Wednesday, November 20, 2013

Pall Mall Puffing Potty Mouthed Role Models

The other day I got to thinking about what a golden opportunity speech therapists have to develop the oh-so-important one-on-one relationship with a child.  Research-based evidence claims this can be the one most important factor for a kid who is struggling – one adult who will listen to them without passing judgment.  I started researching peer-reviewed journals to find quotes and numbers to prove my point, but all day long, Lorraine kept popping into my mind.  Pall-Mall puffing, potty-mouth Lorraine.  So here goes…

When I was a teenager, we had one small bathroom in our farmhouse and had to literally walk through our parents’ bedroom to use it.  Combining that with an ancient septic system and limited water supply, the old outhouse back by the grove of trees was often called into service, especially when extended family came to visit.  I remember Lorraine, my stepmother’s step-niece (I did say “extended”) absolutely hating that trip.  She was about 12 years older than me so in my 15-year old eyes, she was oh so adult.  We often ended up sharing a bed and Lorraine would sock me in the arm in the middle of the night to wake me up and accompany her to the outhouse.  I was honored.  

Lorraine would light up a Pall Mall for the trip and we’d tip-toe down the steps, giggling our fool heads off.  Once out the back door, we’d grab each other’s hands and bolt through the cold wet grass,  Lorraine swearing a blue streak.  My job would be to hold (and puff on) Lorraine’s Pall Mall and keep a look-out for men with axes.  The corn fields of southern Minnesota were full of them - seriously.  Lorraine and I bonded over those trips to the old outhouse.  And once back in the safety of my bed, too wound up to sleep, we would talk.  Well, I would talk, Lorraine would listen.  I could say anything to Lorraine, she would never never pass judgment.  She listened to all my troubles, all my hopes and dreams, she made me feel worthy, heard, and special.   
Now no one in the world would have positioned the Pall Mall smoking, potty-mouthed Lorraine as being a role model for a struggling teenager.  But she was.  She made a difference.  I will never forget her.  

To all the hard-working compassionate speech therapists out there – be the Lorraine in your clients’ life (Pall Malls and potty mouth optional).  You have that golden opportunity – one-on-one uninterrupted time to just listen – no assessment, no judgment.  Just listen. 

Keep Them Talking….


Dori Lenz Holte

Tuesday, November 19, 2013

Kyle Thompson - Powerful Photography Inspired by Anxiety

These amazing photographs came across my Facebook page yesterday.   Viralnova, the site that publicized these photos on the web, says this about the photographer:  
"A couple of years ago, Kyle Thompson became interested in photography. Unfortunately, his anxiety prevented him from talking to people, so he opted to experiment with self-portraits.
He would spend hours, even days, walking alone through forests and exploring abandoned houses. He’s been to over 50 of them. After taking hundreds of photos, he posted some of his best to Reddit. From there, his life changed forever."
These images are powerful, especially for anyone dealing with anxiety-induced silence. I thank Kyle for his amazing talent and images and I am displaying his work here with his permission.   


Wednesday, November 13, 2013

Do They or Don’t They Need Fixing?

Several years ago, while at a conference for families with children who stutter, a speaker/speech therapist called out to the crowd, “Our kids don’t need fixing!”  The crowd, myself included, clapped and cheered in agreement. 

Later that day therapists gathered to share their latest strategies for getting kids to use speech tools.  Parents gathered, often in tears filled with fears, lamenting the fact that their kids didn’t use their speech tools or practice them enough.   So if something doesn’t need fixing, why all the tears and tools?  I have a feeling that I wasn’t the only parent in the audience who applauded and at the same time was thinking “but seriously, help me find a way to fix it!”

Of course I would never want Eli to think he needs fixing or to think there’s something wrong with him, but let’s face it – that ship has sailed.  Consider all the trips to speech therapy, stickers for not stuttering, and using a significant chunk of our family vacation time and resources to go  conferences on stuttering – and then try to convince him that we really don’t believe there’s a problem that needs fixing?   It’s tough enough to hang on to some level of credibility as our children push towards the teen years, let’s not add fuel to their fire. 

