What’s Changed in Stuttering Therapy?

This is a transcript from our podcast episode published May 16th, 2022. The podcast episode is offered for .1 ASHA CEU (introductory level, professional area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.

A special thanks to our Contributing Editor, Caitlin Akier, for reviewing and editing drafts of our transcripts. Her work helps keep our material accessible.

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[00:01:38] Kate Grandbois: We're so excited for today's episode. We have the great pleasure of welcoming Dr. cott Yaris. Welcome Scott. 

[00:01:47] Scott Yaris: Thank you so much, Kate. It's great to be here. 

[00:01:50] Amy Wonkka: And Scott, we're so excited to have you, you are here today to discuss stuttering therapy before we get started. Can you tell us just a little bit about yourself? 

[00:01:59] Scott Yaris: [00:02:00] Sure thing. Thanks Amy. And again, thanks for the opportunity to talk with you and with your audience today.

Uh, yes. Uh, about me, I'm a professor of communicative sciences and disorders at Michigan State University, been a practicing clinician for about 30 years now. And all of my clinical work has been in stuttering. It's all I've ever done. It's the reason I got into the field and, um, I've been very fortunate throughout my career to be able to specialize in this way.

So I teach to do research, do clinical work call about stuttering. 

[00:02:30] Kate Grandbois: That's amazing. How long have you been in the field? Did you say that. 

[00:02:35] Scott Yaris: 30 years. That's a, but 

[00:02:39] Kate Grandbois: that's really, really impressive. Well, we're so excited to learn from, learn from you. We've done. We've worked with your business counterpart and Nina Reeves, and we're excited to get into more of the technical things with you today related to research.

And what's changed over the last couple of years in the world of stuttering, but before we get [00:03:00] into all that good stuff, we have to go over some logistics and housekeeping. Sometimes people write in and ask us to skip this part. I can't ASHA makes me read it. So we're going to get through the learning objectives and disclosures as quickly as possible.

 Learning objective number one, describe what is meant by the statement, stuttering is more than just stuttering. Learning objective number two, list two ways that stuttering assessment and treatment have changed in recent years. Learning objective number three, describe what is meant by the statement it's okay to say.

Disclosures Scott Yaris’s financial disclosures. Scott is a co-owner of Stuttering Therapy Resources, Inc and receives an income related to intellectual property. Scott Yaris’s nonfinancial disclosures. Scott does not have any non-financial relationships to disclose. Kate, that's me, I'm the owner and founder of Grandbois Therapy and Consulting and co-founder of SLP nerd cast, my nonfinancial disclosures I'm a member ofASHA, SIG 12, and serve on the AAC advisory group from Massachusetts advocates for children. I'm also a member of the Berkshire [00:04:00] association for behavior analysis and therapy, Mass ABA, the association for behavior analysis international and the corresponding speech pathology and applied behavior analysis special interest group.

[00:04:09] Amy Wonkka: Amy that's me. My financial disclosures are that I am an employee of a public school system and I received compensation as co-founder of SLP Nerdcast. And my non-financial disclosures are that I am a member of ASHA, SIG 12, and I serve on the AAC advisory group for Massachusetts advocates for children.

All right, we did it. We made it through, the boring bits are done. Scott onto the good stuff, in an initial conversation that we had about this topic. You mentioned, you know, you, you hear often that people don't feel prepared to help children who stutter. Can you tell us a little about that and why, why that is the case.

[00:04:47] Scott Yaris: You bet, you bet. It's a challenge that we face in our field, that many speech language pathologists simply don't feel comfortable with their skills for helping those who stutter. And it's a problem because when [00:05:00] people don't feel as confident in their skills, when they don't feel as knowledgeable, it's harder for them to provide good clinical service.

The clinicians that I've spoken with, they know that they want to help people who stutter and they, they know that they don't feel good about this area. So very often they're eager for more information, they're eager for some validation, for some guidance. As to why this is? There's a lot of potential answers for this.

Some of it has to do with just a lack of training. We have documented over the years that there are many graduate programs in our field that don't provide a course on stuttering. They're not required to, according to ASHA. Oh yeah. 

[00:05:43] Kate Grandbois: Really what? Not to interrupt you. But that is a shocker. 

[00:05:46] Scott Yaris: Yeah. Yeah. Um, there is no requirement for specific courses for accreditation, for graduate programs.

There is instead the requirement to document knowledge and skills, but of course [00:06:00] there's a wide range of ways to document knowledge and skills and what that knowledge might be and what those skills might be is often left to quite a bit of interpretation. And so many clinicians may not have a class, may not have many clinical hours, if any, at all, they may, for example, count hours related to neurogenic stuttering, as you know, fluency.

Types of hours, but they may never have seen a child who stutters in a school setting. And if that's where their career is going to be, then they know they're not prepared. They're know, they know they're not ready to help them, 

[00:06:40] Kate Grandbois: So let me get this. I'm, I'm really digesting this in real life at this exact moment, because I'm really, we graduate as speech pathologists with the scope of practice that is so wide, massive, and I can't wrap my head around universe where [00:07:00] you are given the keys to the car, so to speak, but not taught how to drive it. You're not given explicit instruction or given the, a structured opportunity to gain the content knowledge to do your job. So if in instances where graduates, recent graduates, haven't had a class or clinicians haven't had a formal class, how are the knowledges, knowledge and skills demonstrated?

How do they get away with that? I guess is my question. 

[00:07:26] Scott Yaris: That's a really good question. And I wish I could answer it without throwing a whole lot of people under that car that we're all now driving without keys. Uh, because the challenge is simply that our scope of practice is too broad in my opinion, right?

There's no way that in our graduate programs, we can train everybody in every one of these areas in the time that. As our field has grown as our scope of practice has exploded. Uh, we don't still get more than five or six semesters in the graduate [00:08:00] programs to educate our students. And so something falls by the wayside. 

Often stuttering is one of the areas that falls by the wayside. Voice is another one of those areas that falls by the wayside, organic conditions, cerebral palsy, for example, is one of those that falls by the wayside. And I don't know the issues outside of stuttering, right? I'm only a stuttering guy.

