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In nearly 25 years of clinical practice as a speech-language therapist, listening is the most important skill I’ve had to learn and cultivate on an ongoing basis. Listening skills may appear to be an obvious prerequisite for any therapist, or perhaps it’s an assumed quality that therapists possess, but what does it really mean for a therapist to demonstrate traits of an effective listener?

I have learned most about the art of listening through my involvement and work in the stuttering community. Meeting and working with people who stutter has opened my eyes to the vital need for communicative environments where listening is prioritized and valued.

In the therapy world, whether we call it reflective listening, empathic listening, or active listening, this kind of listening means we seek to listen with understanding, that is, understanding what the speaker is truly feeling and experiencing (Rogers & Roethlisberger, 1952).

The late Carl Rogers (1952) calls this “understanding with a person, not about her.” He defines it as “seeing the expressed idea and attitude from the other person’s point of view, sensing how it feels to the person, achieving his or her frame of reference about the subject being discussed” and being “willing to enter his private world and see the way life appears to him, without any attempt to make evaluative judgments” (Rogers & Roethlisberger, 1952).

Each time a client shares their story, it’s a privilege to be invited into their world—to see life through their eyes. This deep listening—understanding WITH a person rather than merely about them, and without judgment—is transformative in therapy. When we as therapists engage in this way, we create a safe space that encourages our clients to open up further. They begin to share more deeply, express themselves more freely, and experience a genuine sense of being heard, perhaps for the first time.

Rogers also asserts that if we can listen with understanding and “catch the essence” of a person’s hatreds and fears, we will be “better able to help them alter those hatreds and fears and establish realistic and harmonious relationships with the people and situations that roused such emotions” (Rogers & Roethlisberger, 1952). This concept is so applicable to the stuttering experience, so let’s examine further.

Learning from the lived experiences of people who stutter (Tichenor & Yaruss, 2019), we know that stutterers often grapple with complex emotions. These can range from anxiety and frustration stemming from challenging speaking situations to guilt and shame due to societal stigma and unrealistic fluency demands. Many also experience fear and isolation, feeling alone and disconnected from others due to their stutter. In the face of profound and deeply rooted emotions, speech-language therapists have a unique opportunity. By listening with empathy and understanding, we can guide individuals who stutter to explore and reframe their relationships with the people and situations that evoke such intense emotional responses.

Itzchakov and Kluger (2018) highlight Rogers’ theory that “when speakers feel that listeners are being empathetic, attentive, and non-judgmental, they relax and share their inner feelings and thoughts without worrying about what listeners will think of them. This safe state enables speakers to delve deeper into their consciousness and discover new insights about themselves—even those that may challenge previously held beliefs and perceptions.”

Reflecting on this concept, again I consider the experiences of our clients who stutter. They often find themselves in communicative spaces that feel unsafe, where listeners are not empathetic, attentive, or non-judgmental, and are thus hindered in their ability to communicate freely. By contrast, therapists who engage in the art of listening can go against the grain by creating safe communicative spaces that open the door to self-reflection and growth.

We must beware, however, of potential barriers to listening that might keep us from unlocking deeper understanding in our interactions and sessions with clients. Four main barriers warrant our attention:

