There is now wide recognition that therapy should go beyond speech to address the whole person. At the International Fluency Association conference in Dublin last year, Jackie Turnbull showed how counselling in therapy works with people who stammer. Jan Anderson reports.

Many speech and language therapists who work with people who stammer have trained in counselling, for example person-centred or personal construct therapy. However, Jackie raised questions about where counselling fits in, whether speech and language therapists should explore issues such as depression and relationship difficulties, and when they should refer someone on. She considered the role of counselling and introduced an interesting model to illuminate different stages in the counselling process.

Central to the presentation was the description of a model used in bereavement counselling. This dual process model proposes that people oscillate between two stages of grieving during which they alternately confront and avoid their loss. During the former, the person is focused on their loss, breaking bonds and ties and the avoidance of restorative changes. During the latter, people focus on doing new things, distractions from grief, avoidance of grief and new roles and relationships. Both responses are equally valid in the process of learning to live with the grief.

Jackie proposed that it was useful for us to consider these two processes with reference to therapy for people who stammer. Sometimes clients focus on negative thoughts and emotions, avoidances, life restrictions, regrets and so on. Jackie termed this 'suffering-oriented'. At other times they may be task-focused, ready to try out new things and construct a new narrative. This was termed 'restoration-oriented'. The two processes may be distinct or blurred and the person may move quickly from one to another, as in Sheehan's approach-avoidance conflict. Early in therapy clients may spend more time being suffering-oriented, indeed therapy may demand this as the person identifies their stammering pattern and the meanings associated with it.

Jackie proposed that change involves both coming to terms with the suffering brought about by stammering and the development of a future in which stammering is both accepted and modified so its effect on the person's life becomes less pervasive.

Returning to the role of speech and language therapists, Jackie acknowledged that therapists who do not have adequate training in counselling may not feel competent in dealing with some of the more difficult suffering-oriented aspects of stammering and may need to refer the person on to a counsellor or speech therapist who does have these skills. Conversely, many counsellors know little about stammering and may be less able to understand or empathise with the person who stammers.

In conclusion, speech and language therapists often provide a dual role; offering active listening and counselling skills, attending to significant psychological issues as they arise but also offering advice and expertise in technical aspects of speech production and stammering modification.

Jackie Turnbull is a speech and language therapist and qualified counsellor in the Leeds teaching hospitals NHS trust.

More reports from 5th World Congress on Fluency Disorders, 2006...

From the Spring 2007 issue of 'Speaking Out', page 16