In our previous blog on education goals for speech therapy, we outlined some education-focused goals and activities for IEP students who are “over” speech therapy. Some students just don’t want to work on speech goals, and that’s perfectly fine! Empowerment is the second E in our 3Es model of stuttering therapy, and it’s another goal area you can work on to make IEP minutes that doesn’t involve speech goals.
It follows that while the student makes progress with empowerment, it might not look like progress on the outside: I had a parent come to me once, concerned that her 12 year old was stuttering more after coming to speech therapy for a few weeks.
“Great!” I said to mom. That is exactly where we want to be.
Uncomfortable and confused, mom wanted answers. I asked her,
- Is she talking more?
- Is she saying feared words, instead of avoiding them?
- Is she participating in class and/or social interactions more?
- Is she stuttering confidently?
Mom answered yes to all of these questions.
It’s going to get “worse” before it gets better, as is true with a lot of things in life. Stuttering is like an iceberg, the bottom (thoughts, feelings, reactions, avoidances) is the part that is most detrimental to the person who stutters, while the actual disfluencies itself are just the tip of the iceberg. When you address the under-the-surface features, they rise to the top and create a pretty hefty top of the iceberg. But do not fret—over time, it will crack.
Where Do I Start?
If you have a student on your caseload that sounds like this, we can help. You may be hearing the student talk about avoidance, negative life impact, and decreased confidence. You can meet minutes by treating stuttering in a way that is helpful and relevant without targeting physical speech goals.
Not only that, you can write evidence-based, IEP-compliant speech therapy goals that do NOT require actively modifying physical speech behaviors.
In this post, we will focus on empowerment goals for stuttering that are appropriate for a school-based setting. See our previous post on education goals for more ideas.
Writing Goals for Empowerment
There are three important things to remember when targeting empowerment:
- Meet the client where they are. The goals should be challenging, but not too challenging or the client will not complete them. Think of your own fears. If you were scared of spiders, how willing would you be to enter into a pool of spiders? What about watching one live spider from a few feet away? Or maybe, you’re terrified of spiders and right now your goal is just to look at a fake spider. Small steps lead to big changes.
- The goals should be client directed. What empowers one person is different for another person. Goals and activities should be decided on together. They should be carefully thought out—what would benefit the person in front of me? What makes sense to target now? Activities should not be arbitrarily chosen.
- You can’t force someone to do something. Even if you, as an expert clinician, believe that a client should be participating in class more, you are not in control of the success of this behavior. Empowerment is the hardest E to accomplish. It’s likely that it will take several weeks of “just talking” before behavioral change can happen. This is okay and even encouraged.
Some examples of empowerment activities that most clinicians are familiar with include:
- Voluntary stuttering
- Going on a stuttering outing
- Educating others about stuttering
- Participating in stuttering self-help/support groups
- Avoidance reduction/choosing to stutter
Other lesser-known activities that are equally important include:
- Practicing social-pragmatic communication (small talk, networking, etc.)
- Discussing disability rights and neurodiversity
- Learning about diversity, equity, and inclusion (DEI) initiatives at their school
- Using social media to post about stuttering
How can I justify this?
There is lots of evidence to support targeting empowerment in therapy. In fact, there is so much evidence that if you aren’t working this into your IEPs, there might be a question of how EBP your approach really is.
These areas can be justified using rationale goal language:
- “To empower confident communication…”
- “To increase verbal classroom participation…”
- “To decrease social avoidance associated with stuttering…”
- “To empower the client with the ability to take on feared speaking situations…”
These areas can be measured using “product delivery” goal language:
- “...by creating five assignments up the fear hierarchy”
- “...by self-disclosing to [person/peers]”
- “...by creating an advocacy packet to share with teachers.”
- “...by verbally summarizing the DEI initiatives at their school ”
These goals can be time-bound using deadline goal language:
- “...by the end of the term/semester”
- “...within X weeks/sessions”
Working on fluency techniques is useless if the child does not participate in class. Working on an easy onset is not going to empower the student to participate academically or socially. If anything, it might be a hindrance if the child feels that they are unable to use the techniques effectively in that environment. The bottom of the stuttering iceberg is often the most significant. Empowerment activities can help target these aspects.
Because these activities are targeting years of buried behaviors, thoughts, and feelings, bringing them to the surface may actually cause more stuttering. This is progress: increased participation, decreased word and situation avoidance, and less reliance on tricks to pass as fluent. With stuttering out in the open, if the client wants, we can begin to work on ease, or modifying the stuttering to make it easier to talk. Empowered communication is spontaneous, effortless, and confident.
In conclusion, just because a student stutters, does not mean you need to work on speech goals.
...and why would we, when there is so much MORE?
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