Attitudinal Changes
From: Pam Mertz
Comments
Hi
Diane - I loved this article. It makes so much sense and to use the parallels
with Carlin's piece is great. I was doing fluency shaping therapy for a while
(in a teaching program with grad students) and became really frustrated with
the fact that they, as students, had to focus on speech and language goals.
That was way away from where I was, and am presently. I needed to explore the
feelings that had been long buried - namely the shame that really unconsciously
consumed me. I felt that it was seen that I had explored feelings long enough,
and that I had to get on with learning fluency strategies. None of them worked
for me, and needless to say, I no longer go! And thats
OK. But I am so glad to see more and more a shift towards including the harder
stuff - confronting deep feelings, actively working towards reframing
attitudes, and acknowledging that it is ok. And I love the part of getting rid
of "non-essential" numbers. I always hated sitting across from a clinician
and seeing them count my stutters. This was an especially easy read, and very
helpful. Thanks again!
From: Diane Games
HI
Pam...what a beautiful response! You are correct that a lot of programs focus
on one aspect of stuttering. I do work on strategies to help with fluency, but
find that most adults need to explore attitudes and feelings..plus
do some thinking about communication....take care DG It was great to see you in
Cleveland! take care..DG
From: Robert Benton
George
Carlin did NOT write "Philosophy for Old Age". This is a common
misattribution. It was probably written by another comedian named Larry Miller.
The name of the author was changed because Carlin is more well known. See this
website: http://www.snopes.com/glurge/aging.asp
From: Diane Games
thanks
for the reference...as I said in my article, a friend sent this powerpoint to me that was reportedly done by Carlin..with his picture, etc. Live and learn...I really
found a couple of the comments in the PPT applied to the concepts I use in
treatment. I am sorry for not knowing this was not his work and thanks for the
reference.
From: Julie Gasway
Hi
Diane, This is a wonderful article that addresses difficult goals. I appreciate
the handouts on strategies to deal with stress, fearlessness etc., they look
like great ways to help clients take a look at these things in a nonthreatening
way. I think these would also be great for an adult group. I have always felt
rude doing fluency counts and they aren't helpful...thanks for your useful
activities and ideas!
From: Craig
Stephenson
We
are just as intimidated if not more so, when talking to you about our very
personal problem. I admire any S.L.P. that chooses to go into stuttering. No
two cases will ever be the same and itÕs a long hard road. Thank God for those
of you who do. Even if only one percent of the adult population stutters I am
sure if you talk to anyone who dose stutter and finds fluency or is able deal
better without fluency it changes their life forever.
From: Owusu-Yeboah
- Ghana
Hi
Diane, I am a stutterer undergraduate at the university for development
studies, ghana. I have struggled with a stumbling
tongue for the past 14-years to today. I hope and pray I don't want to carry
it(stuttering) with me into the future. Stuttering has cost me alot-making me live under my capabilities everyday in life.I pray if and only if change is important for change I
will witness this change with the help of your article. THANK YOU AND GOD BLESS
YOU.
From: Abigail Cary
Professor
Games- I really appreciate your contribution to the conference. It is
accessible and easy to understand (which is very nice for me, a first-year SLP
graduate student who knows little about stuttering), and I appreciate the
concrete materials youÕve shared to help therapists. I wonder if you think that
modified versions of the worksheets might be appropriate for children. I know
that children-especially young ones-generally experience less
self-consciousness and shame about stuttering than adults to, but I wonder if
using confidence-boosting/balancing materials similar to the oneÕs youÕve
included with ÒCognitive and Attitudinal Changes in Teens/Adults who StutterÓ
might help alleviate some of psychological stress that those kids would face
down the road? Do you have any experience working with the attitudes of
children who stutter? Thanks, Abigail
From: Diane Games
Hi...thanks
for your comments. I do not use these specific activities with children and
rarely with teems as they are cognitively too advanced. I do you simplified
graphic organizers to talk about various situational variables and I use Power
Point to have kids talk about different aspects of stuttering and
communication...it is neat because they can share their thoughts with others.
From: Tara
How
would you respond if a client simply "shut down" in the middle of a
therapy session (they were so discouraged that they refused to go on).
From: Diane Games
Fortunately,
I have not had this happen..but when a client is
upset or an activity is not going well, I stop the session and talk about what
I observe..something like "I can see that this
is difficult" or "I can see that you are upset". I then listen
or sometimes sit quietly with them. I never force an activity....and will
remove it and move onto something less emotional. Hope this helps...sometimes a
client is not ready to talk about certain issues.
