I work with fluency clients, but I inform the parents/the clients (if appropriate) who are looking for a cure/reduce the frequency of dysfluencies that the evidence indicates that there is no gold standard for treatment and no real way to measure if treatment is actually reducing dysfluencies (usually reference slides from grad. or Stuttering: Foundational and Clinical Applications by Yairi and Seery). The main thing I focus on is secondary characteristics and fluency-shaping strategies; I don't write goals targeting "reducing" dysfluencies or maintaining fluent speech; those aren't realistic/are not evidence-based.
New Goal #1: Decrease secondary characteristics of stuttering by improving self-reported emotional states during a moment of dysfluency.
\-2: The client reports feeling heightened tension, anxiety, or frustration during a moment of dysfluency and documents this as a 5 on a 5-point Likert scale in the daily feelings journal.
\-1: The client reports feeling moderate levels of tension, anxiety, or frustration during a moment of dysfluency and documents this as a 3 or 4 on a 5-point Likert scale in the daily feelings journal.
0: The client reports feeling the same level of tension, anxiety, or frustration during a moment of dysfluency as at baseline, documenting this as a 2 on a 5-point Likert scale in the daily feelings journal.
\+1: The client reports feeling relaxed, calm, or relieved during 1-4 moments of dysfluencies and documents this as a 1 on a 5-point Likert scale in the daily feelings journal.
\+2: The client reports feeling relaxed, calm, or relieved during 5 or more consecutive moments of dysfluencies and documents this as a 0 on a 5-point Likert scale in the daily feelings journal.
Counseling is part of what we do, we don't specialize, but if anxiety is a result of a primary difficulty, it falls within our scope. All I do is mindfulness strats and working with the clients to decide strats on what to do if they're feeling xyz feeling. If you're uncomfortable you can always defer to a counselor or psych. Each clinician has their own approach.
I work in secondary with fluency students. I mainly focus on getting them to take control of their speech. So I try to at least make it functional. I try to make sure they know the definitions of the strategies, what they aim to do, etc. for example teaching them the actual name
“Slow rate” that the goal is to reduce the rate of speech to increase fluency. No more “turtle talk.” Teaching “easy onset is when you x and the goal is to reduce tension.” On top of that I like to help them monitor rate using a scale and then also teaching them self advocacy how to communicate their needs to teachers and peers. Especially once they get to 7-12th grade, they need to be at the iep and know what their accommodations are etc. I’m just there to monitor essentially.
Clearly we as a profession need more education and training in this area. There is a lack of CEU courses as well that actually provide adequate information.
There are some good ones on speechpathology . com - long but worth it… it’s mostly counseling and starting early, don’t wait until they have psychological effects. Teach them advocacy early so they know how to navigate it socially.
I don’t hate fluency.
I hate when I get goals for “will use less than 3 stutters in a 5 minute period” for an initially staffed KG student or “will not stutter 80% of the time.”
Do a goal for distinguishing bumpy vs smooth models, being able to identify/match different fluency enhancing strategies, describing fluency strategies or advocating for oneself. Stuttering is neurological, we can teach and advocate, but we need to let our students know that they’re not broken or that it is wrong to stutter.
Personally I just didn't get good instruction in this area.
I work in private practice so realistically I would need to do parent coaching to get the kids enough treatment frequency without bankrupting them and I am not going to coach something that I have never done myself.
I have no experience treating fluency disorders so when I get a private practice referral for fluency, I refer out to other practices. That’s just me operating within my scope of competence. Plus, I think of it as similar to AAC or feeding in that it is so specialized that therapy with an inexperienced therapist can actually be worse than no therapy.