That's all I can really speak to with any authority, but I've talked to friends in other areas that have faced the same issue, um, craniofacial falls by the wayside in many programs. And so clinicians, uh, student clinicians don't get that broad training that they need. And it's simply because the field is too broad.

I don't think anybody is saying, oh, Hey, let's make sure that people don't know anything about stuttering. They're just saying, oh, Hey, we are out of minutes, and our, our, our, our masters students are just stressed beyond belief as it is. So 

[00:08:54] Kate Grandbois: I have to assume this may have something to do with the universities research grants and things.

So [00:09:00] they designed coursework around faculty and staff that they have available. And so, for example, we're in Boston and, you know, there are as a large research lab at BU for this one specific thing. And so they're guaranteed to have courses on that one specific thing. Is there a component of that? And in other words, if you're looking at grad schools and you're, you're a grad student, think about where you're applying for your education, if you're interested in fluency.

[00:09:27] Scott Yaris: That's absolutely right. In part it's it's, if there's a faculty member in the department to advocate for it, for example, in the departments that I've been fortunate to work in, you bet we've had classes on stuttering because I advocate for them and others like me do the same. But if I work there to advocate, then it's possible that somebody else is going to advocate for their area.

Right. And there will be more emphasis and more coursework on some other areas. And so it is an appropriate question for people to, to consider, as [00:10:00] they're looking at graduate schools, if they have an area of interest they want to see, are there courses, or has this topic area that I'm interested in, been combined with some other, you know, and then of course there's the clinical hours.

Am I going to be able to get clinical experience in an area? And unless there is an effort to create a client population in certain disordered areas, stuttering, voice craniofacial. Then the students won't necessarily get thethe hours there. My colleagues and I have done a few research projects looking at the training that's provided in the graduate programs.

Demonstrating that over time, there has been a reduction in the number of programs that require hours in stuttering, that there's been a reduction in the expertise of the faculty in stuttering. They, they don't take stuttering as their primary area of interest. Again, there are only so many areas. I'm sorry.

There are only so many people, there are too many areas. There are only so many people. And so, yeah, it is a challenge and that's one of the [00:11:00] reasons that many clinicians simply don't feel confident when they've graduated. Another one of the reasons not to put this all on, on the graduate programs is a lot of times people will go many years without having a child who stutters on their caseload. And so they don't feel like they've been engaged in this on a regular basis, or there are other conditions that have been demanding their time more. They find that their caseload is filled with autistic children. And they've only got one child who stutters well, when they're trying to decide where they're going to put their CE time, they, they feel pressure, uh, understandably so, to make sure that they're prepared for the larger bulk of their caseload.

And so the problems compound and they build, so that clinicians find themselves all of a sudden, there's three kids who stutter, you know, on their caseload this, this year, or there's, as I've heard from several people, you know, at the beginning of the school year, nine, somebody emailed me. I got nine kids who stutter this year, I haven't seen a kid who [00:12:00] stutters in in years, then they panic. And that's hopefully where we come in is to try to help with reducing that panic. 

[00:12:07] Amy Wonkka: And what would you tell that clinician, if you are that clinician who has one new student or nine new students, and you don't feel confident, whether it's because you didn't get a course in grad school or grad school was many, many years ago, some of the things you learned in your course, you know, what, what would be something that you could tell that clinician?

[00:12:24] Scott Yaris: You bet the most important thing that I start with when I'm talking to clinicians who aren't comfortable with stuttering is that in my opinion, every speech language pathologist can be a superb stuttering therapist.

Even if you don't feel that confidence right now, you can learn what you need to learn to make a real difference in that child's life in that family's life. And so even if you don't feel confident coming in, don't worry. Don't worry because we all start there. No matter what the area is, we can move forward.

[00:12:57] Kate Grandbois: Everything you're saying is making me think of [00:13:00] something. A professor said to me in graduate school, which is speech and language pathology is a science and an art. And when I'm thinking about the scenario you described of a clinician, not having the competence or the confidence, because they have 10 autistic children on their caseload and one child who stutters then, you know, you may have the content knowledge, let's play, pretend that you did get a class, right? You did, you know, you know, the research, you know, the statistics, you know, the, you know, all the things in terms of content, but there is the art piece too, of sitting down with an individual and doing, giving your best therapy that is tailored to, and specific to that individual.

And I wonder if this is related to what's in your first learning objective of stuttering is more than just stuttering because in thinking about what we've learned from Nina [00:14:00] in our other episodes, there is a lot to stuttering therapy that you don't necessarily learn in a book. 

[00:14:07] Scott Yaris: Exactly. The facts I always told my students at the beginning of a semester, facts are easy. Learn them. 

Okay. This class is not about facts. It's about being able to be with another human being who's experiencing a difficulty in their lives and having the skills to be able to help them with that difficulty. The skills aren't really about facts. I personally would much rather have somebody who is a great clinician who can relate to another human being than somebody who knows everything there is to know about stuttering.

They'll learn that stuff if they need to know it, but really what it's about is being a human, being able to be with another human being and bringing those unique clinical skills that we develop as part of our training, no matter what the condition is that we're working with, but bringing those to the [00:15:00] situation, those clinical skills, and one of the things in our, in our school-age stuttering therapy book in particular Nita, and I spent a few words talking about the skills that clinicians already bring to the table. Speech language pathologists, whether they know anything at all about stuttering, they know how to listen. They know how to reflect. They know how to model. They know how to validate. They know how to show empathy. Those are the things that really matter in helping a person cope with stuttering. We'll fill in the facts as we go. We'll fill in the specific techniques as we go. If you have technique without that clinical piece, you can't be a good clinician.

If you've got the clinical piece, even if you don't know the technique yet we will add that part in stuttering therapy is not about strategies. It's not about techniques. It's about connections and speech language pathologists are great at connections. 

[00:15:54] Kate Grandbois: I love that. That was, that was just so great I’m sitting here taking notes.

