered a range of methods to contact the DLOs (phone, email, postal, etc.), an important option for people who may not wish to use the telephone. An issue he found was that about half of the schools did not provide the specific name of a DLO. This can be problematic for stutterers, as searching for a name or not knowing who to speak with can add another later of anxiety and pressure to a situation that they may already find challenging.
Another major issue investigated in this article was whether universities offered public access to any type of guides that provide staff with information concerning the teaching as assessment of disabled- especially stuttering or speech-impaired- students. Though half of the universities did provide access to disability related teaching information, most were not accessible to the general public, and were concerned with popular disabilities (hearing impairment, mobility, mental health, etc.). Disappointingly few of the sites had any information specifically on speech impaired students, including stuttering. What little was provided was very general in content, relatively short, and not well thought out. Many of the strategies for speech impaired students were general teaching strategies should in place to benefit all students, for example ``maintain eye contact``. A simple `Google` search provided the few strategies that were offered, often verbatim. The author was sorely disappointed to discover how little effort is being put into providing the public, potential and current students, and faculty with potentially valuable information from people whose job it is to disseminate such information. Meredith finishes off with a push for such education about stuttering to come from stutterers themselves. He feels being proactive in matters of education, and presenting information to various disability services is the best way to raise awareness, understanding and to formulate strategies for assistance.
The comment I posed to Grant Meredith was that disabilities liaison officers may not be the best people in most universities to advise about certain 'disabilities'. Many universities have undergraduate and graduate programs specializing in speech disorders and/or speech-language pathology. My query was whether these departments’ students and faculty should be involved in disseminating the appropriate information to potential students and teaching staff. It could be made into a special project for the students, and linked to the university's disability services site. This would keep the information provided current and hopefully not blindly taken from other sites.
His response was that the idea of getting SLPs, associated departments and students to disseminate information is a great idea, but may difficult to coordinate. He posed the question back....Are there a lot of programs specializing in speech disorders and/or speech-language pathology that teach and know a lot about stuttering? Direction has to come from those most educated and currently up to date in the field. I guess that is why I preach that PWS themselves should be more pro-active about education the public and the decision makers in the world. An international program of mass stuttering awareness and education to all sectors is called for.
Using Stories to Teach Fluency Strategies to Young Children
My questions were, what age level did the author think this book was appropriate for? and also did the author have any other books with different characters or story lines. The author said this book was apporpirate for ages 2-8. The author is working on other stories that will target negative reactions of stuttering, another that target reduced tension and many other topics. They are available on mcspeechbooks.com
“How Beliefs and Self-Image can Influence Stuttering”, By Alan Badmington
I choose to read the article, “How beliefs and Self-Image can Influence Stuttering”, By Alan Badmington. Within this article Alan stresses the importance of developing a positive self-image, as what one believes about his/her self significantly influences behaviors and emotions.
In order to initiate change, one has to highlight the areas in which they are holding back. Alan stated that while developing a positive self-image is a gradual process, it begins with exploring your belief system and the blue-print you have created of yourself. This exploration begins by looking at what you consider to be your failures and success, strengths and weaknesses, as well as your competency and worth. When you can identify the flaws within this blue-print, you can begin to change/adapt your belief system.
One of the components that Alan discusses in order to help with the development of a positive self-image is the use of visualization. To apply visualization Alan created a visual image of the desired behaviour to improve performance. For example, Alan would imagine the upcoming event, visualize himself doing the presentation, and then ingrain in himself that he had done an excellent job. This process was used as a way to reduce or eliminate the fear of stuttering in specific situations. I found this interesting as I had never thought of using visualization techniques with a fluency client. I think it would be an extremely useful technique to use with individuals who have anxieties about upcoming events/situations. You can not only help the client to develop a positive mindset, but also assist them with identify areas in which they may have difficulties and strategies or techniques they can implement (e.g., easy-onset) to guide themselves if they do experience a problem.