1. Not being present. In an age of constant distractibility and frequent competition for our attention, being present with someone often requires intentionality, even in a therapeutic environment. To this end, we must seek to understand what optimizes our abilities to focus and attend, also realizing that being quiet does not necessarily mean being present. For some, this might mean learning to listen to hear and understand rather than listening to respond in an interaction. For others, it might mean consciously removing visual, auditory, or sensory distractors within the therapy environment. Ultimately, the goal is being fully present and engaged, which enables deeper connections.
2. Our tendency to impose solutions. Therapists who assume they have all the answers risk overlooking tailored solutions that best suit their individual clients. Itzchakov and Kluger (2018) suggest that “the role of the listener is to help the speaker draw up a solution themselves.” A good listener may be able to help elicit solutions with open-ended questions such as, “I wonder what might happen if…” Or “If X happened, what would be different?” Or “What would you be doing differently if…?” By asking thoughtful questions, rather than being the solution generator, the listener may lead the speaker to reflect and dive deeper into their thoughts and experiences (Itzchakov & Kluger, 2018), thus drawing on their own resources to generate possible solutions.
3. Failing to listen for the unspoken or the unnoticed. Sometimes listening is hearing what isn’t said, or it may be hearing what is said in passing or dismissively when that statement might point to small positive changes or hints of progress. Manning and DiLollo (2018) describe this as helping our clients identify alternative ways of interpreting their experiences by listening for cues to moments that have potentially been overlooked, ignored, or dismissed that speak a different story than the story they have habitually told themselves (or the stories imposed by others). Manning and DiLollo (2018) further assert that “dominant narratives can be limiting, thereby preventing people from enacting their own ‘preferred identities’ or narratives that lead them to more fulfilling and functional lives.” As we demonstrate interest in more details of our clients’ stories, we can encourage clients who stutter to consider alternative stories and perspectives by asking open-ended questions such as, “Tell me more about this. I am really interested in what you did to get through it successfully.” Or “How did you manage to do that?” Or “I wonder if there might be another explanation (for this positive outcome).” Or “Can you think of any other times that this has happened—maybe even just small examples?” (Manning & DiLollo, 2018). Change often happens in the small moments and as alternative narratives are recognized and embraced.
4. Holding to dogma. Dogma in therapy means that therapists may hold unquestioning beliefs or unchallengeable convictions about a particular treatment approach or program or certain therapeutic strategies and techniques, even if that means holding on to outdated beliefs. In this way, they become “treatment-directed” rather than client-directed, where the nature and needs of the client should be primary (Manning & DiLollo, 2018). Manning and DiLollo (2018) point to Cooper and Cooper’s writings suggesting that therapists should be “‘devoid of dogma’ and have the ability to adapt the therapeutic approach to the client’s uniqueness and needs.” This means we are listening attentively to the client’s concerns and worries, learning about their experiences, values, and hopes, and gaining a clear understanding of their needs, desires, and goals—in other words, truly hearing and seeing the client. Being devoid of dogma also means that therapists view both stuttering and stuttering treatment holistically, being attentive and attuned to the whole person and the entire stuttering experience (Tichenor et al., 2022). Additionally, holistic treatment means we walk alongside our clients with a willingness to take risks and explore fresh ideas and opportunities, particularly when the process of change is slow or difficult (Manning & DiLollo, 2018).

The art of listening in speech-language therapy, especially for those who stutter, is paramount. It transforms therapy rooms into places where individuals who stutter can safely explore their experiences and challenges and reshape their relationship with stuttering. As therapists refine their listening skills, they not only improve clinical outcomes but also model the patience and acceptance that clients may struggle to find in their daily lives. As we continue serving people who stutter and their families, may we learn and practice listening with understanding, that our clients may truly feel heard!

It is disheartening when we hear that school-based SLPs are still being required to base eligibility for services for children who stutter solely (or primarily) on percentages of observable disfluency.

As our understanding of the speaker’s experience of stuttering increases via research evidence, patient evidence, and clinical practice, eligibility criteria for receiving stuttering services in the schools must be analyzed and challenged.

A Deeper Dive into the Regulations

First, we know that the Individuals with Disabilities Education Act (IDEA’04) mandates state education agencies and local school districts to provide special education services to eligible children ages 3-21 in order to provide a free, appropriate public education (FAPE). The question of “need” for children with communication challenges is tied to how the communication disorder or difference adversely impacts their educational performance. Demonstrating adverse impact on educational performance can become a tricky endeavor for school-based SLPs, particularly for children with good grades, or when eligibility guidelines are outdated and not informed by current evidence-based practice.

Let’s look at the first issue - when professionals limit “educational performance” to showing discrepancies in performance in academic subject areas. This dilemma has caused ASHA to seek guidance from the Office of Special Education Programs (OSEP) on multiple occasions. Over a span of 30 years, OSEP’s responses (dated 1980, 1989, and 2007) have affirmed that whether a speech and language impairment adversely affects a child’s educational performance cannot be strictly based on discrepancies in age or grade performance in academic subject areas.