I can't [00:16:00] emphasize it enough. I guess just to repeat it back to you, because it was so empowering how important it is to bring humanity into your clinical space and to be a person first and the clinician second, and create a safe space for human connection, which can be vulnerable and scary and, and, and, but that's how we grow.

[00:16:21] Scott Yaris: Absolutely. I want clinicians to know that they don't have to know it all before they sit with a client who stutters and it's in fact, it's okay for that student who stutters to know that you don't know everything about stuttering, because we're going to learn it from them. Their stuttering is. So I'm going to learn from them what their stuttering is like.

Uh, I happen because of my specialty. I happened to know lots of individuals who stutter in. I know all of their individual stories, but still, I need to know this individual that I'm sitting with right now when I'm in a therapy session. Uh, and so that's fresh each time. And all of that history doesn't necessarily help me with this particular [00:17:00] person.

I've got to learn about them. And any speech language pathologist can do that once they learn to listen, once they learn to recognize what stuttering really is and not just what people think it is. That's, that's one of the important lessons. Stuttering is not just a speech thing, right? Stuttering is a life thing.

And when we realize that, then we get the opportunity to make a real difference for them. 

[00:17:23] Kate Grandbois: You're dropping so much wisdom. I'm having a hard time coming up with intelligent things to say, because I feel like every other sentence is this beautiful one-liner that I just need to sit and sit with for a while, but something you said just a moment ago, sparked a question in terms of how this relates to the misconceptions of stuttering.

So the clinician who is interested in gaining the content knowledge, interested in refining skills related to counseling and human connection, are there misconceptions about stuttering either [00:18:00] by society at large, that influence how we as clinicians approach this treatment? 

[00:18:09] Scott Yaris: Absolutely. And it's a very difficult thing in my mind because these misperceptions are rampant, first of all, and they're perpetuated not just by society, but also by our own field, unfortunately.

And it relates to that learning objective about stuttering being more than just stuttering. From a listener's perspective, from a perspective of, of a clinician, a family member, a teacher, or a person in society. We think of stuttering as a speech disruption as a moment in time, when the person is stuck saying what they want to say, okay, fine, fine.

But that's only the listener's perspective. It doesn't account for the speaker's perspective of stuttering. And so many of these [00:19:00] misperceptions that we have come from that separation between what we hear and see and what the person is actually leading. The best way to overcome these misperceptions that we have come from making a transition away from thinking about what we hear and see to what the person who stutters is living.

So for example, a common misperception about stuttering is that it's just a speech thing, but we know that, oh, well, you know what? Stuttering is a lot more than just repetitions and prolongations and blocks. It's about fear. It's about anxiety. It's about, uh, difficulty succeeding in class. It's about not being willing or able to raise your hand even when you know the answer or when you have a burning question, it's about not being sure if you'll be able to ask someone out or how you'll do it, the job interview, it's about being terrified of your telephone and about, uh, every time that phone rings, [00:20:00] all of these other aspects of life experience are part of what stuttering is. And that's so much more than, oh, that was a repetition. So while we're focused on the listener or observer perspective, we're thinking about fluency as being something valuable.

But if you ask people who stutter, what really bothers them about their stuttering, they don't say it's my lack of fluency. They say, it's my difficulty in doing the things I want to do in my life, saying the things I want to say in the way that I want to say them about not knowing about whether my name will come out when I go to introduce myself and having the wonder and worry and cringe, when the person I'm talking to says, what did you forget your name? Right? And so it's all of that other stuff. And when we shift toward recognizing that stuttering is more than just stuttering, stuttering as a life experience is about more than just speech behavior.

That's when [00:21:00] we become open to recognizing what our real goal ought to be as speech language pathologists, it's not just to make fluency happen, whatever that is. And that's a different topic, but it's about helping people live their lives to the fullest and helping them communicate in the way that they want to communicate.

Unfortunately, our field doesn't all know that. And unfortunately not only does society perpetuate some of these myths, but our field tends to focus on observable, fluency and value, and honor, and praise people who speak fluently, uh, rather than keeping the focus on communication, which is the reason that we open our mouths in the first place.

Right? When we talk, the three of us, we're not saying, okay, in this next sentence, I want to be fluent. We're saying no in this next sentence, I want to convey an idea. I want it. I want to say something meaningful. People who stutter are like that too, until they're taught that fluency is more valuable than their meaning then their content and their message.

[00:22:00] If we could shift that, boy, could we make a difference in people's lives 

[00:22:05] Amy Wonkka: And it makes me, in listening to you speak? It also makes me think about something that Kate and I have talked about a lot on this podcast in, in a completely different area of the field, um, in augmentative and alternative communication.

Just thinking about the importance of, of client centered intervention, right? And so all of those things that I've heard you talking about are also to me, I'm thinking yes, like shift away from this sort of deficits model of, you know, we need to come in and, and fix the problem. Folks can't see my air quotes, but fix the problem.

And, and in doing that, you shift from exactly that like something's wrong, something's wrong with you, I'm here to fix that thing that's wrong. Um, to shared goals working with your client do identify those goals that are meaningful for them. And it, and it is. I mean, I think in some ways it's sort of a shift in thinking for a lot of us.

Yeah. I [00:23:00] mean, I went to school and not, and I was perhaps, so if my professors would disagree, but you know, I mean, I went into a lot of my therapy sessions, really focused on like fixing the problem, identifying the problem and fix the problem. And so it, it's a bit of a paradigm shift, I think for some of us

[00:23:15] Kate Grandbois: Not only that, but just to piggyback on everything you said with, which I agree with, of course, is anybody who's listening, who is maybe thinking of this paradigm shift for the first time, just remember that our evidence-based practice triangle in speech and language pathology.

One third of that is client and caregiver perspectives and values. So you're actually not really doing evidence-based practice unless you incorporate these components into your therapy. Another way to look at it. By taking the content knowledge and putting it on a shelf or putting a pause button on it or making it second, or even making it the caboose and [00:24:00] focusing on your client and their perspectives and values that is still evidence-based practice.

