Stuttering Intervention 3 PDF

STUTTERING Presented by: INTERVENTION 3 Dr Shabnam Abdoola  Affective (feelings and emotions) Anxiety, fear, avoidance and anticipation Behavior (core ADDRESSING behaviors) THE ABC’S OF Fluency Shaping...

STUTTERING Presented by: INTERVENTION 3 Dr Shabnam Abdoola  Affective (feelings and emotions) Anxiety, fear, avoidance and anticipation Behavior (core ADDRESSING behaviors) THE ABC’S OF Fluency Shaping Stuttering Modification (SSMP) STUTTERING Cognition (Attitudes) Reframing and reorganizing our thoughts and ideas about stuttering and ourselves 2  Impairment Fluency Shaping (FS) Approach - Shaping is about relaxation and motor skills, emphasizing what happens during fluent speech. However, working on modifications and motor skills alone is not enough. Therapy must also address attitudes and emotions, which we’ll discuss last. Stuttering Modification (SM) Approach - is about stuttering more fluently - modifying, changing, or APPROACHES smoothing out a stuttering moment. Students need to look at and work with the moment of stuttering. This may involve negative practice and stuttering on TO THERAPY purpose. The integrated approach Both fluency and stuttering should be honored in therapy. Since most people who stutter will always stutter to some degree, recognizing and targeting fluency alone can be dangerous to self-esteem. Besides, no stuttering therapy approach is 100% successful. All people who stutter should be helped to feel that it’s OK to stutter. 3  SYNERGISTIC STUTTERING THERAPY: A HOLISTIC APPROACH (Bloom and Cooperman) – provides a good summary The synergistic model: ⬥Neuro-physiological demands – reduced speech motor control and language formulation ⬥Physical factors – genetics and possible brain activity ⬥Psycholinguistics – the interplay between language and disfluency ⬥Behaviour - learned ⬥Attitude and environment –self esteem, confidence = how readily they will express ideas and opinions ⬥Locus of control – inner self or external events. The therapist and client should strive to – identify needs especially the debilitating negative emotions  Discuss the normal communication process. Motivate the client – show videos or play tapes. INTERVENTION/ MANAGEMENT Refer to websites. OF THE ADULT Keep note book or journal. Audio or video tape sessions regularly. THE PROCESS Combine modification with fluency shaping - an integrated approach (spontaneous controlled speech) Desensitise Vary and obtain control Use control techniques and modify the stuttering Cancellations Proprioception Transfer to outside situations as soon as possible Encourage to attend groups Must monitor self RELAPSES Discuss what these are Prepare Revisit fears Fake stutters Positive thoughts Discuss and use fears Help set realistic goals Therapy can be quite time consuming The therapist assists and supports the client in reality testing Conture (2001, p 293) “we are guides not magicians” Person- and Family-Centered Practice Consistent with a person- and family-centered approach to stuttering treatment, the SLP educates the individual who stutters and their family members about stuttering and communication and facilitates conversations between the individual and their family about the experience of stuttering, the individual’s communication expectations, their 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: ▪ Open-ended questions ▪ Feedback ▪ Reflective listening ▪ Affirmations ▪ Summarizing Basic principles to encourage positive self talk and emotions and attitudes ⬥create a safe house ⬥client and therapist establish objectives for therapy ⬥create opportunities for success ⬥heighten awareness of fluency ⬥encourage the use of techniques ⬥working on maintenance and carryover ⬥prepare for the outside world ⬥establish good communication skills (pragmatics?) ⬥in order to get a better understanding – therapist to “walk in PWS shoes” Clients need to know ⬥Stuttering is a point of view ⬥DISability or disABILITY? ⬥Have the paradigm of a stuttering – fluency can include stutter ⬥Focus on positive goals and behaviours WHAT MATTERS MOST IS HOW YOU SEE YOURSELF! Clients view stuttering as a barrier to life ⬥“Disorder of the spirit” ⬥Need to access new beliefs – find role models ⬥Against all odds ⬥Take control ⬥Stuttering creates more pain than the pain of therapy. ⬥Build a positive self image – feeling of competence ⬥Find other areas to achieve ⬥Ability to influence others Use the talents you possess. The woods would be very silent if no birds sang there except those who sang best. Henry van Dyke The individual who has