The presenter of this paper has consented to have a personal email address posted here if you wish to raise further questions and/or comments. Contact Lynne Shields at lshields@fontbonne.edu Therapy From: Andy Floyd Date: 10/1/99 Time: 10:34:36 AM Remote Name: 205.188.196.34 Comments Hi! First, it sounds like you give a great class and seem to use tons of extras (stutt-l, support group, adults who stutter, etc). One thing I wanted to ask about is when you actually teach the techniques to the students. My wife (who is in grad school for SLP (speech-language pathology) and I (just graduated with my MA in SLP) have noticed that professors don't always teach the actual techniques - like have the students put them into their own mouths. For your pseudostuttering experiences, have you ever had the students put the techniques they'd be teaching their clients into their mouths instead of pure stuttering (which is great by the way). McKeehan (1994) in a Journal of Fluency Disorders article (vol. 9, 113-123)had students use "fluency facilitating speech strategies" in the outside environment and listeners reacted, often negatively. I thought this probably was a great learning experience for the students since they may see why some PWS (people who stutter) would be hesitant to use their techniques in transfer situations. Sorry for the long post :) great article, Andy Floyd Re: Therapy From: Lynne Shields Date: 10/4/99 Time: 9:59:41 AM Remote Name: 199.217.208.162 Comments Hi, Andy. Thanks for the compliment. I am familiar with the McKeehan article, and am in the process of addressing the issue that you and she bring up. Last year, I had the students do some practice with treatment techniques in the following manner: I assigned small groups of students to become familiar with one session from Dorvan Breitenfeldt's "Successful Stuttering Management Program", trying out the techniques used in the session. I then had each group share a summary of the session they learned, making comments about the techniques used. While this worked out well, and the students stated that it helped them understand the program better, it isn't nearly enough. This year, as we watch segments of the 9-videotape series of van Riper working with Jeff, I am planning to stop the tape at various points and have students practice the same thing that van Riper is having Jeff attempt. I also plan to have them practice fluency shaping techniques when we talk about them. I still have in mind to develop an assignment where they will be doing some of this outside of class, but it won't be ready for this year's class. Perhaps, as you suggest, it might be piggy-backed on the pseudostuttering assignment they are already doing. I am also thinking about some types of practical experiences that may help students understand better how one deals with attitudes and emotions in therapy. Everything I've come up with so far seems too contrived. I do have them keep a journal as a part of the pseudostuttering assignment, and we discuss feelings quite a bit in class, but that's about it at present. Thanks for your input. Congratulations on completing your degree. Lynne A Student's Comment From: Sarah Pauling Date: 10/5/99 Time: 3:34:30 PM Remote Name: 208.25.244.81 Comments Thank you, Dr. Shields, for writing on something so close to my heart right now. I am a first year graduate student in SLP, and I have an adult who stutters as my first patient in the clinic. At the same time, I'm enrolled in the first-year Fluency Disorders class. So, I've had to overcome any kind of trepidation very quickly this semester. You really have some great ideas for making stuttering therapy and theory a little less scary to your students. As a student, I have to say that my primary fear comes from the overwhelming history of stuttering, and seeming lack of a "cure". I have been taught so far that the worst thing a future SLP can do is to make one approach the cure-all with every patient you see. This makes sense to me. The only problem, is that it is hard to really believe in any therapy technique, and it can be too easily discarded as not working, when it wasn't given a decent chance. Do your students have these concerns, too? I really want to help my patient overcome his stuttering, but inside I feel like I am doomed from the start. Again, thank you for your paper. It made me realize that my feeling are not uncommon and that there are people who are working to change things for us. ~Sarah Pauling, East Carolina University, Greenville, NC Re: A Student's Comment From: Lynne Shields Date: 10/6/99 Time: 10:02:46 AM Remote Name: 199.217.229.70 Comments Sarah, I'm so glad to hear from you. You certainly are jumping right on in to the area of fluency treatment, with class and a client all at the same time. While I'm sure that this is a bit scary, you will probably learn more from your class with the immediate chance to put some of the information into practice. What a great opportunity! Now, to address your concerns. They are, indeed, rather universal, so please know that you are in good company. Perhaps a shift in the way you are looking at treatment with an adult may be helpful to you. I think you hit the nail on the head when you say that there seems to be no cure for stuttering. What about helping him learn to manage his stuttering? There is good evidence to support the notion that those who stutter can learn ways to manage their speech, allowing them to communicate very effectively. Just reading some of the other papers at this conference should help you gain confidence in that goal. It seems to me that most of the problem for someone who stutters is not so much the stuttering behavior itself, but all the stuff that they do to try to stop stuttering. Working to reduce those add-ons can make a big difference in the amount of effort a person spends in speaking. And, there are some great techniques, from both the stuttering modification and fluency shaping traditions, that can be quite useful to a person who wants to address those stuttering events, as well. A little 'bibliotherapy' may be helpful in giving you some ideas and a more positive attitude. There are many excellent resources available. A few of my favorites are Barry Guitar's "Stuttering, an integration of contemporary therapies", Walt Manning's "Clinical decision making in the diagnosis and treatment of fluency disorders, and Woody Starkweather and Janet Given's "Stuttering". I wish you the best as you move forward in your studies. Do remember to look for the little successes in therapy-and give yourself and your client a 'goodie' when you find them. Being aware of and rewarding the good stuff can really help change your outlook, and that of your client. Therapy is a two-way street-you two are in this together. Regards, Lynne Idea From: Kelly Birken and Rebecca Hubbling Date: 10/7/99 Time: 4:38:20 PM Remote Name: 134.29.30.64 Comments We are two students in the field of communication disorders. We are currently enrolled in the