An excerpt from one response letter states: “The extent of a child’s mastery of the basic skill of effective oral communication is clearly includable within the standard of ‘educational performance’ set by the regulations – that is, academic failure is not a prerequisite for services. It remains the Department’s position that the term ‘educational performance’ is not limited to academic performance. Services cannot be denied as a matter of policy because the adverse effect on educational performance is not reflected in grades or academic achievement.”

IDEA regulations and OSEP deem educational performance to mean more than grades, therefore, in addition to academic performance, we must look at adverse educational impact in terms of the functional, developmental, social-emotional, and nonacademic needs of the child.

Practical Guidance Summary: Satisfactory academic achievement is not a reason to exclude children from receiving services for stuttering.

How to Gauge Adverse Impact

For a bright child who stutters, the functional, social-emotional, and nonacademic effects of stuttering that adversely affect educational performance may be, for example:

1. Stuttering draws negative and undue attention to the child.
2. The presence of negative social stigma (e.g., wrong assumptions that the child is nervous, anxious, or less intelligent).
3. Embarrassment and fear of stuttering potentially lead to a lack of classroom participation (e.g., oral presentations, show-and-tell, group discussions, storytelling or retelling, asking and answering questions, requesting information, initiating conversations).
4. Reduced confidence in reading aloud in class or in small group settings due to stuttering.
5. The potential of being bullied, ridiculed, or shunned by peers because of stuttering.

Outdated Eligibility Criteria

Now let’s look at outdated eligibility criteria that place too much weight on disfluency counts. First, in accordance with the long-accepted iceberg analogy of stuttering (Sheehan, 1953; Sheehan, 1998), we have come to understand that the visible aspects of stuttering (i.e., disfluencies themselves and secondary behaviors) are only a small part of the stuttering experience. The invisible aspects of stuttering, such as negative thoughts, feelings, and emotions, and the ways in which these impact a person’s self-perception, confidence, and actions, comprise the much larger part of stuttering. In Diagnosing Stuttering in the School Environment (2002), Michael Susca, professor and stuttering specialist, affirms that the majority of stuttering is unobservable.

Recent research based on the lived experience of individuals who stutter confirms that stuttering encompasses much more than the visible behaviors (Tichenor and Yaruss, 2019). With this understanding, Tichenor and Yaruss (2019) proposed an updated ICF (International Classification of Functioning, Disability and Health) model for the complex experience of stuttering to outline the perceptions and lived experiences of people who stutter. This ICF model presents the sensation of being stuck or losing control as a primary symptom of stuttering, and it also includes the individual’s behavioral, affective, and cognitive reactions and responses as well as activity limitations, participation restrictions, and environmental factors as part of the stuttering experience, all of which may significantly impact quality of life. Furthermore, Tichenor and Yaruss (2019) indicate that frequently perceived behaviors during moments of stuttering, such as the sensation of being stuck, the feeling of loss of control, as well as choosing not to speak or removing oneself from a speaking situation, are difficult to observe from the listener’s perspective. In 2022, Tichenor et al. contended that the primary aspect of stuttering is what the speaker experiences, rather than what the listener sees or hears.

So What Does it all Mean for Evaluation and Eligibility?

Susca (2002) suggests that asking key questions “may reveal the presence of a stuttering disorder without the presence of observable symptoms.” Susca also states that a standardized diagnostic assessment alone is “insufficient and in direct violation of the intent of IDEA ’97.” [Currently used: IDEA 2004]. With this in mind, let’s summarize what this means for SLPs in the public schools.

A. Evaluating the “severity” of stuttering for the purpose of diagnosis and determination of eligibility for school-based services cannot be limited to listener perceptions of the frequency of stuttering in a person’s speech.

B. Additionally, the expectation and pressure for fluency often leads individuals who stutter to attempt to hide their stuttering, even from an early age, and these covert tendencies can mask visible stuttering behaviors albeit severe and crippling impact may be present.

