As another school year winds down, I have been both encouraged by the number of school-based speech therapists who have resonated with the message in my book, “Voice Unearthed.”
Over 50 speech therapists have contacted me directly, sharing their concerns, their fears, and their unrelenting passion to help a child who stutters and to do no harm. I have no idea how many have ordered the book through Amazon or as an e-book, but I assume that for every one who has contacted me, there are many more out there who feel inadequately prepared yet professionally obligated to help these kids.
School-based therapists are struggling with ways to get parents involved, developing, measuring, and reporting on IEP goals that go beyond counting speech errors, supporting the child in the classroom, and a host of other issues. Flexibility seems to vary greatly from district to district. Some therapists have been able to be very creative when it comes to keeping these kids talking and engaged. Many feel stymied by the parameters and scheduling options within a school setting.
We cannot keep limping along, hoping that a child who stutters “never darkens my doorway” as one school-based speech therapist put it. These kids deserve better. These therapists deserve better too. Maybe the best place to start is with the therapists themselves.
And start we have! Speech therapists are invited to join the newly created Yahoo Group; Voice Unearthed – Speech Therapists. This is a place they can anonymously or openly share concerns, ideas, and success stories. Go to http://groups.yahoo.com/group/vuspeechtherapists to join!
Please feel free to forward this message to colleagues who might be interested… thank you.
Best,
Doreen (Dori) Lenz Holte
Tuesday, May 22, 2012
Friday, April 6, 2012
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.”
----------------------
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
---------------------
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.”
----------------------
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
Thursday, March 22, 2012
A Chubby Little Hand and Listener Intentions
When Eli was four years old he was sitting on the floor in Sunday school with about fifteen other four-year-olds. There was a little boy sitting next to him – cute little guy, on the chubby side, dressed like a cowboy. Eli had spoken several times and the little boy now had his head tilted and eyes narrowed, studying Eli like a bug. Unbeknownst to Eli, I was standing just a few feet behind them and my heart stopped. I knew something was going to come out of this boy’s mouth and there wasn’t a thing I could do to stop it. Finally the little boy asked in a soft voice, “why do you talk that way?” Eli looked at him and whispered “because sometimes I stutter.” The little boy grinned and patted Eli’s back with his chubby little hand and whispered “oh, that’s okay!” Eli grinned back -- all was good.
Several months later we were at Eli’s older brothers’ baseball game. Eli asked me to walk with him into a nearby church to use the restroom. As we were walking he started to cry. I took his hand and asked what was wrong. He said “a boy just asked me why I talk this way.” Again my heart stopped but I calmly asked him how he felt about that. He stopped walking, ripped his hand out of mine, and said angrily, “MOM, I know the difference between (nice tone), ‘why do you talk that way?’ and (mean tone) ‘why do you talk that way?’”
I don’t remember if Eli was aware that I had overheard the previous conversation between him and the little cowboy, but I was profoundly moved by his insight. To this day he seems to do a good job of considering intention when a listener reacts to his speech. He has taught me to do the same. When we take the time to consider intentions, we find that most often the intentions are good.
Our family, relative to most others, is extremely knowledgeable about and sensitive to the subject of stuttering. I have a friend whose family is extremely knowledgeable about autism, because they have a child who is autistic. The first time I was with that child I made him very angry when I acted appalled at his fixation on snakes. Most boys would have loved my reaction – but not this one. After comforting her son, my friend helped me to understand and gave me guidance as to how to react in a way that was more supportive for him. All was good.
It is not unusual for a listener to react to Eli’s speech with a startled look, a slight frown, or an intense stare. Sometimes a listener finishes his sentence for him and we both feel angry. I have no doubt that my friend’s heart wrenched when her son’s feelings were so hurt by my comment about his love of snakes. I was completely ignorant – as I am about many things – and I was grateful for her compassionate response. I did not mean her son harm.
I often remember that chubby little hand warmly patting Eli’s back and about four-year old Eli’s reminder to consider intention. This keeps both of us from letting those seeds of anger take root and grow like a wildly invasive species, permeating every aspects of our lives.