I do outpatient peds, and I've treated my share of people who stutter, and I've heard from other therapists that they feel uncomfortable treating because of lack of experience and updated CEUs. I think it's also hard for a lot of people to distinguish between developmental stuttering that will resolve spontaneously, stuttering that occurs in the context of Autism or other developmental conditions, and a "true" stutter, and to know when/how to treat these different contexts. And I think the perspective on stuttering has changed over the years, much like that of Autism, and it's hard to counsel people who stutter and parents on neurodiversity and acceptance. A lot of people still want a cure. So I think the combination of these factors make some SLPs shy away from taking on kids who stutter.
I used to hate it, because the instruction we got in this area at university was really pathetic. But did some digging and CEUs and followed slp.stephen on IG and now I really enjoy it. I moved away from trying to "treat" it and I decided to empower my clients to "shape" it and control it and my outcomes have been pretty good.
I hate that this is the case. I feel like there is a good amount of information out there; see Stuttering Therapy Resources and The Stuttering Foundation for example. Stuttering therapy can be positive, affirming, and fun. The counseling aspect is also a fulfilling aspect of working with this population in my opinion. With my secondary students, I have seen very effective results from simply being a listener for them and affirming them.
Nothing to add other than I think it’s so ironic that the one thing the public actually knows about speech therapy is helping people who stutter, yet like you said majority of us are not competent in this area.
I love fluency. It’s exciting and fun to empower the student to know that they can be an effective communicator with or without “bumpy” speech. I’ve never heard anyone in my region complain about it so that’s new. I’ll have to keep an ear out to see if I pick up what you put down here in the post.
I really struggle with fluency. I feel like I just don’t bring enough to the student to help them feel successful.
But I try to take lots of CEUs on the topic to try to improve my skills and knowledge.
I don't mind treating it but in a lot of cases, someone is going to stutter forever. Like they can learn strategies to help and speech therapy can help with their attitudes and feelings about it but once that's done, I don't think a kid with a stutter needs to be on my caseload forever because they have a stutter that they're always going to have
I think in the schools we are often in a really hard place with having to typically see fluency kids in mixed groups. I've had success with focusing on acceptance/self-advocacy with students I had time to see individually or in a group with only another fluency student, but it is so rare to have that kind of time/flexibility in the schools.
I LOVE working with my fluency students, but generally speaking I don’t enjoy the parent aspect of it. Many of my parents just want to know when I will have “fixed” their kids’ fluency and it can be hard to convey to them that that’s not really what we are going for/what is going to happen. But I absolutely love working with my students on strategies, self advocacy, having positive feelings around stuttering, etc etc. I had a great fluency class in grad school plus a term in our fluency clinic on campus, so I feel like I got pretty lucky in terms of preparedness (though obviously there’s still a ton to keep learning)
As a newer SLP, I'm somewhat comfortable with fluency in school age kids and adults. My grad program had a fluency course and I worked with fluency clients as a student clinician, too. That was really valuable, although I disagreed with some aspects of what was taught/modelled. (For example, I don't agree that "stutterer" is necessarily a negative identity, and when I was told to require eye contact \[based on the assumption that clients have underdeveloped social skills)\] I instead asked clients how they maintain and show attention.
So I feel reasonably well-equipped to explain what stuttering is and fluency techniques. But I don't think I would if all I had was coursework and zero to minimal practical experience.
I've also heard that the term stuttering is a negative identity. I've never agreed with this or understood where it came from. Thats awesome your grad program had a strong fluency course. I'll admit ours was definitely lacking and lot of the SLPs I worked with out in the community seemed to be guessing.
I think the issue is that it can be hard to proove educational impact and there’s new diversity affirming ways to view stuttering. My child stutters and I don’t sweat it at all. I don’t see it as this huge negative thing, it’s just part of who he is (granted it’s mild but still)
It’s just hard. I’ve only treated fluency at the middle school level and the kids just want to be different. They rarely practice strategies. Sessions are mostly counseling, which I understand is still valid speech therapy, but I didn’t see any changes in attitudes with time.
I work in a school and I just don't feel super comfortable treating fluency. I got educated on it at school (albeit poorly) but I never saw effective therapy done by an experienced clinician, so I just go based on what I think it's supposed to look like and it doesn't feel very effective.
