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Intro
Kate Grandbois: Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy
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Kate Grandbois: Welcome to SLP Nerdcast. We are here today with one of our favorite repeat nerds. We are here to talk about stuttering and the neurodiversity movement with one of our favorite guests, Nina Reeves. Welcome, Nina.
Nina Reeves: Hi, [00:02:00] I'm, I'm so glad to be back with y'all because we're spreading the nerd love.
Amy Wonkka: I love it. I love it.
It's so nice to have you in the nerd room once again. Um, and you are here to talk to us about neurodiversity and stuttering, but before we get started, can you please tell us a little bit about yourself?
Nina Reeves: Oh, uh, sure. Um, for those of you that are unfamiliar with me, uh, I am a school based speech language pathologist for all of my career, uh, except for last year, which is kind of interesting.
My whole identity shifted, but it's okay. Um, we grow, we change. And I am a stuttering specialist. I have been for, uh, since the initial cadre of stuttering specialists way back in the day. And I work with Scott Yarris as my co author to, uh, produce lots of information and resources for clinicians working with stuttering.
Kids who stutter.
Kate Grandbois: We've [00:03:00] learned so much from you over the last few years. You've come, I think this is maybe your fourth or fifth episode with us and I have learned so much from you. Your perspectives on stuttering, you, you've taught me everything I know. Your perspectives on stuttering are refreshing and, um, so needed in our field and we're really excited to have you back to talk about all of these things.
Um, You mentioned Scott Yaris, you all co own stuttering therapy resources. So for any listeners out there who are not familiar with stuttering therapy resources, a tremendous wealth of information.
And again, something that we've learned so much about stuttering from you all, so thank you again for being here. I do need to read our learning objectives and disclosures before we get started, so I'm going to go ahead and do that quickly. Learning objective number one, describe how the neurodiversity movement is impacting our work with people who stutter.
Learning Objective Number Two lists two ways to create a paradigm shift that is meaningful for people who [00:04:00] stutter. And Learning Objective Number Three lists two ways SLP roles have changed to meet the needs of students who stutter. Disclosures. Nina's financial disclosures. Nina is part owner of Stuttering Therapy Resources Incorporated with ownership, interest, royalties, and intellectual property.
Nina's non financial disclosures. Nina has no non financial relationships to disclose. Kate, that's me. My financial disclosures, I'm the owner and founder of Grand Bois Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosures, I'm a member of ASHA SIG 12 and serve on the AAC Advisory Group for Massachusetts Advocates for Children.
I'm also a member of the Berkshire Association for Behavior Analysis and Therapy.
Amy Wonkka: Amy, that's me. My financial disclosures are that I'm an employee of a public school system and co founder of SLP Nerdcast, and my non financial disclosures are that I'm a member of ASHA, Special Interest Group 12, and I participate in the AEC Advisory Group for Massachusetts Advocates for Children.
All [00:05:00] right, all that stuff is done. On to the good stuff. Nina, why don't you start us off by just telling us a little bit about that first learning objective? So how Is the neurodiversity movement and how has the neurodiversity movement affected our work with people who stutter and maybe how has this changed over the past few years?
Nina Reeves: Oh, that's a, that's a wonderful question. And it's one that, um, those of us in the stuttering community have talked about, uh, ad nauseum for, for the past three or four years, especially it's kind of interesting. Um, it's changed a lot and it hasn't changed. A lot. So let me let me clarify that. Um, those of us who have been in this for decades.
Think about the fact that we've been talking about neurodiversity. Um, concepts for a long time. It's okay to stutter was the is is and was the motto of the National Stuttering Association for decades. [00:06:00] And what was happening is we were all talking about that. It's really okay to stutter. And I think the world was like, it's okay to stutter, you know, somewhat.
There was kind of a limit on it in society. And we were like, no, it really is okay to stutter. So we were, you know, stutter affirming before stutter affirming was cool. However, now we have the language and we have the groundswell of understanding, um, came with the autistic population and the, the voices that came up and said, you know, we are who we are.