C. Therefore, appropriate eligibility determination criteria for services for stuttering should include:

1. Types of disfluencies (i.e., tense-filled repetitions, prolongations, blocks) and avoidance, substitution, or circumlocution of sounds, words, or situations because of speech disfluencies (Susca, 2002).
2. Behavioral, affective (i.e., feelings, emotions, attitudes), and cognitive reactions and responses to disruptions in fluency.
3. Maladaptive coping behaviors (e.g., silence, self/social isolation, avoidance of situations and people, escape behavior due to stuttering).
4. Activity limitations and restrictions impacting speaking, conversing, discussing, forming relationships, interacting, and participating (note: applies to both academic and extracurricular activities).
5. Overall impact on quality of life (Yaruss & Quesal, 2006, 2016).

A wise man once said, “Not everything that counts can be counted, and not everything that can be counted counts.” If we as professionals only consider disfluency counts and erroneously ignore the entire condition of stuttering, potential outcomes for the child who stutters may be: 1) reinforcement of their fear of talking and fear of stuttering; 2) reinforcement of avoidance of words, people, and situations; 3) limited social skills and interaction with others; and 4) lowered educational achievement due to avoidances and participation restrictions.

It is up to us to challenge and work to change outdated and inappropriate eligibility guidelines that do not account for the entire stuttering experience. It may not be easy, but it will certainly be worth it because children who stutter deserve better!

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When we consider “One Size Does NOT Fit All” as speech-language pathologists (SLPs), what is our role in stuttering treatment?

Conventional wisdom in the sub-field of stuttering evaluation and treatment calls on clinicians to meet their clients (and families) where they are. Change cannot be forced on anyone, and as clinical psychologists William Miller and Stephen Rollnick have argued, those who are not yet ready to change will simply supply their own arguments against change (Miller & Rollnick, 2013). This will inevitably lead to behaviors which support those arguments. In other words, change must begin internally, manifest its readiness in language, and then lead to sustained action. This view comports with the available research and encourages speech therapists (in our case) to start with the client rather than a preconceived and rigid plan of action. One size simply does not fit all.

Yet, there seems to be some confusion over the well-known principle: meet clients where they are. Many in the field use this language synonymously with a call to “do as clients wish,” whatever the request and whatever the consequence, thus decontextualizing its potential benefits. It is this latter implicit direction which fails to take into account the very nature of stuttering and its impact. An open-ended conversation with a person who stutters can yield the problems associated with stuttering: shame, guilt, embarrassment, fear, anxiety, saying less, staying home, hiding, hopelessness, concealment, unwanted thoughts, diminished self-worth and confidence, dread of conversation, and physical exhaustion. While this list is far from exhaustive, it is intended to paint a picture of a life which is ruled (in many cases) by stuttering or even the possibility of stuttering–a life in which decisions are made to minimize social stigma and other potential consequences of being a person who stutters. The bad news is that these are not hypothetical consequences for stuttering in our day and age. The good news is that none of these consequences are endemic to stuttering and thus, can be discarded and changed if desired.

Speech therapists possess a unique mixture of specialties in motor speech, counseling, pragmatics, and behavior change, and are in an excellent position to support people who stutter. We can do this by asking open-ended questions to elicit their personal experiences, challenges, resources, and hopes, all from the perspective of a person who stutters. However, we do not merely want to understand their problems or the nature of their problems. We also want to understand the types of change (if any) they desire to make. Broadly, this may sound daunting, or conversely, intuitive until beginning the conversation, only to find that this is easier said than done.

Given the nature of the problem, it is important to know how the client views his or her communication and what he or she is prepared to do about it. The response by most newer clients (or families) is that stuttering is the problem and fluency is the solution. In most cases, clients have not considered the problem beyond these bookends: stuttering and fluency. Many clients appear to lack an imagination beyond an undefined future hope: fluency. When asked what this would mean for them, many struggle to expound on their initial responses. “What would your family notice (or notice you doing) if you didn’t stutter anymore?” Many respond, “Well, they would notice that I’m not stuttering.” This response and many like it evidence a belief that there are only two choices: to stutter and live as “broken” or find fluency and finally begin to live. These choices will be expressed in myriad ways but evidence the same core belief that speech fluency is the only way out of their problem(s). If clinicians simply “give the client what he/she wants,” it will feed these false beliefs and reinforce the notion that fluency will give them what acceptance cannot. If we, instead, pivot to probing their experience of stuttering and the future they envision (if stuttering were no longer an impediment to living the life they want), both client and therapist will begin to peel back the facade of the “fluency solution” and discover the gems hidden below the surface. We simply have to be willing to mine with them.  