We get so hung up on what articles do I need to read? What strategies do I have to have? What's the recent literature and publications and blah, blah, blah. And yes, that's a component of evidence-based practice, but it's not all of it. And so I like to, I like to remind people of that often, because I think it's part of our triangle, our evidence-based practice model that gets lost in the shuffle a lot because in graduate school, we're so continually bombarded with quote evidence or best available evidence or whatever you want to say.

Um, and the person in front of you is the most important part. 

[00:24:41] Amy Wonkka: I think one of the things though, that can make it hard and hopefully, um, Scott, you can talk to us a little bit about this is the assessment process, right? Because our assessment process is really set up to focus on the speech of things, you know, focus on the speech, focus on the language, administer these assessments, identify the [00:25:00] problems.

So if we're trying to focus on more than just the speech or just the language, how do we maybe rethink our assessment process? 

[00:25:12] Scott Yaris: That's one of my favorite questions in the whole world, because that's what my research has been on for, for a long time. Now, more than a couple of decades, when we approach stuttering, how do we measure what's meaningful to the person who stutters? And I came at that because when I was a beginning faculty member, uh, I wanted to study treatment outcomes in stuttering, treatment efficacy, you know, what works in stuttering therapy. But the very first question I had to ask then is what does works mean? And does what works means this person got more fluent?

Well, we know that the evidence shows that fluency is a very slippery kind of thing, and people may be more fluent sometimes, but not more fluid other times. And how do we define what's [00:26:00] fluent anyway, it's a mess. There's a way out of it by shifting our focus away from that observable fluency, recognizing that stuttering is more than just stuttering and looking at the broader impact of stuttering on people's lives.

And that's actually what led me to the development with my colleague, Bob Quesal and the later with Greg Coleman of the Oasis, uh, the overall assessment of the speaker's experience with stuttering or the Oasis is a tool designed to do exactly what you're saying. It's to look at the rest of the condition of stuttering, how does stuttering affect people?

And we know for example, that some people may stutter quite a bit on the surface, right? Yet not have adverse impact in their lives and therefore not need therapy because they're living just fine. Whereas other people may not stutter all that much on the surface. That experience a tremendous negative impact.

And they're the ones who may benefit from what [00:27:00] we have to offer as clinicians. And as we've used the Oasis in research over the years, and as we've used it to look at more different aspects of the experience of stuttering, we've discovered some pretty stunning things that I actually feel are, are, uh, an indictment of our field.

Um, one of the most important findings from a paper, it relates to the point that you brought up Kate about the, the, the research, you know, what papers should I read? Well, my, my colleagues Tisha and I published a couple of years ago now, papers showing that adults who stutter, who take as their goal when speaking to be fluent.

Okay. When they, when they speak, they try to be fluent. Those individuals actually experienced greater adverse impact in their lives than adults who stutter, who take as their goal when speaking saying what they want. Wow, wait a minute. That means that all that emphasis that we've had on being fluent, all this focus on [00:28:00] getting the speech just right, that we, as speech, language pathologists have played into, cause we thought we were supposed to, actually may be associated with greater adverse impact in people's lives.

Now, our evidence then is saying that maybe we should turn that around and focus on helping people communicate and say what they want to say, because those are the people who actually have less problem in their lives associated with their stuttering. It’s not just about speech. And when we focus on speech too much, when we overwhelm people with technique, technique, technique, I think we may be steering them in very much the wrong direction.

[00:28:39] Kate Grandbois: And doing the exact opposite of what, as Amy said earlier, we sometimes intend to do, you know, I have all this knowledge, I'm going to fix it. I'm going to help you. I'm here to help you, but actually I'm making it worse by accident. I mean, not that anybody's purposely doing harm, but this paradigm shift that we need to do, [00:29:00] you know, we can, we have the, we have the risk of causing harm by over, over applying our content knowledge, I guess.

[00:29:08] Scott Yaris: Uh, but now that we know, Ooh, right, before, if we didn't know that, right fine, a speech therapist supposed to work on speech. Okay, great. I'm going to, and now we say, oh, wait a minute. Now we've got this evidence that says that it's not having the desired outcome. We better rethink what we're doing and refocus our efforts. 

Again but that taps beautifully into what speech language pathologists are really, really good. Helping people communicate, validating people, helping them come to terms with the fact that they're different. Oh, we're great at that. So that's what I tell that, going back to the prior question, that clinician who's uncomfortable, don't worry about 8 million techniques.

That's not going to help anybody anyway. There's a place for technique. Sure. But it's part of a bigger picture. And when we take that bigger picture, clinicians feel much, much more confident. Right. One of my [00:30:00] favorite things to do, I, I used to do a lot of live presentations all over the, you know, these days I do them all by Zoom, but I've done over 700 continuing ed talks, uh, around the world over the last many years.

And one of my favorite things is when somebody comes up to me after one of those talks and say, you know, I, I, I kind of had figured this out a little bit, but I didn't know it was okay. I didn't know it was okay for me to stop telling people, to use their techniques and start telling them that they're okay.

And what they say is valuable. But now having heard you say that, it just makes sense to me. And I love to be able to provide that validation. A lot of people have figured this out. People stutter, they know. 

[00:30:44] Kate Grandbois: It's making me think of what I learned in graduate school and how things have changed or have they changed?

I guess that's my question. I mean, I'm thinking about everything you're saying and thinking about our second learning objective, the ways that assessment and treatment have changed over the years, I [00:31:00] have to, I guess I'm assuming that there has been a paradigm shift a little bit at the, maybe the academic level, um, the research level.

And I know it takes a while for some of these things to trickle down and become everyday practice. But where are we as a field in terms of this shift and what other things have changed in this realm of paradigm shift?

[00:31:24] Scott Yaris: Yeah, absolutely. I think if you think it's fair to say that there are there have long been two threats, there have long been two camps, if you will.

Although I don't really like love to put it that way, but there have long been those people who are focused primarily on the speech aspect of stuff. Okay. And those people who are focused on the broader consequences of stuttering and for a while, the battles were fierce between these two factions. You may have heard the, the old, it was supposed to be a pejorative [00:32:00] term to say, oh yeah, you're just creating a happy stutterer as if that's a bad thing, you know, for somebody to be happy.