What is it we are trying to say when we say “they don’t need fixing!?”  Certainly that we will accept, support, and love them no matter what.   But I think it’s confusing to both parents and children when we insist that they don’t need fixing at the same time we are putting great amounts of energy into finding resources to address the issue. 

Maybe “fixing” isn’t the best word for what it is we want to accomplish, but for simplicity’s sake, let’s stick with it.  I sometimes hear “tools” also referred to as strategies and techniques, so for the sake of this posting, let’s define “tools” and “techniques” as any prescribed way of speaking, and “strategies” as a more inclusive approach that is devoid of prescribing a speaking manner, i.e. tools and techniques.   

So let’s replace our tools aimed at fixing with strategies that minimize anxiety and maximize a sense of self, self-confidence, and engagement.  What does that look like?  Have you ever seen a child completely immersed in an activity?  Just the other day Eli participated in a high-energy volunteer activity with his church group.   He told me later that he was having so much fun he didn’t stutter at all because he “forgot to think about his speech.”  Those were his exact words. 

What strategies can we use to nurture that state of mind in our overly-anxious, often perfectionistic children?   Wouldn’t it be lovely if a speech therapist partnered with us to explore the possibilities as they relate to our child?  It would sure be a ton more fun than sitting down and practicing speech tools and techniques!  We need strategies aimed at helping them forget to worry about their speech, not tools that are likely to increase the focus and anxiety around speaking.  It’s crazy to deny the desire to make it go away – to fix it.  Let’s just make sure we are using the right too….er, strategies!  First do no harm…


Dori Lenz Holte

Friday, November 8, 2013

Family-Based Therapy - What Does That Really Look Like?

Another question that came up in response to my ISAD conference submission (The Right Time to Break Out the Stickers – see previous post) was around my opinion of family involvement in the therapy process.  Following are the questions and my answers.

Q: In class we are learning about how important it is to employ a “family based treatment” where not only does the SLP work with the child who stutters, but also educates the family and is interested in the family’s opinions and concerns about their child.  Did any of the speech therapists that worked with Eli also work with you and your husband to teach you what you could do at home to help Eli, or just talked to you about your questions or feelings about how Eli was progressing? Stacey

A: I’m not a speech therapist, but in my opinion, “employing a family-based treatment” is only helpful depending on exactly what you are asking the family to do. We felt that we were employed when the therapist helped us to understand the speech tools and ways we could practice at home. I begged for this involvement as I could not imagine he would ever be able to use these naturally without lots and lots of practice. Same with educating the family…depends on what you’re educating them to do…how to make fewer speech errors, or keeping them talking and engaged in the world around them. Too often the family involvement is hinged on practicing speech tools and working to transfer these into their real world. There is so much a family can do to encourage talking, to keep talking fun, to enhance communication, and to build on what the child does well and with a passion. And this can be done without risk of silence and withdrawal.

Q: Did the speech-language pathologists who treated your son ever take an approach to therapy that included the entire family system?  Do you feel this would have been beneficial?   Laura

A: One speech therapist included Eli’s brothers, dad, and myself in some of the sessions. She also had Eli bring a friend once. Was it beneficial — not really.  Is it a good idea? Depends on the focus of the therapy. Is it necessary? Absolutely. How’s that for confusing?

As a parent, I think therapy should focus on keeping the child talking, addressing the emotional aspects, and minimizing anxiety around communication. If this is the focus, then parental/family involvement is pretty crucial. If the focus is on eliminating disfluencies, then family (and teachers and grandma) can turn into the speech cops. Surrounding a child with speech cops runs the risk of increased anxiety, silence, and withdrawal.

