Please enable JavaScript.
Coggle requires JavaScript to display documents.
Adult stuttering Tx (1) - Coggle Diagram
Adult stuttering Tx (1)
-
Considerations for Tx
Some adults seeking Tx have never had intervention, know very little about stut. External locus of control, blaming everything, everyone else for their stut, view of stut
-
-
Others may have had Tx, present as disappointed, frustrated- figure out how this can work for them. Difficult bcos now you are giving them more of what they already had.
-
-
-
-
Proficient practice: Maintain fluency even at that slow speech rate, using technique to do that
Key treatment concepts
-
Successful Tx requires focused attention to speaking, especially when stut is anticipated
Successful Tx depends on increasing approach behaviours, reducing avoidance
Adults who stutter may continue to have speech processing deficits after Tx and may need to continue to compensate for them
Measurement of progress and outcome: %SS, SSI-4, Erikson scale S-24
Start slow bcos of problem with motor programming, giving them time, want to stabilise what is an unstable speech motor system
Control vs. cure
-
Tough qns: why me? Why won't it go away although I did everything you asked me to? I have been coming to Tx? Is it my fault or your fault that I still stutter? Is therapy forever--> Open door policy, if you need me when you need me then you can come back to me, rmb goals: if they have achieved it, discharge them
Make clients full partners in Tx, clarify locus of control and responsibility. Adolescents' parents are bringing them to Tx, but how commited are they to doing Tx themselves?
Clarify locus of control and responsibility. Increased emphasis on complex Tx (smooth speech), cognitive, affective aspects, participation factors, stress mgm, counselling
-
-
-
Other considerations
-
Indv diff in nature of stut. behaviour, including subtypes as stutter is not unitary disorder, diff Tx emphases may be required for diff ppl
Not everyone should be treated solely by a single program, not one size fits all
Quick total cures or promises of fluency perfection cannot be held out as ethically realistic possibilities
The ultimate therapy focus should be on the person and their possibilities for self growth, not just increased fluency
-
Impv fluency may bring other challenges for client and clinician must try to anticipate these and assist, within reasonable limits. Possibility of self-resistance, self-sabotage, over-reliance on therapist
Relapse should be prepared for, along w means to cope with this, should have tools to regain fluency control, letting them know relapse may happen
Tx should teach person sufficient clinical competence regarding his own problems so that in the future he can cope w these himself, become his own clinical resource
-
-
Therapeutic experience--> independence, self sufficiency that is only relative: transfer issue, making sure that this needs to continue outside. Are we doing enough in our clinical setting so that they feel motivated to practice? Rmb ICF!
Treatment goals
-
-
-
-
Enhances client, clinician r/s
Examples
-
Reduce negative feelings, thoughts, attitudes about stuttering and speaking
-
-
-
LTG
Able to manage fluency in particular situations at normal speech rates or that they feel comfortable with
-
-
-
-
Ultimate goal: true self-directed mastery over fluency, person can control their fluency in whatever situation they wish, whenever they choose.
You are the master, when do you want to be fluent? We are going to use some tools to help you do this
Main classes of Tx
Simple vs. complex Tx: Lidcombe program (not changing child's speech) vs. Speech restructuring is the highest level in treatment planning (Changing person's way of speech)
Operant reward, self-imposed timeout
-
-
-
-
Programmed vs. non-programmed: Mater SS (criterion based, when you reach the lvl then you move on, learning behavioural control w small increments in hierarchy of easy-difficult) vs. Camperdown program (Top down, throw program to them and hope it fits, teaching, modelling for them)
Speaking fluently vs. stuttering fluently: Fluency shaping (decrease stuttering by changing the way you talk) vs. stuttering modification (X make blocks so severe, change the way it sounds)