From: Alyssa Saunders
This
is a wonderful article. I especially like the article about the
"inner" game of tennis. I deal primarily with voice disorders. I
myself have had a voice disorder and know that one must change the inner voice
before he/she changes the outer voice. Learning to TRUST oneself is the hardest
thing to do, but the most important when it comes to any speech disorder, be it
fluency or voice. Thank you for the great article.
From: Janet Skotko
I
have read that generally with teens and adults, the search for tx or return to tx is due to a
more mature acknowledgement of the need for some help due to an upcoming event
in life; they also are more motivated and simultaneously want a faster 'fix'.
Do you see that?
From: Diane Games
Janet...I
have seen that with some clients, but often adults who stutter are just
"tired" of avoiding, changing words, or dealing with the management of
speaking...but, no matter what brings a client in the door, they need to
examine how stuttering impacts their life....and to work on change. the process
is different with every client..there is no one way,
activity, etc..thanks for your comments..DG
From: Rachael A.
Professor
Games, I appreciate your contribution to this event. Your paper reminded me of
a class discussion in my fluency class this week. I am a first-year graduate
student in Speech-Language Pathology and this semester is my first experience
with stuttering. WeÕve been discussing ÒsuccessÓ and how to help clients
realize their own success both in and out of the therapy session. I believe the
difficulty with adults and older teens is that they are aware of the goals they
have set, and thus are much more likely to adopt a discouraged attitude when
they do not reach their goals in the time they had expected. I think it is
important for clinicians to help their clients realize that success is possible
without achieving a long term goal or even a short term objective. There can be
success in each session. I thought your handouts/worksheets would be very
useful in helping clients see and experience their own success. It seems as
though this counseling aspect of fluency therapy would be very beneficial. In
your experience, do you find that people respond better to therapy when they
have a positive attitude and understanding of success? Thank you for your time.
Rachael A.
From: Diane Games
Hi!
You have targeted the main reason so many people get discouraged in
treatment...as a therapist you need to prepare your client for the various
aspects of change..and when changing any behavior, it
is a process..and with people who have stuttered a long
time, it takes time to work through these issues. This is my problem re:programs that deal only with the surface features of fluency..thanks again for your thoughtful comment.
From: Emily and
Alicia
We
were wondering what advice you offer to your clients when they tell you their
family and friends give them unwanted advice about their stuttering? Thanks!
From: Diane Games
Date: 24 Oct 2010
Time: 21:49:28 -0500
Remote Name: 76.17.183.48
Hi
to both of you! As with many things, family and friends are often the first to
offer advice about stuttering...and someetimes the
advice is not "evidenced based"!! I always do an educational piece
with my clients..usually over several sessions. I
also give them articles to read thoughout treatment..this helps to counter the "advice"
from others which is usually given to help, but not always accurate!
From: Lindsay Chargois
I
really liked your comment about focusing more on the positive (strategies the
client uses to minimize his or her stuttering) instead of the negative (how
often the client stutters). Do you think that fluency counts are completely
nonessential for the adult population or that they just shouldnÕt be used as
much?
From: Diane Games
thanks
for your comments..I work on fluency
shaping/stuttering modification strategies in every session! This article is on
one aspect of my therapy. I do fluency counts at different times based on the client..the need/amount of time in treatment/the difficulty
he has in using the strategies. These counts are very important in treatment
and I do them regularly! This article is about another aspect of treatment that
I do simultaneously with the target work. I will add that the amount of
strategy work depends on the client.
From: June Sultan
Hello.
I am currently a first year graduate student at NYU taking a course in fluency
disorders as well as adolescent development, so I would first like to say that
I found your paper extremely interesting! In my fluency class we talk a lot
about the idea that we do not know if we can ever completely "cure" a
client's stuttering. I was just wondering what you do in a situation where your
adolescent client is set on "curing" his or her stuttering. Do you
work on changing his or her attitude about stuttering first? Or do you go along
with the idea that the stuttering can be "cured" so that their
commitment to therapy won't become diminished?
From: Diane Games
Jane,
I accept the beliefs of each client..nothing is
presented as the wrong/right way of doing things!! Therefore, often the client
problem solves many of the issues...with my guidance. I never tell an adult
client that they are "dismissed" from treatment and I keep the door
open for a return to treatment..making the transition
easier for them...thanks for your nice comments.. DG
From: Monica Johnson
Date: 24 Oct 2010
Time: 22:01:39 -0500
Remote Name: 76.17.183.48
I
really enjoyed this article and appreciate you writing it for everyone to read.
I have a quick question: Trying to address long-standing emotions and thoughts
about communication in therapy activities, do you ever feel that dealing with
emotions is out of our scope of practice? How and where do you draw the line
from speech therapy to referral to seek counseling?
