Reflecting upon another Saturday of speech therapy, I marvel at how the day is planned yet unpredictable. The longer I work as a stuttering specialist, the easier it has becometo let go of detailed lesson plans and allow each session to evolve in its own unique way. My lesson plans are now guidelines that structure the first 15 minutes of a session and act as an invitation for the client to talk about his goals - in that moment of time. Together, a loosely structured interaction begins in which constant give-and-take results in useful work accomplished in only 60 minutes.
The lesson plan is nearly sacred to the student of speech-language pathologist. A few summers ago, I supervised a student from Boston University who was earning her Masters Degree and had a special interest stuttering. She wrote lesson plans with specific goals and descriptions of therapeutic methods that would be used to help her clients achieve those goals. The university required that she write extensive evaluations of her sessions when they were done, presumably in order to prepare the next set of lesson plans. Whew!! This kind of preparation was fine at the start of my career. But now, I find this approach often ignores the reality that each client has lived for days, weeks and sometimes months between each speech therapy session. The slp needs to know what's happened in that space of time that might affect what kind of work the student is ready for next.
Yet, there are important long-term goals and methods to keep in mind. E. Charles Healey, professor of speech pathology at the University of Nebraska, penned a two-part series called Seven Principles of Stuttering Therapy http://www.mnsu.edu/comdis/isad10/papers/healey10.html and www.mnsu.edu/comdis/isad11/papers/healey11.html which addresses this. Let's take Principal 4 as an example. How can the slp and client work for increased fluency while accepting stuttering at the same time? I attempted to accomplish this goal in 3 different ways with the 3 clients I saw today.
1.) A teen spent some time reading aloud because he sometimes needs to read aloud in school. I ask if he is choosing to practice with fluency enhancing techniques and, if so, which ones. I ask for a self-evaluation of his reading. But, most of all, I comment on the content of what he has read, not the fluency. I accept the mild persistent stuttering. And I tell him that he reads very well - which he does. He leaves having written 3 "change cards" with goals he came up with on his own.
2.) With a new client, one of the first things I do is demonstrate stuttering. Because I am a fluent speaker, I seldom experience that frightening loss of control that can accompany real stuttering. Nevertheless, my message is that stuttering is just fine by me. As a knowledgeable listener who has accepted the intractable nature of stuttering, I can suggest a plan based on principles of speech therapy.
3.)With an elementary school child, there is time at every session to talk about home and school, regardless of stuttering. When we get to work on a particular fluency enhancing technique, the rewards are not for fluent speech. Rather, they are for consistent use of a chosen technique. Today he earned an outstanding reward for extra-ordinary focus on his goals - even though there were still times when he stuttered. We accept the stuttering. With this acceptance we can move forward to learn new ways of talking without fear or shame.
Change takes time, energy, and flexibility. During one of the International Stuttering Awareness Day Online conferences, I asked the "Professor Is In" for an easy-read about change for clients to understand the process and remain motivated. The recommendation was Changing for Good by James O. Prochaska, Ph.D., John C. Norcross, Ph.D., and Carlo C. DiClemente, Ph.D. (Avon Books, 1994). Sure enough, this book talks about the long term process of change, primarily for adults. The concepts in this book are only recently being researched in the field of stuttering.
The process of change is a journey. A journey requires a map (or GPS). Speech therapy can influence that map by offering information and guidance. But the client is the traveler. The traveler chooses when to move, when to rest, when to pause and appreciate the view.
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