We intend to argue in this paper that it is the job of the therapist to elicit insights into the nature of stuttering and explore associated problems with clients and to illuminate the variety of choices for communication with guidance in achieving whatever desired outcome is expressed. The key is “informed desired outcome,” but what do we mean by this? As aforementioned, sometimes the individuals we serve, young and old, come to speech therapy with a valid desire, even need, for fluency that is often informed by a limited view and understanding of stuttering. This is heavily influenced by recurring negative listener reactions, trauma experienced due to stuttering, cultural views surrounding differences, societal norms of what is acceptable or preferred, as well as internal and external pressures for fluent speech. Let’s imagine for a moment the first time one experiences the ocean. What’s the difference between swimming in a lake versus swimming in the ocean? You might be content with lake water if you know nothing different, but once you’ve seen and experienced the clarity and beauty of the ocean, it’s unlikely you’ll desire lake water again. What if our role as SLPs was to guide our clients/students to see the beauty of the ocean of spontaneous and joyful communication rather than remain in the murky waters of fluency at all costs? A shift of this sort would see SLPs as guides in expanding a client’s imagination of what is possible, slowly removing the blinders to enable them to see the panorama. Seeing a possible preferred future which was previously unimaginable can lead to hope, the belief that what is possible might be probable. And increased hope can lead to genuine choice. After all, who chooses an option which they believe is not truly possible?

It is here that an important qualifier must be added and that qualifier is this: each client brings unique personal experiences, readiness, personalities, values, and personal resources which will impact and inform the change(s) they make. It should be noted that this is an aspect of meeting clients where they are which should be upheld. Clients must have complete autonomy over their treatment and the pace of the work, even while clinicians play a role in shaping that experience and coaching or guiding clients toward their preferred future.

Joze Piranian, speaker, comedian and person who stutters, presented a similar idea with a different lens when giving a keynote address at the 2023 NSA conference. He shared a quote by Persian poet Rumi, which speaks to the work we do with people who stutter, “Why do you stay in prison when the door is so wide open?” As SLPs, it’s a beautiful picture of the power of treatment when we help people finally see wide open doors in order to come out of whatever “bondage” they find themselves in (i.e., limitations, restrictions, confinement due to stuttering).

In a recent video depicting positive outcomes of effective speech intervention (https://youtu.be/l4pddgtEH3g), Mike conveys such a powerful message, stating, “After my perspective changed, I pretty much stopped worrying about it (stuttering), which is really something I’ve been seeking my whole life which I didn’t even know that I was seeking for it, so it was a huge help in just a perspective change on my entire social interactions.” Mike didn’t even know that what he was seeking in treatment was freedom–freedom from a mind consumed with stuttering (or not stuttering), freedom from the shame he experienced, freedom from the pressure he felt to speak fluently and never stutter, and to “get this fixed” so he could finally achieve his goals. For the first time, Mike understood the false dichotomy between “either fluency or…dating/marriage, a career, friendship, participation, independence (or fill-in-the-blank).” He describes this change as an inward change–an inward change he never knew was possible. In other words, his speech therapist helped him consider possibilities and outcomes he didn’t know existed. If his therapist’s approach had been to simply give him what he wanted (i.e., tools to reach fluency), his vision for his life would have remained restricted and narrow.