From: Diane Games
I
do think about ethical practice with all of my treatment and have served as
chair of Ethical Practice Committee for the state of Ohio. To treat stuttering,
a clinician must deal with the motor, attitudinal and affective parts of
stuttering. I have studied with some of the best clinicians in our country and
a comprehensive program of treatment is not seen as un-ethical and is used in
many centers To answer your question, I also would not hesitate to refer a
client for counseling if needed. I feel that an approach that only deals with
the motor aspect of stuttering is sorely lacking from the emotional aspects
along with cognitive aspects of the disorder. SLPs
are trained to do this type of treatment..though it
takes practice and study with other professionals which I have done...hope this
answers your question.
From: Allison
Fontenot
I
really enjoyed your article and would like to ask you a quick question. As a
Speech- Language Pathologist, do you agree with the third point discussed in
ShapiroÕs book? I understand how important it is to address the feelings of the
person who stutters, but I was wondering if you ever tend to see the complexity
of behaviors, beliefs, and thoughts decrease with time? I ask this because I
think of those who, over time become more familiar with the factors that often
trigger the stutter and find ways to compensate for these factors and gain the
motivation needed to help with the changes they are hoping to make.
From: Diane Games
What
a great question!! Not a quick one..:) Every client is different and certainly
with clients who stutter, there are a lot of variables. I do therapy that is
individualized to meet the needs of the clients. What you are seeing in this
article is a compilation of activities that have been successful with several
clients...but no client does these in the same order and some so not do them at
all. No one therapy is workable for all clients...as for working on the
cognitive and emotional aspects of stuttering along with the motor aspects...all
of my clients get a dose of all three!! I have studied with some wonderful
therapists, but the ideas and my approach is a compilation of several types of
therapies. in my experience, no two clients do things in the same way and I do
not going into therapy expecting that...I am constantly developing new
worksheets to address issues...as for the motor part of treatment...this
happens every session!!!! Thanks for your great question.
From: Teela
Faircloth
I
really enjoyed your article and found it extremely important to know that
negative emotions are sometimes associated with stuttering and should be dealt
with. However not all PWS will have these negative emotions and treatment
should only focus on what the client needs. I like that you included the
importance of educating family members on the emotional state of the teen/adult
who stutters. As a current graduate student, I would like to pose a quick
question, when is providing counseling for a client outside our realm of work
and when should outside referrals be appropriate? I guess what I am asking is
where do SLP draw the line when counseling clients? Also in your opinion do you
think there should be classes in college that teach/inform this type of
counseling for individuals with communication disorders? Thank you.
From: Diane Games
Date: 24 Oct 2010
Time: 22:14:08 -0500
Remote Name: 76.17.183.48
SLPs counsel in every
session...i.e. when you tell a mother what to do with regard to handling
various treatment disorders. I did a lot of training with slps
who are very talented in treating stuttering..yes,
this type of treatment is within our scope of practice, but if ever I am
uncomfortable re: a client's need for counseling, then I do refer out.
From: Erin
I
appreciate your post and found it interesting to read. The materials you
provided at the end of the article were great to think about how they would be
implemented in therapy. You mentioned the importance of working with the family
and maintaining positive relationships. I was wondering if you would recommend
similar handouts for parents/family/friends to discus their perspectives? It
appears the attitudes of listeners in the individuals environment are also
important. Especially at the beginning of intervention, are there ways for them
to break down their thoughts and how they want to help the person who stutters?
Erin...this
is a great idea. I usually have family members attend some sessions, but it
would be great to have some feedback from them..it
also might open some dialogue about important issues.
From: Kassie
Lawson
I
am a current Graduate student in Speech Language Pathology and really enjoyed
reading your paper because it went along with what I learned in a counseling
class this summer. When adults come to therapy they are usually coming on their
own, they dont have someone making them come so I
have a question pertaining to that. At the initial meeting with the adult would
you kind of lay out everything or just take things as they go. For instance
would you tell them about the 'causes' of stuttering, ask them about emotions,
feelings, or problems with others, and those things? or would you just let them
express emotions, guilt, problems with family members, and things on their own?
Thank you for your time.
From: Diane Games
Kassie, First I do a
complete evaluation that includes Attitudinal, Cognitive and Motor assessments.
After the assessment, I schedule a meeting to "go over" the
information that I observed in the dx. Listening
during this entire process is the best advice that I could give. I learn so
much during this process. I always set up each session with the reasons why I
am doing an activity and this relates to the dx
information. I don't treat any two adults in the same way...but I do have some
activities that I like to use with all adults when they are ready.
From: Kayleigh
Barton
Diane:
Thanks for the great article, I loved how holistic and simple your tips were.