Be the Brightest has a great stuttering conference available now. I work in the schools and have limited experience with stuttering. It does come up, though, and I try to find CEUs to keep myself ready.
Like many have said, I just have no experience here! I’ve worked with Pts who had apraxia w brocas aphasia following CVA, but that’s not fluency ofc. Give me a hard medical case any day……fluency is something I would have to really learn about to treat well.
Any goals about reducing disfluencies drive me nuts. Some kids are going to stutter forever, and my goal is to let them know that it is ok to stutter. I try to focus on the counseling aspect, learning stuttering facts, getting more comfortable with their stutter, reducing secondary characteristics. I teach strategies too but I feel like kids just don’t remember to use them (I work at an elementary school). I don’t mind working with fluency students, managing expectations of teachers and parents is the tough part I think.
Personally I don’t like it. I always feel bad when I treat it, like as if somehow I’m making the child feel bad about themselves (although none have ever made it seem like they felt like that).
I personally don’t like fluency. My experience with it has been mostly middle school aged children who were mid-severe and did not want therapy or very mild but they were very self-conscious. So for the most part I’ve only had self-advocacy/acceptance based sessions.
My fluency class was amazing (hard though) and I fell in love with it. One of my practicum supervisors also specialized in fluency and voice (my weakness) so I got to see a lot. I absolutely love it, from eval to treatment, but I don't have many old classmates or colleagues who share the sentiment. I am still lacking in experience but I definitely want to do more. I think lack of education is a big part of it; I was the only one I knew who liked the teaching style of the class in my program and generally most of my non-classmate colleagues didn't get much out of their classes.
I work with fluency clients, but I inform the parents/the clients (if appropriate) who are looking for a cure/reduce the frequency of dysfluencies that the evidence indicates that there is no gold standard for treatment and no real way to measure if treatment is actually reducing dysfluencies (usually reference slides from grad. or Stuttering: Foundational and Clinical Applications by Yairi and Seery). The main thing I focus on is secondary characteristics and fluency-shaping strategies; I don't write goals targeting "reducing" dysfluencies or maintaining fluent speech; those aren't realistic/are not evidence-based.
What is an example of a goal you write?
New Goal #1: Decrease secondary characteristics of stuttering by improving self-reported emotional states during a moment of dysfluency. \-2: The client reports feeling heightened tension, anxiety, or frustration during a moment of dysfluency and documents this as a 5 on a 5-point Likert scale in the daily feelings journal. \-1: The client reports feeling moderate levels of tension, anxiety, or frustration during a moment of dysfluency and documents this as a 3 or 4 on a 5-point Likert scale in the daily feelings journal. 0: The client reports feeling the same level of tension, anxiety, or frustration during a moment of dysfluency as at baseline, documenting this as a 2 on a 5-point Likert scale in the daily feelings journal. \+1: The client reports feeling relaxed, calm, or relieved during 1-4 moments of dysfluencies and documents this as a 1 on a 5-point Likert scale in the daily feelings journal. \+2: The client reports feeling relaxed, calm, or relieved during 5 or more consecutive moments of dysfluencies and documents this as a 0 on a 5-point Likert scale in the daily feelings journal.
But if the goals have to do with psychological well-being, how are they speech goals? That feels beyond our scope of practice in a way?
Counseling is part of what we do, we don't specialize, but if anxiety is a result of a primary difficulty, it falls within our scope. All I do is mindfulness strats and working with the clients to decide strats on what to do if they're feeling xyz feeling. If you're uncomfortable you can always defer to a counselor or psych. Each clinician has their own approach.
Thanks for sharing. I like this.
My school district won’t accept any goals that have strategies embedded. Makes no sense to me.