But that was what the fluency related people would say to those of us who looked at the whole person. Right. And you can hear my bias as I'm talking about it, because I can't talk about it in any other way, other than my bias, you know, approach of saying, yeah, we ought to be looking at the whole person because that's who comes to us.

Right. I don't have a stutter walk into my clinical setting. I have a person walk into my clinical setting. So I have biases about that. But this battle has been going on for, for decades. I think it's fair to say that the shift is that there's greater consensus amongst most, but not all specialists and other clinicians on the importance of the human being in stuttering therapy.

It's not a hundred percent by any means. There are still those out there who would say that the primary issue for people who stutter is their speech fluency, [00:33:00] even though evidence suggests otherwise there are still people out there who would say that the goal of the speech language pathologist should be to focus on fluency, even though the ASHA scope of practice says otherwise.

But I think we're in the majority these days, I don't know you, you may have listeners who will disagree with me and they get to do that, but right now you're recording me. So I get to say my opinion, but yeah, I think that that's really what the shift is though, is that there is a broader recognition of the fact that we need to be broader in our therapy and look at the rest of the human being.

It's still a battle. So it's, it's an ongoing disagreement that we have, but I do think that the change is accelerating lately because of a shift away from more medical terminology for describing conditions like stuttering, for example, you will notice that I don't use the word [00:34:00] disorder when I'm talking about stuttering.

I'll use characteristic, I'll use condition. I'll use difference rather than disorder, because as we, um, embrace a neurodiverse view of conditions like stuttering, we have the opportunity to change how we talk about and how we think about people who stutter or as many people who start or prefer stutterers.

And it's completely okay to say that even though for awhile, it wasn't right. We're we're going through this change. Um, autistic people led the way. Uh, on this and are still leading the way and are still fighting this battle on a, on a daily basis. In stuttering, we are facing this as well. Understanding that speech language pathologist, unintentionally engage in microaggressions every session when they're praising somebody’s fluency. That's a problem [00:35:00] because there are entire therapy approaches based on praising fluency, right? So we are right in the thick of this battle, this of this internal strife, right? Cause even, even though I'm trying to understand this myself, I'm still on the learning end, uh, as well.

So, uh, but we have some great, great leaders in the fields who are talking about how to view stuttering as, uh, uh, not a dis a difference that needs to be viewed negatively. Um, people talk about the, the joy of being in a moment of stuttering and being able to feel that stutter and not feel disordered or different or bad, you know, bad, different because of it.

We have a ways to go, but it's an exciting change, uh, right now that's going on. Uh, and so that's part of what that paradigm shift is, and it's current and it's going on right now. And, um, what, well, our field has changed so much. Everything I learned in graduate school is not what I teach. [00:36:00] In graduate school now, right.

Everything. And that's great because that's science that's, what's supposed to happen. Right. If I was still teaching the same thing that I learned 30 years ago, then I would feel like we had a problem because that would mean that our science was, was, has had stagnated. Uh, no, I teach what I'm going to teach this year is different from what I taught last year.

Uh, and I hope that that'll continue to be the case because it means we're changing and growing and learning and struggling, and it's hard. Uh, but it shows that. 

[00:36:27] Kate Grandbois: Can you tell us a little, maybe this is a bad question, in which case you can say so, but I'm wondering if the role of addressing your own implicit bias or self care or, um, you know, doing a lot of self-reflection work on the part of the clinician is a critical piece of this.

Just knowing that there is a, this paradigm shift you're talking about going away from content knowledge and, and towards person centered care. You [00:37:00] know, there is a, there is a counseling component there, and there is, you know, in order to make space for someone else, you really need to be, I think, in a pretty good place yourself, is that an appropriate assumption?

Yes, you can tell me I'm wrong. That's fine. I'm feeling a little vulnerable. 

[00:37:18] Scott Yaris: Yeah, no. And I appreciate your you're putting that out there and sharing it. I, I agree. You know, if we compare what we do to another field, like say counseling psychology, for example, uh, we use a lot of the same skills that counseling psychologists would use.

We use them on different topic areas, certainly, but we use a lot of the same skills. And if you look at the graduate training for counseling psychologist, they do indeed go through that self reflection, self exploration process. And, and our students often don't get the opportunity to do that because we are as a field still [00:38:00] so focused on content.

And as our scope of practice grows and expands even further, there's more pressure on us as faculty to shove more content into the program. And it is a ongoing every, every institution that I've been at, uh, and that I have friends that, it's an ongoing challenge talking about how can we fit more content in, we can't.

And so we need to go through this shift of all right. Well, let's focus on creating the human being skills that we want our clinicians to have. Uh, and then we'll fill in the content, uh, as, as we can as needed. But a lot of it's going to ultimately fall to continuing education because we can't do it all in five or six semesters anyway.

But I would rather, if I had the opportunity, find a way to give our students the opportunity to go through that growth and reflection, because that will help them develop the empathy and the ability to be [00:39:00] with people in times of difficulty. That is frankly hard. You know, it, it, it takes a vulnerability.

You just use the word, you know, to be able to be a really good clinician. Graduate school is already a really vulnerable time. So it's very difficult, you know, to put this burden on our students as well. 

[00:39:19] Kate Grandbois: If anyone is listening and wanting to get more information about counseling skills, we interviewed Dr. David Luterman about a year ago, and I can link it.

Um, he gave a list of resources and suggestions for improving your skills in counseling. I, that I can list in the show notes. And for the sake of saying it, you've referenced a bunch of great resources, the Oasis, um, uh, the, when you discuss the results of the paper that you published, we'll list all of those in the show notes as well.

So that, um, anybody who's listening and driving and jogging or whatever, has a little, has a little body of their own, a little library of the resources that they need in their phones. I'm wondering as we sort of [00:40:00] continue to reflect on this paradigm shift, you've mentioned the Oasis, which is, I'm not sure when that was published, but I assume that was a shift in terms of looking at the whole person in assessment.