graduate level stuttering seminar course. We just thought we would mention a project our class is currently working on. Our professor, Judy Kuster, receives numerous requests for advice from people through her email every day. Each week one of her requests is fowarded to the class, with all identifying information deleted. Each individaul in the class is then responsible for finding correct information and/or advice to give the individaul. This sometimes just means telling the person where they can look for further resources. We have found this very beneficial for two reasons. The first is we are learning to deal with "real life" situations and the second is it usually facilitates a very interesting class discussion. It teaches us how to be careful in our choice of words as well as cautious not to diagnose or treat through correspondence. Our answers are first screened by Mrs. Kuster, before being sent to the individual. This has been a really great learning experience. It has taught us how to search for information and make use of a wide range of resources. Re: Idea From: Lynne Shields Date: 10/8/99 Time: 10:14:04 AM Remote Name: 199.217.208.162 Comments Kelly and Rebecca, Thanks for posting your class assignment. What a good activity to get you working on real problems and/or questions. Judy sounds like a great teacher. Of course, I don't get the kind of e-mail that she does, since I'm not the queen of the Stuttering Homepage, but the basic idea of giving students a variety of problems to research is easily adapted to other formats. I will definitely file this away for future use. I appreciate your sharing the idea, and wish you both the best in your studies. Regards, Lynne Course content From: Sheree Reese Date: 10/11/99 Time: 6:19:22 PM Remote Name: 205.188.208.38 Comments Hi Lynne, I enjoyed your article...I felt as if I could have written it, we've had such similar experiences.I also found comfort levels didn't really change as students went from the course to clinical experience (I think they just got better at answering survey questions) and I too have included all you mentioned. Two other experiences that have been helpful were actually doing therapy in front of the class with a live client (I was lucky to find one) and inviting practicing slp's to come to class with videotaped samples of clients they were stymied by and working with the class to problem solve. I'd love to talk to you about it some time. Re: Course content From: Lynne Shields Date: 10/13/99 Time: 11:41:57 AM Remote Name: 199.217.219.197 Comments Sheree, Thanks for posting your comments. I like your idea of having working SLP's come to class with real clinical problems to solve--wish I'd thought of that. I used a variation of that when I did a workshop for school clinicians on fluency treatment last spring. I had those who wished submit a problem they were experiencing with a fluency client from their caseloads on index cards, including a list of questions. After a short presentation, we spent most of the time working as a group on those problems, and I think it was a good way to address treatment with a group of practicing clinicians. I have typically done case studies in class, and particularly talk with the class about clients currently being treated for fluency disorders, following them for the semester and discussing solutions to problems that occur over time. To bring in others from outside of our clinic would greatly expand the possibilities. I'm not sure I'd ever convince one of my clients to do therapy in front of class--you found a brave individual! How lucky for your students. I'd love to chat further with you. Please feel free to contact me by e-mail (lshields@fontbonne.edu). And, thanks for taking the time to respond--I appreciate the feedback. Regards, Lynne Desensitizing SLP Student From: Steve Hood Date: 10/11/99 Time: 8:24:39 PM Remote Name: 205.188.198.174 Comments BRAVO, Dr. Shields, BRAVO Thank you for trying to SENSITIZE your students to issues related to stuttering, to people who stutter, and to the fears/uncertainties faced by clinicians in general, and SLP student in particular. Thank you for your efforts to help desensitize them to their own insecurities and fears. Indeed, there are many clinicians who would prefer to work with clients other than those who stutter. And alas, ASHA really dropped the ball and made a tragic mistake when it no longer required students to have at least a bare minumum of clinical experience in the area of stuttering. (But my beef with ASHA is food for another table.) It is relatively easy to teach students about stuttering. It is difficult to "teach" students about the PERSON who stutters: child, adolesent adult. I share your enthusiasm for introducing students to the NSA, SFA, groups such as Friends. Students need to know about these valuable resources, as well as autobiographes such as Marty Jeser's. Like you, I show portions of the Van Riper/Jeff video, and show videos from the NSA and SFA. I invite members of our local NSP chapter to visit class. I also have student assignments where students engage in pseudostuttering and go into real situations in order to work to learn and produce such modification techniques as cancellations. Recently, on STUTT-X, there have been several threads regarding the pros and cons of these outside assignments for students. Indeed, there are many students who would avoid these assignments if possible, and I think this is regretable. In order to be effective, students must develop as much empathy as possible, and must be able to "go first and demonstate." They need to be able to model the desirable targets. One of the common worries of the students in my class who do the pseudostuttering assignment is being able to do it realistically. If you ever have the same problems, here are a few ideas I'd suggest: You do not need to be the most severe person who stutterers that ever lived. You need to do enough stuttering to be realistic. There are four basic ways to look at the overt/behavioral characteristics of stuttering. Here they are, and here are my suggestions: Frequency -- try to stutter on about 15%-20 % of words spoken Effort -- Try to have moderate amount of tension/struggle. Maybe have some increase in loudness/pitch, or maybe show some tension in your jaw or slight tremor. Duration -- Shoot for stuttering of about one second duration Type -- Various types of of sound and syllable repetitions, some prolongations. These reps and prols can be both voiced (vvvvery) and voiceless (ffffast.) Or like p-p-p-paper -- or buh-buh-baseball. Try some hard contacts/tense pauses, and some blocks. For my own students, we practice some of this in class. I demonstrate, and they break into groups of two or three students to practice with each other, IN CLASS, and in front of each other. I encourage them to practice on their own -- to tape record themselves, and to watch themselves in the mirror. These students, individually and collectively, get to be pretty good