This isn't, this isn't, you know, an articulation lisp. This is us. And who we are neuro wise and so trying to have people who stutter act like they're not people who stutter decreases their identity and doesn't allow them [00:07:00] to show up authentically as who they are in society. or in any speaking situation.
So the neurodiversity movement has really, you know, been that sort of open call that, uh, that now the profession is really, you know, moving into an understanding. And I think that that's an amazing part of the last three, four, five years is that understanding that trying to fix stuttering, which every clinician knew they weren't doing.
Or couldn't do, but they went ahead and tried to do it because they thought that was expected of them, or that's how they were trained, or that's what the parents wanted. This is, that's what the kids wanted, right? They wanted us to make it go away. And instead of sort of sitting back and saying, wait a second, this is not really our [00:08:00] role because scientifically we're not rewiring anyone's brain.
And so let's try to help and align, let's align with the stuttering community, the voices that are saying, I'm, I'm me, uh, let me be in that way, but also support me in my journey, because this isn't something that everyone can just do on their own, is to learn how to navigate stuttering in a world that doesn't get it.
Kate Grandbois: I love that you use the word groundswell. Uh, I think it makes me think of, you know, this, this cresting wave, which implies this momentum, this forward momentum. Um, and I have to assume that with that momentum that was presumably started by the autistic community, there was this, there was [00:09:00] this cresting wave of, of forward movement for the stuttering community as well.
And I, I have to imagine in just thinking about. That groundswell, that forward thinking and all of the small changes that we've seen. So therapists now using words like neurodiversity, affirming therapy, neurodiversity, affirming goals, bringing in the voices of mark from marginalized groups, listening and centering those voices, which has always been a part of our EBP triangle.
We've always have patient centered value, you know, patient perspectives and values as part of our EBP triangle. But. Really should making that shift to put that at the center of what we do. I have to assume that this is not just for preschoolers who have a diagnosis of autism. This is this is everywhere.
So what are you seeing? How are you seeing this trickle into the detail of working with individuals who stutter?
Nina Reeves: Great thought. It's I love [00:10:00] the momentum that you mentioned. And the idea that this is helping to switch. All of those SLPs who never thought that they were supposed to be trying to fix kids who stutter, they're taking a big, deep sigh of relief.
Okay. Like, wow, thank you for giving me permission to stop writing fluency goals when I never felt good about them anyway. Um, and to look at stuttering the way, uh, it, in my heart of hearts, I knew these kids did not need me to fix them. However, Now, if you're going to sort of empty that cup of, you know, let me work on tools, let me work on tools, this is what I do, then we have to be ready to fill up the cup with what am I doing instead.
And there lies the [00:11:00] shift that is still happening. It's, you know, and I'm sure I know, I feel that it's not happening fast enough, but what we have to realize is that this is like turning a, a, a cruise boat, like the culture surrounding not only the stuttering community, but also the profession of speech language pathology is the idea of.
Slow, but sure, we've been trying to turn the cruise ship for a long time, but now we're having some momentum, but it's still not going to be overnight because we have a couple of generations of SLPs working in the field right now, who that's all they know is how to do tools and how to, and in fact, if we can get down to the nitty gritty, how to do fluency tools.
People call their kids [00:12:00] fluency kids. They call their therapy fluency therapy. We've been yelling about that for a long time. It's stuttering therapy. Call it what it is. And now people are getting it, even people in the upper echelons, say, of our profession, um, who are finally understanding that the fluency focus was always in the direction of Increasing negative impact for people who stutter.
Um, instead of decreasing it, because we know from from literature now that those people who have the idea that they have to stop stuttering have more negative impact on their lives. And those who realize that coming to terms with stuttering. Even though that's not just, you know, easy coming to terms with stuttering and [00:13:00] accepting that part of their identity have had a, an easier road of it.
So it's important to realize that that's, that's the shift.
Amy Wonkka: Right. And from a, from a clinical skills standpoint, there must also be, I know we've had you on before and we've talked to you a lot about counseling and how important counseling is. Um, and I think that that's something that is. pervasive across the field.
