The role of counseling in stuttering treatment, Part 1

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For many years, the discussion of personal feelings was not considered to be part of treatment for people who stutter. There has been a shift in the past decades, however, as practitioners start to address the emotional aspects of stuttering with clients. Not everybody in the field agrees with this approach.

Controversy

Conflicting opinions came to a head in 2012 when a prominent American researcher and Speech-language Pathologist (SLP) wrote an editorial in a professional scientific journal criticizing a trend she saw in the treatment of stuttering children. This trend encouraged the children to accept their stuttering, and focused on reducing negative secondary behaviours rather than the stuttering directly.

The pendulum had swung too far in the other direction, in her opinion, and practitioners were abandoning professional expertise and giving up on fluency, opting for a feel-good approach that had no clinical basis or evidence of efficacy. Not only that, this trend was compromising the integrity of the field of Speech Language Pathology as an evidence-based practice.

Backlash

The backlash was enormous. A group of prominent SLPs wrote an article objecting to the editorial. Hundreds of practitioners in the field attached their names to it.  In response, the letter stated that most SLPs advocated a balanced approach between achieving fluency and addressing emotional issues, that both can be a part of effective treatment for stuttering, and that evidence did indeed exist that supported this approach as contributing to a child’s rehabilitation. The researcher who wrote the editorial backed down slightly from her initial hard-lined stance in a responding article, but disagreements still exist as to what role a speech pathologist has in the emotional health of a patient.

The role of counseling

Last month, the podcast site Stuttertalk featured David Luterman, a researcher and clinician in the field of Communication Disorders, discussing the role of counseling in stuttering treatment. David Luterman is an audiologist and the author of the text Counseling Persons with Communications Disorders and their Families, currently in its fifth printing. Stuttertalk host Peter Reitzes, a practicing SLP and a person who stutters, mentions that as part of his training as an SLP he was told not to address feelings when treating people who stutter. Luterman agrees that therapists were trained to be primarily “information givers” who provide clients with helpful exercises and advice and dispense facts about their conditions. The “emotional realm” was deemed to be off limits in this treatment process, at least officially.

But Luterman, like a lot of therapists who treat individuals with communication disorders, has found counseling to be essential to his role in helping his clients and their families cope with difficult circumstances.  “Giving information is not enough,” he says in the interview, as he found that clients don’t  process information well when they are emotionally upset. Advice-giving is also unhelpful most of the time, and sets up an unencouraging power dynamic between the client and therapist. While he acknowledges that SLPs are not mental health professionals, that is not what is necessarily called for when a patient is having normal reactions to a difficult situation.

Empathetic listening

David Luterman applies basic principles of empathetic listening and gives clients a chance to express themselves in a non-judgemental environment. In the course of therapy a person with a communication disorder is confronted with the harsh realization that they will never be “normal”.  A patient must take true ownership of the problem and want to change – something that can be a painful process. As he says in the Stuttertalk interview, “People who stutter are dealing with loss. There is a loss involved. Let them grieve that loss.”

SLP training

Diane Kendall is an SLP and researcher who also found that emotional factors had to be considered in the therapeutic process with patients and families. Her view is that counseling skills should be part of the training curriculum for SLPs and audiologists. In her paper “Counselling in Communication Disorders” she states that supporting her clients this way “was an experience that required skills in communication and counseling that were not provided in any of my graduate school classes or fellowship training... [We] as clinicians feel the need to be the information provider in the white lab coat and often we want to be the rescuer. The result of this type of approach leaves the client feeling powerless, such that any change that will occur will come from an external source rather than from within."

 

Next week: Counseling and children

 

Diane L. Kendall "Counseling in Communication Disorders". Published in Contemporary Issues in Communication Science and Disorders, Volume 27 • 96-103, Spring 2000.

Stuttertalk podcast 443, Counseling in Stuttering Treatment, interview with David Luterman

Stuttertalk podcast 372, Stuttering Disagreements in the Field, interview with Marilyn Nippold