Finding the Perfect Speech Therapist for Stuttering.

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Finding a speech therapist to facilitate stuttering-related change.

You may be trying to make stuttering-related change on your own, with internet resources as your guide.

But after a while, you may seek out a professional guide to help illuminate the way, at least for a little while.

Finding the right speech therapist is an important decision.

How do you pick the right clinician, a clinician who understands your experience as a person who stutters, who is competent, warm, caring?

In this post, I’ll first provide tips about finding local speech language pathologists who specialize in stuttering.

Then, I’ll list therapist qualities linked with lasting therapeutic change.

First, a quick note:

There are many names for professionals who deal with speech, language, voice, and swallowing. These include: speech language pathologist, speech language therapist, speech therapist, speech pathologist.

In this post, I’ll refer to these professionals as SLPs, short for Speech Language Pathologists, as well as therapists, and clinicians.

Where to find an SLP?

Many online tools can help you locate the SLP of your dreams.

ASHA Profind

The ASHA Profind tool lists ASHA (American Speech-Language-Hearing Association) certified SLPs. 

This tool allows you to filter therapists based on location, age range treated, disorder areas of expertise, and bilingual abilities.

With this tool, stuttering is called fluency, so be sure to check the box next to fluency, in the Area of Expertise filter.  

American Board of Fluency and Fluency Disorders

You may want to find a therapist who is has a certification from the American Board of Fluency and Fluency Disorders.

These therapists are stuttering specialists who: 

… have demonstrated in-depth knowledge of the nature and treatment of stuttering and other fluency disorders, and have undergone peer review of their qualifications (retrieved from the American Board of Fluency and Fluency Disorders website.)

Keep in mind:

Many effective therapists don’t have this cert for a variety of reasons unrelated to their competence as clinicians for people who stutter.

Speech Buddies

You can also find an SLP and book services on the Speech Buddies website. 

This tool is similar to ASHA Profind, in that it is a directory of certified SLPs. You can filter clinicians based on location and areas of expertise.

This tool has an edge over ASHA Profind in that each therapist listing includes a bio in addition to contact information.

You can book services through the Speech Buddies site, or you can contact therapists initially through this site, then communicate with them further via email or on the phone.

Qualities of Effective Clinicians

Plexico, Manning, and DiLollo discovered characteristics of effective and ineffective SLPs who treat stuttering in their 2010 study.

Using various qualitative research methods, these researchers analyzed twenty eight participants’ written narratives in response to questions about their experiences with SLPs, who had treated their stuttering.

Plexico et al. found (summarized from Manning and DiLollo (2017)):

Effective clinicians empower client’s autonomy and cognitive change by: 

  1. Being professional, passionate, committed, and confident
  2. Expressing understanding of the stuttering experience 
  3. Believing in the therapeutic process and in the client’s ability to change 
  4. Making clinical decisions based on client needs and goals 
  5. Actively and patiently listening to clients 

Ineffective clinicians, on the other hand, created an environment charged with frustration, embarrassment, guilt, and anger for these participants by:

  1. Not appearing knowledgeable about the stuttering experience 
  2. Being inattentive to clients 
  3. Appearing not to actively listen to client goals 
  4. Adhering dogmatically to a particular therapy protocol, leaving the client feeling misunderstood, discouraged, and without hope.

You will probably notice these positive and negative qualities during a consultation or an early therapy session.

The Common Factors Model

Research suggests therapeutic change can be achieved through a variety of methods and that differences across therapy approaches have a small effect on treatment outcomes (Wampold, 2015.)

Yes, you understood that correctly: 

It really doesn’t matter what therapy program your clinician uses (as long as it’s evidence and experience based.)  

In fact, just having therapy at all has been shown to have a huge effect on therapeutic change (Wampold, 2015).

This suggests that the therapeutic process is extremely effective (Wampold 2015)!

What matters, instead of specific therapy ingredients, is whether the clinician and therapy experience embody specific qualities, common among many therapy models. 

How was this discovered? 

A researcher in the field of psychology, Bruce Wampold (2015) used statistical techniques like meta-analysis to study hundreds of published studies.

These studies sought to determine the extent to which psychotherapy treatment outcomes can be controlled, predicted, or explained by various variables.

Herder, Howard, Nye, and Vanryckeghem (2006) completed similar research, analyzing twelve studies, which explored how stuttering treatment outcomes are effected by various variables. 

Both research parties came to the conclusion that differences across specific therapies had little effect on treatment efficacy.

Instead, various common factors across these treatments seemed to account for therapeutic change! 

So, what are these common factors?

1. Therapeutic alliance

The therapeutic alliance is by far the most researched common factor (Wampold, 2015). 

It also is one of the factors that has been found to have one of the greatest effects on treatment efficacy (Wampold, 2015.)

The three components of the therapeutic alliance are (Wampold, 2015): 

  1. The bond between the therapist and client 
  2. Agreement between the therapist and client about therapy goals
  3. Agreement between the therapist and client about therapy tasks, that is, agreement about the ways through which these goals are worked towards and achieved

2. Empathy and Positive Regard/Affirmation

Empathy and positive regard/affirmation, two other characteristics common across successful treatments and therapists, have been found to greatly affect treatment outcomes (Wampold, 2015).