judges of being realistic. Lynne, I think your students will benefit greatly from the kinds of things you are trying to do to help them to be more emphathic, more understanding, and more knowledgeable. I enjoyed your article. I agree with your article. And, I am glad you shared this with the ISAD visitors. After ISAD is over, and as you continue to develop your course, I hope we can continue to exchange ideas. We can try to develop creative ways to help expose students to these important concepts. Thanks for sharing, Lynne. This is an important contribution. Steve Hood Re: Desensitizing SLP Student From: Lynne Shields Date: 10/13/99 Time: 2:09:30 PM Remote Name: 199.217.219.197 Comments Steve, Thanks for your comments and support. Your online course information has certainly been a great source of inspiration for me as I've gone about working on my course, so I can officially thank you now for all of the help you've been to me. And, thanks, too, for the suggestions about the pseudostuttering assignment. I'll share that with my class. One of my students mentioned just last week that she sounded so unnatural when stuttering. We did some in-class practice and talked about ways to "improve" our stuttering. Your suggestions will help there, I think. I also talked with them about the nature of making changes, that it SHOULD feel a bit awkward to do something that your speech mechanism doesn't ordinarily do, and that I suspect many of the clients feel awkward, too, when we ask them to make changes. I rather like future SLP's to "get" that concept of change and why it can be so hard to do. Old shoes always feel so much better than putting on those stiff new ones. I would really like to see more interaction among all of us who teach fluency courses. Sheree Reese mentioned the same in her post right before yours. I am gathering that a number of us have been down the path of working out how to teach more effectively in this area. Having a vehicle for sharing ideas could be quite useful. Do you know if anyone has used the SID-4 listserv in the past for that purpose? I just recently signed onto that one, but haven't seen one posting on it to date. Regards, Lynne Re: Desensitizing SLP Student From: steve Hood Date: 10/14/99 Time: 9:17:20 AM Remote Name: 199.33.133.50 Comments Lynne -- Use of the SID-4 listserv would be a good idea. So far as I know, it has not yet been used in the way you are suggesting. Maybe after things settle down after the conclusion of the ISAD events, we can do some things like this. Maybe some other folks will pick up on this theme and offer additional ideas. Cheers, Steve Hood One of the /crowd From: Janell Larsen Date: 10/12/99 Time: 10:14:05 AM Remote Name: 204.72.75.234 Comments When I read this paper I felt that you were writing about me, a SLP with 15 years of experience. I wish I had some of these experiences and I know of others who feel the same way. Thanks. Re: One of the /crowd From: Lynne Shields Date: 10/13/99 Time: 2:53:16 PM Remote Name: 199.217.219.197 Comments Janell, Thanks for your comment. For those of us who have been in the field for some time, I think that there are many more avenues for increasing our knowledge base and comfort level with fluency therapy now than in the past. I have attended some excellent sessions at ASHA over the past few years on fluency, some with a very practical focus. NSA and SFA both have some wonderful resources for clinicians. There are also so many opportunities for learning on-line, through listservs, The Stuttering Homepage, this conference, and so forth. There are often folks in our field who have good expertise in fluency right in our own communities. I hope that SLP's who want to learn more about treating stuttering will feel free to call them up and pick their brains. I used to be afraid to do that--how would it look if I admitted that I didn't know something? I do it shamelessly now, and I learn so much from my colleagues. It makes the person you call on feel good, too, to be of help, so it's a win-win situation in most cases. Regards, Lynne Densensitization From: Ed Feuer Date: 10/13/99 Time: 5:01:21 PM Remote Name: 216.81.20.236 Comments The recent battle on the Stutt-X newsgroup between students who reject pseudo-stuttering with highly transparent excuses and PWS who tell such people to never have stuttering clients reveals that something certainly is amiss. It's my impression that at most universities, pseudo-stuttering is treated at best by profs and students as a token assignment. The fluent students' situation is a mirror image of that of the PWS. Many of the students resist, sabotage and avoid for the same reasons PWS do it in therapy. Both lack adequate desensitization. While Lynne is headed in the right direction, I would urge the creation of much more comprehensive and structured systematic desensitization hierachies for the students. They gain crucial empathy including gauging listener reactions. It will also prepare the students for helping stuttering clients set up a systematic desensitization hierarchies. Modelling of behaviours by SLPs outside the clinic room is also essential in desensitization. Pseudo-stuttering should be regarded as a valuable learning opportunity, not as something to fear. Ñ Ed Feuer edfeuer@escape.ca Re: Densensitization From: Lynne Shields Date: 10/14/99 Time: 9:52:32 AM Remote Name: 199.217.219.197 Comments Hi, Ed, I'm glad that you brought up the issue of the pseudostuttering assignment. I would disagree with you that it is considered a token assignment, at least for my own class. It is a credit-bearing assignment, and is set up to cover a period of five weeks in the middle of the semester. I do have some heirarchy of difficulty built into it, beginning by stuttering only with their partners, then phone calls that are scripted, then unscripted phone calls, followed by outside situations. All along they are to be meeting with their partners for practice and support. But, I agree with you (and your previous post to Stutt-L on the issue) that it can be made more systematic. Now that you've got me thinking about this, I'm considering having the students set up their own heirarchy, actually, with several components required to be included. In this way, they might learn more effectively how to go about developing a heirarchy with their clients, by evaulating their own and making revisions. In addition, after talking with students this semester, it is apparent that I need to spend more time working with them in class on pseudostuttering before they begin the assignment. They seem to be having difficulty getting the stuttering behaviors down to begin with, and I may be able to remedy this by having small group practice in class. I do pseudostuttering for them during class fairly often, to demonstrate, but they need to get it into their own mouths earlier on. I appreciate your suggestions regarding the assignment. The suggestions I have received in response to this paper, including yours, are already