Navigating Adult Stammering 100 Points for Speech and Language Therapists
This book, the first in an exciting new series, provides speech and language therapy students and newly qualified and beginning stammering specialists with 100 key points that will help form a strong foundation for their work supporting adults and teenagers who stammer.
Composed of practical, relevant and useful advice from an experienced clinician, chapters break advice down into sections which include information about the therapeutic relationship, therapeutic approaches and signposts to further resources. Throughout the book, comments from stammering specialists describe what they wish they had known at the start of their careers.
- Puts the person who stammers at the heart of therapy, following the clinical choices they might make
- Is written in an accessible style, designed to be dipped in and out of as required
- Draws on the experience of therapists working with those who stammer
Full of advice and guidance to support effective practice, this is an essential resource for anybody new to this client group.
Introduction Section A: The Person who Stammers Generic features State of self Stammering features Reasons for wanting therapy Knowledge about stammering Understanding of stammering Understanding of therapy Outcomes Stages of change Section B: The therapist Who am I to be? What would a client value from his clinician? The clinician’s journey Being client centred Listening Acceptance and positive regard Empathy Using affirmations Summarising Humour Silence Reflective skills Specific skills Language and messages to the PWS Being an ambassador for the stammering community Section C: The therapeutic relationship The importance of the therapeutic relationship Rapport Openness Self disclosure The balance of power and control Ask the client Choice Flexibility/adaptability The relationship with the significant others Section D: Beginning sessions Finding out about the other Taking time to hear the narrative How to not use the case history Goal setting Assessments Formal assessments Informal assesssments Outcome based assessments Section E: Therapy: General points Service delivery Aspects of therapy common to all approaches: an overview Therapy approaches Effective therapy Principles of stammering therapy Pre-requisites Openness Desensitisation Voluntary stammering Avoidance reduction Section F: Therapy: Fluency modification or speak more fluently approach Using multiple strategies Targeting strategies Teaching fluency modification strategies Light contacts Prolongation of sounds Easy onset Rate control Breathing Section G: Therapy: Stammering modification or stammer more easily approach What is the stammering modification approach? Background Who to use stammering modification with? How to teach stammering modification Identification Variation Block modification Section H: Therapy: Stammer more proudly Opening comments What is ‘Stammering Pride’? The Social Model of Disability Social model and stammering Critical theory Critical theory and stammering The therapy context Mobilisation of the stammering community Goals of ‘Stammer More Proudly’ Therapy and ‘Stammer More Proudly’ Section I: Psychology approaches The role psychological approaches play in the management of stammering What kind of psychological issues can develop in an adolescent and adult who stammers? What to do? Mindfulness Acceptance and commitment therapy (ACT) Personal Construct Psychology (PCP) and Therapy (PCT) Cognitive Behavioural Therapy (CBT) Narrative Practice (NP) Solution Focused Brief Therapy Section J: Maintaining positive outcomes and planning for the re-emergence of roles and behaviours Defining this stage How can such a period of difficulty be identified? Background Maintenance and its place in therapy Integration of strategies to manage setbacks in therapy What does a PWS need to be able to maintain his therapy gains Strategies for maintenance Endings Section K: Support Networks The context Significant Other (SO) as agents of change The nature of SO involvement in therapy The other side of stammering Support groups Final Thoughts What do I wish I had known from the start? The dance Appendix 1: Formal assessments currently in use Appendix 2: Cognitive Restructuring: learning to attach unhelpful thoughts
Dr Trudy Stewart has done it again: written a highly accessible, comprehensive and practical book aimed at newly qualified and therapists starting to specialise in stammering. I would argue that this book is also useful for experienced speech and language therapists looking to keep up-to-date with the latest thinking on therapy approaches for young people and adults who stammer.
Navigating Adult Stammering has a pleasing logical structure, starting (quite rightly) with the person who stammers, moving onto the therapist and the relationship between the two, before describing a range of therapy approaches. In this way the reader gains an overview of the different options available. The book is peppered with useful example of real people Trudy has worked with over the years and their stammering therapy journeys, bringing to life the therapy process. In this way Trudy generously shares her skills and knowledge and is not afraid to describe when she has not always got things right and what she learnt from those experiences. In line with this desire to share learning from others, she includes comments from practising therapists reflecting on what they wish they had known at the start of their work with dysfluent clients.
Another useful feature occurring throughout the book is the way Trudy highlights commonly occurring difficulties/challenges and possible solutions when describing particular ways of working. In this way Trudy skilfully anticipates the questions often posed by therapists new to the stammering field: ‘what do I do if this happens?’. Moreover, she signposts the reader to a list of useful resources at the end of every section.
