This text-based course is a transcript of the webinar, “Counseling in Stuttering Treatment,” presented by Craig Coleman, M.A., CCC-SLP, BCS-FD.
>> Craig Coleman: Counseling is certainly an interesting topic to me and one that I am passionate about. Today I plan to provide an overview of counseling, some basic principles and models of counseling and then to weave some of the discussion related to stuttering into that model and those principles.
I will start off with my disclosures first. I am on the faculty at Marshall University. I am the owner of the Virtual Stuttering Center and MC Speech books, and also an author of the OASES, which I get royalties from Pearson. My nonfinancial disclosures include being the associate coordinator of ASHA’s Special Interest Group 4, a member of the ASHA Scientific and Professional Education Board and also the past president of the Pennsylvania Speech and Hearing Association.
Should We be Counseling?
The first question we have to ask is, “Should we be counseling?” This is not as easy of a question as it may seem, especially as it relates to stuttering. There is often a big divide in our field in terms of whether or not the speech pathologist should be the one to counsel people who stutter. Some people still use the old-school philosophy that if it involves counseling or if it involves anything related to feelings or emotions, than a psychologist or a counselor would be a better fit for a person who stutters than a speech language pathologist. But I am going to make the counterargument that we absolutely should be doing counseling and in order to provide good therapy, we need to be doing counseling.
In order to address the first question, “Should we be doing counseling?” ASHA says yes, we should. If you look at our scope of practice, from the ASHA Scope of Practice document in 2007, it says that our scope includes “counseling individuals, families, coworkers, educators, and other persons in the community regarding acceptance, adaptation and decision-making about communication and swallowing.”
There are some key components to this that are worth addressing. If we look at how counseling is defined we are not just talking about counseling the person with the communication disorder. We are talking about their families, coworkers, educators/teachers, and other persons in the community.
We are not just talking about educating them, because it says “counseling regarding acceptance, adaptation, and decision-making.” That is a pretty broad scope of practice that we have in terms of how counseling fits in. However, that is a good thing because so much of what we do in stuttering is counseling. I always say that it if you have a good speech therapy session going on with a client who stutters who is beyond the preschool years, about 85% of that session should look like counseling. Maybe 15% to 20% should look like traditional speech therapy in terms of how we would define it.
We are working on much more than just the surface level characteristics of dysfluencies. We are working on acceptance. We are working on adaptation. Adaptation does not mean working on helping those who stutter become avoiders, because we are not. We are working on the complete opposite of that, in terms of adapting their own frame of mind so they do not feel like they can participate in situations only if they do not stutter. We can show them that they can be effective communicators as people who stutter, without being completely fluent all the time. That has a huge counseling component that is involved. I think we would all agree that based on this definition in the scope of practice that when it comes to counseling people and their families in the community about communication disorders, we are really the ones to do that.
This is where the rubber meets the road for us in a counseling perspective though. Despite this being a big issue in our scope of practice - and I say it is a big issue because if we think about how that scope of practice defines counseling and all of the different disorders we work with as speech language pathologists, counseling should be at the top of our list in terms of coursework, continuing education, other areas that we need to help clinicians and students focus on because we do so much of it. However, it really is not. Despite the fact that counseling is in the scope of practice, many SLPs are not receiving formal training in counseling people with communication disorders in their graduate programs or from the continuing education standpoint.
If you search one of the “big nine” practice areas in our field (e.g. stuttering, speech sound disorders, language disorders, etc.) there are a plethora of continuing education opportunities. If you search counseling in communication disorders, there are fewer educational opportunities because not many clinicians are doing work in that area. There is a major need to have strategies in place so clinicians can state, “We can do this effectively, because we have the skill set to do so.” Right now, many of us do not have the skill set to do so because we are not being trained in counseling.