proving quite helpful to me as I begin planning for my next class. Thank you, Lynne Re: Densensitization From: Sheree Reese Date: 10/15/99 Time: 8:40:10 AM Remote Name: 205.188.193.151 Comments I too have been watching the controversy on the listserv over the pseudostuttering assignment...it crops up every now and then. I can honestly say that looking back at over 100 students who have done this assignment in my classes, I can only think of one who did not learn a valuable lesson from it...and my guess (and my hope) would be that she will opt never to work with a person who stutters ...I've been very impressed with how seriously my students take the assignment, how diligently they try to learn from it and how sensitively they examine the experience afterward. Re: Densensitization From: Steve Hood Date: 10/15/99 Time: 10:35:20 PM Remote Name: 152.163.204.36 Comments Ed--- While I tend to agree with much of what you said, e.g., that too few students in classes on stuttering get full benefit from pseudo-stuttering and desensitization assignments, I must disagree with part of what you said this is a "token assignment." When done correctly, it is far from a token. Some of my past and present students are either actively participating in this ISAD conference, or are passively lurking. Maybe they will respond. I hope so. Stuttering in public, engaging in mofication exercises such as cancellations, pullouts, high stimulus speech, using exaggerated continuous phonation, etc, -- and modeling "Turtle Talk" with REAL CHILDREN is hardly a token assignment. Having students demonstrate their pseudostuttering in class is not a token assignment. I think you again make a grave error in overgeneralizing on this issue. As part of the final examination, I am considering having an oral component, in my office, wherein the students will need to make a phone call, to demonstrate some of the stuttering behaviors and/or modification procedures they have learned...... Yes, I know you would like me to take them to the Mall, and do this in public, but realistic fact is, that there are time constraints. I hope that if there are students reading these posts about pseudo-stuttering, that they will feel free to enter into the discussion. I hope that these discussions will stimulate thought and action. Ed and I have discussed and debated this issue in the past, so this response is really not directed to him..... Rather, to the rest of you who might be reading, and hopefully THINING, about the importance of the issues of desensitization and pseudo-stuttering. AND -- To Lynn Shields. My continued appreciation for bringing this topic to the ISAD forum. Steve Hood Re: Densensitization From: Lynne Shields Date: 10/18/99 Time: 10:56:37 AM Remote Name: 199.217.208.162 Comments Thanks for the added comments, Sheree and Steve. I'd like to add some feedback that my class gave me last week as we discussed how their pseudostuttering assignments were going. Most of them have done their second set of phone calls. While none reports that they are easy to do, several of them indicated that they feel a real sense of accomplishment (as well as relief) when they have finished. There is no better way to demonstrate how good it feels to carry out a specified task successfully. I hope they all remember this when they begin to work with clients on outside assignments! One student reported a near hang-ups when she blocked on the first word she attempted, while another said she was put on hold forever, and is convinced it is because of her stuttering. I think that they are beginning to understand how easy it is to feel insecure about speaking situations when one stutters. This assignment gives them that very important taste of stuttering, but I see them accomplishing so much more than that as they work through the difficulties that are inherent in such a task. Regards, Lynne I know how they feel From: Laura Kriniske Date: 10/14/99 Time: 2:56:38 PM Remote Name: 128.147.91.147 Comments I am a graduate student at the University of Pittsgurgh studying with Scott Yarus. I found your class set-up very intersting, especially the pseudo-stuttering assignment. I am happy to report that Scott has us complete the same type of assignment and I expereinced many of the same emotions that your students report. I am glad that professors take the time to make students aware of the desensitization process and encourage us to take the time now to become more comfortable with stuttering, before we work with our first clients. Re: I know how they feel From: Lynne Shields Date: 10/14/99 Time: 4:01:41 PM Remote Name: 199.217.219.197 Comments Laura, Thanks for posting your comments. It is nice to hear that students do understand the purposes behind the assignments, particularly the pseudostuttering assignment, and see the benefits, even when it isn't necessarily fun to do! Be sure you let Scott know, too. We need feedback from our students, so that we can continue to work on improving our courses. Best wishes as you complete your graduate studies, and in working with fluency clients. Regards, Lynne Fluency -facilitating techniques From: Gail Lind, Ed. SLP Date: 10/17/99 Time: 4:22:50 PM Remote Name: 63.11.58.142 Comments I was curious about a comment in the last paragraph concerning techniques you want to try in the future - Could you expand a bit on the fluency-facilitating techniques regarded positively by the graduate students mentioned? Thanks! Re: Fluency -facilitating techniques From: Lynne Shields Date: 10/18/99 Time: 10:22:46 AM Remote Name: 199.217.208.162 Comments Gail, Thanks for your question. I am planning to add more practical content into my course next Fall, including something similar to that reported by Ann McKeehan in the article I mentioned. She taught students to use fluency facilitating techniques such as lengthened vowels, frequent pauses, and short utterances. As you are probably aware, these are among the techniques that can be used to improve fluency for people who stutter. The students were asked to use these techniques at all times when they spoke for a period of one week, and keep a record of their contacts. They reported on listener reactions and their own reactions to their use of the techniques. McKeehan concluded that students learned how to use speech modification techniques, and came to better understand listener reactions to these techniques and how difficult it is to apply and self-monitor the techniques in everyday speaking situations. Not a bad lesson to learn for future SLP's. I am currently having students do some in-class practice with both stuttering modification and fluency shaping techniques, but I would like to increase the time spent in practice, so that they get some idea of what is involved in trying to make changes in their speech over a longer period and in a setting similar to what their clients will experience during carry-over practice. Hope this answers your question. Regards, Lynne Reducing the Fear From: Meghan Telitz Date: 10/18/99 