I know every time I leave a conversation with you, I'm like, Oh my gosh, this is so applicable to everybody. Um, but I wonder if you could talk to us just a little bit more about that shift away from an emphasis on tools to an emphasis on those counseling skills that are so important for the speech language pathologist to have.
Nina Reeves: Yes. Uh, I, I love this topic because, um, I have learned that Those of us who are, you know, supposed leaders. I don't like to call myself a leader, but you know that we're up here talking about this, [00:14:00] that we have to be okay with having the unpopular opinion. Okay. And we have to say the things that need to be said, even though most people don't want to hear it.
And so the, every time when I'm presenting and teaching other SLPs about all of this, I use the word counseling and there's an immediate like reaction, you know, well I'm not a counselor and nobody trained me on this and, and I, and I understand that I really do. I also understand that it is part of our, our, you know, our principles of practice we're supposed to be at least understanding of counseling skills for communication differences.
Not that we're supposed to have a counseling, you know, degree. We're not supposed to handle counseling about, you know, a child's issues that are beyond the scope of our practice. But we do, [00:15:00] we are supposed to be aligned with the idea that people come to us as people and not disorders. They come to us as trying to navigate something that is challenging.
Think about stuttering as we're talking about today. Stuttering can be challenging in, especially in society that doesn't get it and wants a quick fix and everybody wants it to just go away because it takes patient listening and understanding, which are not highly valued. or utilized in our society. So counseling skills become a huge part of what we do in stuttering therapy.
And that's the bucket I was talking about that we have to continually fill up. And we've been working to do that with professional development and a few university programs around the [00:16:00] country have been really trying to focus in on that. I believe that that has to be a huge change from the top down in Um, how university programs are designed going forward so that SLPs can at least come out.
They don't have to know everything because, you know, university programs can't prepare us for everything, but have those basic clinical counseling skills that will allow us to sit across from a kiddo who stutters, who is crying about being bullied on the playground. And we're not going to give them easy starts.
We're going to have to learn how to sit in that moment and discover what, how that is impacting this child and how we can be of support.
Kate Grandbois: You just said something that was completely parallel to a question that was percolating in my mind as you were [00:17:00] speaking about the clinical experience, you know, living in our society that doesn't necessarily value.
Patience or empathy or, you know, acceptance, you know, our, our society is very ableist and I don't think that anybody who is listening would be surprised to hear me say that. Um, but when you're working clinically with a family or a student or a client individual who comes to your office and says, I don't want to stutter anymore.
It's my value to get rid of this. Uh, this is causing me a lot of. Discomfort or pain, um, I would imagine this also come, would come out of the mouths of parents like he's stuttering, she's stuttering and you have to, you have to fix it. So then you're, I have to assume that you're sort of faced with an even larger counseling task.
How, how would you recommend that we, you know, resolve some of that tension for families? What do we do in that situation? Well, that brings up, you know, the million
Nina Reeves: dollar question [00:18:00] is how, how can we be stutter affirming and not drive an agenda? Eeky beekies. You know, this isn't what, I'm not going to give therapy what I want you to do.
Okay, and that's tough because I've seen down the line what You know, that fluency focus has done to people who stutter over the years. Okay. Um, but I also have to let everyone have their process. Okay. So we can't flip from, I need you to be fluent. I will, I'm writing fluency goals for you or at you to, I need you to just accept your stutter.
That's not going to fly again. We're turning the culture persistently and patiently. Okay. a little at a time. We can't just flip a switch and now go, it's okay to stutter. So go out there and do your best. There has to be some sort of support and [00:19:00] middle road that, that addresses those needs and desires of the client.
Now we meet people where they are. Yes, but we also have to bring in the evidence base, which does mean we can't cure stuttering. So how do we, how do we balance that? And how do we talk about it with the people surrounding the child and the child? That's where counseling has to come in. We have to be able to perceive what's in front of us, ask deeper questions, and then align ourselves with appropriate expectations.
