Developing Skills For Counseling People Who Stutter And .

Developing skills forcounseling people who stutterand their familiesEllen Bennett, Ph.D., CCC-SLPUniversity of Texas – El PasoWalter H. Manning, Ph.D., CCC-SLPUniversity of MemphisC. Woodruff Starkweather, Ph.D., CCC-SLPTemple UniversityJ. Scott Yaruss, Ph.D., CCC-SLPUniversity of Pittsburgh1

Developing skills forcounseling people who stutterand their familiesWhat do I do now?!?(Part of a Panel Presentation at ASHA 2000, withEllen Bennett, Walt Manning, and Woody Starkweather)J. Scott Yaruss, Ph.D., CCC-SLPStuttering Center of Western PennsylvaniaUniversity of Pittsburgh2

“What do I do now?!?” Oneof the most commonquestions asked by clinicians Whatdo I do next? What do I say next? Whatif I don’t know what to do next? How do I know if I did the right thing? Alsoone of the most commonquestion asked by our clients3

Purpose Topresent an overview ofthe process of counseling(i.e., what to DO next) Todiscuss differentways to respondto clients (i.e., whatto SAY next)4

Defining Counseling WhatIS counseling? Morethan just talking about problems also about finding solutions Whendoes counseling occur? Counselingis just one part of treatment,but the counseling relationship shouldbe consistent throughout treatment Thus, counseling CAN occur everytime you interact with your clients5

What Do CliniciansDo in Counseling? Gather E.g.,informationdiagnostic interviews Provide E.g., Listeninformationeducating client about stutteringto clients andconvey understandingof the client’s concerns6

What Do Clients Doin Counseling? Talkabout their problems Talkabout the kinds of solutionsthey would like to see Talkabout ways to achievethose solutions7

What do Clients and CliniciansDo in Treatment Together? Worktogether to foster changein the client’s behaviors or situations8

Working Together whenTalking about problems Whendescribing their situation, clientsmay not see their situation clearly Theymay not accurately understandthe nature of their situation They may focus on what others havedone and not see their own role Clinicianscan help clients perceivethe situation more accurately9

Example Themother of a child who stuttersmay have fears about whether herchild will ever be able to get a job Theclinician can acknowledge thatthe mother’s fears are real and giveher an opportunity to discuss them Theclinician can provide informationthat may allay the mother’s fears10

Example Anadult who stutters may be angrybecause somebody cut him off orfilled in words for him A cliniciancan acknowledge that theclient has experienced frustration Theclinician can also probe how theclient’s own concerns about stutteringmay have contributed to the situation11

Working Together whenTalking about Solutions Whenconsidering solutions, clientsmay have limitations in their ability toenvision different possibilities Highexpectations (unrealistic goals) Low expectations (limiting goals) Clinicianscan help clients considernovel possibilities and differentperspectives12

Example Themother of a 5-year-old is havingdifficulty deciding whether to hold herchild back from kindergarten Theclinician can help her identifythe pros and cons of various options,reflecting her concerns back to her soshe can gain a better understandingof what her fears may be13

Example Anadult who stutters has beenunsuccessful in prior treatment,and now he doesn’t know whathe wants out of speech therapy Theclinician can help the clientexplore different options fortreatment, considering how theoptions relate to his goals14

Working Together whenTalking about Strategies Whentrying to figure out how toachieve their goals, clients may notsee all possible options Notknowing how to achieve goals Not being able to get started once agoal has been selected Clinicianscan help clients evaluatedifferent strategies and begin theprocess of making changes15

Example Theparent of a child who stuttersmay want to help her child becomemore accepting of stuttering, butcan’t see how to do that. Theclinician can help her identifyways to work on her own acceptanceof stuttering so she will be moreavailable to help her child16

Example Anadult may want to use fluencytechniques in everyday speakingsituations, but he finds that he isunable to apply them that frequently Theclinician can help the clientidentify the roadblocks that areholding him back and brainstormabout new strategies he can use toimprove his use of fluency techniques17

A Model of the Helping Process(Egan, 1996)Stage I:Current ScenarioStage II:Preferred ScenarioStage III:Action StrategiesHelping theclient tell hisor her storyIdentifyingpossibilitiesfor the futureIdentifyingpossiblecourses ofactionIdentifying"blind spots"Setting andagenda forchangeDetermining"best fit"Determiningwhich issuesshould beaddressedCommittingto theprocessDevelopinga plan toachieve theclient's goalsACTION leading to the desired outcomes18

What do I SAY now?Listening and AttendingUnderstandingResponding19

Listening and Attending Todevelop a counseling relationship,show that you value your client Bevisibly tuned in to the client Use SOLER skills Listenfor the client’s Experiences:What happens to the client Behaviors: What the client does Affect: How the client feels20

Example – Scenario Theparent of a 9-year-old who stuttershas reacted negatively to your treatment,which involves helping the child accept hisstuttering. She says, “His pediatrician hasbeen telling me for years that he’ll outgrowit If you tell him to accept his stutteringnow, that’s just giving in to it andpractically encouraging him to stutter!” What are the client’s experiences, behaviors, affect?21

Example – Message Experiences Receiving (mis)information from pediatrician BehaviorsReacting negatively to you Not getting more information about stutteringeven though the child continued to stutter Affect Fear22