The two sections which I believe deserve particular mention focus on psychological approaches and the stammer more proudly movement, the former for the way it brings so many different psychological approaches together in one place, the latter for its inclusive and reflective content. For any therapist working in stammering, whether new to the area or experienced, it is incredibly helpful to become more knowledgeable about the ways a client can be supported psychologically and how we as therapists are often the best people to carry out this role.
With regards to the Stammer more proudly section. I was deeply impressed by the way Trudy describes this relatively new way of considering stammering through the lens of the social model of disability. She takes into account ground-breaking work in this area as well as seeking individual views of people who stammer. She does not shy away from reflecting on the potentially uncomfortable questions the stammer more proudly movement pose for us as therapists, and how her own thinking and practice has changed.
In summary, Trudy proves herself once again to be the ultimate clinician’s clinician. Drawing upon her decades of working with people who stammer, she offers through this book an invaluable overview and insight into how we as therapists can best empower our clients who stammer.
Rachel Everard, Speech Therapy, City Lit., London
Recently, the publishing market has come with more and more increasingly valuable publications on stammering. Trudy Stewart's book, although intended for newly qualified speech-language therapists and those just starting to specialize in stammering, will – without a doubt – be enthusiastically received by experienced fluency experts as well. This publication covers all the essential topics related to the stammering intervention. Attentive readers are granted access to both – the primary theoretical content and the details on stammering therapy practice. The publication also discusses the psychological approaches used in stammering. Furthermore, the author explains complex topics, e.g., relapse in stammering therapy. The book is written clearly and reader-friendly while integrating updated knowledge with the author's rich clinical experience. From the very beginning, the reader will confront a holistic and humanistic approach to stammering and people who stammer. This book promotes stammering therapy based on trust, acceptance, and partner cooperation between the speech-language therapist and the clients along with their families and community.
The uniqueness of this book is that it was written by a wise, extraordinarily experienced, and modest professional who emphasizes building a partner relationship from the first moments of contact with the client. The author shows how important it is to become an attentive therapist who can listen to the clients – learn from them and with them. It should be appreciated how open and ready the author is to share her own thoughts, be authentic and sincere in contact with the client. Her eagerness as an SLT to reveal her imperfections is laudable. Her understanding and acceptance toward the stammering phenomenon and individuals who stammer can model her readers. Above all, the commentaries by the experienced clinicians, including the author herself, wishing that they had attained this knowledge when they were newly qualified clinicians have added vital wisdom. These comments are a treasure trove and contain important lessons for any clinician.
I cannot wait for this book to be available in the bookstores. As a professor, I can imagine how meaningful it will be for speech-language therapy students to familiarize themselves with its content. I wish I had had the opportunity to read this book when I took my first steps in stammering therapy.
Professor Katarzyna Węsierska, University of Silesia in Katowice, Poland, European Fluency Specialist & ECSF coach, International Cluttering Association Secretary
Despite stammering being a core part of Speech and Language Therapy training, the first steps into working with clients who stammer can be daunting. I well remember the anxiety before stepping into the waiting room to greet my first adult client who stammered. What if they ask me something I couldn’t answer? Am I up to the job of this ‘specialist’ area? And, worst of all, what if my lack of experience makes their situation worse? In this book, Dr Trudy Stewart eases the transition into the world of working with adults who stammer by acknowledging these worries and providing clear and sensible steps forward.
Dr Stewart has long been a leading voice in the field of stammering. Her background of clinical work, leadership, research and teaching all have a common thread of ‘client-centeredness’ woven through them. The same is true from this book. Through these navigational points she provides a road map for working with adults who stammer, but with the reassurance that the final destination isn’t ours to know. The client will set the destination and choose the mode of travel. Our job is to help plan the route and make appropriate stop offs at key places.
Through a clearly laid out and accessibly written series of chapters we are guided through this journey; starting with first principals about stammering and challenging the potential preconceptions that newer clinicians may have about their role and purpose when working with adults who stammer, moving through initial meetings and case histories and into the range of therapy and support options we may employ. To do this she draws on well-established ways of working and also introduces newer ideas (e.g., stammer more proudly) with equal weighting to the old. She shares what has worked from personal and shared experiences, as well as discussing what the academic literature has to say on the subject, suggesting stop off points along the way by sign posting resources or further reading for those who wish to delve deeper. Throughout the book Dr Stewart provides a neutral discussion about the range of approaches to working with stammering, placing herself firmly in the midpoint, not pushing a particular approach on the client, but being there to explore options and find what works for them. Each chapter is broken down into short bite sized points to consider along the journey. This allows the reader to dip in and out of the book, using the book as a reference guide and checking in throughout working with the client.