Time: 10:23:23 AM Remote Name: 204.72.77.97 Comments Dr. Shields, Last spring, I took a course by Jerry Halverson through the University of Wisconsin at River Falls. While reading your paper, I felt as though I was reading the course syllabus for his course. I learned a great deal through this method of teaching. By having people who stutter come in and tell their own stories about fluency therapy and various levels of effectiveness, I was able to put my own fears aside and concentrate on each individual. Another approach that I feel is very helpful, is to watch therapy sessions either in person or on videotape. This allows a student to see how different techniques are employed. It is refreshing to see more professors step away from the 'typical' class formats and incorporate lessons that are so important for students to learn. Thank you for your time. Re: Reducing the Fear From: Lynne Shields Date: 10/18/99 Time: 11:08:53 AM Remote Name: 199.217.208.162 Comments Meghan, Thanks for your comments. I'm glad to hear from students who have had similar experiences in fluency courses. I am hopeful that with more faculty trying to de-mystify fluency therapy, there will ultimately be more SLP's working who are good fluency therapists, and who LIKE it! Your point about being able to watch fluency therapy, either live or via videotape, is a good one. I agree that it is so important to see the techniques being used. It certainly makes it much more concrete for students, as opposed to simply reading and hearing about the methods. Best wishes to you as you complete your training and move into the workforce. Regards, Lynne Desensitization Paper From: Susan Olson Date: 10/18/99 Time: 9:06:26 PM Remote Name: 209.32.211.237 Comments I was glad to read that many other clinicians are uncomfortable working with stuttering. I have taken courses on stuttering and have also attended several workshops. Part of the problem for me, is that I work in the public schools and I will often times go many years with out a stutterer on my case load. I have also found that each student I have had usually is very different from other stutterers. One may also have the characteristics of apraxia, autism, or many social-emotional problems. It is very difficult to stay up-to-date with therapy techniques in the many areas of speech-language. I am excited, however, about the many opportunities that the internet will provide! Re: Desensitization Paper From: Lynne Shields Date: 10/19/99 Time: 10:36:50 AM Remote Name: 199.217.208.162 Comments Susan, I'm glad to see you at this conference. This is one very good way to increase your knowledge in the area of stuttering. There are many good resources available in the form of books and internet sites. I would also encourage you to make use of personnel resources that may very well exist in your own community. Find out the names of any SLP's in your area who specialize in fluency treatment. They can be an excellent source of help for you when you have a fluency client on your caseload. Consult freely! Visit with them and learn from them. Ask them to do a workshop for SLP's in your district. If one of them works in your school district, then consider trying to arrange for this individual to work directly with the client, at least for a time, or serve as a co-therapist, while you learn from them. I can hear you say that the administrators won't allow for such an arrangement. However, there are both ethical and legal issues that arise from treating a client in a case where you do not feel fully qualified to treat--it is referred to as malpractice in the medical community. While school administrators may not be inclined to buy this, you need to be sure that you make this point clear and document it. Whether or not you are successful in gaining what you request, you will be pushing home the point that school districts need to: a) provide for continuing education for their SLP's and other staff, and, b) make sure that they provide appropriate services for all of their students. I am not suggesting, Susan, that you are incompetent to treat stutterers. (rather, the above is my plug for school SLP's to give those districts a push in the right direction!) You have many of the skills necessary to work with fluency clients, gained from your work with many other disorder types. In addition, you are working to gain further knowledge by attending workshops, taking courses, and reading the papers at this conference. I applaud your efforts and encourage you to continue gaining competency in working with children who stutter. The time spent will make you feel more confident and able to treat fluency clients, and I think you'll find that the skills you gain can be applied to children with other disorders to whom you provide services, as well. One additional resource that I'll mention in closing--all of the SLP's who have participated in this conference. If one of us lives in your area, I'd bet that person would be happy to consult with you when you have a tough case. You are welcome to contact me, though I don't promise to have answers to all questions. :-) I can be reached at: lshields@fontbonne.edu. Best wishes, Lynne psuedo-stuttering From: Debra Blanton Date: 10/19/99 Time: 7:35:48 AM Remote Name: 209.214.44.95 Comments Lynn, I am a graduate student of Dr. Hood's. I am so happy to have this assignment. My undergraduate course at a different college taught me nothing and I worked in the schools for two years with NO ability to work with PWS. I have attempted to stutter to strangers and have lost my nerve so far. I feel anxious and guilty about bothering the listener. I will succeed at stuttering, but I have a small taste of the emotion already. I know it will take years to become a good stuttering therapist, but I feel these assignments have at least set the right direction. Re: psuedo-stuttering From: Lynne Shields Date: 10/19/99 Time: 10:47:01 AM Remote Name: 199.217.208.162 Comments Hi, Debra, I think that you are very lucky to be able to learn from Steve Hood. You'll gain so much from participating in his class. I'd like to sit in on his classes myself. You certainly are having some common reactions to the pseudostuttering assignment, and you'll remember it when you work with fluency clients, I'll bet. So, don't worry that your nerve is suffering at the moment. You're in good company, and you'll do it, and do it well when you get down to it. Perhaps this is a good time to set yourself up with a heirarchy, like Ed Feuer suggested, to help you move on more easily. If stuttering with a stranger is too aversive at the moment, who could you stutter with and feel less nervous? Your mother? Best friend? The dog? An ant on your windowsill? Go for it! best wishes to you in your studies and in your future career. I'll be looking to see your name on one of these papers, maybe at the 10th Annual ISAD conference. Regards, Lynne Re: psuedo-stuttering From: Walt Manning Date: 10/19/99 Time: 5:15:25 PM Remote Name: 141.225.97.53 