The first place I went for help regarding my stuttering was a psychologist. On the surface, it may not make much sense, but it made perfect sense to me. Sometimes I had difficulty talking, and sometimes I didn’t. I could say the words fine when I was by myself, but I would block on all of them when someone else was around. My stuttering caused and was caused by anxiety, frustration, embarrassment, and anticipation. It was a vicious cycle. Because of this, I fully believed the cause of my stuttering was psychological.
People who stutter often end up in the hands of psychologists, but should stuttering be discussed in psychotherapy? If so, how? What is the best counseling approach for people who stutter? How do you talk about it if you don’t know a lot about it?
It’s complicated. Good speech therapy for stuttering addresses the psycho-social components of stuttering. However, some people need additional support for other mental health concerns which may or may not be related to stuttering. Due to the significant life impact stuttering can have and the co-occurrence of depression and anxiety amongst people who stutter, it is common for folks to be in both psycho-therapy and speech therapy. The overlap between the role of a psychologist and the role of a speech therapist in stuttering can be tricky. Here are some dos and don'ts for psychologists to keep in mind when working with people who stutter.
- Address the elephant in the room. Ask them curiously how their stuttering has affected their life. Understand that stuttering often has a significant life impact. Ask about their thoughts and feelings toward stuttering. Approach this topic with a curious eye. They are experts on their stuttering.
- Use a trauma informed approach. Stuttering is a highly stigmatized disorder and moments of stuttering can be traumatic (e.g., bullying, negative reactions, feelings of isolation, embarrassment).
- Collaborate with their speech therapist, if applicable. It’s important for both providers to be on the same page and using the same language. Speech-language pathologists can help psychologists understand the complexity and paradoxes of stuttering. Psychologists can help speech-language pathologists understand the potential barriers to success in therapy.
- Understand that stuttering is not caused by nervousness or anxiety. Although nerves and anxiety can certainly be a trigger, they are not the reason. Don’t assume that the person is stuttering more around person A or in situation B because they are more nervous around them.
- Comment on their fluency. “I notice you are stuttering a lot today” or “You stutter less around me” are comments which are not helpful. Stuttering is inherently variable, so someone might be stuttering more or less for no reason at all. This doesn’t quite mean anything, and it backhandedly rewards fluency, something they have no control over.
- Attribute everything to their stuttering. Sometimes clients who stutter blame all or a lot of their problems on their stuttering (my dating life sucks because I stutter, I will never get promoted because I stutter, etc.) Although it has a significant life impact, guide the client through other reasons this might be happening, and remind them that certain situations are hard for everybody.
- Blame their past for their stuttering. Stuttering is not caused by a traumatic event that happened in childhood. The person did not start to stutter because of the way their parents treated them or because of something that happened to them when they were younger.
- Think that the life impact is low because they don’t stutter that much. Some of the most covert people (people who hide their stuttering and pass as fluent) have the greatest life impact. The avoidance, stigma, misunderstanding, and hiding eat at them every day.
Stuttering is complicated and different for everybody. If you are unsure of how to behave or respond, ask. There is no one size fits all. The counseling approach that works best is listening to the person in front of you. Validate their feelings, try to understand their struggle, and work with them to have a positive attitude toward their stuttering. You may just change their life.