low esteem reacts by “I can’t” Thus: ⬥we demean our own talents, ⬥feel others don’t value us, ⬥we are powerless and lack self confidence. In turn easily manipulated by others, becomes sensitive, easily frustrated and tends to blame others for own weaknesses. If the therapist (environment) can build up high self esteem and praise the action: the client will act independently in making choices, assume responsibility act promptly and confidently be proud of accomplishments approach new challenges with enthusiasm exhibit emotions and feelings without self consciousness tolerate frustration feel special to those they love, play with or work with feel capable of influencing others. Extent of impact Social aspects Vocational aspects Clinical process Themes of successful stuttering management RET (rational emotional therapy) or CBT (cognitive behaviour therapy). The client has a long history of loss of control – “fight or flight” Indoctrination of illogical, inconsistent unworkable values Attitudes from false interpretation of events  A. Activating event E. Changing B. Person’s belief system irrational belief C. Emotional D. Irrational consequence belief A something unpleasant happens B we interpret the event C consequences – we get upset or “awfulize” the situation D you question and change your thinking about the event E irrational to rational TEACH POSITIVE AND NEW VALUES: Maslow quotes: “no psychological health is possible unless the essential care of the person is fundamentally accepted, loved and respected by others and himself.” Negative irrational self talk can also been seen as Bill Murphy (1997): The “stinkin thikin” which involves three levels of thinking/perception the descriptive level – I get the message making inference – I decide that the word are demeaning my cognition evaluates the comment and appraises. These beliefs can determine emotional health and in turn negative disturbed emotions so I start “awfulizing” “I’m bugged because I’m plugged” – a magical belief that becomes overly exaggerated (Emerick) Leads to F - false E - evidence A - appears R - real The aim is to control the products of primal processing (fear, self criticisms) → to learn more adaptive flexible behaviours. For example: You stutter→ the negative reinforcement → “I will never speak right” (this is an over generalization). A positive thought – “this was a momentary lapse on a good day what could I have done” or “I am making progress”. THE THERAPIST AND CLIENT SHOULD STRIVE TO – IDENTIFY NEEDS ESPECIALLY THE DEBILITATING NEGATIVE EMOTIONS. Break out New experience and positive Fear and anticipation Prediction and negative feedback Incident Stronger Getting Stuck Bogged Down Environmental feedback: Self fulfilling prophecy School – teachers Comparing with Work previsions – repeated Home – parents, history siblings A few simple tips: ▪ teach the client that he is not a bad person if he does not always achieve his goal ▪ perfection is not required to be a worthwhile person ▪ popularity and achievement are not necessarily related to being worthwhile nor is 100% ▪ teach the client that minor setbacks are not catastrophes. CBT steps: (See Emerick (1988), Bloom and Cooperman (1999) and Manning (2001) for an easy to follow programme). Information giving – a map of the therapy process and involve client to help set up objectives. Cognitive appraisal - the client summarizes in his own words the contents of the therapy programme and makes sure it suits his needs. Identify the self defeating thought patterns (identify the repertoire of negative thoughts). Thought reversal – reduce and eliminate the negative thoughts, “thought stopping”. Subject these “old” hypotheses to reality testing – the therapist helps by modelling, or role play. Substitute with self-enhancing language Coping skills Gerald Johnson (1985) 10 Commandments for long- term maintenance” uses the following 10 helpful steps: engage in an objective self analysis develop rational thinking work for philosophic change achieve spontaneity keep yourself healthy do not fall victim to the guru complex do not procrastinate achieve independence your choice – is positive self talk (Mental Health week task) MAP – monitor action and performance → your way to fluency. (similarly to sport = changing motor patterns) STARTING SELF-HELP GROUPS Rationale: The value of groups: ▪ support ▪ offer information and advice ▪ service delivery ▪ alternative therapy programme ▪ group activities FRAMEWORK OF A PROGRAMME Needs assessment Composition of the group Eliciting communication Choice of activities and topics