Book Study: Therapy Applications

Today is our final book study post, so if you haven’t gotten in all your comments, please do so before you leave for winter break! Today, Lexie Cunningham shares some therapy applications based on our book:

The conundrum of school-based speech therapy is presented in a raw and real fashion in this novel, as Katherine openly discusses her disdain and disappointment with speech therapy services as a child. From a speech therapists standpoint, we are constantly faced with the moral dilemma of adverse impact. In the case of Katherine, I have asked myself over and over again what it is I would have done had she been referred for speech therapy in our public school system. Clearly there is academic impact in that she avoids speaking during classroom activities/discussions. She is a loner in social situations with peers. She has few friends, and her teachers have no idea how to handle her stutter. Yet, Katherine despises having attention directed towards her disability. She would not want to have been pulled from class for therapy. From day one she was against formal speech therapy services. In her case, she states that she liked her first speech therapist and wanted to please her. However, when she wasn’t “cured” the first go around it made a lasting negative impression on her.

From a clinical standpoint, we have all been trained on stuttering modification therapy techniques vs. fluency shaping therapy techniques. I would venture to say that most of use of combination of both in our daily practice. We arm students with the fluency shaping techniques such as easy on-set, light articulatory touch and continuous phonation. At the same time, we also educate our students on stuttering modification techniques like pull-outs, cancellations, etc. We provide a safe and loving environment for our students to practice their techniques. Like with Katherine, many of us have students who are able to be completely fluent in our therapy rooms. They politely complete the tasks we give them, come religiously every week and even convey their appreciation for our time and patience. Yet, they continue to suffer once they leave our therapy rooms. So what do we do?

In my opinion, there are three big concepts from this book that have inspired me to modify how I conduct school-based speech therapy services for students who stutter:

  1. Honesty
  2. Education
  3. Collaboration

I can say with absolute certainty that in the last ten years, I don’t think I have ever sat down on day one with a student who stutters and had a real and honest conversation with them about my role. I was teary-eyed when Katherine stated in the book that she felt like a failure when two weeks following her first formal speech therapy treatment, her stutter returned and she felt like a failure. I wonder how her childhood years might have been different had her therapist stated from the beginning that she was not going to be able to “cure” her stutter. I want to make a conscientious effort with all my students to let them know up front that I’m here because I care, because I want to give them all the knowledge I have on the subject, because I want them to go out into the world armed with some tricks up their sleeves. I want them to know that nothing in life is a guaranteed success, but that they are not alone. I wish Katherine had been given that.

I hope that all of us who read this book feel the need to do a better job of educating teachers about how to handle students that stutter. Yes…we do give them handouts about stuttering. Some of us tell teachers not to spontaneously call on our kids, to give them plenty of time to prepare if they are required to speak in front of the class, etc. But do we educate them on our own non-verbal body language and how we are impacting the feelings and anxiety of the stutterer with our eyes? Or in Katherine’s case, even the lack of eye contact? Do we do a good enough job of educating adults in our buildings about the importance of not finishing sentences? And even more importantly, do we educate our students who stutter how to be self-advocates for themselves? Katherine mentions throughout the book that she was weary of certain people based on their initial reactions to her stutter. She was constantly making assumptions about how others perceived her. Again, I wonder how her childhood might have been different had she been told at a young age not to assume that people were judging her or feeling sorry for her. She speaks during her boarding school years how she amassed a small “army” of safe people. Yet, how neat would it have been for her to have had the confidence to go up to some of those girls or to a teacher and say, “That makes me uncomfortable. I stutter. Sometimes it takes a while for me to get out my message, but it doesn’t mean that I don’t have something to say.”