The last point about "keeping it simple" to help increase carryover
is very powerful. I know you only mentioned carryover briefly, but I was
wondering in general what your thoughts were about how well stuttering therapy
does carryover with adults. Does there have to be some kind of
"acceptance" by the PWS before you see that carryover? Or does the
drive to improve work for some? Thanks for you time.
From: Diane Games
Concerning
your question about carryover with adults who stutter: in my experience, adults
are variable in all of the areas that we see variability in children/teens..but they have been stuttering longer which does
often impact confidence and expectations for success. There is also an issue of
motivation..once some people realize the amount of
work and effort needed to make change, they become less interested. On the
other hand, many adults make excellent changes in their speech....finding that
having some problem solving strategies really helps them.
From: Jennifer Cosentino
You
speak about letting the client handle any grief he may have during therapy.
When a client begins to talk about guilt and the emotional aspects of
stuttering during therapy, how do you personally determine between what is
within the scope of practice and what needs to be referred out? Where does the
line get drawn between helping a client work through grief to move forward in
treatment and discussing grief to the point where it might be a psychological
issue that SLPs are not adept in handling?
this
is a great question that probably does not have an exact answer...some clients
come to treatment for stuttering while in counseling...other have been in
counseling for periods of time. Some adults do not need counseling! I keep
discussions focused on the issues related to stuttering and when the client
keeps moving to discussions emotional/attitudinal issues not related to
stuttering, then I refer them for general counseling. Discussions of grief and
emotions related to stuttering are welcomed..i.e. not
speaking in various situations, or feelings from past difficult interactions,
or negative reactions from close family members, etc.
From: Courtney Sacco
I
have come to learn that a beneficial part of therapy in relation to stuttering
is the idea of increasing a person's acceptance of their stuttering through
reducing feelings of shame, guilt, and embarrassment. I know you touched on the
aspect of reducing the guilty feelings within one of your clients, but I was
curious in connection to working towards this goal with a client, have you
experienced any challenging escape behaviors that are occurring due to the
negative affect and what type of therapy methods did you find most sufficient
in addressing the behaviors?
From: Diane Games
I
have had some clients use some escape behaviors and to be honest, I feel that
this will continue for some people despite making good progress in treatment. I
approach this type of discussion with 1) defining escape behaviors, 2) making a
general list of these types of behaviors, and 3) what does escaping vs. not
escaping accomplish for the speaker..or something
along that line. I know that it is not an easy behavior to manage and I respect
that issue for my clients...I approach it as a problem that will be addressed
over a long period of time.
From: Katara
Tabaa
I
appreciate the treatment concepts that were adapted from "Philosophy for
Old Age!" I agree that counts should focus on the positives. As a general
rule, we all like to hear what we did well (vs. where we could have improved).
Focusing on the positives is much more empowering. I also agree that the client
should learn about stuttering, I feel this would empower the client (i.e.,
because they are involved and understand stuttering). Laughter is the best
medicine! If a client feels comfortable to laugh and smile in therapy, we are
doing something right :) I think listening in a non-judgmental manner is always
important, not only for the clinician. It is important to address guilt. Guilt
may arise with individuals who stutter (and with other individuals). I feel it
is important to address the guilt because this will help the individual to form
a more positive relationship with their clinician. I find it very important to
teach others about stuttering. There are many stereotypes associated with
stuttering. As a future SLP I feel it is part of my job to dispell
these stereotypes. And lastly, I agree 100% that a client should leave therapy
feeling empowered to make change. Knowing that a client is empowered is the
most positive feeling an SLP can have. Thank you for sharing these points.
These are things that I have never thought about directly...and sometimes we
need things pointed out for us :)
From: Abby Waller
Professor
Games, I am a first year graduate student in WCU's
Communication Sciences and Disorders program. Before entering this new field I
had been working in the mental/behavioral health field. Much of my past
professional experience has been working with teenagers who have become
overwhelmed with the pressures of growing up without adequate coping skills. As
a mental health clinician building rapport and making progress with a teenager
can be very different, and often more challenging, than with adults.
Interventions that work with adults may not be effective for teens and there is
often more resistance to treatment. I'm wondering about your experience as a
SLP in working with teenagers as opposed to adults and the differences you've
encountered. Thanks!
From: Diane Games
Date: 30 Oct 2010
Time: 22:15:42 -0500
Remote Name: 98.28.157.96
Abby..what a great
question! My experiences with teens is generally they want a
"quicker" fix..not all of them but some. I
also vary my presentation of concepts with teens...focusing on motor issues
initially and then generally problem solving situations and then more into the
attitudinal/cognitive aspects of treatment. BUT every client is different and I
feel that treatment needs to be varied based on a number of client issues.