Keep them talking, keep it fun!
Best,
Doreen (Dori) Lenz Holte
Several months later we were at Eli’s older brothers’ baseball game. Eli asked me to walk with him into a nearby church to use the restroom. As we were walking he started to cry. I took his hand and asked what was wrong. He said “a boy just asked me why I talk this way.” Again my heart stopped but I calmly asked him how he felt about that. He stopped walking, ripped his hand out of mine, and said angrily, “MOM, I know the difference between (nice tone), ‘why do you talk that way?’ and (mean tone) ‘why do you talk that way?’”
I don’t remember if Eli was aware that I had overheard the previous conversation between him and the little cowboy, but I was profoundly moved by his insight. To this day he seems to do a good job of considering intention when a listener reacts to his speech. He has taught me to do the same. When we take the time to consider intentions, we find that most often the intentions are good.
Our family, relative to most others, is extremely knowledgeable about and sensitive to the subject of stuttering. I have a friend whose family is extremely knowledgeable about autism, because they have a child who is autistic. The first time I was with that child I made him very angry when I acted appalled at his fixation on snakes. Most boys would have loved my reaction – but not this one. After comforting her son, my friend helped me to understand and gave me guidance as to how to react in a way that was more supportive for him. All was good.
It is not unusual for a listener to react to Eli’s speech with a startled look, a slight frown, or an intense stare. Sometimes a listener finishes his sentence for him and we both feel angry. I have no doubt that my friend’s heart wrenched when her son’s feelings were so hurt by my comment about his love of snakes. I was completely ignorant – as I am about many things – and I was grateful for her compassionate response. I did not mean her son harm.
I often remember that chubby little hand warmly patting Eli’s back and about four-year old Eli’s reminder to consider intention. This keeps both of us from letting those seeds of anger take root and grow like a wildly invasive species, permeating every aspects of our lives.
Keep them talking, keep it fun!
Best,
Doreen (Dori) Lenz Holte
Thursday, February 23, 2012
Speech Therapists Are Reading "Voice Unearthed"
A group of speech therapists out of Texas is reading "Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter" as part of a book study group. I am so honored! With permission, I am sharing the following review written by one of the therapists:
Two things in the book really stuck out when I read it. First, the idea that SLPs can actually do more harm than good when it comes to treating children who stutter really struck me to my core. As a person who stutters, this had never crossed my mind. Perhaps this is because of the fact that the SLP from my childhood actually helped me learn to become fluent, to the point where I rarely have to think about it. However the more I pondered this concept the more it made sense. For people who stutter, therapy can become a vicious cycle of trying to “fix” their speech which in turn makes them afraid to speak- just like Eli. This idea will definitely influence my approach to therapy.
Second, I absolutely loved reading about Dr. Halvorson’s approach to “therapy” with Eli. His main goal for Eli was to make him comfortable when speaking. The more I read the more it became apparent to me that this is the most important thing to address when treating individuals who stutter. Most people who stutter are never actually “freed” of it. So it makes sense that they should learn to become comfortable with their speech, whatever it may sound like. Many children who I have treated for stuttering have expressed that they are afraid to talk. Undoubtedly, this stems from years of trying to “fix” their stutter. As a result, the idea that “stuttering is bad” became firmly rooted in their mind. It goes without saying that this will affect my approach to therapy.
I have already recommended this book to the parents of my students who stutter The main goal in therapy for my students will be to make them comfortable with their speech. As all SLPs know, stuttering is intricately connected to a person’s feelings and thoughts about their speech. This idea is even more abundantly clear to me now. Targeting these related feelings has taken a more prominent role in therapy sessions with my students who stutter.
This book has also influenced my opinion on when direct therapy for stuttering should be started and how that should be approached. If direct therapy is indicated, then therapy should start by addressing feelings about their speech and targeting their comfort level during different speaking situations. The SLP should not immediately start with fluency enhancing strategies. This may in fact cause the child to view their speech negatively and exacerbate the stuttering.