That is, therapists who are empathetic and display positive regard and affirmation are more successful at helping their clients achieve therapeutic change than therapists who do not possess these qualities.

When the clinician truly takes the perspective of their client, the bond between client and clinician will likely grow, thus strengthening the therepeutic alliance (Manning and DiLollo, 2017.)

Also: 

Understanding the stuttering experience, especially understanding the loss of control that accompanies stuttering moments (Manning and DiLollo, 2017), is a critical characteristic among successful therapists of people who stutter.

(Side note: Has anyone ever told you that they stutter sometimes? I have had two people in my life tell me this. And at the time I didn’t believe them. Yes, maybe they repeat words sometimes. But did they really feel this loss of control during those moments, like I did? I didn’t think they truly understood my situation.)

Because understanding the stuttering experience is so crucial in helping those who stutter, some suggest that SLPs who stutter are most equipped to treat others who stutter.

Now: 

I can think of several of SLPs, who have a deep understanding of the stuttering experience, despite never having experienced stuttering firsthand.

But a history of stuttering affords intimate knowledge about the stuttering experience, which could increase the likelihood of successful therapy outcomes. 

3. Goal Consensus and Collaboration

Agreement about therapy goals and collaboration between the therapist and client when creating these goals seem to have the most impact on therapy success than any other factor addressed in Wampold’s study (Wampold, 2015.

(It’s worth noting that fifteen studies pertaining to goal consensus and collaboration were considered in Wampold’s meta-analysis, compared to the over 200 studies focusing on the therapeutic alliance.)

Stuttering clients also consider therapists who take client goals and needs into consideration more effective than therapists who treat dogmatically, without personalizing therapy to fit client needs (Plexico et al., 2010 )

This means: 

Therapists who seem interested in your story and who center therapy around you and your needs will likely help you make more therapeutic change than therapists who try to fit you into a cookie cutter therapy program.

Many people who stutter and SLPs take things a step further: 

They feel clinicians should not only influence the goal-making process, but should also play an active part in achieving goals and participating in therapy tasks (Manning and DiLollo, 2017.)  

Clinicians should model therapy room activities they ask clients to perform, like working through stuttering blocks by openly stuttering or
voluntarily stuttering (Manning & DiLollo, 2017, p. 23.)

Perhaps more importantly, clinicians should perform therapy tasks outside the therapy room before expecting clients to participate in these tasks (Manning & DiLollo, 2017, p. 23.)

For example, let’s say a client’s assignment is to stutter openly instead of using a secondary behavior while ordering at a restaurant.

It is suggested that both client and clinician should go together to the restaurant, and the clinician should openly stutter first, before expecting the client to participate.

Or if the client’s goal is to tell others about their stuttering, a clinician who also stutters might invite the client to a presentation they are giving to colleagues and self-disclose about their stuttering before the start of the presentation.

Other clinicians may participate in their client’s therapy process by setting goals for themselves to step out of their own comfort zones. They may pledge to learn a new skill, like jet skiing or learning a foreign language, and create goals and assignments aimed at achieving these goals.

In short:

Effective SLPs feel very comfortable with stuttering.

If a speech therapist seems anxious about stuttering and about the tasks they assign their clients, how can clients expect to feel comfortable following this therapist’s recommendations (Manning & DiLollo, 2017, p. 23)?

The Common Theme Among the Common Themes…

Seems to me that the underlying theme among all these common factors is:

Personalization of the therapy process for each client is crucial.

If a potential clinician seems to be creating cookie-cutter goals for you, without taking your needs and thoughts into consideration … she’s probably not the clinician to help you make lasting change.

If a clinician seems uncomfortable with the topic of stuttering, does not seem to understand the stuttering experience in general, and does not seek to understand your experience personally…she’s probably not the clinician to help you make lasting change.

And if a clinician sees you as a case and not a person…she’s probably not the clinician to help you make lasting change.

Also:

Make sure your therapist’s therapy style jives with your values. 

If not, you likely will not agree with proposed therapy goals and will not follow through with completing tasks to achieve these goals.

For these reasons, you will not experience much therapeutic change! 

Now I want to hear from you:

What qualities have you valued in a speech language pathologist? Which qualities have you found unhelpful?

Leave a comment and let us know!

Finding a speech therapist to facilitate stuttering-related change.


Resources

Herder, C., Howard, C., Nye, C., Vanryckeghem, M. (2006). Effectiveness of Behavioral Stuttering Treatment: A Systematic Review and Meta-Analysis. Contemporary Issues in Communication Science and Disorders, Volume (33) pp. 61-73.

Manning, W. H., Dilollo, A. (2018). Clinical Decision Making in Fluency Disorders, Fourth Edition. San Diego, CA: Plural Publishing. 

Plexico, L. W., Manning, W. H., DiLollo, A. (2010). Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. Journal of Fluency Disorders. 35 (4), pp. 333-54

Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry. 14(3). pp. 270-277.

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