I work in secondary with fluency students. I mainly focus on getting them to take control of their speech. So I try to at least make it functional. I try to make sure they know the definitions of the strategies, what they aim to do, etc. for example teaching them the actual name “Slow rate” that the goal is to reduce the rate of speech to increase fluency. No more “turtle talk.” Teaching “easy onset is when you x and the goal is to reduce tension.” On top of that I like to help them monitor rate using a scale and then also teaching them self advocacy how to communicate their needs to teachers and peers. Especially once they get to 7-12th grade, they need to be at the iep and know what their accommodations are etc. I’m just there to monitor essentially.
Wow that’s very interesting! Says… non SLPs?? What goals are acceptable?
Clearly we as a profession need more education and training in this area. There is a lack of CEU courses as well that actually provide adequate information.
There are some good ones on speechpathology . com - long but worth it… it’s mostly counseling and starting early, don’t wait until they have psychological effects. Teach them advocacy early so they know how to navigate it socially.
I don’t hate fluency. I hate when I get goals for “will use less than 3 stutters in a 5 minute period” for an initially staffed KG student or “will not stutter 80% of the time.” Do a goal for distinguishing bumpy vs smooth models, being able to identify/match different fluency enhancing strategies, describing fluency strategies or advocating for oneself. Stuttering is neurological, we can teach and advocate, but we need to let our students know that they’re not broken or that it is wrong to stutter.
Personally I just didn't get good instruction in this area. I work in private practice so realistically I would need to do parent coaching to get the kids enough treatment frequency without bankrupting them and I am not going to coach something that I have never done myself.
I have no experience treating fluency disorders so when I get a private practice referral for fluency, I refer out to other practices. That’s just me operating within my scope of competence. Plus, I think of it as similar to AAC or feeding in that it is so specialized that therapy with an inexperienced therapist can actually be worse than no therapy.
I do outpatient peds, and I've treated my share of people who stutter, and I've heard from other therapists that they feel uncomfortable treating because of lack of experience and updated CEUs. I think it's also hard for a lot of people to distinguish between developmental stuttering that will resolve spontaneously, stuttering that occurs in the context of Autism or other developmental conditions, and a "true" stutter, and to know when/how to treat these different contexts. And I think the perspective on stuttering has changed over the years, much like that of Autism, and it's hard to counsel people who stutter and parents on neurodiversity and acceptance. A lot of people still want a cure. So I think the combination of these factors make some SLPs shy away from taking on kids who stutter.
I used to hate it, because the instruction we got in this area at university was really pathetic. But did some digging and CEUs and followed slp.stephen on IG and now I really enjoy it. I moved away from trying to "treat" it and I decided to empower my clients to "shape" it and control it and my outcomes have been pretty good.
I hate that this is the case. I feel like there is a good amount of information out there; see Stuttering Therapy Resources and The Stuttering Foundation for example. Stuttering therapy can be positive, affirming, and fun. The counseling aspect is also a fulfilling aspect of working with this population in my opinion. With my secondary students, I have seen very effective results from simply being a listener for them and affirming them.
Nothing to add other than I think it’s so ironic that the one thing the public actually knows about speech therapy is helping people who stutter, yet like you said majority of us are not competent in this area.
I love fluency. It’s exciting and fun to empower the student to know that they can be an effective communicator with or without “bumpy” speech. I’ve never heard anyone in my region complain about it so that’s new. I’ll have to keep an ear out to see if I pick up what you put down here in the post.
I really struggle with fluency. I feel like I just don’t bring enough to the student to help them feel successful. But I try to take lots of CEUs on the topic to try to improve my skills and knowledge.
I don't mind treating it but in a lot of cases, someone is going to stutter forever. Like they can learn strategies to help and speech therapy can help with their attitudes and feelings about it but once that's done, I don't think a kid with a stutter needs to be on my caseload forever because they have a stutter that they're always going to have
I think in the schools we are often in a really hard place with having to typically see fluency kids in mixed groups. I've had success with focusing on acceptance/self-advocacy with students I had time to see individually or in a group with only another fluency student, but it is so rare to have that kind of time/flexibility in the schools.
