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A Cognitive/Affective Approach to Stuttering Treatment

A Cognitive/Affective Approach to Stuttering Treatment
Janet Skotko, M.Ed
July 7, 2003

A Cognitive/Affective Approach to Stuttering Treatment

Janet Y. Skotko, M.Ed. CCC
Speech/Language Pathologist
Board Recognized Fluency Specialist
Tampa, Florida


For too many stutterers, what comes from the mind is not based in knowledge. While stutterers profess to desire changes in their lives, very few professionals guide them as to how to accomplish this. More often, professionals want to change the way the stutterer speaks first! I believe the successful stutterer begins his journey by intellectually defeating stuttering, not himself, through positive learning.

Positive learning leads to an understanding of just how to flip that "old" psychological coin and enjoy the "new" side. The new side of the coin allows stutterers to be their own producers, cameramen, directors, actors! It allows them to be more in control. This is not to "downplay the lifetime turmoil which tarnished (many) to different degrees" (Chris Roach, 2002). Rather, it is to define a cognitive-affective approach to stuttering treatment.

The initial goal is to learn about the subject of stuttering and others who stutter: to become a student of stuttering. This can be accomplished many ways. Among them:

Find articles your unique stuttering client will enjoy.
Vary the articles - alternative approaches, other societal/cultural treatments, including the intellectual to the bizarre.
Encourage "noodling" through quality websites.
Create a support group or take your client to a locally established group.
Be an advocate; show your client that you educate others as well.
Know your client, so you can creatively guide his/her search for knowledge.

CSAS: The Circle of Self-Assessment for Stutterers.

The CSAS began, quite literally, for lack of words! As the stutterer begins to show real enthusiasm about learning, "circles" are introduced. Attempting to differentiate normal stuttering (normal non-fluency) from persistent stuttering and severities, I formed a small circle with my hands. My client "understood" and drew this circle, and then a much larger circle, to show dimensions of persistent stuttering. "Yes," I said, "that's exactly it." He pointed to the outermost point of the circle and he defined it, using a bit of exaggeration for emphasis, "This is ''I can't take it - just shoot me!'"

The first goal I proposed was to "plot" self-perceived stuttering severity on the circles. Stutterers spent anywhere from several seconds to several minutes pondering exactly where to place their "dot." Stutterers reported their effort was due to the availability of movement and recognition of change, without the "harshness" and "restrictions" typically encountered with numbers and scales.

Points evolved to include more aspects of their whole sense of being, such as "How others perceive me," "My quality of life," and "How I feel about myself." As the points changed, its value became even more relevant to each person to reflect upon.

As one client put it, the circles "provide a visual diagram of your feelings. I was able to plot my feelings and leave them there. I found the approach cathartic and enabling for me to understand my personal iceberg."

Janet Skotko, M.Ed

Related Courses

The Ripple Effect of Stuttering: A Community-Based Approach
Presented by Craig Coleman, MA, CCC-SLP, BCS-F, ASHA Fellow, Mary Weidner, PhD, CCC-SLP
Course: #9217Level: Intermediate2 Hours
This is Part 2 of a four-part series. The stuttering experience has a ripple effect that extends far beyond the child who stutters. Parents, teachers, peers, and others must possess both knowledge and skills to best support children who stutter. This course will highlight new clinical tools and resources to provide a community-based treatment approach for stuttering. (Part 1 - Course 9278, Part 3 - Course 9301, Part 4 - Course 9304)

Creating Allies and Developing Advocacy Skills in Stuttering Therapy
Presented by Brooke Leiman Edwards, MA, CCC-SLP, Hope Gerlach, PhD, CCC-SLP
Course: #92232 Hours
This is Part 3 of a four-part series. This course will focus on specific strategies for involving parents/caregivers in stuttering therapy, and promoting self-advocacy skills among clients who stutter. Through the use of case studies, the speakers will problem-solve obstacles commonly faced by speech-language pathologists when addressing these important aspects of therapy. (Part 1 - Course 9278, Part 2 - Course 9286, Part 4 - Course 9304)

Best Practices for Stuttering Assessment and Treatment Including the Role of Support Groups
Presented by Katie Gore, MA, CCC-SLP, Craig Coleman, MA, CCC-SLP, BCS-F, ASHA Fellow
Course: #9225Level: Intermediate2 Hours
This course is Part 4 in a four-part series. It will provide an overview of stuttering peer support communities and the clinical importance of incorporating community experience into therapy. Current research and practical application questions will address goal writing, SLP roles and responsibilities, and common challenges connecting therapy to the community. Case studies will be shared to highlight assessment and treatment across various age ranges. (Part 1 - Course 9278, Part 2 - Course 9286, Part 3 - Course 9301)

20Q: Early Childhood Stuttering: Less-Direct and More-Direct Treatment
Presented by J. Scott Yaruss, PhD, CCC-SLP, BCS-F, Nina Reardon-Reeves, MS, CCC-SLP, BCS-F
Course: #8978Level: Intermediate1 Hour
This course addresses key issues in the treatment of early childhood stuttering, with a focus on less-direct and more-direct treatment approaches. The course will discuss ways that clinicians can draw upon various approaches to develop individualized treatment so that each child’s and family’s individual needs are addressed.

Ethical Considerations When Working with Those who Stutter
Presented by Lisa R. LaSalle, PhD, CCC-SLP
Course: #8991Level: Intermediate1.5 Hours
This course will discuss how the stigma of stuttering, advocacy, empathy, caseload management, and the structure of various settings in which we work (e.g., schools, medical settings, university clinics) impact our work with people who stutter, across the lifespan. Case scenarios involving ethics and stuttering will be presented for participants' consideration.

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