Alan’s discussion on the development of a positive-self image addressed the importance of discussing attitudes and feelings in the therapy setting. Using the Synergistic approach in fluency therapy can help clinicians target all areas of need. I think attitudes and feelings are extremely important to address in the therapy setting as without a strong sense of self and the belief that you are able to succeed, progress in treatment would be slow and limited. This article would be beneficial to show to clients to clients of all ages, as it stresses the importance of coming to terms with your stuttering and ways in which you can do so.
I asked Alan for strategies or tips that he would recommend in order to encourage client’s to discuss attitudes and feelings. I have not heard back yet, but will be sure to post his answer.
Sunday, October 18, 2009
"Things I learned in Therapy" by Pam Mertz
As clinicians, we must also be open and accepting of stuttering, as many of our clients will be struggling with this issue as well. As we learn in class, we must have fun with stuttering, get it out in the open, and get rid of that stigma that surrounds subjects that are just not talked about. We also must be willing to stutter ourselves if this is what we will ask of our client. How could we ask them to do something that we would not be willing to try? Our goals must follow the client’s goals. They need to be meaningful to the client in order to increase motivation. Goals should not be based on required clock hours or good data collection. This is a person we are working with and their life is in our hands! We must be open and honest with our clients, as this will help to build a good relationship. If we are inexperienced with an area, we should let the client know and ask for help, as we can learn just as much from the client as they learn from us. Lastly, we must know when and how to push the client to the next level in order for them to feel successful. It is important for the client to feel successful in therapy for them to keep coming back.
I asked Pam if she thought the key points that she learned in therapy applied for the children in the program, as well as adults. She thinks that these things are important for older children, teens, and adults. She added that she is not the “typical fluency client”, who wants to work on strictly fluency. Also, most parents of children who stutter will want to see more structured and goal oriented therapy. When I asked her for some tips to help build a strong relationship between clinician and client, she pointed out that a client clinician relationship should be a mutual give and take, built upon healthy rapport. The clinician should be authentic, attend to client needs, and not focus too much on data collection.
Overall, it was a great article, especially for those of us who will be participating in fluency council. I highly recommend everyone reads it!
Changing Attitudes in Children and Teens Who Stutter, by Diane Games
- Learning vocabulary to describe stuttering, the speech process and techniques to modify rate and tension
- Learn to analyze and problem solve approaches to various speaking situations
- Understand the impact of negative thinking on attitudes while speaking in difficult situations; transfer negative thoughts into positive ones
- Tell your story! Read stories of other children/teens!
- Meet other people who stutter!
Mrs. Games describes activities and procedures that help children gain control over their stuttering, such as creating PowerPoint presentations where they can share their information with others. The students who work with Mrs. Games are encouraged to bring in positive thoughts and feelings associated with their stuttering and in communication in general. This is in direct correlation to what we’ve learned class. It is based upon the idea that the more comfortable a person who stutters is with their stuttering, the less tension they will have in conversation therefore decreasing their stuttering. One thing Games suggests is that tension makes it harder for the child to use the strategies they learn in therapy. This seemed to me like a great way to explain to children how anxiety can affect their speech. She also says if there is tension, it “Makes avoiding seem like a good idea!”(Games, 2009). She seems very skilled at knowing how to communicate with children and teens on a level that they will understand and benefit from. In discussing with children ways to improve their speech, Mrs. Games includes a PowerPoint slide with a picture of a magician saying “Call a magician?”, which is a fun way to get the message across that it is the children who have control over changing their communication.
When I wrote to Mrs. Games, I asked her whether she uses the PowerPoint activity with a group or in individual sessions and how the final product is presented. I also asked her what she would do if a child was resistant to meeting other children who stuttered, and continually refused this. She began her response with this: “Melissa..first of all, I spent a lot of time at St. Rose with my dear friends Sr. Char Bloom and Donna Cooperman! You have a wonderful program.” She continued on to say that the PowerPoints are usually used in individual treatment sessions so no one is influenced by others, and that it is the students’ option to share. She said if they are resistant, at least we have opened the door for communication. Some children may simply not be ready to take this step even though we think it is right for them.
