Stuttering Intervention 3

Stuttering Intervention 3

• Stuttering intervention focuses on affective (feelings and emotions), behavior (core behaviors), and cognition (attitudes).
• Affective aspects include anxiety, fear, avoidance, and anticipation.
• Core behaviors are addressed through Fluency Shaping and Stuttering Modification (SSMP).
• Cognitive aspects involve reframing and reorganizing thoughts about stuttering and the person.

Approaches to Therapy

• Fluency Shaping (FS) emphasizes relaxation and motor skills during fluent speech.
• Stuttering Modification (SM) aims to modify or change stuttering moments, potentially involving negative practice.
• A combined approach (integrated) honors both fluency and stuttering.

Synergistic Stuttering Therapy

• The synergistic model considers neuro-physiological demands (speech motor control and language formulation).
• Physical factors (genetics and possible brain activity) are part of the model.
• Psycholinguistics, behavior, attitude, environment, and locus of control are also integral features.
• Therapist and client should aim to identify negative emotions, especially debilitating ones.

Intervention/Management of the Adult

• The normal communication process should be discussed.
• Motivating the client involves showing videos or playtapes.
• Use of websites, note-books/journals, and audio/video taping are supported.

The Process

• Combining modification and fluency shaping is an integrated approach (spontaneous controlled speech).
• Desensitization involves varying and controlling stuttering, using techniques for modifications, and practicing cancellations.
• Proprioception involves transferring to outside situations and encouraging group participation.

Relapses

• Discussing relapses, preparing for, and revisiting fears are useful steps.
• Client should have positive thoughts, realistic goals, and the therapist assists/supports in reality testing.

Person- and Family-Centered Practice

• A person- and family-centered approach involves education, conversations, and communication about stuttering, experiences, life goals, and holistic support.

Changing Cognition

• A quote about the desire for someone to inspire action is given (Emerson).

Motivational Interviewing

• Techniques include open-ended questions, feedback, reflective listening, affirmations, and summarizing.

Basic Principles for Positive Self-Talk and Attitudes

• Creating a safe space for the client
• Establishing objectives for therapy
• Facilitating opportunities for success
• Increasing awareness of fluency
• Encouraging technique use and carryover
• Preparing for outside situations.
• Improving communication skills (including pragmatics).

Clients Need to Know

• Stuttering is a point of view, and not a disability.
• Focus should be on positive goals and behaviors.

Client View of Stuttering

• Clients often view stuttering as a barrier to life.
• Reasons include "disorder of the spirit," lack of access to new beliefs, and difficulty managing control, leading to self-image issues.
• The pain of stuttering might outweigh the pain of therapy.

Low Self-Esteem Reactions

• Individuals with low self-esteem often react with "I can't."
• They may de-value their talents, feel unappreciated, and lack power and confidence.
• These individuals may become easily manipulated and be sensitive to frustration.

High Self-Esteem through Therapist Action

• Therapists can foster positive self-esteem through independent client choices, acceptance of responsibility, confidence, enthusiasm, and emotional expression.

Extent of Impact

• Stuttering impacts social and vocational aspects, and the clinical process.
• Successful management has related themes.

RET/CBT

• Rational Emotive Therapy (RET) or Cognitive Behavioral Therapy (CBT) are tools the therapist uses.
• Clients may have a history of loss of control, illogical values, and inconsistent attitudes.
  • The therapy addresses false interpretations, or beliefs, and helps identify the thought processes using an A-B-C-D-E model. A = activating event, B = belief system, C = emotional consequence, D = irrational belief, and E = changing to a rational belief.

Teach Positive and New Values

• Maslow quotes emphasize the importance of acceptance, love, and respect.
• Negative self-talk (e.g., "stinkin' thikin") is addressed by understanding the thought process (levels of thinking), the inference (e.g., demeaning inferences), and the resulting appraisals.

Overly Exaggerated Beliefs

• Overly exaggerated beliefs (like "I'm bugged because I'm plugged") are common.

Controlling Primal Processing

• Controlling primal processing (fear and self-criticism) guides the development of adaptive behaviours.

Therapist-Client Striving

• Therapists and clients should identify and work to change debilitating negative emotions in a process from incident, fear/negative predictions, and getting stuck and struggling into a break-out and new positive experience.

Simple Tips

• Clients should not be judged harshly for setbacks, failures, and lack of perfection.
  • Setbacks are normal parts of life, not catastrophes, and clients need to be reassured about their self-worth which isn't judged by achievement or popularity.

CBT Steps

• Cognitive appraisal steps help clients to understand the CBT process and become involved.
• Identifying self-defeating thoughts, changing through thought-stopping, and reality testing strategies are helpful ways to develop strategies.
• Substitute negative thoughts with positive self-affirmations, including ways to use self-enhancing language and development of coping mechanisms.

Long-Term Maintenance

• Steps for long-term maintenance include self-analysis, rational thinking, and achieving spontaneity.
• Avoid guru complexes and procrastination to foster independence and mental health.
• Monitoring action and performance helps to support fluency.

Starting Self-Help Groups

• Group support, offer information, provide a service, and use alternative therapy programs and activities.

Program Framework

• Needs assessment, group composition and communication needs, and choosing groups, activities, and topics are all helpful in developing a framework.