Stuttering Intervention 3

Stuttering Intervention 3

• Stuttering intervention focuses on affective (emotions), behavioral (core behaviors), and cognitive (attitudes) aspects.
• Affective factors include anxiety, fear, avoidance, and anticipation.
• Behavioral factors include fluency shaping and stuttering modification (SSMP).
• Cognitive factors include reframing and reorganizing thoughts about stuttering and oneself.

Approaches to Therapy

• Fluency shaping (FS) focuses on relaxation and motor skills during fluent speech.
• Stuttering modification (SM) involves modifying or changing stuttering moments. It may include intentional stuttering.
• An integrated approach is recommended, recognizing that stuttering will often persist to some degree, and that success should involve building positive self-esteem.

Synergistic Stuttering Therapy

• A holistic approach, incorporating neuro-physiological demands, physical factors (genetics/brain activity), psycholinguistics (language/disfluency interplay), learned behaviors, attitudes, environment (self-esteem, confidence), and locus of control (internal/external).
• Therapists and clients should identify needs, particularly debilitating negative emotions and actively work to address them.

Intervention/Management of Adults

• Discuss normal communication processes
• Motivate clients through videos, play-tapes, and websites
• Maintain a note-book or journal
• Regularly conduct audio or video tape sessions.

The Process

• Combine stuttering modification with fluency shaping.
• Encourage desensitization and obtain control over stuttering behaviors/moments.
• Use techniques to modify stuttering and practice smooth transitions.
• Gradual transfer to outside situations.
• Encourage attendance at support groups.
• Clients should monitor their progress.

Relapses

• Discuss the meaning of relapses.
• Help clients prepare for revisiting and overcoming fears.
• Encourage positive thinking and set realistic goals.
• Understand that therapy takes time and involves practical assistance from therapists.

Person- and Family-Centered Practice

• Consistent with a family-centered approach, speech-language pathologists (SLPs) educate individuals and their family about stuttering and communication.
• Conversations should focus on the experience of stuttering, the individual’s communication expectations, life goals, and how to holistically support communication.

Changing Cognition

• "Our chief want in life is someone who will make us do what we can.” - Emerson

Motivational Interviewing

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

Basic Principles for Positive Self-Talk

• Create a safe and supportive environment in therapy.
• Collaboratively set specific therapy objectives.
• Create opportunities for success.
• Increase awareness of fluency.
• Encourage use of communication techniques.
• Prepare for the outside world (communication skills).
• Understanding of client perspectives.

Clients Need to Know

• Stuttering is a matter of perspective
• Dis/ability concepts.
• Stuttering and fluency coexist and can be included and addressed.
• Focus is on positive goals and behaviors.

Clients View Stuttering as a Life Barrier

• Clients may feel that stuttering is a “disorder of the spirit.”
• They may resist change and need help to find role models and access new beliefs that focus on control and personal growth.
• Stuttering is actively viewed as a barrier, and painful.
• Clients need to build positive self-images to achieve greater fulfillment and independence.

Low Self-Esteem

• Individuals with low self-esteem tend to demean their own talents, feel unvalued, lack confidence, and feel easily manipulated.
• They might blame others for their weaknesses and struggle to achieve goals.

Therapist and Praising Actions

• Therapists help clients build self-esteem so clients can make choices independently, take responsibility in a confident way.
• Individuals should feel proud of their accomplishments and approach challenges with enthusiasm.
• The therapist promotes tolerance for frustration.
• Clients feel appreciated by important people in their lives.
• Individuals feel capable of influencing others.

Extent of Impact

• Stuttering's impact on social and vocational aspects.
• Implications for clinical practice.
• Successful stuttering management themes.

Rational Emotional or Cognitive Behavior Therapy (RET/CBT)

• Clients might have a history of loss of control.
• Therapists address illogical, inconsistent, and unworkable values.
• Attitudes or beliefs that result from false interpretations of events must be addressed.
• RET/CBT diagrams the process of an activating event -> belief -> emotional response.

Teach Positive and New Values

• Emphasize that psychological health results from respect and love from others.
• Identify and address negative self-talk ("stinkin' thinkin")
• Separate descriptive level (facts) from inferences (interpretations)
• Therapists can teach and help the client evaluate and change negative interpretations to rational ones.

Overly Exaggerated Beliefs

• Irrational beliefs can evolve into unrealistic and painful experiences.
• It is important to recognize that such beliefs may be erroneous.
• The idea that something bad might happen is not a realistic reason to be fearful or unhappy.

Control Processes of Fear and Self-Criticism

• Therapy addresses the primal processing of fear and self-criticism.
• Clients are encouraged to replace negativity with positive thoughts, making progress, and overcoming past difficulties.

Therapist and Client Needs

• Therapists and clients focus on identifying and addressing negative emotions.
• There is a focus on breaking out of negative thinking patterns and creating positive experiences.
• Therapists and clients address feedback from schools, work, home and other settings.

Practical Tips

• Clients should be reassured that not achieving their goals does not make them bad people.
• Perfection is not required, and people can still be good and valuable even without perfection.
• Factors like popularity, achievement and success are not necessarily related to worth.
• Minor setbacks do not mean total failure or catastrophe.

CBT Steps

• Information is given so clients understand the process and objectives
• Cognitively assess what is important to the client
• Identify negative thought patterns (self-defeating thoughts)
• Replace these thoughts with more adaptive alternatives.
• Test the "old" hypotheses, and actively reframe them with reality testing, role play, and modeling by the therapist.
• Replace negative talk with self-enhancing language.
• Develop coping skills.

Long-Term Maintenance Steps

• Implement objective self-analysis.
• Develop rational thinking skills.
• Change thoughts to become more philosophical.
• Develop spontaneity.
• Maintain good health.
• Avoid the guru complex.
• Do not procrastinate.
• Develop self-independence.
• Use positive self-talk in all aspects of life.
• Monitor actions and behaviours, like athletes monitor workouts to track progress toward fitness goals.

Starting Self-Help Groups

• Groups offer support, information and advice, service delivery, alternative therapy, and group interactions.

Programme Framework

• Conduct group needs assessments
• Explore the group's composition (diversity of experience, needs, and opinions).
• Encourage open communication.
• Decide on activities and topics.