Final Flashcards
What treatment is designed to do:
Eliminate
Modify
Compensate
What should you discuss with your client before starting treatment?
Overall goal of treatment
Your role
Their role
Things to avoid and why
1) Inform or infer that PWS can stop if they set their mind to it. The perservance of developmental stuttering does not represent psychological issues that must be overcome or represent the lack of effort on the part of the client.
2) Diagnose developmental stuttering in preschoolers as normal disfluency. If disfluencies are stuttering like, then the child stutters.
3) Blame anyone for treatment that doesn’t work
4) Rely on “magic tricks” unless you can apply it outside of the treatment room.
Why we include the client in goal setting
Make sure that the client is involved so that they feel like they are in partial control and not having useless information being thrown at them, but rather goals they want to achieve.
Common long term goals
Reduce the frequency of stuttering
Reduce the abnormality of stuttering
Reduce negative feelings about stuttering and about speaking
Reduce negative thoughts and attitudes about stuttering and speaking
Reduce avoidances
Compare and contrast stuttering modification and fluency shaping
Stuttering Modification: Stuttering results from avoiding or struggling with disfluency. The goal is reduce speech related avoidance behaviors, reduce fear, and negative attitudes towards speech, modify the form of stuttering. Acceptable Outcomes include spontaneous fluency, controlled fluency, and acceptable fluency.
Recognizing SM: Person who stutters is active participant in all aspects of treatment, change takes relatively longer, requires more skill on part of clinician
Fluency Shaping: Stuttering is a learned behavior. The goal is to establish fluency in controlled environment, shape pseudo-fluency into actual fluency (generalization). The acceptable outcomes are spontaneous and controlled fluency.
Recognizing FS: Highly structured, quick change, possible decrease in naturalness
Make a recommendation (either stuttering modification or fluency shaping) based on characteristics
SM those who: are open to discussion, exhibit frequent avoidances, and may benefit from a more positive self image
FS those who: Exhibit less native associations with speech and do not avoid speaking situation
Stuttering modification
Van Riper
Founded upon Learning Theory, servotheroy, psychotheory
Believes stuttering is predictable
Basic program minimum includes 1 hour individual and 1 hour group therapy, 3 days a week, and 3 to 4 months
Secondary program (maintenance) includes 1 to 2 times a week for 1 hours (individual or group) for 3-4 months
Why clinician must convey in motivation
Must demonstrate genuine interest in the PWS as person
Support
Permissiveness
Understanding
Techniques of motivation
Clinician should imitate stuttering behaviors exhibited by client
Encourage client to discuss feelings about themselves as a person who stutters
Clinician should summarize those feelings, but allow for correction
Encourage fluent moments and lesson stuttering moments
A brief overview of treatment should be provided
Client must be made aware that they are an active participant
Client should accept “cost”
Motivation must be addressed frequently
Overall (overarching) goals of identification
The client must identify and evaluate the unique factors of their stuttering.
Goal is to specify of what must be unlearned and to place responsibility of doing something about the problem of the client
Types of behaviors that should be identified in identification
Identify fluent words Identify stutters Identify avoidances Identify timing/struggle behaviors Cues (verbal or behaviors)
Overall goals of densensitization
Reduce speech related anxieties and negative emotions
Learn new methods of copping with and responding to stuttering
Dissociate response from stimuli
Ultimate criteria of desensitization
Introduce stress
Establish hierarchies of stimulus sets
Threshold: When PWS cannot handle the task without negative emotions disrupting it
How to implement pseudo-stuttering in treatment
Goals: avoid avoidances, teach fluent stuttering
Avoid feared words and sounds
Begin in treatment room
Begin with mild repetitions and prolongations (progress to more severe forms if allowable)
Must be done without emotionality!
Logical progression/regression of desensitization goal
Example 1: Observe clinician stuttering in fluent manner, imitating (specific) abnormal behaviors, imitating client’s stuttering behaviors on the phone, imitating client’s stuttering behaviors at a store
Example 2: Client will observe facial features in mirror while reading along with clinician/pantomiming/ whispering/singing, client will imitate her own stuttering behaviors, client will observe themselves imitating their own stuttering behaviors in a mirror, on a video, while speaking with the clinician, while on the telephone
