Working with people who

stutterAddressing cognitions, emotions, and behaviors at different

ages.

Kurt EggersThomas More U College – U of Turku

European Clinical Specialization Fluency Disorders

Workshop Istanbul

2019

• Workshop 1: Introduction & basics

Phenomenology, models, EBP,

common

factors, efficiency

• Workshop 2: Preschool children

• Workshop 3: School-age children

• Workshop 4: Adolescents & adults

Workshop overview

• Brief recap

• YOUR clinical cases, questions, problems

• Finalization Tx school-age CWS

• Adolescents/adults WS

Assessment

Emotional, cognitive, & behavioral restructuring

Dealing with anxiety & unhelpful thoughts

Some examples of fluency shaping approaches

Beware of devices

Self disclosure

Self-help groups

Two day overview

Day 1

Day 2

But first… a brief recap

How do you decide in preschool CWS to start

Tx or not?

Mom: “My son has the problem, why do we

need to change some things?”

What do you assess in school-age children?

How do you ensure having a good view of the

stuttering of your client?

Dad: “Explain me what to expect from

treatment for my 10-y old son”

But first… a brief recap

Try to think of a difficult/awkward situation.

Case questions, videos, problems, ideas, suggestion

• Motivation

• Identification

• Desensitisation

• Variation of moments of stuttering

• Approximation of desired behavior

• Stabilisation (transfer…)

Treatment steps

Cognitive restructuring

Emotional restructuring

Behavioral restructuring

• How is speech produced?

• What happens during stuttering?

• What causes stuttering?

• (Simplified) theoretical model of stuttering.

Identification: Why do I stutter?

• What is stuttering?

• Normal disfluencies – stuttering disfluencies

• Recognizing normal disfluencies & moments of

stuttering

therapist, videos, live

quiz, games,

power of the group!

Identification: How do I stutter?

• Secondary behaviors: client generates himself

explain why

short term/ long term effect

flooding with examples (videos,

live,

others, himself)

Identification: What else do I do?

• Difficult (speaking) situations

• Easy (speaking) situations

• Why difficult (giving cognitive insights)

Identification: Speaking situations (triggers)

• In case of a moment of stuttering:

What do I think? How do I feel?

How do I react?

• In case of the idea of going to stutter:

What do I think? How do I feel?

How do I react?

Identification: Reactions (triggers-consequences

• How can people react? vs How do people react?

• Why?

• Which thoughts/feelings are being evoked in you?

> first step in cognitive/emotional restructuring

Identification: Listener reactions

Desensitisation

Repetitions, prolongations, blocks

Secondary behaviors

1.Choose a person you haven’t really talked to so far.

2.Choose a specific outdoor speaking situation.

3.Try-out min. 3 times EACH.

4.Actor: report on cognitions/feelings/behavior (before, during,

after)

5.Compagnon: observe behaviors of listener/PWS

6.Write down in short overview

7.Report back to group

1 hour

Exercise

• Situation

• Before

• During

• After

Listener reactions

Looking away

Finishing words/sentences

Laughing

…

Triggering situations

Behavior modification

Behavior modification

Speech

• Changing speech behaviors (speed, soft starts …)

• Learning to change the moments of stuttering

• Reacting adequately to listener reactions

Finding solutions (problemsolving)

Testing and training via role play

• Reacting adequately to triggering situations

Recognizing

Applying fluency techniques (more)

Variation

• Soft starts – gentle voice onset

• Changing speed of talking – slowing down speech

• Adding additional (natural) pauses

• Stretching syllables, sounds

• Voicing

Variation: different techniques

59.00 - 1.35.00

Coffee

Cat

Canoe

Coke

Camel

Kill

Cow

Cord

Cupboard

z

Funny

Vast

Vest

Fingers

Foam

Fell

Soup

Somebody

Socks

Tom

Ten

Tammy

Test

Tinkerbell

Two

Taekwondo

Tow

Trespassing

Apple

Oak

Elephant

If

I

Also

All of us

Everyone

Ork

Soft starts

• Pseudostuttering

• Holding or tolerating moments of stuttering

• Blockmodification = pull-outs = in block corrections

• Postblock-corrections = cancellations

Variation: techniques for moments of stuttering

1.35.00 – 1.45.00 (In block correction)