Are there any other resources that you would recommend to our listeners that can help them continue this paradigm shift through evaluation and treatment? 

[00:40:23] Scott Yaris: Well, I'm so glad you asked about that because one of my personal goals, my personal mission is to try to help speech language pathologists, feel more confident in their skills for helping people who stutter, because ultimately I think that'll lead to better clinical services, right?

For this population that I, that I care so deeply about. So my friend, my colleague, that you mentioned before, Nina Reeves, uh, and I started a company years ago called stuttering therapy resources. And what we do in stuttering therapy resources is we develop resources for stuttering therapy. Our tagline, our mission is [00:41:00] helping speech language pathologists, help people who stutter.

And what we try to do through STR is identify those gaps. In, um, materials that are available because there are a lot of great materials out there. I don't mean to say that we're the only ones who do this, but try to identify, uh, ways of helping clinicians know what to do in stuttering therapy, but not just as a cookbook instead to know why they're doing what they're doing and of therapy.

And the reason for that is simple. There is no study that's ever been done, and there is no book that's ever been written that can tell you what to do with the specific client who's sitting in front of you in a therapy setting, because every person is unique. So when we talk about evidence-based practice and going to the available literature, I can't find a study that says, well, this is what to do with Jay Scott Doris, when he's sitting at, [00:42:00] at this point in his life, when he's 53 years old and he's had these experiences in his experiences in his life, he needs this.

Right. That just doesn't exist. So, what we try to do is help clinicians understand the rationale for what they're doing in therapy. Have the confidence to be able to flex it. As we like to say, to adapt the therapy to that particular client's needs at that particular time in their life with their unique background.

And so we write books, uh, we have two primary therapy guides, one for young children who stutter one for older children who stutter. We write materials for teachers and parents. Uh, we have a focus on helping children who experienced bullying and, and the emphasis in all of our books and our materials is on the we like to call them, thinking,clinicians guides to stuttering therapy, uh, so that they understand what, what the principles are that they want to apply and adapt and adjust.[00:43:00] 

Uh, so that's what we do through stuttering therapy, resources, in addition to blog posts and blogs and handouts and videos, uh, and all, uh, um, all sorts of materials, all designed to increase that sense of confidence. Again, I don't mean to suggest that we're the only ones out there doing that. There's some great stuff out there, but, uh, but we, we do like to try to put this angle on, um, helping clinicians develop that sense of confidence, that they can sit with a person who stutters and don't, and not feel like they need a script, but feel like they have that ability to be with them and follow their clinical and personal intuition. But know why. 

[00:43:41] Kate Grandbois: That's a great list or description of what you guys have. And I will say I've been on your website. It is full of information. You guys have so much stuff up there and I'll link everything so that our listeners can find things pretty easily. I wanted to, um, you mentioned the Oasis. Do you have a link to the Oasis on your [00:44:00] website? I believe you do. 

[00:44:02] Scott Yaris: Stuttering therapy, resources.com/Oasis 

[00:44:05] Kate Grandbois: there you go. I wonder if there is, if you could tell us a little bit about like it app applying assessment across the lifespan. So are there different lenses that you take from a preschool assessment versus a school-age assessment? How do you, what are some of the guideposts that you use?

[00:44:27] Scott Yaris: You bet. Absolutely. And indeed, there is a difference in my assessment goals at the preschool age compared to basically school, age and above. That's the main distinction that I make is preschool and young school, age ages say two to six versus school, age and above ages, six to infinity. Because the question that we face with the young ones is not so much whether they're stuttering, because if they're stuttering on the surface, you can see [00:45:00] that on the surface with little ones, the young ones haven't yet learned how to hide their stuff.

Uh, adults who stutter teens, school-aged children, they can hide it from you. Right. And so for them asking, did I see a stuttering behavior that doesn't really tell you anything meaningful. Little preschoolers will try to do that too, but they're frankly not that good at it yet because their brains are just this big, you know, they're still, they're still developing and you can typically tell them that if they're demonstrating stuttering behavior, then they're stuttering.

The question is not, are they stuttering? But rather are they likely to continue stuttering? So for those young ones, assessment is about, what's the risk that this child will continue to stutter without therapy. And if the risk is high well that I want to treat them right. And if the risk is lower, then I may not need to be quite as urgent about getting them into a formal therapy session, but I definitely want to help the parents.

And the child, [00:46:00] not to worry along the way. So we know that most preschool children who stutter will indeed grow through their stuttering. It'll be a stage that they go through as part of their development, but it won't stick with them over the long-term. We want to make sure that if they are at greater risk for continuing to stutter, that we're providing more formal therapy, but even if they're not, we want to provide support. 

After about age six or seven though? The chances of that recovery occurring, diminished tremendously. It's not to say it never happens, but most children who are still stuttering by about age six or seven or eight, are likely to continue doing that in some fashion throughout their lives. And it's at that point that we shift our focus from, are they stuttering?

Are they going to continue stuttering too? Are they experiencing negative impact associated with their stuttering? Because if they've [00:47:00] experienced negative impact, well, then we want to reduce that negative impact. That's what we do in therapy. The hard news that is difficult for our field to accept, it's difficult for families to accept, but it can be accepted is that there's no cure for stuttering.

Right. So if a person of age 12 or 15 is still stuttering, uh, they'll probably be dealing with stuttering in some fashion throughout their lives. Our goal is to make sure that they're not experiencing a burden associated with their stuttering, that it's not causing a problem in their lives. If they're experiencing a problem, we treat the problem in particular, the burden, the adverse impact, the difficulty with communication.

If on the other hand, they stutter, but it's not holding them back. They're not feeling negatively about it. They're not restricted in their ability to do the things they want to do in their life. And they don't need us that they don't need therapy [00:48:00] just cause they stutter if they have no negative impact.

So that's really where that key differences in the assessment with the little ones, it's a risk assessment to try to prevent the development of lifetime stuttering for the older ones where lifetime stuttering is highly likely. We want to prevent the adverse impact. 