But I'm going to, I'm going to wheel back to something you said that has been on my mind, uh, so, so, um, it's pervasive on my mind all the time. The idea that, of course, people who stutter come and say, I don't want to do this anymore. [00:20:00] Of course, caregivers, teachers, parents, siblings, everybody wants it to be gone.
Because it's a challenge. And it's. uncomfortable, both internally for the person and can be uncomfortable externally until people learn how to desensitize and accept that there are differences in communication. But those initial stages, I just look at people that say, I want fluency and I'm thinking, boy, are you normal?
I validate that. Then we have to think about what is the fluency going to get you? Let's think of two things. Number one, has anybody ever given you a different choice? Has anyone ever said out loud that it's okay to stutter and meant it? Not, it's okay to stutter, but make that one smooth, [00:21:00] right? So, has there been another perspective that has been in the mix of what we might want for kids who stutter?
As parents, as teachers, as teachers. as ourselves, as children who stutter. So number one, has there been another perspective even raised? And number two, okay, so if the fluency is what you want, I want fluency because, so what is the value? This would be acceptance and commitment therapy coming through. What are the communication values?
What do you want that you don't think you can get? If you stutter and then that list age appropriate as it is becomes what we work towards is working towards the values and I'm going to tell you every single time those things can I want to tell a joke. I want to be able to raise my hand in class and not feel so icky.
that I [00:22:00] might stutter. That doesn't come with fluency. It comes with acceptance and understanding that you are a perfectly great human being and stutter.
Kate Grandbois: That was so well said, it was so well said. And I also want to mention for people listening who are not familiar with ACT, ACT stands for Acceptance Commitment Therapy.
It is a, I don't believe it's considered cognitive behavioral therapy. I think that it's kind of straddles Applied Behavior Analysis and Cognitive Behavioral Therapy. Um, there is a book called The Happiness Trap that was a New York Times bestseller that describes acceptance commitment therapy. Highly recommend.
We're all clinicians working with anyone in, in the world. It's, it's a really wonderful strategy. And I'm so glad that you brought that into this conversation to refocus the work we're doing to support someone in their goals and in their [00:23:00] values and how those values can be uncoupled from the experience of stuttering.
It's, it's brilliant, brilliant.
Nina Reeves: Well, and and listen, there are people that have been writing about this in the stuttering speech pathology community for a long time. Um, the, the idea of there's a book called more than fluency. Which we'll put in the show notes, the idea, uh, there are different chapters in there.
Of course, there's a chapter on it, cognitive behavioral acceptance and commitment, avoidance, reduction therapy. There are many ways that speech language pathologists can learn about these aspects of the counseling world that are then brought in and applicable to our work. And I'll, I'll go even farther.
I think the happiness trap. And how to talk so kids will listen and listen so kids will talk should be a prerequisite reading, not only for speech pathologists, [00:24:00] but for educators of all kinds and human beings. I just think it's, it's a helpful way for us to understand the relational part of communication.
Because, you know, is communication is the goal of communication to be fluent in any in any way, shape or form. Are we all supposed to be fluent communicators? Because it doesn't exist. Perfect fluency does not exist in the stuttering community or in the, we call them fluenter community. Okay, it's not, it's, it's about being able to get your needs met, to communicate and connect with people.
That's what communication is for. And so if we refocus just that shift of the mindset that I'm working on communication therapy with kids who stutter instead of fluency [00:25:00] therapy, then it brings open everything. And when we talk about it in that way to parents and teachers, it starts to open up the idea that we are not technicians who just focus on the motor behavior.
When, when our scope of practice and the ICF model, the International Classification of Functioning model from the World Health Organization, which I'll put some references to, they tell us that it's not just about the impairment. We're not just functioning on our focusing on the functional impairment, we have to be looking at the larger scope of how this communication difference this verbal diversity, as we like to call it, um, how this impacts this.
this person who is sitting in front of you.
Amy Wonkka: I wonder if you can give us some examples. [00:26:00] If you take us back to that child who's sitting in your therapy room with you and they're upset and they just want this to go away and you're talking to them through those components of like, okay, let's get a little bit more information about. The why, um, how, what are some of the next steps?