In conclusion, attitudes and feelings should be a main focus in stuttering therapy with children and teens. Mrs. Games introduces and exciting teaching tool to use in therapy that can help children gain control over their speech. I would recommend anything Diane games writes as it seems she has the same philosophy as our program does in working with clients. This article was interesting and gave me some great ideas for therapy.
"How Beliefs and Self-Image Can Influence Stuttering"
Saturday, October 17, 2009
"Stuttering: The Rest of the Story."
I would recommend any graduate SLP read this article to realize the life changing effect that we can have on people. I was so moved by this article and it was written from the heart.
The question I asked Bobby was: Dear Bobby- Reading your article confirmed why I decided to go into Speech as a profession. I was so touched by your kind words regarding Graduate Students working with people who stutter. I have one question for you. Do you ever wish that you had your positive experience working with a graduate student earlier in your life? I only wished that you did so you didn't keep living in shame about your stuttering. Don't you feel like you have missed out on so many years? Thank you again for commending how graduate student SLP's affect people who stutter in a positive, life-changing way!
Bobby’s response to my question: Rachel: Hindsight is always 20-20, and wishing that something in your past had been different is of no practical use. I’m not really sure that I missed out on much growing up. My stuttering only increased my natural tendencies to be left alone, it did not cause it. I’ve probably used my stuttering as an excuse for my “lone-wolf” attitude much more than I should have. I will admit that when I was younger, especially in my teenage years, I was ashamed of my speech, but now it’s more frustration at not being able to convey what I want to say. Frustration is the reason I took up writing because when I write I don’t stutter and I can then express myself. I just very, very seldom ever let anyone read what I wrote because it allows people see a part of me that I have tried to keep “out of sight” for years. I do hope though that other people who stutter have the opportunity to work with graduate SLP students. The students are always so eager to try out their new skills and test their knowledge that it tends to infect the client with the same optimism. I know a couple of times with my student SLP’s I had the urge to place a large heavy rock on their heads to keep them from bouncing out of their chairs. Their enthusiasm carried over into me and changed my attitude towards my speech for the better. If I could make a wish and it be granted, it would be that all PWS’s have the chance to work with students at least for a while. Both parties benefit because the client gets to see themselves through the student’s eyes and the student get insight as to how a PWS’s mind considers their stuttering. I am very grateful for the student SLP’s that helped me, and I hope that I was able to help them in their careers just a little bit.
Changing attitudes in Children Who Stutter
1. First: Learn vocabulary to describe stuttering, the speech process and techniques to modify rate and tension.
2. Second: Learn to analyze and problem solve approaches to various Speaking Situations
3. Third: Understand the impact of negative thinking on attitudes while speaking in difficult situations; transfer negative thoughts into positive ones.
4. Fourth: Tell Your Story; Read the stories of other children/teens!
5. Fifth: Meet other people who stutter
I asked the author what she would do when working with a child who was hesitant to open up and talk about stuttering. Here is her response: “Great question...sometimes clients are not ready for what you (as a clinician) may think is best. I really try to listen to what the client is saying and thinking. Then explore those issues. Sometimes, I suggest some activities. This is one reason that I generally start with some discussion of the various aspects of stuttering. The powerpoints often help as the client is responding to another person's feelings/comments.”
I thought that her response was very insightful and definitely came from a place of experience and knowledge. It made me realize that just because I may think it is best to be open and talk about feelings and attitudes related to stuttering, the child may not. This may be a very sensitive subject that they have a difficult time talking about and I need to be aware of this and give them the space they need to feel comfortable to eventually talk about it. I will always try to refer back to this when working with a child who stutters.