[00:48:21] Kate Grandbois: And is the, is the lens similar for treatment?

[00:48:26] Scott Yaris: Yes, absolutely. Absolutely. The treatment goals then for the young ones, we're focused on increasing the likelihood that recovery will occur. In other words, giving the child the best chance of being one of those children who grows through their stuttering. For the older ones, it's to help to reduce the burden.

So identify the ways in which stuttering is having a negative impact on their lives and focusing specifically on reducing that negative impact. That may [00:49:00] involve some fluency work, but more often than not, it involves all sorts of other things as well. 

[00:49:08] Amy Wonkka: Well, and as somebody who, you know, doesn't really work in this area of the field and I'm not super familiar with the Oasis, it does make me wonder, you know, if I'm using an assessment tool like that, what are some pieces of that assessment that are going to help guide me as a clinician to make sure that I'm not over focusing on those strategies or fluency and making sure that I'm aware of all of these other things that I need to be aware of?

[00:49:36] Scott Yaris:  Absolutely. Great question. The Oasis. I just give a super quick background on it. It was developed based on the world health organization's framework, the international classification of functioning, disability and health or ICF for short. Okay. Many of your listeners may already be familiar with the ICF.

I hope they are because if [00:50:00] they've read their ASHA scope of practice document, they'll find that it's right there in our scope of practice, the ICF was designed to describe not what can go wrong with you. It's not a diagnostic tool it's designed to describe what that means for your life. How does it affect your life that you stutter that you have whatever other difference or condition you might have?

What does that mean for you? And so, because the Oasis is based on that directly, it's divided into different subtests that tell us about different aspects of the overall experience of stuttering. So for example, section two of the Oasis focuses on the kinds of reactions that people might have to the fact that they stutter reactions can occur in a variety of different ways.

For example, we can talk about how a person feels about the fact that they stutter their emotional reactions, maybe embarrassed, maybe fearful about talking, maybe [00:51:00] ashamed, feeling like they've done something wrong. You can talk about physical reactions, like tension or struggle. That you might commonly see in people stutter or attempt to knots that are like avoidance or escape behavior.

You can talk about thought reactions, like low self-esteem, low, self-confidence a poor sense of self efficacy or not thinking like you're a good speaker. Those feelings and actions and thoughts actually are what contribute to the adverse impact that a person experiences. But if I have a person who scores high on section two of the Oasis, higher scores mean more adverse impact in that area.

Then I know that I need to focus some of my therapy on reducing those negative reactions. If on the other hand, I have a person who has relatively minimal, lower scores on section two, then I may not spend much of my time in [00:52:00] that aspect of therapy and I may focus my therapy on other areas. So the idea was to use it as a, not just a diagnostic tool, not just as an, uh, uh, treatment, um, um, not just as an assessment tool, but as a treatment planning tool to say, oh yeah, this person is having a lot of difficulty, the section three, communicating in the work setting, I'm going to focus my therapy on generalizing to the work setting. This person is experiencing difficulty in their ability to pursue their life goals or in their satisfaction with communication that's section four. Well then I'm going to be focusing on improving their overall sense of satisfaction with communication and their lives as a whole related to centering.

So yes, it's designed to tie directly in section by section to different aspects of the therapy process. 

[00:52:50] Kate Grandbois: That's an incredibly comprehensive assessment. I mean, I'm as, says the naive person who has not at all familiar with it because I don't work. I work with I'm an AAC quote, [00:53:00] unquote specialist, but I love that there is an assessment tool out there to support this paradigm shift and to look at the whole person and not just percent fluency, which is what I recall from my graduate education 15, 15 years ago.

And it is also making me think a little bit about this last learning objective and the sentence it's okay to stutter. I wonder if you want to tell us a little bit about that. 

[00:53:29] Scott Yaris: You bet the four most important words, that speech language pathologists, teachers, parents, and of course people themselves can learn as soon as we acknowledge the fact that there's no cure for stuttering.

And that's a difficult fact for many to acknowledge. I get that. I totally do. But as soon as we acknowledge that, then we have no choice. But to accept that and say, well, then if I can't change [00:54:00] this about myself, if I can't eliminate this characteristic about myself, that I may not love, uh, that means I have to learn to live with it.

And if it means I have to learn to live with it, I have to accept it.

Now acceptance is a concept that has caused all sorts of difficulty in my field in particular. It probably has in other areas of the field, but I only know stuttering because people, some people tend to view acceptance as this all or none kind of thing. You accept something, you're, you're just letting yourself go.

You're not going to work on it. You're just gonna, you know, that happy stutter complaint again, but that's not what acceptance means. Uh, Nina and I were fortunate at the last ASHA schools connect just this past summer, uh, to do a presentation on what acceptance means in stuttering therapy. Acceptance does not mean giving up.

[00:55:00] It does not mean giving in. It does not mean just stuttering all over the place and not caring. Acceptance is an active process by which an individual comes to terms with the fact that they are different and that it's okay to be different. And that being different does not mean that you're bad or that you've done something wrong or that you need to be fixed.

It means that you're different and that's it. And you can be striving to change that difference. You just don't have to hate yourself along the way. And that's true for many, many areas of our field. I can give you plenty of examples, for example, um, my father has Parkinson's he's in the relatively early stages.

He does not love the fact that he has Parkinson's of course not. Right, but he doesn't have to be mad at himself for the changes that he's experiencing. It's not his fault that he's [00:56:00] experiencing these changes. Uh, what he can work on instead is learning to live with those changes in the most effective way possible.

Well, it's not the fault of my clients who stutter that they stutter. They don't have to hate themselves for the fact that they stutter. They can accept the fact that their speech fluency is different from other people's speech fluency. And they can still be working to change that speech fluency if they want. Okay.

But along the way, they can recognize that they're okay, that they can still live full, productive, happy, active lives, that they can still say what they want to say, do what they want to do. And indeed be who they want to be. Even though they're different. This is not an easy thing. In fact, coming to terms with our differences, coming to accept ourselves for who we are and how we are.