Comments Debra- I've enjoyed following along with with comments about Lynn's paper. I also have my students do a rather lengthy series of voluntary suttering experience...much of it follows the system that Steve Hood developed. I have then rate their anxiety and score their clinical abilities on a self-efficacy scale that we developed a few years ago. You mentioned that you feel bad about "bothering" listeners and I fully understand. But one of the things that I encourage my students, and especially my clients, to do, is to alter their attitude about this and actually "use" listeners in order to change their speech. I know this could sound a bit harsh but, within limits, it's actually rather healthy, I think. One good example is to "use" the people who call you on the telephone when you are busy or about to sit down for dinner. This is a perfect opportunity to practice your voluntary stuttering since they "used you first". Responding to listeners in a more assertive manner is a reasonable part of the treatment process. Re: psuedo-stuttering From: Lynne Shields Date: 10/20/99 Time: 3:53:56 PM Remote Name: 199.217.208.162 Comments Walt, Good to hear from you, and thanks for the encouragement for students (and clients) to get bolder about pseudostuttering. I may take you up on the idea of pseudostuttering with those irritating home sales calls--even though I don't have an assignment to do it! You remember, of course, having helped me work on my pseudostuttering assignment some years ago. I'm so thankful for your suggestions, which were of great value in shaping the assignment. I'm still working on it! Now, can I borrow from your self-efficacy scale?? Regards, Lynne I wish I could take your course From: Suzanne Danforth Date: 10/19/99 Time: 8:36:21 PM Remote Name: 24.218.91.126 Comments It is always heartening to hear an experienced clinician discuss their practice as a work in progress especially re: fluency. I have treated stutterers of all ages intermittently, but only felt somewhat comfortable with 4 and 5 year olds. The format of your curriculum is terrific and I hope your students avail themselves of all the opportunities you provide. Re: I wish I could take your course From: Lynne Shields Date: 10/20/99 Time: 4:05:37 PM Remote Name: 199.217.208.162 Comments Suzanne, Thanks for the compliments. You, too, can do some of the activities I use with my class, even though you are no longer in school. And, I'd encourage you to do so. I set up the class with the idea of exposing them to some of the experiences that I found most helpful to me when I started working on my own desensitization process. The videos I use are those that I think have some good, practical suggestions. The ones available from the Stuttering Foundation of America are VERY reasonably priced--$5-$10 for most of them. Pseudostuttering is a great experience to do, too--you can learn right along with your clients on that one. This semester, one of my graduate students was assigned to work with an adult fluency client. I think on the first or second day of therapy with this man, I walked in and asked the student to do some pseudostuttering with him. She may have been a bit taken aback (we hadn't yet begun to do this in class), but I demonstrated and she jumped right in, learning to imitate the client's stuttering. If you are planning to attend the ASHA convention this year, I know there are quite a few sessions on fluency, and many of them look to be very good, practical sessions. Hope to see some of you there! Thanks for posting your comments. Regards, Lynne Desensitization for SLP students From: Celeste Ruebl Date: 10/20/99 Time: 12:57:57 PM Remote Name: 204.169.193.61 Comments Lynne, Thanks for your great article!! I wish I could take your class...any plans to go around and do the inservice/conference circuit? I did go to a workshop that Kristin Chmela did in St. Paul last February and it really helped my comfort level. I currently have a graduate student working with me and she has been very honest about how uncomfortable she is working with stutterers. I am sharing your article with her and I have also been sharing the information from Kristin as I use that with a client of mine. We also have two stuttering referrals 'in process'. I think she is seeing what a big job it is evaluating, planning, and working with the students in addition to counseling the parents and school staff involved. Thanks again for a great article! Re: Desensitization for SLP students From: Lynne Shields Date: 10/20/99 Time: 4:13:41 PM Remote Name: 199.217.208.162 Comments Celeste, I don't have any plans to take my class on the road at the moment, but thanks for asking! Get someone to invite me to come to St. Paul--one of my sisters lives there. I'm pleased that you think my article worth sharing with your student. You all might want to do some of the same types of activities that I use in class together, tailored to fit your clients. I, too, think that Kristin Chmela has some wonderful ideas with regard to working with fluency clients. I have her SFA tape on working with attitudes and emotions, and it is one of those that I show in class-and watch periodically for myself. Best wishes to you in your practice, and a big THANKS to you from an SLP in a college setting for your willingness to take students. You provide a great service for training, and we couldn't do it without you. Regards, Lynne your previous students From: Faith Sansone Date: 10/20/99 Time: 5:30:43 PM Remote Name: 141.225.97.60 Comments I really enjoyed reading your article and it sounds like you teach a very informative class. I was just wondering if you've done any recent research with your previous students or current students that shows their comfort with stuttering clients before and after your class? Re: your previous students From: Lynne Shields Date: 10/20/99 Time: 10:32:30 PM Remote Name: 199.217.219.197 Comments Faith, Good question. I have done no formal studies on the effectiveness of the fluency course, although I do make an attempt to collect some information that will help me evaluate and make changes in the course. I ask students at the beginning of each semester that I teach the fluency disorders class about their background in stuttering and their comfort level. At the end of the semester, each student completes a course evaluation, which is one that is used across all courses at the college. For the past three years, I have added my own second sheet of questions to the standard form, and this includes questions asking about their perceptions of the course assignments and content, and whether they feel prepared to work with fluency clients. I then compare the early responses, which I keep notes on, with the end-of- semester evaluations. I have never directly surveyed former students to find out whether or not they were actually sufficiently prepared. I do get feedback from former students that indicates that they feel confident and successful with fluency clients. I'd say I've heard from