We will presume you are fully convinced by this line of argumentation and speak to the “how” of expanding realms of possibility in everyday life. Motivational interviewing and solution-focused brief therapy provide helpful models of questioning which ask the client to “use your imagination” to discuss what might be different if the problem were suddenly gone. The focus is on positive solutions to the problem at hand, what the person would be doing that he or she is not doing now, or is doing now but might hope to do even more. The therapist reflects these responses back and provides additional questions to “mine” for concrete behaviors (gems) which might become actionable. For example, responses such as “I would be happy” or “I wouldn’t feel so afraid” are insightful but offer no clear opportunities for concrete change. The clinician might then ask, “If you were happy, what would be different?” or “If you felt happy, what would that free you up to do?” Solution-focused therapy often utilizes the question, “And what difference would that make?” or “Suppose that happened, what would be different?” to delve further into this hopeful future. These conversations often generate lists which can be shaped into goals and insights into the changes a client would like to make. I want to talk more, I want to give better eye contact in presentations, I want to have fuller conversations (rather than cut them short or say as little as possible), I want to ask questions in class. These responses reach far beyond “fluency” and into the everyday life of a client. In the same way a client may state, “I want my stuttering to go away” or “I want to be more fluent,” a client may also state, “I want to introduce myself to new kids at school.” Unless SLPs ask the question, many people who stutter might never share these hopes. Indeed, a client might never voice these hopes because he or she does not consider them worth uttering. The key is taking small, tangible steps over time which lead to meaningful changes. Books and articles by William Miller, Stephen Rollnick, Kidge Burns, Insoo Kim Berg, and Steve de Shazer, can help to flesh out the methods discussed briefly in this paper in greater detail.

In summary, “One Size Does NOT Fit All” means that it’s not only ethical and reasonable for SLPs to serve as guides to worlds unexplored, but it is our role and responsibility to do so. We carefully cultivate a culture in which change is viewed as possible and in which desires, needs, and hopes can be actualized within and beyond the therapy room.

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In 2015, I found myself with 15 years of experience as a speech-language pathologist (SLP) and yet felt completely ill-prepared and lost when my son began to stutter. How could I as an SLP be utterly lost when facing my son’s stutter? Change is needed.

Later in 2015, I found myself as an SLP trainee at an overnight camp for nearly 60 youth who stutter. Though I felt completely out of my element and learned more about stuttering in a week than I remember learning in my graduate school Fluency Disorders course, it was a life changing experience both personally and professionally. I left that experience thinking, how can more SLPs experience the magic of a place like this? Change is needed.

At a conference in 2018, I was surrounded by parents of children and teens who stutter, and I realized for the first time how many parents aren’t aware of the limited training SLPs receive to work with people who stutter. I also realized that so many families don’t have access to specialists in the area of stuttering, and they don’t quite know what to look for in a generalist who knows more about stuttering than the average SLP. How can we connect families with SLPs who are knowledgeable and confident working with children who stutter? Change is needed.

By 2019, I had experienced first-hand the power of support organizations for people who stutter both nationally and abroad. I realized that so many people who stutter often go years and years without ever meeting someone else who stutters. They often find themselves alone and isolated from people who truly understand the experience of stuttering. How can we connect families and individuals with more sources of support and community? Change is needed.

Circling back to the preparation of SLPs, in the last year I have learned from recent studies that have been very eye opening (see reference list). I learned that in 1997, 59% of graduate students in the field of speech-language pathology could graduate without any clinical experience in stuttering. There was an increase to 65.1% of graduate students without clinical experience in 2000, but then thankfully a decrease to 31.5% in 2013. Though we see a higher percentage of students graduating with clinical experience, it was reported that clinical hours in the assessment and treatment of fluency disorders are guided by less experienced clinical supervisors. Change is needed.

In terms of coursework, 17.8% of students could graduate without taking any courses exclusively devoted to fluency disorders in 1997. There was an increase to 22.6% of students in 2000, but then a decrease to 14.2% in 2013. This means a lower percentage of students graduating without coursework devoted to fluency disorders, however, 9.6% of programs still reported having no required or elective graduate course in fluency disorders. Thus, the number of programs providing minimal education about fluency disorders remains high. While the 2019 survey of graduate students showed an increase in knowledge and comfort levels by students, they still reported not having adequate knowledge with regard to administering assessment tests or differentiating between various types of treatment. Results showed students still felt uninformed or uncertain about fundamental aspects in fluency disorders.  Change is needed.