Additional thought:  Insurance companies insist that speech therapists can only bill for time spent directly with the child or at least having the child present.  It is my understanding that they cannot bill for time spent alone with the parent.  This puts extensive communication with a parent on the back burner.  And yet, in my opinion, extensive time with parents is critical to the process.  A speech therapist can help parents create an environment where their child enjoys talking, communication is relatively stress-free and anxiety is kept at a minimum.  

So "family-based therapy” can look very different from therapist to therapist.  Again, I think it's critical to the process, but it can also be damaging, depending on what the family is being instructed to do.  I will definitely do more research around how this approach is presented academic systems.... feel free to enlighten me!

Dori Lenz Holte

Monday, November 4, 2013

I Kept Him Fed and Watered...

Good Monday morning.  Had a nicely quiet weekend and up early today with that pesky time change.  Maybe it will become the new normal?  I doubt it...  I will continue to share questions and responses that occurred in response to "The Right Time to Break Out the Stickers" (see previous post) during the October ISAD Conference. 
Another question that came up was around how, if, and when I communicated with Eli's speech therapists.  Franky, I wasn't a very good advocate because I knew nothing - absolutely zippo - about stuttering or therapy for children who stutter.   I figured I made the appointment, drove him there, did "special time" at home and kept him fed and watered...wasn't that advocacy enough?  So here goes...

Q: I was wondering if you were outspoken about Eli’s therapy from the beginning or if it took several years for you to become comfortable enough to question treatments and research? When speaking to future SLPs, do you have any advice on what we can do as professionals to empower parents to advocate for their children? Martha

A: I, too, was one of those parents who didn’t feel equipped to question the professionals, at least not for many years. I agree that parents should be advocates, at the same time, the helpfulness of this advocacy depends greatly on what exactly is being advocated! If a therapist suggests that your child can use speech tools to help “manage” their speech, and you encourage this at home and at school, you are being an advocate. But is this such a good idea?

There are SLPs out there who are having parents read my book, “Voice Unearthed” prior to therapy. The book helps to educated and empower parents as they are the crucial decision-makers on this journey. It gives them a voice…kind of ironic!

Q: Did you ever encounter any situations throughout therapy where you felt the need to interject in the therapy process with the SLP and Eli? and if so how did you handle that situation?  McKayla

A: In short, some therapists allowed me to observe therapy (where, of course, it looked like Eli could successfully use his speech tools), most suggested exercises and games to do during our “special time” at home where he was to practice his speech tools. I didn’t question this because I knew nothing, absolutely zippo, about speech therapy for children who stuttered. I tried hard to support and nurture the therapist’s recommendations. Eli’s struggle went from mild, to moderate, to severe. All we were told was to keep practicing. I had nothing to offer for the SLP to go against until I did six years of research, reflection, writing, and working with Dr. Halvorson. That’s why I wrote the book, so other parents and speech therapists could be educated, self-empowered, and aware of the risks. 

Q: From a parents perspective, do you think that it is hard for parents to consult with their SLP’s regarding effectiveness of the rewards?   Allie T.

A: It depends so much on the SLP. Like in any field, some are more welcoming and receptive to parental insights, some not so much. And some parental insights are constructive, some not so much… no easy answer there! 

Next blog:   Bring the Whole Fam Damily - Or Not. 

Keep them talking!

Dori Lenz Holte

Friday, November 1, 2013

International Fluency Association Recognizes "Voice Unearthed"

I am honored to be recognized by the International Fluency Association* (IFA) with the Unsung Hero award.  Thank you Mike Retzinger for the nomination and David Shapiro and Joe Donaher for their consideration. Go to  and click on IFA Newsletter 2013 to view the nomination.  

The IFA's stated purpose is to "increase communication amongst the membership of the IFA to forge dialogue regarding topics on which we agree and on which we might hold quite diverse perspectives."  

I love that.

Dori Lenz Holte

*  The International Fluency Association is a not-for-profit, international, interdisciplinary organization devoted to the understanding and management of fluency disorders, and to the improvement in the quality of life for persons with fluency disorders.