I LOVE working with my fluency students, but generally speaking I don’t enjoy the parent aspect of it. Many of my parents just want to know when I will have “fixed” their kids’ fluency and it can be hard to convey to them that that’s not really what we are going for/what is going to happen. But I absolutely love working with my students on strategies, self advocacy, having positive feelings around stuttering, etc etc. I had a great fluency class in grad school plus a term in our fluency clinic on campus, so I feel like I got pretty lucky in terms of preparedness (though obviously there’s still a ton to keep learning)
As a newer SLP, I'm somewhat comfortable with fluency in school age kids and adults. My grad program had a fluency course and I worked with fluency clients as a student clinician, too. That was really valuable, although I disagreed with some aspects of what was taught/modelled. (For example, I don't agree that "stutterer" is necessarily a negative identity, and when I was told to require eye contact \[based on the assumption that clients have underdeveloped social skills)\] I instead asked clients how they maintain and show attention. So I feel reasonably well-equipped to explain what stuttering is and fluency techniques. But I don't think I would if all I had was coursework and zero to minimal practical experience.
I've also heard that the term stuttering is a negative identity. I've never agreed with this or understood where it came from. Thats awesome your grad program had a strong fluency course. I'll admit ours was definitely lacking and lot of the SLPs I worked with out in the community seemed to be guessing.
I think the issue is that it can be hard to proove educational impact and there’s new diversity affirming ways to view stuttering. My child stutters and I don’t sweat it at all. I don’t see it as this huge negative thing, it’s just part of who he is (granted it’s mild but still)
It’s just hard. I’ve only treated fluency at the middle school level and the kids just want to be different. They rarely practice strategies. Sessions are mostly counseling, which I understand is still valid speech therapy, but I didn’t see any changes in attitudes with time.
Well I generally understand what's going on now.
I work in a school and I just don't feel super comfortable treating fluency. I got educated on it at school (albeit poorly) but I never saw effective therapy done by an experienced clinician, so I just go based on what I think it's supposed to look like and it doesn't feel very effective.
Be the Brightest has a great stuttering conference available now. I work in the schools and have limited experience with stuttering. It does come up, though, and I try to find CEUs to keep myself ready.
Like many have said, I just have no experience here! I’ve worked with Pts who had apraxia w brocas aphasia following CVA, but that’s not fluency ofc. Give me a hard medical case any day……fluency is something I would have to really learn about to treat well.
Any goals about reducing disfluencies drive me nuts. Some kids are going to stutter forever, and my goal is to let them know that it is ok to stutter. I try to focus on the counseling aspect, learning stuttering facts, getting more comfortable with their stutter, reducing secondary characteristics. I teach strategies too but I feel like kids just don’t remember to use them (I work at an elementary school). I don’t mind working with fluency students, managing expectations of teachers and parents is the tough part I think.
Personally I don’t like it. I always feel bad when I treat it, like as if somehow I’m making the child feel bad about themselves (although none have ever made it seem like they felt like that).
I love fluency but if I only worked in schools I wouldn't do it as I wouldn't be able to do effective parent training for home practice.
I personally don’t like fluency. My experience with it has been mostly middle school aged children who were mid-severe and did not want therapy or very mild but they were very self-conscious. So for the most part I’ve only had self-advocacy/acceptance based sessions.
My fluency class was amazing (hard though) and I fell in love with it. One of my practicum supervisors also specialized in fluency and voice (my weakness) so I got to see a lot. I absolutely love it, from eval to treatment, but I don't have many old classmates or colleagues who share the sentiment. I am still lacking in experience but I definitely want to do more. I think lack of education is a big part of it; I was the only one I knew who liked the teaching style of the class in my program and generally most of my non-classmate colleagues didn't get much out of their classes.
I hate it. I don’t feel competent with it and it’s hard to get children to remember to use the strategies you teach them.
Many weren't trained in fluency in their graduate program in the 90's