I know the title of this blog post sounds harsh but can we all just agree to unite as SLPs and decide that we will work hard to educate fellow co-workers, parents, educators, psychologists, doctors, and other professionals that the age-old idea of “controlling” a stutter is obsolete? Studies have been revealed over and over again that pushing the idea that one can and should be able to “control” his/her stuttering, only induces anxiety and fear of communication while resulting in the use of secondary characteristics as well as avoidance techniques. We as SLPs know this old idea does NOT work. We KNOW it’s a MYTH! Don’t we?
Several months ago, I was surprised to see a FB thread discussing this very same topic of “controlling” one’s fluency being lead by an SLP, of all professionals. You can imagine my shock and dismay reading such a thread perpetuating this myth once again and by someone of my own profession. Oh how my heart sunk! At that moment I decided I needed to address this topic head on in this blog post. So bare with me as we take this wild ride!
I spent the summer taking CEU courses. I just so happened to take 3 hrs of CEUs (courtesy of speechpathology.com) on this very topic so the newest information is quite fresh in my mind. Let’s tackle the hard questions here.
What should fluency treatment look like?
Step 1: Education!
If we are concerned with mirroring our treatment practices after EBP (evidenced based practice) as I know we all are, then we can no longer ignore the shift in treatment focus for fluency cases over the last decade or more. The shift began with attempting to focus on family intervention, meaning we began to look at how caregivers interacted with the client/student who stuttered. We attempted to train family members on ways to encourage fluency at a young age by using a number of techniques which are still good practice today: encourage caregivers to slow down their own rate of speech when speaking to the child, avoid interrupting the child or doing other tasks that seem to say “I don’t have time to wait for you to speak”, avoid pressuring child to perform in front of strangers, family members, when tired or excited, etc. All of these techniques have been found to be helpful but clinicians have discovered we can go even further. The current treatment model is extending into community based treatment services, encouraging education and training for ALL who work and communicate with the child/student on a daily basis. So treatment today, wants to focus on educating not just parents but teachers, reading specialists, coaches, babysitters, paraprofessionals, librarians, etc.
Step 2: Techniques!
Yes we can still teach the well known techniques such as cancellations, pull outs and easy stutters, but the PURPOSE of these techniques are no longer to reduce the frequency of stuttering events or “control” one’s stuttering. Rather the purpose of teaching these techniques is to train our students/children that they CAN COMFORTABLY stutter thus reducing the use of secondary behaviors and attempting to eliminate the idea that one must avoid communication due to stuttering.
Step 3: Address Emotional component of Stuttering!
This is probably the hardest step in the process and the one that some specialists believe will take up more than 80% of your treatment time. Teaching our children/students or adults who stutter that it is OK to do so. Practicing intentional stuttering, playing around with different types of dysfluencies, manipulating dysfluencies and demonstrating to our clients that we can stutter easily in public takes time and MUCH emotional support.
So in a nutshell this is the latest EBP approach to dysfluency treatment. If this information is new to you, then I encourage you to sign up for some CEU courses that will do a much better job of explaining this process than I every could. In the meantime, can we all just agree to STOP perpetuating the myth that: “Stuttering can be controlled”? Oh, I hope so!