This was an awesome book that really changed my life as a therapist. Thank you SO much for finding this book!!!
Katie M., Texas
It's so promising to hear from therapists who are making the shift to keeping kids talking rather than eliminating speech errors. Hopefully the entities that educate and certify speech therapists will work on making the necessary changes in their infrastructure to support this approach. At minimum, it should be mandatory that therapists help parents to understand the risks of suggesting a child change the way they talk in order to not make speech errors. Thank you Katie, and all the others down there in Texas, for listening and for wanting to make things better for these kids.
Best,
Doreen Lenz Holte
Two things in the book really stuck out when I read it. First, the idea that SLPs can actually do more harm than good when it comes to treating children who stutter really struck me to my core. As a person who stutters, this had never crossed my mind. Perhaps this is because of the fact that the SLP from my childhood actually helped me learn to become fluent, to the point where I rarely have to think about it. However the more I pondered this concept the more it made sense. For people who stutter, therapy can become a vicious cycle of trying to “fix” their speech which in turn makes them afraid to speak- just like Eli. This idea will definitely influence my approach to therapy.
Second, I absolutely loved reading about Dr. Halvorson’s approach to “therapy” with Eli. His main goal for Eli was to make him comfortable when speaking. The more I read the more it became apparent to me that this is the most important thing to address when treating individuals who stutter. Most people who stutter are never actually “freed” of it. So it makes sense that they should learn to become comfortable with their speech, whatever it may sound like. Many children who I have treated for stuttering have expressed that they are afraid to talk. Undoubtedly, this stems from years of trying to “fix” their stutter. As a result, the idea that “stuttering is bad” became firmly rooted in their mind. It goes without saying that this will affect my approach to therapy.
I have already recommended this book to the parents of my students who stutter The main goal in therapy for my students will be to make them comfortable with their speech. As all SLPs know, stuttering is intricately connected to a person’s feelings and thoughts about their speech. This idea is even more abundantly clear to me now. Targeting these related feelings has taken a more prominent role in therapy sessions with my students who stutter.
This book has also influenced my opinion on when direct therapy for stuttering should be started and how that should be approached. If direct therapy is indicated, then therapy should start by addressing feelings about their speech and targeting their comfort level during different speaking situations. The SLP should not immediately start with fluency enhancing strategies. This may in fact cause the child to view their speech negatively and exacerbate the stuttering.
This was an awesome book that really changed my life as a therapist. Thank you SO much for finding this book!!!
Katie M., Texas
It's so promising to hear from therapists who are making the shift to keeping kids talking rather than eliminating speech errors. Hopefully the entities that educate and certify speech therapists will work on making the necessary changes in their infrastructure to support this approach. At minimum, it should be mandatory that therapists help parents to understand the risks of suggesting a child change the way they talk in order to not make speech errors. Thank you Katie, and all the others down there in Texas, for listening and for wanting to make things better for these kids.
Best,
Doreen Lenz Holte
Thursday, January 26, 2012
The Only Context That Matters - Real Children's Lives
Over the past month or so, I’ve been reacting to a publication that was sent to me by its author – a leader in the field of stuttering therapy for children. She was responding to my claim that parents and children are too often blamed for poor outcomes during therapy rather than the irrelevance and inappropriateness of the therapy itself. It seemed clear that the author had not taken the time to read my book before she responded – or I can’t imagine she would have sent me this article as it only seemed to justify my perception, which she claimed was “taken out of context.”
I did pose my comments and questions to the author prior to the more public discussion on my blog, hoping that I would be welcomed to the spirited debate. I waited two weeks for a response – but got silence which continues to this day. This was disappointing as I believe parents (especially those who don’t agree!) must be welcomed into this debate in order to do better by these children.
I’m always perplexed as to why I continually find respected voices that express concern, lack of evidence, and frustration over the therapy and it’s outcomes, and yet when I, as a parent and writer, repeat this message, those same voices go quiet.