maybe 15 former students on this subject in the past five years. In addition, some of my former students in the fluency course will later have a fluency client while they are still enrolled in the master's program. In our on-campus clinic, I generally supervise these clients, and I have been very pleased to see student clinicians who have a good idea of how to go about selecting treatment methods, who appear comfortable in working with their clients, and who ask good, focused questions of me as their supervisor. Of course, I have no way of determining how much is due to their having taken the class, and how much is due to their having a supervisor (me) who is also more comfortable in working with fluency clients now, compared to 10 years ago. I suppose I should give up doing the supervising and get feedback from another supervisor to help me tease that one out, but I'm too selfish. We don't get scores of fluency clients, and I like to work with them myself. Hope this answers your question. If you have any other ideas about how I might go about gathering data, I'd be happy to hear about it. Regards, Lynne Desensitization From: Janet Hartman Date: 10/21/99 Time: 10:31:23 AM Remote Name: 206.10.49.101 Comments Your course sounds terrific! Upon completion of a degree, one feels that they should have at least some of the answers. My limited experience with clients who stutter leads me to believe that I have few if any answers. One course in fluency disorders at the undergraduate level, twenty years ago and four clients later does not make me an expert. I continue to be fearful when a student is referred for fluency. Desensitization for clinician should be included in any course dealing with fluency. Thank-you for your article. It made me feel that although inadequate and fearful, I am not alone. Re: Desensitization From: Lynne Shields Date: 10/21/99 Time: 1:27:49 PM Remote Name: 199.217.208.162 Comments Janet, I'm glad that you found my article useful and encouraging. I hope my paper will give working SLP's a push to take the bull by the horns and do as much self-education as possible--reading, attending sessions at conventions, participating in on-line discussion groups on stuttering, and picking the brains of SLP's in their area who do have skills in working with fluency clients. Best wishes to you in your work and, here's to having a great adventure in learning with your next fluency client! Regards, Lynne desensitization From: Amy Rosonet Date: 10/21/99 Time: 12:26:49 PM Remote Name: 199.33.133.81 Comments My name is Amy and I am a first year graduate student attending the University of South Alabama. I am currently enrolled in a graduate fluency class. Our class also has several assignments of psuedostuttering. I am very nervouse about this assignment, but I am grateful to my professor for "making" our class complete the assignment. I feel that I will be more confident when working with a person who stutters. I will have a little knowledge regarding the feelings experienced by stutterers. I enjoyed commenting on this article. Re: desensitization From: Lynne Shields Date: 10/21/99 Time: 1:32:53 PM Remote Name: 199.217.208.162 Comments Amy, Thanks for your comments. I'd like to point out that most of us who assign our students to do pseudostuttering know that it is not fun, and feel very much for you as you work through the assignment. But, we are also convinced that it is a worthwhile activity, and that you will find the rewards really do outweigh your discomfort. Good luck to you in your training. I hope you are able to work with a few fluency clients while your are in school, so you can apply some of the great skills you are learning in class. Regards, Lynne Desensitization From: Hazel Camagong Date: 10/21/99 Time: 12:36:00 PM Remote Name: 199.33.133.81 Comments Your article was very interesting. Some of the assignments you mentioned apply to our fluency class as well. For the past few weeks, Dr. Hood has shown us the Van Riper series with Jeff. It was interesting to watch him improve! We have a few assignments where we have to stutter while asking people for directions, and practice repititions,prolongations, and canelling. Good ole Dr. Hood is preparing us and letting us get a little feel of the emotions experienced (postponement, anxiety, etc.) I feel all of those now and we have an assignment coming up where we have to tape record ourself in Van Ripers third stage of stuttering. I just wanted to comment on how our syllabi are similar. Interesting that we are not the only ones (graduate students) who have to voluntary stutter in public! Wish me luck, I'll need it. Re: Desensitization From: Lynne Shields Date: 10/21/99 Time: 1:37:11 PM Remote Name: 199.217.208.162 Comments Hazel, I appreciate your taking the time to comment on my article. And, I'm glad that you can now feel in good company--there are SLP students all over the country pseudostuttering along with you, and participating in a variety of assignments designed to help you gain experience and confidence in working with fluency clients. I do wish you the best as you get out there and stutter. It's the old 'no pain, no gain' philosophy, right? Take care. Regards, Lynne Website Resources From: Karla Becker Date: 10/21/99 Time: 3:38:58 PM Remote Name: 207.109.214.34 Comments I appreciate the effort that you have made to prepare your students for working effectively with stutterers. As a school speech/language pathologist,I have had only limited experience/exposure with stuttering students myself. I plan on using some of your teaching ideas to help reduce my own anxiety surrounding my ability to provide effective services to these children. Could you provide a listing of the specific web- sites that you feel are excellent resources of in- formation. Thanks!! Re: Website Resources From: Lynne Shields Date: 10/21/99 Time: 3:48:28 PM Remote Name: 199.217.208.162 Comments Karla, I'm so pleased to read that you are planning to do some self-desensitization! Wonderful--GO FOR IT! The best website for getting information for yourself and your fluency clients is Judy Kuster's Stuttering Homepage, which I assume you have been using to access this conference. Two other sites that I have found to be most useful are the websites for the National Stuttering Association (http://www.nspstutter.org/) and the Stuttering Foundation of America homepage (http://www.stuttersfa.org/index.html). I encourage you to explore all of these, and make use of the resources you find there. You may want to consider joining one of the various listservs on the topic of stuttering--several of them are listed on Judy Kuster's web page. That is a good way to learn, either by lurking or by participating actively. Best wishes to you, and thanks for your comments. Regards, Lynne Another Dr. Hood student From: Julie Estis Date: 10/21/99 Time: 4:53:25 PM Remote Name: 199.33.133.81 Comments Hello! I have enjoyed reading your article and the comments/questions that have followed. I am another