This is my second blog posting in response to Stuttertalk Podcast #2 (episode 630) in a series of six podcasts asking the question “Should SLPs treat stuttering?”. Host Peter Reitzes interviews Rodney Gabel, a professor at the University of Toledo, speech-language pathologist, a board-certified specialist in fluency disorders, and director of the Northwest Ohio Stuttering Clinic. He is also the vice chair of the Executive Board of the American Board of Fluency and Fluency Disorders.

(I’m wishing I could get through these podcasts more quickly [They are long!] and provide these summaries in a more timely fashion, but please be patient! I will get through them because they contain important information for parents. )

Highlights of this podcast include:

Highlight topic #1: The reality of school-based therapy.

Reitzes acknowledges that many SLPs are uncomfortable with treating children who stutter yet he’s never heard of an SLP recusing themselves.

My response: I’m amazed that Reitzes is so surprised that school-based SLPs don’t recuse themselves. It is my understanding that most do not have that option. School districts believe that a speech therapist is a speech therapist, and they consider stuttering a speech issue. If their therapist didn’t treat the child, the school would be obligated to pay an outside resource – and in this day and age very few, if any, school districts will pony up that funding.

Reitzes states that “to this day, to be the stuttering expert in a school district, all you have to do is say ‘I love stuttering!’ It’s the wild west out there!”

Highlight topic #2: The damage that can be done.

Gable states that he spends much of his time undoing the damage that has been done by previous therapy. He speaks of secondary behaviors and negative reactions that become habituated over time and inhibit communication. They call for a warning label on stuttering IEPs – because so many SLPs have shared that therapy can seem to do damage.

My response: Parents – take heed. This is exactly the point of Voice Unearthed. I am NOT universalizing my experience, as Reitzes insisted in our interview last year. I will die happy (not that I’m going anytime soon) if the day comes that all SLPs automatically educate parents about the risk of harm inherent in so much of the therapy today.

Reitzes talks about the need for better training around best approaches.

My response: What would they be trained to do and what is Reitzes referring to when he talks about “best approaches?” I don’t think the field is anywhere near agreement on any of this. Reitzes often refers to the “royalty” in the field who seem to have it all figured out. If that’s the case, what exactly are they doing and why doesn’t everyone just do that? I’m confused.

Highlight topic #3: The shortcomings of graduate-level communication disorder education.

Reitzes and Gabel discuss how all communication disorder graduate students come out with a generalist degree. They do not have the option of specializing unless they go for their Ph.D. or pursue their Board Certification in Fluency Disorders through ASHA – both which take considerable investments of time and money. Few will invest these resources when the chances are slim that they will ever have more than a handful of clients who stutter.

They suggest that to work with stuttering, an SLP should need some type of additional requirements, maybe not as extensive as a Ph.D. or the Board Certification process, but more than the “nothing” they often get through their graduate work. They also suggest that communication disorder students should be able to specialize during their graduate program.
Reitzes suggests that “ASHA do a consumer advocacy campaign that lets the public know that not all SLPs are equal.”
Gabel talks about developing new platforms that are more affordable and accessible than conferences and CEUs.

My response: Spot on – but again, what is that education and training going to look like? We need a broad universal approach that supports keeping kids talking and that is far less likely to first do no harm. University programs are a long (long) ways from having this standard in place. I imagine it will take decades and in the meantime, the harm is being done…each and every day. Here is where I wholeheartedly agree with Reitzes questioning whether speech therapists should, at this stage, even be treating children who stutter.

Highlight topic #4: What about telepractice?

Reitzes states that there are barriers to telepractice. For example, a therapist needs to have a license in every state. “That precludes a lot of good therapy (again, please describe what you mean by that) from getting done or it turns us into petty criminals.” That’s a really manageable piece if ASHA could get behind it and it would increase access to therapy.

My response: I absolutely agree!! Removing the barriers to providing remote therapy would fix a whole host of challenges in this field. More therapists would see the investment in formal education, CEUs, and/or the board certification processes worth their time and financial resources, creating a larger population of knowledgeable speech therapists for consumers to choose from rather than being severely limited by geographic proximity. Think of it… there are two board certified speech therapists in the Twin Cities metro area for consumers to choose from Even with the limited number of those who are certified in the U.S. (160 out of 160,000+), being able to access remote therapy would blow the consumer options wide open and force a higher standard of therapeutic outcomes. It’s truly breathtaking to think of the positive impact this could have on everyone involved.

Highlight topic #5: A point I make to all speech therapists I speak to

Gabel states that SLPs need to understand that there’s “a good amount you can do in that 30 minutes to impact how they feel and build a positive foundation, maybe not how they sound, but how they feel.”

My response: I could not agree more. How they feel is far more important than how they sound.

Please feel free to post comments. I would love to hear from you!