Thursday, February 21, 2008

What many therapists really think!

Have you ever wanted to know what your therapist really thinks? Here it is. I got an email from a therapist who shared his private views. I find that his views are quite similar to what other therapists tell me privately:
I am from Australia and currently work as a speech pathologist (as we are known here). I do not specialise in stuttering, but have seen around 15 cases of stuttering in children aged 4-14 since graduating 7 years ago. I read some of your blog early last year, and was reminded of it when I found an old email that I'd sent to a friend, who used to be a speech pathologist, regarding your "Do therapists believe in their therapy?" post. I thought what you wrote in this post was very accurate, and can be applied to other areas of speech pathology besides just stuttering. Currently, high-level scientific evidence (from meta-analysis of several independent randomised controlled trials) is lacking in virtually all areas of the profession. Your blog has many valid points regarding therapists and therapy for stuttering. I commend you for taking a sceptical approach to stuttering therapies, and am writing to tell you of some of my experiences. When I was a student, I took a semester subject on stuttering in the 3rd year of the degree course (of 4 years). The subject differed to other speech therapy-specific subjects in the course, in that it only had one lecture given by somebody other than the subject examiner. Nearly all of what was taught in the subject was 'smooth speech' (a variant of prolonged speech) for adults, and the Lidcombe Programme for children. I felt very much that the therapy techniques our lecturer used/preferred were emphasised, rather than giving equal time to other techniques. Much lecture time was also spent on practising 'rating' videos of stutterers - where we would count the number of syllables spoken, syllables stuttered, etc. We had a few 'recovered' adult stutterers who had gone through the university's intensive fluency clinic (learning smooth speech) speak to us of their experiences. We got to observe our lecturer taking a case history with an adult, and deliver a therapy session to a pre-school child.

In the final year of my degree, there was the option of undertaking an intensive fluency ('smooth speech') clinic with adults, but not everybody undertook this placement as it was part of an elective clinical subject, and not a core one. I did not do this placement, and the only stuttering clients I saw as a student were 2 adults, for 2 sessions each, in another placement at a rehabilitation hospital. I never directly worked with a child who stuttered until my first employment upon graduation. This level of exposure to stuttering would not have been uncommon amongst the students in my course. From my experience of working with children who stutter, the 'success' stories have all been with students aged under 7 (mostly under 6), and using similar techniques to the Lidcombe Programme and environmental modification (i.e. counselling parents and teachers on how to maximise their child's fluency/modify their own speech/what to do when the child stutters). I don't feel as though I have directly 'cured' the stutter in these cases, even though the students have gone on to have fluent speech. Rather, I may have helped assist/speed up the natural recovery process, and minimised the risk of the stutter becoming worse. It's possible that these children may have recovered on their own without my input. I must say that I do feel less competent when working with older students who stutter, because I feel that the expectation is that speech therapy should be able to 'cure' the stutter, but so far I've not been able to do this with the handful of older students I have seen. The stutter is usually also more advanced, and the student has passed the period of likely spontaneous recovery.

I agree with you on thinking that therapists' focus on the other, non-speech stuff may be because deep down they know (or soon realise) that fluent speech maintained over time isn't likely to occur due to their therapy; and that it's too easy to blame it on the patient when the therapy doesn't work. One of the greatest barriers to developing 'expertise' in stuttering for the typical speech therapist is that it isn't something that most of us commonly see. I might see 2 students who stutter a year, but 100 or so students for other speech/language disorders. Frequency and duration of therapy is also another issue, as currently I am typically able to see a student once a fortnight maximum during the school year. Also, there are also always new referrals/assessments, etc. to be done. One of the most frustrating things I think I would find with speech therapy, if I stuttered, is the therapist believing that *they* are the 'expert' in stuttering, when they haven't stuttered a day in their life. By the way, the lack of male speech therapists isn't just specific to Europe - in Australia it's around 3% male, and I believe something like 6% of ASHA members are male in the USA.


Anonymous said...

It should be noted, that this testimonial is just that, an opinion. What about the suggestion that there are "sub-types" of stuttering. As a therapist, I would argue that a lack of success probably stems from over applying broad techniques, when there is a need to determine specific techniques for more specific problems. It could also be argued that to help cope with the symptom/ stuttering, a specialist in stuttering (Speech pathologist, MD etc..) could be one facet of managment.

Anonymous said...

I forgot to post my name :-)