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Previous research has shown that many individuals who stutter report negative feelings of embarrassment, dissatisfaction with life, shame and difficulty speaking to due to stuttering (Yaruss, 2010). These negative reactions can cause people who stutter to withdraw from social situations and have low self-esteem. In a study by Irani et al., (2012), participants reported that counseling activities during therapy created positive changes in attitude toward stuttering.
Counseling in the form of conversation and writing have proved to be effective ways of improving attitude and self-confidence, therefore both approaches were used simultaneously in this study. Irani et al., (2012) found that the clinician’s understanding, willingness to help, and nonjudgmental nature during therapy had a positive impact on the client’s motivation to make changes and benefit from therapy.
The purpose of this case study was to determine:
1) the changes in negative reactions to stuttering by implementing a guided journal writing activity in therapy
2) the likelihood of participating in activities that were once avoided due to fear of stuttering after completing the guided journal writing activity
3) if positive outcomes in therapy are dependent on positive clientclinician relationships
The client in this case study was an 18 year-old female who was seen in the Marshall University Speech and Hearing Center. A journal was used for directed discussion to focus the client on her reactions to stuttering. Each week a new entry was written based on the topic selected by the graduate clinician. A questionnaire was administered after completion of the journal to measure how the activity helped her decrease avoidance behaviors and how the clinician relationship impacted her progress. The Overall
Assessment of the Speaker’s Experience of Stuttering (OASES; Yaruss &
Quesal, 2010) was also administered prior to initiating the journal and after its completion to compare results.
The client was seen for speech treatment one time per week for 12 sessions over the course of one semester.
Another important finding in this study was that positive outcomes in therapy may depend on the relationship formed between the client and the clinician. The survey revealed that the client strongly agreed that the clinician was: knowledgeable about stuttering, non-judgmental during discussions, willing to listen, able to give effective and appropriate feedback, able to relate to/share her own experiences, and able to create an environment of trust. She also agreed that the clinician had an impact on her excitement and desire to attend therapy each week. In the written section of the survey, the participant stated that some of the clinician characteristics she found most helpful were friendliness, positive attitude, ability to listen and being able to give advice. She also stated that her relationship with the clinician allowed her to be comfortable, honest, and open up about problems during therapy sessions.
The present study revealed that open discussion and guided journaling about past and present experiences may decrease negative reactions to stuttering.
After completing the survey, the client reported that she strongly agreed that the journal activity made her think about future experiences as a person who stutters, as well as utilize information learned in therapy in real-world situations. She also reported that she agreed that the journal positively changed her attitude toward stuttering. In the written section of the survey, the client indicated that the journal was one of the most beneficial activities used in therapy and that she had gained confidence as a person who stutters. In addition, the overall impact score on the OASES improved by 1.2 points.
The client did not report that she was neutral, disagreed, or strongly agreed to any questions regarding the clinician on the survey.
We are currently working on administering the client-clinician survey in broader settings. In addition, a new tool is in development that assesses parent-clinician relationship for clients who are too young to take the survey.
The present study also revealed that the journal activity may increase the likelihood of participating in activities that were once avoided due to stuttering.
The client agreed that the journal activity gave her more confidence in social situations and pushed her to engage in situations previously avoided.
The client remained neutral in determining if the journal activity lowered her fear of stuttering in social situations. This may indicate that journal activities may not reduce fear, but may reduce avoidance. She did not disagree or strongly disagree to any questions about the guided journal activity.
Irani, F., Gabel, R., Daniels, D., & Hughes, S. (2012) The long term effectiveness of intensive stuttering therapy: A mixed methods study.
164-178.
Yaruss, J.S. (2010). Assessing quality of life in stuttering treatment outcomes research.
190-202.
Yaruss, J.S., & Quesal, R. (2010). Overall Assessment of the Speaker’s Experience of Stuttering.
Pearson. Bloomington, MN.
Craig Coleman is a co-author of the OASES-S and OASES-T and receives royalties from
Pearson.