In 1997, SLPs indicated that graduate and undergraduate courses mainly stressed theory and treatment was less emphasized. In 2000, there was a reported increase in the number of programs that emphasized clinical application in their graduate courses, rather than focusing primarily on theoretical issues and background. Even with this positive trend, the 2008 study of SLPs showed that 50.8% of SLPs could not differentiate between the two main approaches to stuttering therapy and 46.5% were not comfortable working with children who stutter. Let that sink in…nearly half of the SLPs surveyed were not equipped to work with people who stutter. Additionally, 66.4% did not use attitude scales to assess stuttering, which means a large focus on the behavioral aspects of stuttering while ignoring the affective and cognitive aspects of stuttering as well as its impact on the individual. Change is needed.

In summary, even with many years of experience, studies show that stuttering is a low preference disorder among SLPs and that a vast number of SLPs feel inadequate and uncomfortable treating stuttering.

CHANGE. IS. NEEDED.

All these studies point to a call for the better equipping of graduate students and speech-language pathologists, and so in 2020, a nonprofit organization, Spero Stuttering, Inc., was born! Our vision is to help, empower, and advocate for the stuttering community and their families by equipping those who work with people who stutter. Our heart is to change the reality that many SLPs are ill-equipped and unprepared to work with stuttering.

We seek to encourage and recruit practicing SLPs to obtain more training in the area of fluency disorders by providing guidance, stipends, and recognition for SLP training and hands-on traineeship experiences that promote a philosophy of treatment that seeks to see people who stutter and their families find connection and resources, discover their authentic voices and self-acceptance, and communicate effectively in their everyday lives.

We developed the Ally of Stuttering^TM Seal to recognize SLPs who are committed to prioritize stuttering as an area of professional growth and who are involved in the stuttering community. The seal is an accessible training path for the generalist SLP to learn more about stuttering, people who stutter, as well as research-based and holistic therapy approaches. It demonstrates that the SLP holding the seal has a special interest in stuttering and has received intentional training beyond graduate school. The seal also indicates that the Ally of Stuttering^TM SLP is committed to ongoing training and professional development in the area of fluency disorders at regular intervals.

Furthermore, this allows us to connect families and individuals with SLPs with more training and experience, particularly when a specialist is not readily accessible. It is important to note that the seal does not endorse or guarantee the quality of services provided by that Ally of Stuttering^TM. It is still up to the individual or family seeking treatment to determine if the SLP is a good fit, but we believe there is value in families knowing if their SLP has more training in the area of fluency disorders than the average SLP, since our Certificate of Clinical Competence doesn’t indicate preparedness to work with people who stutter. Our scope of practice in the field of speech-language pathology is simply too large, yet our scope of competence is much narrower. SLPs must recognize this gap, actively seek to learn more, and do no harm in the process!

We now have a growing number of Ally of Stuttering^TM SLPs (in 25 different states!) who are committed to improved quality of services through more specialized training and engagement in the stuttering community! We have awarded graduate research scholarships for minority students studying fluency disorders as well as Continuing Education and Traineeship (CEAT) stipends for SLPs to obtain more training. With the help of key corporate sponsors (Stuttering Therapy Resources, The Informed SLP, SLP Nerdcast, Northern Speech Services, Change & Impact, Oficina de Fluência, WorkReady Texas, and Higginbotham), we also put on the Strides for Stuttering Virtual 5K Fun Walk/Run fundraiser where more than 70 people participated nationwide, helping us raise funds for this important work.

On a personal note, my son’s stutter eventually resolved, but stuttering left an imprint on my heart, and I have become passionate about serving people who stutter. We hope we can fuel more passion among practicing SLPs, particularly school-based SLPs, equipping them to work with people who stutter with confidence and effectiveness!

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When I think about a world that understands stuttering, I consider my own journey of coming to understand stuttering as a speech-language pathologist (SLP) and as a mother whose son went through a period of marked disfluencies in his own speech. As a young therapist, I did not understand the multifactorial nature of stuttering or the multifaceted impact of stuttering on a person’s life. My approach was limited to external strategies or “tools” to manage what seemed to be unpredictable communication challenges. These challenges were also largely addressed in the context of contrived therapy experiences. This written reflection is my attempt to portray the importance of SLPs growing in their own understanding. My desire is that we may help individuals who stutter find what’s already within and accessible to them to become effective communicators, with or without stuttering, in the context of meaningful life experiences.

