Again, First Do No Harm

Recently I was forwarded a comment made by a professor of communication disorders on a professional listserve. She stated that students of speech therapy “MUST be taught that they are not going to make the person who stutters worse by anything they do.” I feel compelled to respond to that by reproducing a section my book, “Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.” In Chapter 4, I write about the assumptions we made as parents and one of them was “he loves his therapist and thinks therapy is fun, so it can’t do any harm.” I go on to say…
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When talking to other parents at conferences, I often heard about how much fun their child had at speech therapy and about how much they loved their therapist. Eli was, for the most part, no exception. In retrospect, it was easy for us to get distracted by a therapist’s encouraging tone and good intentions and to lose sight of what we were trying to accomplish. Eli didn’t need to go to speech therapy to make friends and have fun. Speech therapy was supposed to help him to speak more easily and none of his therapy helped with this outside the clinic setting.

But therapy certainly didn’t hurt Eli, or did it? First let’s consider the logistics…hours in the car, time in the clinic, and time spent practicing therapy at home - over a five-year period. Add in the financial impact, the cost of gas, wear and tear on the car, and the therapy itself. Well worth it if the outcomes are good. But they were not, and that’s a significant chunk of time and effort out of a child’s life that could have been spent engaged in activities with better outcomes such as playing with friends or hanging out at Grandma's.

Even more importantly, I can’t remember one conversation between myself and a speech therapist that didn’t indicate that Eli was doing great in therapy. And yet our efforts over a five-year period only resulted in:

- Eli becoming more and more silent.
- Eli participating in fewer and fewer activities that involved meeting and talking with
strangers.
- Eli acquiring secondary problem behaviors including turning his chin to his shoulder, dropping his jaw, and growling to get himself started.
- Eli growing increasingly depressed.
- Eli feeling exhausted and experiencing major sleep issues.

Medical ethics include a fundamental principle of “first do no harm” stemming from Hippocratic writing Epidemics. Hippocrates states that “the physician must be able to tell the antecedents, know the present, and foretell the future - must mediate these things, and have two special objects in view with regard to disease, namely, to do good or to do no harm.”
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Speech therapists, parents, grandparents, friends, neighbors – all can contribute to a child’s increased anxiety and tension around communication. There is hope in this statement – because if we can create an environment that contributes to the exacerbation of stuttering, we can create an environment that minimizes the progression and even contributes to the regression of anxiety and tension around speaking. First do no harm, keep them talking!

Best,
Doreen (Dori) Lenz Holte