That's the hardest thing about. Right. No matter what your differences, that's the hardest thing in the world [00:57:00] yet when you live with a stigmatized difference, like stuttering, it's that much harder because everywhere you look, the messages that you receive from society, from your parents, from your teachers, from your speech language pathologist, is focused on your deficit as they view it.

And to be able to stand up in, in light of all of that and to say, I know I'm different and I'm okay. That takes all the strengths that takes all the strengths. And so I view our role as speech language pathologists as being one of helping people have the strength to stand up and make that statement to say that they're okay.

And I got to tell you, we don't do that by praising their fluency. We don't do that by holding up examples of fluent people who stutter. And saying, oh, look, if you only try hard enough, you can be like that person. We don't [00:58:00] do that by, um, you know, some people who stutter actually, I'm a, uh, fluent person who stutters or, you know, I, oh, I haven't stuttered in what messages does that does that send?

So our job as speech, language pathologists, I think is to help people be who they really are and that's hard and that's hard. So that's why I say the four most important words that any person who stutters any parent, any clinician, any teacher can ever learn is that it's okay to stop because it's not the person's fault that their neurological system is different.

Once upon a time, it was considered a terrible thing to be left handed. Right? Well, guess what, today, our society does not hold that stigma as much anymore. Maybe we can get to a few. What our society does not hold that same stigma about having a difference in the smoothness of your speech production, [00:59:00] but we won't get there if we are continuing to value perceptibly, fluent speech, over speech that is different in terms of its rate or rhythm or effort or smoothness. Uh, but if we know that it's okay for speech to be stuttered, if it's okay for there to be a disruption in speech, but the person boy had amazing and wonderful things to say, that's where I'd love to see us get.

And I think that we as speech language pathologists actually have a responsibility to try to push the field in that direction because sadly we've played a role in supporting the stigma, not intentionally, but because, you know, we thought we were supposed to we’re speech, speech therapists, speech teacher, you know, speech, speech, speech.

I really would like our field better. If we were communication specialists. 

[00:59:50] Kate Grandbois: I have said that so many times. Oh yeah. Agreed, agreed. Anyway, continue your professing. Because what you're saying [01:00:00] is beautiful

[01:00:01] Scott Yaris: That's that's where I am though. That's my, my thing is, you know, and not just me, there's lots of folks who agree with me on this, but it is a bit of an uphill battle, especially around stuttering because stuttered speech can look different and it can sound different.

And if people feel like, oh no, I'm supposed to do something about that. And I got to tell you, speech, speech, language pathologists, they're the worst at this because we feel this sense of responsibility. Like, oh, I was supposed to do something and I didn't know what to do. That's that brings us back to that first learning objective about clinicians’ own sense of a lack of self-confidence.

They feel like they failed in some way when their kids continue to stutter. It is not the job of a speech language pathologist to fix a person. As a person who stutters is not broken, they're different. There are different can break them. I don't want to minimize the pain that people who stutter experience.[01:01:00] 

Right. A couple of my colleagues and I right now are working on a paper of suicidal ideation amongst people who stutter. It can cause tremendous pain for people who stutter. So I'm not saying this to belittle or diminish that, but if we can change how we think about stuttering for change, how we talk about stuttering, if we can change how we view this with respect to societal stigma, self-stigma professional stigma within our field, perhaps we can diminish some of that burden 

[01:01:30] Kate Grandbois: In our last minutes do you have any rec any final recommendations or action steps that anyone who is listening, who feels inspired and wants to contribute to make these changes? Do you have any suggestions? 

[01:01:45] Scott Yaris: Oh, yes, absolutely books and books worth. But yeah, in a, in a, in a quick nutshell, one of the things that Nina and I are often commenting to each other about is this, remember clinicians, [01:02:00] you have what it takes.

Every speech language pathologist can be a superb stuttering therapist. Don't forget all the things that you already know, just because you heard the word stutter, right. Because that's the, taps into our insecurities and it taps into our uncertainties to hear that, oh, I don't know anything about stuttering.

No, but you know about people, you know, about listening, you know, about validating, you know, about all these great things. And if you can sit with a person who's in crisis, a person perhaps who stutters, or a person who has some other condition and share their ver their vulnerability, be in that moment with them convey positive regard to use some counseling catchphrase.

To validate their fears and to let them know that you may not know all the answers, but you'll be there with them as you explore it together. Uh, very often that's what people who stutter [01:03:00] like so many other people need to hear is that we're, we're gonna work through this and to convey to people who stutter, just as I want to convey to people who clinic, uh, there is hope there is good reason for optimism when we're talking about stuttering.

Yes. It can be a hellishly difficult condition for some people to live with. Absolutely. But there's also reasons for hope and optimism because people who stutter can do anything they want to do. And they don't have to be famous people who started to do it. They can be people like you and me doing the things they want to do being fulfilled.

And the stuttering doesn't have to hold them back. And once we know that as speech, language pathologists, we have to know that in our soul, then we can convey that to our clients. That's the most important thing 

[01:03:55] Kate Grandbois: I don't, I can't follow up with anything that was just so good. I could [01:04:00] listen to you talk forever.

This has been such an, uh, an amazing discussion and we're so grateful for all of your expertise. Everybody who's listening. All of the resources will be listed in the show notes. And thank you times a thousand. Thank you so much for being here with us. 

[01:04:19] Scott Yaris: I'm grateful to the two of you for inviting me. This was great fun.

I hope we'll get to do it again. There's so much fun stuff yet to talk about. And I think we share some interests in science fiction and we share some interests in 

[01:04:37] Kate Grandbois: Scott we're friends. Thank you so much for joining us.

[01:04:38] Scott Yaris: Absolutely. Thank you again for the opportunity. 

[01:04:43] Kate Grandbois: Thank you so much for joining us in today's episode.

As always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count for professional development in your area of study, please check [01:05:00] in with your governing bodies or you can go to our website, www.SLPnerdcast.com.

All the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@SLPnerdcast.com. Thank you so much for joining us and we hope to welcome you back here again soon.