I am seeing more and more references to Cognitive Behavioral Therapy (CBT) as a promising approach for those who stutter. The National Alliance on Mental Illness (NAMI) describes CBT as “a form of treatment that focuses on examining the relationships between thoughts, feelings, and behaviors.” There is often resistance to connecting the stuttering diagnosis with a mental illness – and it’s important to distinguish between what causes stuttering and what exacerbates the behavior.
I don’t believe that mental illness causes stuttering, but I do believe that emotional responses to both external and internal reactions to stuttering can and do contribute to negative thoughts, feelings, and behaviors that often create a far greater handicap than the stutter itself.
I recently listened to a Stuttering Foundation of America (SFA) DVD “Implementing Cognitive Behavior Therapy with School-age Children” by LIsa Scott, Ph.D., Florida State University. At no time did she suggest that the therapy itself can contribute to the need for CBT, as I believe, but it still gave me hope. I also questioned a professional for whom I have tremendous respect, about CBT coming up on the radar of mainstream support organizations like SFA — here was her response:
“As far as CBT goes, many in the field are talking the talk. I do think that some are walking the walk as well… the SLPs we train each year are introduced to it- but only superficially. Recent issues of the Journal of Fluency Disorders have had articles on CBT as well. How many SLPs actually read the journals is up for grabs. The problem is, that to be truly good at administering CBT you need training… that probably isn’t going to happen at the institutional level any time soon. But people are interested.”
So while hopeful – I think her response is appropriately cautious – because to “truly be good at administering CBT, you need training” and I do not get the impression that the field of speech therapy is currently embracing the necessary level of training and focus for this to safely become mainstream anytime soon. More importantly, how can we create an experience for our children that minimizes the need for CBT in the first place?
The focus within therapy must be on minimizing the development of these thoughts, feelings, and behaviors – so does this challenge really belong in the field of speech therapy? Are speech therapists being trained to adequately and effectively address these challenges? If they were, I would hope they would see the inherent risk of suggesting a child use speech tools and techniques to fix the stutter and eliminate this from their treatment of children who stutter. (I always feel the need to clarfiy – I’m talking about children ages 5 – 12 or so, not teens and young adults.)
And how do we minimize the need for Cognitive Behavioral Therapy as a child grows?