Appropriate, Effective Treatment

The conference title was “Unique Challenges and Common Themes in Stuttering Assessment, Treatment, and Research.” It was January 29-31, 2010 in Tampa, Florida. This was my 5th ASHA Special Interest Division 4: Fluency and Fluency Disorders conference and I was thrilled to attend. For 3 days I wallowed in workshops related stuttering. So did more than 100 other professionals equally interested in this esoteric topic. At home, I am the Sole Proprietor of a private practice that caters to stutterers exclusively. It can be a lonely career choice! However, at The National Stuttering Association and SID4 conferences, I meet with colleagues who are also fascinated by and committed to speech therapy for stuttering. I always return home refreshed and enthusiastic about new practice goals.

Jennifer Watson’s (1) presentation on Sunday morning was brilliant. She must have been paying close attention the previous 2 days because her topic drew directly from the presentations of Friday and Saturday. The title of her talk was “Research and Clinical Connections in Stuttering: Busting Barriers and Building Bridges.” I really appreciated her effort to review some reasons why it is difficult to translate current research immediately into therapy practice. She reviewed the current Framework for Evidence Based Practice (EBP) - a triangle, the three of points of which represent Current Best Evidence, Clinical Expertise and Client/Patient Values. Dr. Watson felt EBP should be represented by Venn diagram of interconnecting circles (rather than a triangle) to illustrate how important it is that research, clinician, and clients impact one another. There needs to be more communication between these three stakeholders in order to make progress in the field.

Dr. Watson recommends a “Deployment-Focused Model of Intervention Development and Testing.” I cringe at the military connotations the word ‘deployment’ has for me; nevertheless, her point is that all research and practice in the field of fluency and fluency disorders must has some genuine relevance to the real-life conditions in which speech-language pathologists work and persons who stutter live. The gems in her argument included:

•Improving client-to-treatment matching: Which treatment protocols work the best for which client profiles?
•Identifying change mechanisms: Are there key elements that promote and support client progress, for example, the concepts of “therapeutic alliance” or “stages of change.”
•Changing from a mentality of “best” treatment to “best fit.” It’s unlikely any one person is going to devise the “best” treatment for all persons who stutter. Clients are individuals and stuttering may be a heterogeneous disorder, which means, one-size will not fit all.

Walter Manning (2) had opened the conference with “Clinically Significant Change for Persons who Stutter” in which he statistical differences that indicate significant research findings are qualitatively different from clinical differences that indicate client satisfaction. Dr. Manning reviewed several ways to consider the client’s point of view. He emphasized that emotional and cognitive goals are equally as important, if not more so, than speech fluency goals in some cases. He recommended The Anatomy of Hope (3). He referred to a Contextual (or Common Factors) Model of therapy with the “therapeutic alliance” as a key ingredient to progress. Building such an alliance requires frequent, honest input from the client and Dr. Manning reviewed several methods for doing so. Constant client input ensures that the client is designing personal goals and taking ownership of the change process. It also detects any initial breakdown of the “alliance” so that immediate repairs can be made. One of his slides stated: “It’s not so much the presence of a positive relation but the absence of positive qualities that is strongly correlated with poor outcome. Thus, it is the negative feelings about therapy that need to be addressed.”

This conference highlighted the clinical relevance of research but I was incredulous when a speech-language pathologist challenged the relevance of Dr. Luc D’Nil’s brain imaging studies during a small group round table discussion. I thought the studies were fascinating, enjoyed reading articles by this particular researcher and felt her comments were disrespectful. Dr. D’Nil’s credibility and character only increased in my eyes when he graciously acknowledged the woman’s complaint and raised her issue again on Sunday when 5-minute summaries of each session were shared with the entire group. I find these conferences allow me a glimpse at the people behind the names I read in professional journals and faces I see on International Stuttering Awareness online conferences. I discover professionals in the field I really like and wish I could get to know better. They are the ones I rely on to guide my own clinical decision making. They are the names that are footnoted in my clinical reports.

I’m looking forward to the next time I can attend a SID 4 conference.

(1) Jennifer B. Watson, Ph.D., CCC-SLP, ASHA-F, Texas Christian University, Forth Worth, Texas.
(2) Walter Manning, Ph.D. The University of Memphis
(3) By Jerome Groopman, (2005) NY: Random House, Inc.

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.