The most important impact this book has had on me is the need for collaboration with my students who stutter. I realize that they know more than I do, and should really be the ones driving the therapy process. It never occurred to me that my kids probably have an elaborate system in place for maneuvering through communicative exchanges until I read chapter four. Katherine lists her “tactics for communication warfare” which included speaking in an accent, timing when to enter a conversation, and word substitution to name a few. Perhaps before we begin teaching therapy techniques, we consult with our kids on what system they already have in place. If a student knows that they don’t stutter when they speak in an accent or when singing, start with continuous phonation or a modification of melodic intonation therapy.

In the end, with all of our students not just those who stutter, it’s really about showing them that someone cares. Yes…this is a job. We show up, we do our paperwork, we see the kids, and we get our Winter Break, Spring Break, and Summer Vacation with a pay check every two weeks. But with anything in life, in the end it’s about the relationships that we have made along the way. The people that we have impacted. The courage to do the right thing and the willingness to be kind even in tough situations. So love your students. All of them. The good and the bad. You will never know the impact that you have made on them…unless they decide to travel the world and write a book!

Thanks, Lexie!

5 thoughts on “Book Study: Therapy Applications

  1. Carrie Kaelin says:


    Your article/ summary is amazing. Thanks for your insight! I’ve learned so much from the book and the summaries written by everyone in our book study. This would make for a great summer PD!
    Last year, I met a very successful entrepreneur in our community who is dysfluent (mild-moderate), and he shared a bit of about the tricks he uses when speaking. I bet he would be willing to come speak to our group. Just a thought.

    It really is so important to individualize the treatment based on the student. For one of my students, it wasn’t helpful for the teacher to give her time to think about an answer, or to know when she would be called on to give a grade (e.g. I get called on right after Suzie….).She stated that knowing that her turn was approaching caused her to be anxious and then in turn, to stutter. It helped her more if the teacher called on her spontaneously. I have also suggested to teachers that they give answer choices / avoid open-ended questions, but honestly I don’t think I discussed that with the student, and certainly should have.

    This book study has definitely had a positive impact on my ability to help my students.

    Happy holidays everyone!

  2. Chelsea says:

    Yes! Everytime I meet with my students who stutter, I think about Katherine’s words. She haunts my sessions, and it has opened me to be more creative and with my sessions. Today my student and I explored the NSA website and brainstormed about WHY in the world Louisville doesn’t have a chapter! We saw that the NSA hosts a Family Fun Day, and discussed the possibility of hosting one. We talked about who might come, what we could do, and how to find other people who stutter.

  3. allison forrester says:

    See Below: I sent information about the first group that met in October to a family of one of my student’s and they went! The mother emailed the information for the next meeting date, which is this weekend. She reported that it was well attended and they were looking forward to the next meeting. I will send flyer in an email too.

    Stuttering Support Group
    Y o u ‘ r e i n v i t e d !
    f o r s c h o o l – a g e c h i l d r e n & t h e i r p a r e n t s
    S a t u r d a y , D e c e m b e r 9 t h
    1 0 : 3 0 a m – 1 1 : 3 0 a m
    C r e s c e n t H i l l P u b l i c L i b r a r y
    2 7 6 2 F r a n k f o r t A v e n u e
    * B a s e m e n t M e e t i n g R o o m *
    E n j o y g a m e s , s n a c k s , a n d g o o d c h e e r !
    e m a i l a l e x a n d r a . b i r m i n g h a m @ l o u i s v i l l e . e d u f o r q u e s t i o n s

  4. Sarah Crady says:

    Thanks for your insight! I agree with you that the most impactful part of Katherine’s story was how aware she was of her stutter and her tricks for avoiding it at such a young age. It made me re-think my therapy sessions with my current fluency students and find out their current ways of avoiding dysfluency.

  5. lauren wempe says:

    I agree that I/we need to increase our honesty with students and staff about the topic. As in Katherine’s life, I feel that people are often scared and shy to talk about stuttering openly with an individual who stutters. However, many times throughout Katherine’s young life she wondered why no one was discussing her speech with her. I think by increasing our openness to talk about stuttering we can decrease any stigmas associated with it.

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