Thursday, January 24, 2008

Lack of motivation a convenient excuse?

When I talk to therapists and ask why many (most?) patients are not succeeding in therapy over the long-term. I often here things like "you are not motivated enough" or "the moment is just not right" or "there are no cures" or "we just don't know enough about stuttering" or "you need to practise more". Could I not turn this around and blame relapse on the therapist because s/he was not able to motivate the patient hard enough or made practising unnecessary difficult due to bad advice?? Have you ever heard a therapist at a conference talking about their mistakes? I haven't to this day. I only heard talks about success, enriching personal development experiences for the patient, and so on. And they also revel in showing just how sensitive, caring, bonding, holistic, intelligent, hard working, smiling, and most importantly professional (what ever that term may mean?) therapist they are; attributes that, to put it mildly, people who stutter are not that interested in, all they want are results for them!

Here is my analysis. Yes, it is true that motivation plays an important role in long-term success. You do need extraordinary motivation. For example, I was absolutely motivated at each of my therapies, though not obsessively. Even a good therapist might not be able to motivate some patients. However, this argument even though it is correct to some degree is also a very dangerous argument, because mediocre therapists can use it as an excuse for their own failure. They can hide behind it. This is also true for non-professional therapists like the crackpot award winners that I nominated. A healthy advice would be: if you are a patient and you fail, look at yourself to find points of improvements; if you are therapist and your patient failed, look at yourself to find points of improvements!

And here is a challenge to all therapists: I will buy that therapist a drink who gives a talk with the topic "The mistakes I made and why they were mistakes"! I would even offer a meal, but a meal with me might be too much punishment for the winner! :-)


Anonymous said...

I'm not a speech therapist, but an Occupational Therapist, currently in the public school system. The last district I worked for had 120 OT's and we approached personal "failure," as an opportunity for collaboration with a therapist that had demonstrated successes in that area. When you and your student are in a "slump," you need someone outside of the setting to observe and make comment. It's hard to work in isolation and develop "perfection" in all areas needed in a diverse practice. I've also observed that OT's and probably speech therapist see a successful intervention and overuse it, so it is not as successful as it could be within specifically defined parameters. I personally would love to be back in a situation where this level of self critique and the money flow allowed for continuing education and ongoing opportunities for research. (This is the drive behind "No Child Left Behind" and "Response to intervention" documentation within the public school system.) Is this really significantly different from other fields? Don't most professionals make similar errors and benefit from a collaborative working environment and opportunities for continuing education?

Anonymous said...

"You don't practice enough."

I have a very hard time saying my name when I call people who I don't know or have never talked to. My friends? Calling them is easy. I can say my name easily to them over and over again.

So how am I to practice?

I have been tempted to call a therapist friend of mine and let her give me the numbers of her colleagues so I can try to call them and introduce myself. I guess they wouldn't think it too weird.

I can, like a lot of others, say my name all day in the privacy of my office to myself, but once on stage, it's lights out.

Nel20906 said...

I find it amazing that people who stutter come from all walks of life. Well i'm 26, been raised in the U.S. almost all my life. I developed a stutter at the age of 6, and it's been with me since.

For the longest time I've allowed my stuttering control my life and until recently i decided to embrace it. I still stutter, but proudly, I dont know why I'm proud but hey, it beats being afraid.

Well i found your blog through google. Every now and then I just check up on stuttering and any updates, and I found your blog.

I checked the video link you had on one of your blogs and that is some interesting stuff.

Well thanks for your blogs, I'm glad to know that I'm not alone, that there is always hope.


Chad said...

A few months ago when I was trying to find a therapist in my area I met with one who actually started the meeting by telling me most people are not willing to do the work it takes to improve on or get rid of their stuttering. She went on to say that the forms of practice, exercises and especially the self-examination are simply too difficult and most patients fail or lose motivation.

I told her I didn't understand what she could possibly mean by this, and asked for an example of something that would be so hard that I would rather continue stuttering than go through it. Unfortunately she was unable to do so. Shortly thereafter she informed me of her fees, refusal to take insurance, and then gave me a $150 bill for the consultation.

Uh, thanks anyway. I'll look for someone else to help me.

Dinsdale said...

I'm a 46 year old severe stutterer and I used to be a PFSP junkie. About 20 years ago, it was the only thing that ever worked for me, and it worked amazingly well, possibly because of my limited expectations...for a relatively short time. But I was hooked, and the therapists knew it. When repeated refreshers at increasing personal expense would lead to diminished results, I was just told to stay the course, monitor targets, and, of course, sign up for the next refresher. The implication was that, I wasn't working hard enough or using the tools effectively. The fact that long term fluency for severe stutterers was (is) nearly impossible, was never raised. I was only encouraged to get back to my "dealer" ASAP to buy a few weeks of sweet, sweet, fluency, before inevitably falling back to the reality of my organic persistent, incurable, but manageable problem.

I still stutter up a storm at times, but I've given up on therapy. Too much attention was given to achievement and maintenance of fluency by myself and others, that it became the measure of my self-worth. I still don't have warm 'n fuzzy feelings for the therapists who sold me a bill of goods, rightfully knowing that the effect was temporary, and addicting.