What might that look like in your next few sessions with that student? Who's, you know, who's really upset. You're trying to help them navigate kind of the, the underlying pieces of connection that they're looking for. Um, what other things might you do? Just so SLPs who maybe are still really working on fluency, in their sessions.
Like how does, how does that shift look?
Nina Reeves: Um, wow. I think the, the most major shift would be learning how to listen. Okay. Letting the child tell you the story, learning how to ask probing questions [00:27:00] that aren't driving an agenda, but are getting curious. We're getting about what that means for you. Um, so listening and validating.
Are two things that we can do in those moments where it becomes imperative for us to say, I hear you. I'm sensing that you're upset and, and that how to talk. So kids will listen and listen. So kids will talk book taught me how to say, you know, I'm sensing that, or I, I'm hearing that there might be some upset feelings and if kids aren't feeling upset, they'll let you know.
No, I'm not upset. I'm sad or I'm mad or whatever it is. They'll help you out with whatever feeling word. Of course, we want to continually help kids. The underlying message in that is we have to give them some, you know, emotional vocabulary and talking about what they're really feeling. But [00:28:00] whatever comes out, it's like we validate that.
Yeah, that sounds, that sounds like it's okay to be upset by that. And now we're not going to fix it. We don't have to take the next two sections to fix their which is what, in essence, we thought we were trained to do. Right? Let's, you know, I don't want him to cry in my therapy room. It's like, well, then, you know, don't work with people who stutter.
I don't know what to tell you because there's gonna be some emotion in this and emotions are okay. It's not that positive emotions are better than negative emotions, right? It's that all emotions are validated. They just are. There's not good or bad emotions. Now. Let's take that further and think about, okay, we're feeling upset.
We're feeling like, you know, we have to get this thing to stop. Okay. So let, then we can [00:29:00] dig deeper about, like you said, the wise. Okay. I need it to stop because. Okay, and then you start hearing of all the impact that's happening, all the things that are happening that because my grandma tells me to slow down and it makes me mad because the kids laugh on the playground.
Okay. Now, can I work on environment in the home, can I work on learning how to handle negative listener reactions. Yes. Can I change those people. Okay. No, but I can help them learn to respond in a way that is helpful to the person who stutters instead of trying to help by fixing. Everyone seems to be trying to help by fixing and that is the culture shift.
It's the, what do you praise? Do you praise fluency? Well, what if the kid didn't [00:30:00] say what they wanted to say? They only said two words instead of the 13 words, and we just praised them for that. We just taught them that it's more valuable to appear, let's get that lexicon going, appear fluent. I was writing some of these down.
The idea that they're seemingly fluent, apparently fluent, appear to be fluent, which is different than being fluent, than experiencing fluency in their talking. So did, did we, just by praising that fluency. In indirectly and unknowingly praise them for masking themselves in the world. I was just going to bring up the word masking.
Kate Grandbois: I was just going to bring up the word masking asking if that was an applicable description here because I've heard it used in the autistic community as part of this. You know, you mentioned earlier the neuro, um, the, the vocabulary, we have all this [00:31:00] vocabulary for it now as part of that groundswell groundswell, as part of that wave, as part of that momentum and masking is a huge piece of that.
I'm so glad that you use
Nina Reeves: that word. Well, of course it's applicable in the stuttering community because, um, for all of the decades where people have been trying to help people be fluent, they in turn have had to struggle To use, um, like who wants to sound like a turtle, who wants, I mean, these are just like ways of being fluent that then mask the child's ability to just communicate freely and authentically and spontaneously, you know, if it's okay to stutter, all of them, big, chunky ones, big, you know, um, big ones that, that You know, come out [00:32:00] and letting them out is an appropriate goal, which it is, by the way, then it becomes a freedom for people who stutter and an allowance for them to say, this is how I talk sometimes.
This is, you know, my kindergartners are like, that's how I talk sometimes. And, you know, we just learn to help them say out loud that they are who they are and that you can accept me or not accept me. It's up to you. It's not up to me, but I'm not going to change myself to make you feel more comfortable.