Example – Scenario Anadult who stutters hasn’t been given asmuch responsibility at work as he wouldlike. He has been in treatment improvingboth his fluency and his attitudes. He says,“I don’t know if they’re going to promoteme that’s not up to me. I’m not even surethey know I want to be promoted! I justkeep waiting, but they never give me thechance I deserve.” What are the client’s experiences, behaviors, affect?23

Example – Message ExperiencesHasn’t been promoted Good success in therapy BehaviorsWorking hard in therapy Not advocating for himself (a blind spot ?) Affect Frustration24

Understanding Bylistening and attending to theclient’s messages, we can begin tounderstand his situation Wemust take into account the client’sperspective (context) Wedon’t have to agree with the client,but if we are going to show that wevalue him, we must acknowledge hisright to have a different perspective25

Responding Afterwe have listened to the client,and understood his concern,we must respond to him Evenif you understand your clientperfectly, it does no good if you don’tcommunicate that understanding Thereare many ways to respond, andthis is one of the primary sources ofconfusion when SLPs try to counsel26

Types of Responses(from Luterman, 1996) Content Response AffectResponse Counterquestion Reframing Affirmation “Sharingself” Silence27

(Some) Types of Responses(from Luterman, 1996) Content Response Providing the client AffectResponse Counterquestion Reframing Affirmation “Sharing Silenceself”with information,perhaps in responseto a question, butmany times not. “stuttering iscaused by ” “to speak morefluently, you ”28

(Some) Types of Responses(from Luterman, 1996) Content Response Identifying the AffectResponse Counterquestion Reframing Affirmation “Sharing Silenceself”client’s feelings. “it sounds like thatwas frustrating” “you seemdisappointedabout how shereacted to yourstuttering”29

(Some) Types of Responses(from Luterman, 1996) Content Response A type of challenge AffectResponse Counterquestion Reframing Affirmation “Sharing Silenceself”in which the cliniciandoes not confirm theclient’s expectationsto help the clienttake responsibility “Why shouldn’tpeople react toyour stuttering?”30

(Some) Types of Responses(from Luterman, 1996) Content Response Helping the client AffectResponse Counterquestion Reframing Affirmation “Sharing Silenceself”find opportunitiesthey might not see. “Driving your childto treatment threetimes per weekhas given you achance spendtime together.”31

(Some) Types of Responses(from Luterman, 1996) Content Response Provides indication AffectResponse Counterquestion Reframing Affirmation “Sharingself”that the messagehas been receivedwithout providingspecific input Encourages theclient to continuetalking Silence32

(Some) Types of Response(from Luterman, 1996) Content Response Sharing some of the AffectResponse Counterquestionclinician’s experienceswith the client Helps buildcredibility Lets the client knowhe’s not alone Helps client exploreother options Reframing Affirmation “Sharing Silenceself”33

(Some) Types of Response(from Luterman, 1996) Content Response We don’t have to AffectResponse Counterquestion Reframing Affirmation “Sharing Silenceself”talk the whole timeSometimes silencecan encourageclients to continuetalkingMust be usedsparingly andcarefully.34

(Some) Types of Response(from Luterman, 1996) Content Response All of these types of AffectResponse Counterquestion Reframing Affirmation “Sharing Silenceself”responses must beused carefully, whenit is appropriate touse them.Don’t over-useresponses or relyon a responding“formula.”35

Which Response Do I Use? ManySLP clinicians tend to be morecomfortable with content responses(informing) or questions (probes) Needto demonstrate our expertise tobuild credibility (particularly at thebeginning of our careers) Needto provide clients with answers Easierthan talking about feelings!36

Counseling teaching Watchout for too much informing Wedo need to provideinformation (Butdon’t bowlthem over withtoo many facts) Trynot to betoo directivein treatment37

“Nothing more than feelings” Manyclients experience significantemotional reactions to their stuttering Infact, the client’s reactions play amajor role in determining his degree ofdisability or handicap (Yaruss, 1998) Whena client shares his or her feelingswith us, we MUST respond if we wish toshow that we value the client38

The Empathetic Response Demonstratingour understanding ofthe client’s message by responding tothe client’s: Experiences Behaviors Affect TheFormula: Youfeel this way because of experience or behavior 39

Examples “Youfeel frustrated because youdon’t know why they haven’tpromoted you” “You’reworried that acknowledgingstuttering will make it worse” “Youfeel alone because peopledon’t talk with you and it’s hard foryou to seek them out”40

Remember Thegoal of the empathetic responseis to communicate that we havereceived and understood the client’smessage don’t take it for granted Wemay have more to say, but beforewe do, we should at least acknowledgethe feelings the client shared Asyour skills develop, you can useyour own words for the client’sbehavior, experiences, and affect41

Example – Scenarioparent of a 3-year-old says “I justdon’t know what to do he startsstuttering and my mind just freezes.It’s so hard to watch him do that.Sometimes I just tell him to stop it! Iknow that’s bad, but I just can’t helpmyself. What will this do to his life?!?Am I a bad mother?” The How could you respond using the formula?42

Example – Responding ThemessageExperience: Child is stuttering. Behavior: Telling child to stop. Affect: Guilt, fear, anxiety Someempathetic responses (by formula) You’re afraid that this will have a long-termimpact and you don’t know what to do about it You feel uncertain about how to respond andafraid you might do or say the wrong thing43