I heartily recommend this book to clinicians taking their first steps into the world of stammering. I’m certain that had this been available to me as a new clinician I would have had a well thumbed copy in the top drawer of my desk at all times. And who knows, I may still do so. Whilst reading this book I couldn’t help but reflect on the clients that I’m currently working with, checking in that I had spent enough time at each stage of the journey, making sure that I hadn’t missed or over looked part of the process. After all, even experienced travellers need a map sometimes.
Ben Bolton-Grant, Course Director, MSc Speech and Language Therapy, Speech and Language Sciences, Leeds Beckett University
I never thought I’d say this about a textbook but this book is a great read! The book is filled with an extensive variety of information and approaches which is not only detailed, but clear and comprehensive. From a Speech and Language Therapist (SLT) student’s perspective (having not learnt about stammering yet), the book gave me a deep insight into dysfluency and most importantly, individuals who stammer.
Trudy truthfully reflects on her personal growth as a therapist and emphasises the positivity in inexperience; showing your uncertainty and vulnerability is an influential approach when working with a client. I can only imagine how useful this book will be to a therapist who is feeling inexperienced in a role where they are new to stammering. The advice felt relatable and reassuring, whilst reminding me that we, as therapists, should always aspire to self-improve. What traits can I develop further? What can I do now that I wasn’t doing before?
The use of hypothetical situations, real-life case examples and analogies helps evoke a profound sense of empathy and understanding from the reader - making the book distinct in contrast to other textbooks. By the end of the book, I felt I had a well-rounded, holistic view of the person who stammers and the various therapy approaches. The use of critical evaluation in the book on perspectives such as the medical and social models of disability also allows the reader to challenge the generalizations and stereotypes associated with stammering.
This book is invaluable to a therapist new to stammering, as Trudy talks about knowledge that she wishes she had known at the start of her role. I really recommend this book, whether it is utilised to update therapists on new research or as a starting out ‘go to’ resource. I will certainly take forward many of the book’s approaches and advice into my future as a SLT.
Isobel Hart, Student Speech & Language therapist
Dr. Trudy Stewart has composed a true gift for both Speech and Language Therapists (SLTs) working in the field of Stammering, as well as clients seen by therapists who read this book. I would go as far to say that this brilliantly structured book is a Stammering Therapy Bible for SLTs. Dr. Stewart’s wealth of knowledge and experience is admirable, and she has created a practical, applicable, and generalisable guide for SLTs. This book is extremely comprehensive whilst remaining concise and easy to read and navigate, and is essential reading for SLTs in this field. It will support therapists to be truly person-centred, use evidence-based practise, and empower and promote advocacy for a person with a stammer. The incorporation of advice regarding how to be a good therapist and build an appropriate, strong, therapeutic relationship is invaluable. For newly qualified therapists or those starting out in this area, the many therapeutic methods in this field can often feel overwhelming and daunting; however, this book consolidates the extensive volume of research and therapy approaches available into an organised filing cabinet. The anecdotal examples, structure and diagrams make this book highly accessible and enable a therapist to apply their knowledge from this book to their practise. This book is also a fantastic resource for further reading, as Dr. Stewart provides references and recommendations regarding where to find further information on specific areas- essentially, doing all the legwork and saving many hours of research for the reader. Furthermore, this book is highly relevant to current times in terms of considering and exploring newer approaches such as telehealth, the social model to health, the importance of psychological approaches such as mindfulness, and stammering pride. I am truly grateful for Dr. Stewart’s ability to create such an enjoyable, comprehensive, and accessible book for which I would like to thank her on behalf of all SLTs with an interest in this area.
Ashleigh Wolinsky, Speech and Language Therapist, Gesher School
It's far too common to see a great divide in the world of stuttering. The divide between the top of the iceberg and the bottom of the iceberg, between professionals and people who stutter, between the push to change and the need to accept, between the individual journey and the broader movements.
This book weaves it together - presenting a broader range of perspective and experiences. The reader of this book will be smarter about stuttering in general.
And more importantly and far more rare, the reader will understand more of the inside story.
Uri Schneider, MA CCC-SLP, Director, Schneider Speech Faculty, University of California Riverside School of Medicine