one of Dr. Hood's gradute students. As you have heard from my classmates, we are working on some pseudostuttering assignments. I hope that as I practice stuttering and approach it head on, I will gain some understanding of how people who stutter think and feel. I know that I can never fully grasp the emotions of a person who stutters, but pseudostuttering will give me a reference point to work from. Thank you for your insight and helpful suggestions! Julie Estis Re: Another Dr. Hood student From: Lynne Shields Date: 10/21/99 Time: 6:05:58 PM Remote Name: 199.217.208.162 Comments Julie, It is great to hear from some of you who are currently studying under Steve Hood. You've are correct when you say that approaching the assignment head on will help you gain some understanding of stuttering. And, it will really help you understand how hard it is to do those assignments that you suggest to your fluency clients. I'm pleased that you are approaching the assignment with such a positive attitude. I know you'll succeed! Thanks for posting your comment. It is good to hear from students at other programs. Regards, Lynne Addressing our fears. From: Katharine M. Foster Date: 10/21/99 Time: 7:29:32 PM Remote Name: 209.12.238.24 Comments Ms. Sheilds, It was very good to read your paper on Desesitization. I worked last year in a rural school system. I had one client who stuttered severely and also had Down's Syndrome. Needless to say - as a person working with only my bachelors degree I felt very inexperienced in general. I had no idea that there were so many resources that I could have explored/used to be a better clinician last year. I found your paper very helpful in relating resources and other activities as a way to combate inexperience. This year I am blessed to be in a graduate program instead of practicing with so little knowledge. Dr. Hood's class has helped a great deal. We have wathched the Van Riper series and we will also do the pseudostuttering assignments. I know that even with all this exposure this fall in fluency class- it is only a drop in the bucket in terms of becoming a good clinician. I am encouraged to know that I am not the only one who feels inexperienced and that there are resources to help along the way. Thanks for working to make your class a more tangible and lasting experience. Sincerely, Katharine M. Foster Re: Addressing our fears. From: Lynne Shields Date: 10/21/99 Time: 10:48:23 PM Remote Name: 199.217.219.197 Comments Katharine, Being in Steve Hood's fluency class is a great start toward learning what it takes to do good fluency therapy. I was just showing portions of two of the videos of van Riper working with Jeff this evening in class. I'm finding that every year when I show them, I see more of what van Riper was doing and why--so I'm still learning from those tapes myself. Best wishes as you continue in Steve's class, and as you take part in the other activities that he has assigned the class. And, thanks so much for your kind words. It is encouraging to hear from students who are seeing the benefits of being more active participants in their education. Regards, Lynne Desensitization From: Kelly Gibson Date: 10/21/99 Time: 11:39:44 PM Remote Name: 205.188.197.27 Comments I found your article to be both insightful and rewarding. As a first year graduate student at the University of South Alabama, I too, like your students, feel inadequate in providing therapy for stutterers. I have had a fluency class in my undergraduate work and am now currently taking the advanced fluency class under Dr. Stephen Hood. He has incorporated many assignments, lectures, video tapes of Jeff and Van Riper, as well as having an actual classmate who stutters, all to enhance our knowledge and understanding of stuttering. I think the greatest gain that we can receive as students is for us to have as much opportunity to work with individuals who stutter, to engage in outside stuttering (which makes us all gain a greater appreciation for individuals who stutter) and to receive as many insightful tips, advice, and personal experiences from our teachers. I also wanted to say that I admire that you felt discomfort, apprehensive, and indadequate in providing therapy for these individuals. It makes students,like myself, feel better about ourselves as clinicians when we understand that our professors once felt the same way. Thank you for sharing your experience. Sincerely, Kelly Gibson Re: Desensitization From: Lynne Shields Date: 10/22/99 Time: 9:39:52 AM Remote Name: 199.217.208.162 Comments Kelly, I appreciate hearing from students. Thanks for your comments. You express so well the views that I hope all students have in approaching a course of learning in their field. And, I think you are right when you say that it makes it easier to know that one is traveling a road that others have been down before. Best wishes to you in your studies, Lynne Dear Students ------------ From: Steve Hood Date: 10/22/99 Time: 1:03:49 PM Remote Name: 199.33.133.50 Comments As students, and this goes for practicing clinicians as well, you have been exposed to some very important concepts. I hope you have made a copy of Dr. Shields's fine paper, and I hope you will read it again when you have your first stuttering client, read it again when you start having your client do outside "stuttering assignments." Read it again before you take the ASHA/CCC exam. Read it again when you finally receive your CCC-SLP. Most of the questions and comments also deserve to be printed and reviewed from time to time. If you will be working with "brothers and sisters of the tangled tongue" you will want to do all you can to reduce your own sensitivity, fear and apprehansion. You will need to do all you can to learn to stutter openly and honestly yourself. You will need to be prepared to go with your clients on outside assignment, to be able to model the targets you are hoping your client will achieve. You cannot sit passively by the road and require that your client run past you. No, Indeed, you need to join with your client and run the race together. You students of today are the clinicians for the next century. Please do all you can to accept the challenge, and strive to be up to the task. You have before you a wonderful opportunity, and an asesome responsibility. Best wishes, and good luck !!!! Steve Hood Thanks, Steve, and all who have read my paper From: Lynne Shields Date: 10/22/99 Time: 4:42:06 PM Remote Name: 199.217.219.197 Comments Steve, I can't thank you enough for your support on this discussion. You have added much to the content of my paper, and given so many words of encouragement to students and working clinicians. TI also want to thank all of you who have read this paper, and especially to those of you who took the time to respond to it. I am pleased to find so many who are doing some of the same things that I have tried to do with my course, and that there are so many of you who see the value in addressing this topic. With regard, Lynne