Which is what's been happening.
Kate Grandbois: I have another question that I hope is not a bad question. I know you're never going to yell at me for having, for asking a bad question. I'm, you mentioned, you know, the, that it's perfectly okay to have a goal [00:33:00] for letting it out. And it made me think about, Being a clinician and listening to you talk, listening to this new paradigm shift, this new lens, this different way of thinking, and thinking about my kid on my caseload who, or my student on my caseload who stutters, and then sitting down to write the goals.
And what that, what that process, that overwhelming, how overwhelming that must be. I'm wondering if you can tell us if you have any tips or tricks where, I was going to say where the rubber meets the road, but I'm going to say where the pen meets the paper because we're writing goals in terms of, you know, if we don't have a ton of counseling training, how, how do you write goals that reflect.
what you're doing in your therapy session, which is maybe 70, 80 percent counseling focused or defining values or working on self acceptance or self advocacy or You know, being more comfortable unmasking, what, what does that feel like to write goals like [00:34:00] this, particularly when we, most of us, I'm speaking for myself, but I think it's safe to say most of us don't have that training explicitly.
Nina Reeves: Um, again, we are building the plane while we're flying in it, so let's talk about the shift. But I'm, I do have some pro tips. Number one, you, you asked that question and immediately I'm like, Oh, here comes the gold question. And, but it's valid, right? I'm sorry. Did I give you a lot of anxiety? No, it brings anxiety because here's what happens.
Teach me how to write the goals. What does that even mean? If you don't know how to do the therapy, I can, I can give you a goal of amazing stutter, affirming neurodiversity, affirming goals. But if you don't know how to do the therapy, I don't even care if you know how to write the goal. Now, [00:35:00] unpopular opinion.
But I have to write the goal, so teach me how to write the goal. So, you'll, Scott and I have talked about this for decades. You're not going to get a goal bank from us. Everybody says you've got to give a goal bank. There's goal banks on, you know, platforms out there. You know, and of course they make us cringe, right?
Because they're not stutter affirming. And the fact is, is that knowing how to write a goal does not help. move us past sitting in front of the child and being able to manifest that goal in a therapy process. So I'm always, you know, one of the, one of the Instagram and Facebook posts I want to do is, um, look beyond the paperwork now on popular opinion.
So here are a couple of pro tips. Every goal that you write, If you know the International Classification of Functioning [00:36:00] Disability and Health, if you know the ICF model, Function, Reactions, Environment, Impact, then you do your, uh, assessment, to find out what's happening in those areas in the child's life, and then you find out the strengths that you can use to address the challenges, um, That they still have in each one of those areas.
So let's just say for years and years, function. Okay, we're working on the speech motor, and that was it. We're assessing the speech motor, and that was it. And so we were missing 90 percent of what we were, um, we were supposed to be working on as professional speech language pathologists. So, if you look at the ICF model, it'll help you frame your assessment.
which will help you frame [00:37:00] your therapy planning, which will help you frame your goals and your documentation of those goals. It's like the framework from heaven. I don't know. I don't know how else to put it. It's how I do everything and how I check in with myself to say, have I been, you know, addressing one area more than the other?
Cause they all, the beauty of the ICF model, especially the one that is out there for stuttering. Tichenor, Herring, and Yarris, and also Tichenor and Yarris as references. That one is something that you can check in with yourself on. And it just gives you that overwhelming understanding of what you're supposed to be doing.
So how do I write the goals? dismisses, did I do an appropriate comprehensive assessment and dismisses, do I know how to do [00:38:00] the therapy and then how to document it? So we do give sample goals in our books, in our writings. We talk about, you know, everybody knows you have to have that criterion and the setting and, but you don't always have to have percentages, which is another pro tip because everybody likes to count stutters because it's, You know, it's dichotomous.