Friday, October 16, 2009
Changing Attitudes in Children & Teens who Stutter
1. Learn vocabulary to describe stuttering, the speech process and techniques to modify rate and tension
2. Learn to analyze and problem solve approaches to various speaking situations
3. Understand the impact of negative thinking on attitudes while speaking in difficult situations; transfer negative thoughts into positive ones
4. Tell your story; Read the stories of other children/teens!
5. Meet other people who stutter
I found these strategies to be particularly helpful in seeing the counseling aspect of fluency and in seeing how to modify negative attitudes towards stuttering. When I came upon strategy # 2, I did not think of fluency as thinking of ways to problem solve to various speaking situations. In this part of therapy the client identifies the difficult places and situations in which they speak and then they develop a hierarchy of difficulty and come up with ways to manage and analyze changes while speaking in these situations. I also found it interesting that time pressure and avoidance are key aspects to address when coming up with ways to manage stuttering in difficult situations. I posed a couple of questions to the author. I asked the author how she approaches parents of the children who stutter in terms of ways they can help their child accept their stuttering. I wanted to know how you can help parents look at stuttering in a positive light? I also asked about the Behavior Assessment Battery that was mentioned in the article. I wondered how this battery measured the child's behavior and perception of their stutter. The author responded by saying that the Behavior Assessment Battery is a published test that addresses a number of areas that are relevant to communication. She said that measuring attitudinal change is important over time and that she sees gradual changes in attitudes on this type of test. The author also explained she works with parents in private practice in that the parents are bringing in their kids so it gives their kids the opportunity to explain what they have done in treatment and how to see stuttering in a positive way. I think this article was worth reading because it brought up ways of treating the attitudes of stutterers in both children up through teens and into adulthood. The article also provided links to related activities and information on each strategy/approach. All of these strategies are very helpful in modifying the negative feelings and attitudes.
A Stutterer's Pain
I have recently invited friends to share some of their stuttering experiences on my blog. The most recent guest blogger's story generated a LOT of interest, discussion and comments.
I really can't offer much insight on the experience of severe stutterers. But, I do think that all of us who stutter can relate to the core feelings of shame, fear and pain at some point in our journeys, regardless of severity.
So, I invite you to read Adam's story here. It is poignant, emotional and raw, and opens your eyes to the pain of some people who stutter. Adam wrote to me one night last week, and his words so struck me, that I asked for his permission to share his story.
Please, let us know what you think. Leave a comment here or on the other blog, or both!
Saturday, October 10, 2009
Apologizing For Stuttering
I asked him about that, and we had a lengthy conversation about why we apologize, and how sometimes saying "I'm sorry" doesn't mean an apology at all.
This post generated some good responses. Please take a look, by clicking on the title of this post. I would be interested in what you think! You may run across this with future clients who stutter.
Tuesday, October 6, 2009
Working on Blocks
I am pretty certain now that my resistance has come from the need to accept myself fully as a person who stutters. I am sure you have heard that in class. That clients receiving therapy for stuttering very often need to work on acceptance - either simultaneously with fluency targets or before attempting fluency work.
I am probably as close as I am ever going to get with acceptance. I am comfortable with my relaxed, easy stuttering. For the most part, it is forward moving, and my stuttering does not impede my communication.
I do not like the blocking that I have been doing more and more of. I have tried to even deny that's whats going on, but it is what is happening. I am getting stuck, because my breathing pattern is off. So, momentous for me, I have AGREED to work on identifying moments of blocked speech, getting a feel for whats happening in the block, and finding ways to get out of it.
I am doing this with the two grad student clinicians I am working with this semester.
This is huge for me. I have consistently resisted working on speech tools. Maybe now I'm ready. Stay tuned - I will report here how this goes over the next weeks. We are going to record some conversations so that we all can see where my tension is when I block! Cool!
Thursday, October 1, 2009
Secondary Behaviors
You can click on the title "Secondary Behaviors" and it should take you to the youtube video of Ellis Lankster (they spell his name incorrectly) really using secondary behaviors to try not to stutter. This is the video of what was played on Howard Stern that we heard through www.stuttertalk.com. It's very hard to watch this man struggling so hard not to stutter. As SLPs, we have to make sure that we are not falling into the same trap as our clients, and just helping them do other things not to stutter. Stuttering, as Walt Manning has said, needs to be picked up, plopped down on the table, and really worked with. You cannot just try to work on Fluency... the stuttering is the problem, and the trying not to stutter is perhaps a bigger problem...