Yes, I suppose you can say that I did take things “out of context” – away from the publications that exist primarily within the professional arena (peer-reviewed journals, textbooks, research reports) and into the context of real life and real children – for access by real parents and families. For that I do not apologize. Parents have the right to understand the lack of evidence, the opinions behind the spirited debate and the risks of silence and disengagement that go along with the openly reported dismal results of relapse.
My book, "Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter" is now available in all e-book formats and online at Amazon and Barnes & Noble. Print versions can be ordered through Amazon and www.voiceunearthed.com. The beat goes on – let’s keep them talking!! Thanks for your ongoing support.
Best,
Doreen (Dori) Lenz Holte
I did pose my comments and questions to the author prior to the more public discussion on my blog, hoping that I would be welcomed to the spirited debate. I waited two weeks for a response – but got silence which continues to this day. This was disappointing as I believe parents (especially those who don’t agree!) must be welcomed into this debate in order to do better by these children.
I’m always perplexed as to why I continually find respected voices that express concern, lack of evidence, and frustration over the therapy and it’s outcomes, and yet when I, as a parent and writer, repeat this message, those same voices go quiet.
Yes, I suppose you can say that I did take things “out of context” – away from the publications that exist primarily within the professional arena (peer-reviewed journals, textbooks, research reports) and into the context of real life and real children – for access by real parents and families. For that I do not apologize. Parents have the right to understand the lack of evidence, the opinions behind the spirited debate and the risks of silence and disengagement that go along with the openly reported dismal results of relapse.
My book, "Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter" is now available in all e-book formats and online at Amazon and Barnes & Noble. Print versions can be ordered through Amazon and www.voiceunearthed.com. The beat goes on – let’s keep them talking!! Thanks for your ongoing support.
Best,
Doreen (Dori) Lenz Holte
Tuesday, January 17, 2012
Self confidence far more valuable than speech tools!
Came across a lovely article written by Matt Day, appearing in The Chronicle (Dunsville, Ontario, Canada) today about a magician named Claude Haggerty. Here's an excerpt:
http://www.dunnvillechronicle.com/ArticleDisplay.aspx?e=3438166
Keep them talking! Keep them engaged!
Best,
Doreen Lenz Holte
Growing up in Dunnville, Haggerty remembers having self-confidence issues, specifically a speech impediment which saw him stutter through his words.
He taught himself to overcome that obstacle after being encouraged by his high school principal to pursue his dream of performing magic tricks.
"Without learning the illusions, I probably still would be stuttering today. A lot of children just need that confidence boost to get going, especially in today's times where it's tough for many families."
I hear this type of story over and over again - how focusing on a passion and/or interest was attributed directly to overcoming the stuttering challenge. It's like one mom told me recently, "The thought of focusing on the strength of the soul while still talking has given us a new sense of optimism." Follow this link for the full article.http://www.dunnvillechronicle.com/ArticleDisplay.aspx?e=3438166
Keep them talking! Keep them engaged!
Best,
Doreen Lenz Holte
Wednesday, January 4, 2012
Stop Blaming the Parents and Children for Unsuccessful Therapy
I hope all of you were able to share time with loved ones, enjoy some R&R, and eat too much…which is pretty much what happened over this holiday season in the Holte household!
This is second in a series (how many, who knows?) of postings inspired by a book excerpt authored by a respected leader in the field of therapy for children who stutter. This person sent the excerpt to me in response to my book “Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.” Again, I will not name the author as I am challenging the messaging and belief system – the same messages and belief systems embraced and promoted by many leaders in the field of speech therapy for those who stutter.
Too often the blame for poor therapy outcomes with children falls directly on the client unit – the child and/or the parent. The author quotes others as stating that “What a client wants from treatment and how those goals can be accomplished may be the most important pieces of information that can be obtained.” So a parent wants a child who does not stutter. The child could either care less about their speech, or will want the same, to not stutter. If they knew how to accomplish this, they would probably not be seeking professional help. What should the therapist do with these “important pieces of information?” The easiest path, in the short-term, is to focus on encouraging the child to use speech techniques that are intended to accomplish this goal.