Prisms refract light. Though my understanding of physics and the properties of light waves is meager, when I see a rainbow, I understand the refraction of light. Water droplets refract light, breaking it into its spectrum colors, and subsequently, unveiling a stunning sight.

This summer I was able to participate, for the second time, in a therapeutic summer camp for youth who stutter (Camp Shout Out). I am always amazed at how much I learn when surrounded by 50 young people who stutter as well as dozens of dedicated speech-language pathologists (SLPs) and graduate students who are passionate about serving them.

I returned home with the picture of a prism in my mind. As I sought to understand prisms, I learned that originally it was believed that white light was colorless and that prisms themselves produced color. Through Sir Isaac Newton’s revolutionary experiments, it was discovered that the colors already existed in the incoming light. In other words, the prism did not create colors; instead it separated colors that were already there.

I witnessed a lot of “refraction” during this year’s camp experience. What stood out to me the most was the emphasis on guiding children and teens, to access what was already present within them, in order that they might become the best communicators possible. Instead of being guided to “pick up speech tools” to manage their speech, they were guided to engage in tangible actions that were readily available and within reach, which yielded effective communication. I marveled as I watched SLPs and graduate students become prisms, not creating color but making present colors beautifully visible in young people.

You might be thinking to yourself, what are these present colors that can sometimes appear as colorless light? The simplest yet most powerful one is the breath – merely attending to the breath and letting the natural “phrase of exhalation” be the “phrase of talking” (Kristin Chmela, SLP and fluency specialist). Another action was tangibly acknowledging and reinforcing the evidence of assertiveness and confidence such as powerful voices, strong handshakes, sustained eye contact, tall postures, and courage to take on difficult speaking situations. The concrete acknowledgment of positive thoughts and actions is amazingly transformative.

In a nutshell, through the intentional process of observing, noticing, modeling, encouraging, guiding, and praising powerful actions, we saw young people access their limitless potential within. As I strive to grow as a therapist, I desire to be a prism, that the true colors of individuals I serve may shine brightly – and that the world may better understand stuttering!

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Camp Shout Out is a unique camp where youth with fluency disorders, graduate students, and speech-language professionals come together to “learn, teach, and empower each other to become more competent communicators and therapists in a safe, fun, and natural environment.” (www.campshoutout.org)

As I reflect upon Camp Shout Out, the pervading image I see is an avalanche.  A start zone, a trigger, a shift in the snowpack, a track.  Fast acceleration, rapid growth, and the entraining of everything in its path.  Do you see Camp Shout Out yet?

The start zone – a rustic campground on beautiful Big Blue Lake.

Trigger #1: A supportive community of people with shared experiences, shared challenges, shared tears, shared goals.

Seismic activity has begun.

Trigger #2: Five guiding principles that teach us all to be…

Attentive as we listen to each other and our own bodies;

Assertive as we dare to conquer our fears and challenge self-imposed limits;

Confident as we stand up majestically and replace mistaken thoughts with helpful thoughts that lead to powerful actions;

Effective as we commit to continued learning with specific goals as we strive to become effective communicators;

Proactive as we practice and plan and set ourselves up for success and simple happiness.

Major metamorphic changes in the snowpack continue.

Trigger #3: New found understanding, peace, self-worth, courage, strength.

Deep breath in…and there flows the snow, unable to resist the imposing force, except its track is the surface of precious lives – children, young adults, old folks – all moving through their own journey, yet now with rapid acceleration and growth because they’ve all learned a great deal.  They carry with them invaluable lessons, lessons that will entrain all those who cross their paths – family members, friends, teachers, co-workers.

You see, avalanche initiation starts with small amounts of movement, small variations in the surrounding conditions.  However, under all of the right conditions, that small beginning evolves into a giant force.  Camp Shout Out is an avalanche – an avalanche of empowerment and transformation, not of destruction.  May its forward flow continue for years to come.  May it grow exponentially and entrain multitudes because this force is truly life-changing!

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