As an undergraduate SLP student, I was given the opportunity to work with a child fluency client at the University of Texas Speech and Hearing Center. This chance was especially exciting for me because I am a PWS myself (or “Person Who Stutters” for those of you not current on stuttering lingo).
It is from this perspective (of an eager SLP student with little experience as a practicing SLP but much experience as both a child and adult speech therapy client) that I write this post.
Most of my advice comes from my experiences receiving therapy, not giving it, which I think can provide a fresh perspective when it comes to strengthening your clinician-client relationship and providing effective treatment.
According to my parents, I have stuttered since the age of four and, after many experiences with speech therapy, assume I will continue stuttering for the rest of my life. Of course, my experiences as a PWS give me increased insight into the lives and challenges of other PWS, which definitely helped when providing therapy to my client.
1. Listen to Your Client and Adjust to Their Input
Developing and practicing effective listening skills is extremely important for fostering a happy and productive therapy relationship with your clients.
During my previous experiences attending speech therapy, my family and I encountered several SLPs who appeared to lack this skill. My mom often tells the story of my first interactions with an SLP. The speech pathologist, who I’m sure had the best of intentions, seemed to completely ignore the issue my parents were most concerned about: my fluency. Instead, she focused solely on a few articulation issues. Eventually, my parents, frustrated by the lack of attention towards my stutter, pulled me out of therapy altogether. (I’m sure some of you are thinking, “perhaps the speech pathologist had legitimate reasons for focusing her attention primarily on the articulation issues!” Don’t worry! I will address this in the next point). Regardless of intention, my parents felt their concerns and input were being completely ignored, which undermined the entire clinical relationship.
My most successful experience as a client was due to my clinicians’ willingness to listen.
During my first session and at several “check-in” points along the way, I would often discuss which specific situations I wished to focus on. Most of the time this involved completing a hierarchy of feared or difficult situations. For example, I might place making phone calls at the top of the list (because making phone calls is always hard!) and having an job interview at the bottom (because job interviews are so fun, right?!). While this may be a nice way to occupy fifteen minutes of a therapy session, this activity would have been useless if my clinician had not actually listened to my input. However, lo and behold, I would then spend several sessions working on making phone calls (or whatever I listed as my most-feared situation). In addition to addressing a real issue in my everyday life, this also strengthened the trust I felt toward my SLP. I knew that when I discussed my feelings about a certain technique or situation that my clinician was listening and truly working WITH me. I had a say in my therapy, which greatly improved my motivation to work on my speech goals.
2. Explain What You are Doing in Speech Therapy and Why You are Doing It
Explaining what you are doing and why you are doing it is extremely important to the client and/or parents.
As discussed in my previous point, my first experience receiving speech therapy ended when my parents felt their main concerns had not been addressed. Of course, the SLP probably had legitimate reasons for focusing on my articulation issues instead of my fluency disorder. Perhaps she felt the articulation issues were more urgent and required immediate attention. Perhaps she believed my stutter would go away on its own and did not want to bring attention to a non-issue. Perhaps she felt uncomfortable treating fluency disorders. Or, she may have actually been treating my stuttering (unfortunately I only remember playing Candy Land) but failed to communicate that to my parents. In any of the above cases, the SLP could have explained what she was doing and why she was doing it and perhaps avoided the disappointing ending to my time with her. My parents then could have made a more-educated and informed decision on my future in speech therapy. Instead, they were left to believe their main concerns went relatively unaddressed, which elevated their frustration with the whole experience.
My clinician did not expect me to blindly follow their advice but instead provided evidence to motivate my adherence to the techniques.
My success with therapy at the UT Speech and Hearing clinic came from my clinicians’ willingness to explain their techniques and the research that supported their use. I was even asked to read research articles supporting the use of certain strategies. If I had any questions or concerns, they always provided a thorough explanation of the techniques and the reasoning behind their use. Had my original therapist provided such information and open dialogue to my parents, I’m sure the relationship would have ended on better terms.
3. Check-In Often
After you have made sure to listen and explain, do not forget to check-in often with your client.
Oftentimes, I have felt frustrated with certain techniques or activities but did not address them with my clinician for fear of seeming too needy or difficult (a totally illogical fear, I know!). However, I’m sure many other clients have felt this same trepidation to address their concerns with their SLP. To prevent this, I think SLPs should make an effort to check-in with their clients at regular intervals. There are so many problems that could be resolved from simply checking-in. Maybe your client finds a certain activity completely useless or unhelpful. Maybe they do not fully understand a technique but do not want to address it. Maybe they have a really important issue they would like to address but do not want to interrupt your current focus. Providing an opportunity to discuss these and other issues can both prompt your client to share their opinions and feedback and strengthen the client-clinician relationship.
I’m sure that most of these points sound like common sense, but I think it is important to remind yourself that clients (both young and old) are people with their own opinions, feelings, and goals, something you must remember when providing therapy. While one issue may seem most important to you, and the treatment path clear and straightforward, your client (and their parents) may have completely different concerns and priorities. Taking the time to discuss their goals, consider their input, explain your approach, and check-in often can really go a long way in strengthening your clinician-client relationship and allowing you to provide the most effective therapy possible for each individual client.
Here are some great resources on Stuttering while we are at it:
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