Beyond fluency- Anti-ableism and stuttering.m4a

Liz Watson, MA, CCC-SLP

MA, CCC-SLP

General

Ethics

<blockquote>“Concern for the struggles of disabled people is not ableism. However, the refusal to see the value in neurodiversity and the insistence that normalization is the only solution to impairment certainly is.”&nbsp;– Gerlach-Houck &amp; Constantino, 2022</blockquote> <a target="_blank" rel="noopener noreferrer" href="https://www.theinformedslp.com/review/am-i-qualified-let-s-talk-about-ableism">Ableism</a> is the belief or assumption disabled people are inferior to able-bodied people. While there has been much discussion about fighting ableism within autistic and Deaf communities, SLPs have a responsibility to consider how ableism impacts all clients, including those who stutter. (Side note: stuttering, like autism, is a form of <a target="_blank" rel="noopener noreferrer" href="https://therapistndc.org/stuttering-is-a-type-of-neurodivergence/">neurodiversity</a>.)<figure class="image"><img src="https://tislp-bucket-assets.s3.amazonaws.com/review_image_381ec494_bbaa_49f2_8698_851e7b92f5e7_de0c2c35da.png" alt="Anti-ableism and stuttering, The Informed SLP"><figcaption>Molly Alampi, MA, CCC-SLP</figcaption></figure>In this <a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1044/2021_PERSP-21-00109">tutorial</a>, Gerlach-Houck &amp; Constantino challenge the one-sided narrative that stuttering is solely a negative experience and a detraction from able-bodied ideals. They ask the reader to think of positive aspects of stuttering. Is stuttering ever desirable? Would you be excited to stutter or to pass stuttering down to your future children? The fact that these questions might be difficult to answer (and they are for people who stutter as well as SLPs) is the result of ableism. In fact, many people who stutter report gaining things from stuttering including strength, empathy, determination, and life perspective, although these advantages arise from the general experience of living through hardship rather than the specific experience of stuttering. &nbsp;<a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1080/14417040412331283048">Past research</a> has shown that many stutterers find fluency strategies (e.g., fluency shaping)&nbsp; unpleasant and difficult to use outside of a contrived therapeutic situation. If a stutterer finds that speaking fluently is burdensome and difficult, are we really benefiting them, or are we benefiting listeners by making them feel more comfortable? It’s time to think critically about the role ableism plays in our stuttering intervention.&nbsp;&nbsp;<blockquote>“[By] working together, people who stutter and SLPs can make the world a safer place to stutter.”&nbsp;– Gerlach-Houck &amp; Constantino, 2022</blockquote>&nbsp;<h3>Here are five concrete strategies that SLPs can implement in our daily practice to challenge ableism in the fluency world:</h3>&nbsp;1. Explore healthy therapy outcomes<ul><li>Goals might include increasing spontaneity and joy of communication, decreasing physical and mental speaking effort, or promoting self-advocacy.</li><li>Ask yourself whether your therapy goals are listener-focused or speaker-focused.</li><li>Model empowering ways of talking about stuttering.</li></ul>2. Commit to using inclusive language<ul><li>Adopt client’s terminology when they express a preference (e.g. person who stutters vs. stutterer).</li><li>Instead of “bad” or “worse,” describe what is happening, like “tense” or “frequent”.</li><li>Focus on “living with stuttering” rather than “overcoming” stuttering.</li></ul>3. Amplify stuttering support and self-help groups<ul><li>Self-help and support experiences are associated with increased acceptance, social participation, and normalization of stuttering.</li><li>See: <a target="_blank" rel="noopener noreferrer" href="https://westutter.org/">National Stuttering Association</a>, <a target="_blank" rel="noopener noreferrer" href="https://www.friendswhostutter.org/">FRIENDS</a>, <a target="_blank" rel="noopener noreferrer" href="https://www.stuttersocial.com/">Stutter Social</a>, <a target="_blank" rel="noopener noreferrer" href="https://www.say.org/">Stuttering Association for the Young</a></li></ul>4. Recognize and resist institutional barriers&nbsp;<ul><li>Advocate within your own institution or place of employment for non-ableist stuttering practices.</li><li><a target="_blank" rel="noopener noreferrer" href="https://www.asha.org/siteassets/uploadedfiles/advocacy/comments/stuttering-coverage-support-letter.pdf">Lobby for insurance coverage for stuttering treatment</a>.</li><li>Help your clients recognize and respond to discrimination.</li><li>Interrupt and challenge ableist discourse from colleagues.</li></ul>5. Engage with people who stutter<ul><li>Incorporate client’s personal values, priorities, and expectations into your practice.*</li><li>Consider involving people who stutter in future research.</li></ul>&nbsp;Changing the way we think about stuttering as a disability may be challenging, but it is worth it to protect and empower our clients who stutter. Check out the <a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1044/2021_PERSP-21-00109">article</a> for an in-depth discussion of ableism and stuttering, as well as even more examples of how you can challenge ableism in your daily practice.&nbsp;&nbsp;*Make sure to consider the client’s culture when addressing these topics. A recent <a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1111/1460-6984.12617">survey</a> found that an individual’s “home culture” (i.e., the culture of where they were born) has more of an influence on attitudes toward stuttering compared to the culture of where they live.&nbsp;&nbsp;Want a quick reference for these strategies? <a target="_blank" rel="noopener noreferrer" href="https://tislp-bucket-assets.s3.amazonaws.com/Beyond_Fluency_TISLP_3e717097cc.pdf">Download a handout version here</a>.

BeyondFluencyTISLP.pdf

Stuttering (Fluency)

Anti-ableist goals for people who stutter might include making speech as fluent as possible so that listeners feel more comfortable.

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Break down barriers for people who stutter with these anti-ableist therapy practices.

Beyond fluency: Anti-ableism and stuttering