Coffee

Cat

Canoe

Coke

Camel

Kill

Cow

Cord

Cupboard

z

Funny

Vast

Vest

Fingers

Foam

Fell

Soup

Somebody

Socks

Tom

Ten

Tammy

Test

Tinkerbell

Two

Taekwondo

Tow

Trespassing

Apple

Oak

Elephant

If

I

Also

All of us

Everyone

Ork

Make a stutter

Make a stutter + secondary behavior

Coffee

Cat

Canoe

Coke

Camel

Kill

Cow

Cord

Cupboard

z

Funny

Vast

Vest

Fingers

Foam

Fell

Soup

Somebody

Socks

Tom

Ten

Tammy

Test

Tinkerbell

Two

Taekwondo

Tow

Trespassing

Apple

Oak

Elephant

If

I

Also

All of us

Everyone

Ork

Make a stutter and let go

Coffee

Cat

Canoe

Coke

Camel

Kill

Cow

Cord

Cupboard

z

Funny

Vast

Vest

Fingers

Foam

Fell

Soup

Somebody

Socks

Tom

Ten

Tammy

Test

Tinkerbell

Two

Taekwondo

Tow

Trespassing

Apple

Oak

Elephant

If

I

Also

All of us

Everyone

Ork

1.45.00 - … (Post block correction)

Last vacation

Latest movie you’ve seen.

Favorite hobby

Describe my room

Describe my house, garden

TV-show

If I would own a million dollars…

If I would be king…

Cancellations in speech

Pull-outs in speech

Last vacation

Latest movie you’ve seen.

Favorite hobby

Describe my room

Describe my house, garden

TV-show

If I would own a million dollars…

If I would be king…

Some taste of fluency

shaping techniques

Stretched syllable speech

Stretched syllable speech

Today the teacher farted.

It was an awful smell.

It was just like a rotting egg,

Straight from the depths of hell!

Stretched syllable speech

Dentist and the Crocodile by Roald Dahl

The crocodile, with cunning smile, sat in the dentist's chair.

He said, "Right here and everywhere my teeth require repair."

The dentist's face was turning white. He quivered, quaked and

shook.

He muttered, "I suppose I'm going to have to take a look.""I want

you," Crocodile declared, "to do the back ones first.

The molars at the very back are easily the worst."

He opened wide his massive jaws. It was a fearsome sight––

At least three hundred pointed teeth, all sharp and shining white.

…

Stretched syllable speech

Behavior modification

Non verbal

Eye contact

Dealing with interruptions

Topic retention

Good coping abilities: self disclosure

Good coping abilities: self disclosure

Good coping abilities: self disclosure

The Power of Groups

What are the difficulties of

working with groups?

What are the advantages of

working in groups for children,

parents, young people and

adults with fluency disorders?

52

Shared experience

Reduced isolation

“I’m the only person in the world who

has this problem”

SAfety

Normalising stuttering

• Acknowledging thoughts and feelings

• Recognizing coping strategies

• Sharing bullying & teasing experiences

Confidence building

• Giving and receiving praise

• Praising self

• Confidence-building activities

Natural setting for

social interaction

& technique skills practice

Peer support

Expanding comfort zones

Working in pairs/small groups

Group presentation opportunities

Speaking to a group

Speaking Circles

58

Cost effective

• Therapists: client ratio

• Faster progress

• Improved generalization

• Improved maintenance

Setting up groups

Selection criteria

Assessment to identify individual needs

Establishing conditions for inclusion e.g.

attendance levels

Accommodation & venue

Resources

Program

Seating

Group gelling

Identify shared goals/aims

Group rules

Homework tasks

Beginnings

Endings

Group gelling

Activities:

• Name games

• Discover shared experiences

• Team activities

Group rules

Examples

Group develops poster

Group monitors rules

Confidence building

Identifying own strengths

Accepting praise

Giving specific praise

Stretching comfort zones

Reviewing ‘what’s going well’

Develop social interaction

skills

Turn taking

Listening

Eye contact

Volume

Posture

Identification & Desensitization

Watch videos of others & identify

stuttering

Generic iceberg

Personal iceberg

Tallying

Teaching other person to stutter

Stuttering to a stranger

What techniques?

• Least first

• Prolonged speech model

• Block modification

• Pseudo stuttering

Technique practice

• Individual/paired/group

• Increase length & complexity

• Structured/unstructured activities

• Spontaneous use

• Generalization

Challenging thinking patterns

Cognitive cycles

Self challenge

Peer challenge

Therapists challenge

TB’s vicious cycle: being asked a question in class

I’ll stutter

People will laugh

They will think I am odd

Say “I don’t know”

‘Freeze’

Look down

Let someone speak for me

Nervous (70%)

Embarrassed (90%)

Heart races,

body tenses,

feel hot

Specific situation practice

e.g. Interview panel, telephone practice

Case questions, videos, problems, ideas, suggestion

15’

What? Why? How?