Ideally (in Doreen’s world), a therapist responds to this “important piece of information” by explaining the risks in attempting any therapy that incorporates teaching a child speech techniques designed to minimize and/or eliminate the stuttering behavior. These risks include silence, disengagement, poor self-esteem, and ironically, increased secondary behaviors and tension around the stuttering moments. Parents deserve to understand that while their child is using techniques that successfully eliminate or minimize stuttering moments, especially while in the clinic setting, they may also be acquiring behaviors and beliefs that can lead to a far greater handicap – some that can last a lifetime. The short-term successes can lead to long-term disaster.
It is also recommended that therapists suggest to parents that “most of the time parents have a fairly good idea of not only what is causing the stuttering problem but also of what will help.” I seriously have to pick myself up off the floor every time I read statement. In reality, most of the time parents are blindsided and have no clue as to how to effectively support their child as is the case with many speech therapists I’ve spoken to. Another reality is that as of this date, even the best researchers only have vague theories as to the cause of stuttering and how to best address it, especially in children. Again, this feels to me like a deflection of accountability – away from the therapy itself and onto the client unit.
We, as parents, deserve the opportunity to hold these influential experts accountable for their published statements. Our perspective, along with our questions and challenges, must be welcomed and embraced so we can all, together, do better by these kids.
I look forward to your feedback. Wishing you all the absolute best in 2012 – and remember – keep them talking and keep talking fun!
Best,
Doreen (Dori) Lenz Holte
This is second in a series (how many, who knows?) of postings inspired by a book excerpt authored by a respected leader in the field of therapy for children who stutter. This person sent the excerpt to me in response to my book “Voice Unearthed: Hope, Help, and a Wake-Up Call for the Parents of Children Who Stutter.” Again, I will not name the author as I am challenging the messaging and belief system – the same messages and belief systems embraced and promoted by many leaders in the field of speech therapy for those who stutter.
Too often the blame for poor therapy outcomes with children falls directly on the client unit – the child and/or the parent. The author quotes others as stating that “What a client wants from treatment and how those goals can be accomplished may be the most important pieces of information that can be obtained.” So a parent wants a child who does not stutter. The child could either care less about their speech, or will want the same, to not stutter. If they knew how to accomplish this, they would probably not be seeking professional help. What should the therapist do with these “important pieces of information?” The easiest path, in the short-term, is to focus on encouraging the child to use speech techniques that are intended to accomplish this goal.
Ideally (in Doreen’s world), a therapist responds to this “important piece of information” by explaining the risks in attempting any therapy that incorporates teaching a child speech techniques designed to minimize and/or eliminate the stuttering behavior. These risks include silence, disengagement, poor self-esteem, and ironically, increased secondary behaviors and tension around the stuttering moments. Parents deserve to understand that while their child is using techniques that successfully eliminate or minimize stuttering moments, especially while in the clinic setting, they may also be acquiring behaviors and beliefs that can lead to a far greater handicap – some that can last a lifetime. The short-term successes can lead to long-term disaster.
It is also recommended that therapists suggest to parents that “most of the time parents have a fairly good idea of not only what is causing the stuttering problem but also of what will help.” I seriously have to pick myself up off the floor every time I read statement. In reality, most of the time parents are blindsided and have no clue as to how to effectively support their child as is the case with many speech therapists I’ve spoken to. Another reality is that as of this date, even the best researchers only have vague theories as to the cause of stuttering and how to best address it, especially in children. Again, this feels to me like a deflection of accountability – away from the therapy itself and onto the client unit.
We, as parents, deserve the opportunity to hold these influential experts accountable for their published statements. Our perspective, along with our questions and challenges, must be welcomed and embraced so we can all, together, do better by these kids.
I look forward to your feedback. Wishing you all the absolute best in 2012 – and remember – keep them talking and keep talking fun!
Best,
Doreen (Dori) Lenz Holte
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