It's like there or not. There's your stutter or not your stutter problem is and you'll hear us, you know, continually talk about this. That's the listeners experience of the speakers stuttering and has nothing to do with how much there was stuttering on the inside that you didn't even see. So read, uh, a point of view about fluency, read the idea that the literature is telling us that the most, uh, utilized definition from people who stutter is the feeling of [00:39:00] stuckness, which listeners can't always observe.
So counting stutters and writing fluency goals is actually. Insane. Oh, she said it. It's like a definition of insanity. You're chasing a grease pig because stuttering is variable always. And so it's never going to be a certain percentage. And then if you, if you write a percentage and the child makes it, you have to understand why did he use a strategy?
Did they, um, avoid the word or was it lucky, you know, sort of people who stutter have fluency. So was it just regular fluency? at that moment. It has nothing to do with what you did in therapy. I know paradigm shifting and makes everybody's heads spin off their shoulders. However, most clinicians, when they hear [00:40:00] that go, Oh my gosh, that's so totally correct.
And so when we talk about it in that way, it also helps society see it that way.
Kate Grandbois: Every time I, every time you come onto this podcast and you talk about something that I don't even do in my clinical life, I have A million light bulbs that go off because I think what you're saying is so, is, is saying that it's liberating, aggressive?
I don't know. It's, it's inspiring. It's, it's a different way of thinking about things. And I agree. I think as a, as a working clinician, when you engage this paradigm shift, it is, it feels a little more It feels refocused on the things that matter, which alleviates some of the pressure to do all the extra little things.
And I know we have to write goals, and I know we have IEPs, and we have paperwork, and there is things that we're never gonna get rid of. But what matters is the person in front of [00:41:00] you. What matters is, is how you show up in that therapy room, and, and how you're making space for all that really important, important.
Refocused, paradigm shifted counseling work. I, I, it, it's, it's, I'm gonna use the word liberating. I'm gonna double down on it.
Nina Reeves: You know, It's, uh, when I talk with you both, we, we have a lot of fun and there's back backstories and all sorts of fun things. And sometimes I leave a podcast thinking, wow, I just babbled. I have no idea if I said anything appropriate or if I, cause I do, I just did it, I do a thing where I get excited and then I don't finish a sentence.
I'll insert an example before I finish the sentence, so I'm hopeful that it, that it, thank you for saying that something's coming through because this is such a passion, um, in my life that [00:42:00] it, there's so many things in my brain that want to just be spilled out, and I'm hopeful that it comes out in ways that people can grab a hold of and hold on to as they make this shift, because I've been doing a lot of writing and you'll see it in our blogs and in, you know, in social media and in our new books that what we're really shifting.
And I wasn't going to talk about this, but I will, because we do this, um, mindset ours. And by the way, others are message. The message is. easier communication, functional communication, free, spontaneous, lovely communication. So that's the message. Then our model changes because our, what, what we model in therapy is not stop and try that one again and make it fluent, right?[00:43:00]
So that changes. Then of course, the meaningfulness, which is what you just said, which sparked my attention to this, the meaningfulness of our therapy changes. It becomes what matters to the student, which is really their value of communication. What do they want to do when they talk with other people? And the values, which are bigger, you know, sort of the overarching understanding.
Pretty much when I do values work with kids, I don't think I've ever had a child write down fluency as a value.
So I'm thinking that mindset model. message and meaningfulness. Yes, I love alliteration are what we can help ourselves. No, those are the shifts and [00:44:00] one follows the other. They're very synergistic with each other. So it's not like here are the 3000 things you have to do to do this better or to do this in this way.
There are begin with your mindset. If your mindset shift is I always thought that kids who stutter should be allowed to stutter. What I want to help them with is to decrease their struggle. Well why do they struggle? Because internally it's not comfortable and externally they get messages that say this isn't okay.
So then they struggle harder, and we've known for decades that the more you try not to stutter, the bigger the stutters become, okay? Not just the motor, but all the stuff that you do around it, the moment becomes longer and bigger because you're [00:45:00] trying not to stutter. And that is internal. and externalized stigma.
We're, we're stigma busters. If you want to really get to it, we're stigma busters. And that is part of our role, um, to align with the stuttering community, their voices elevated and honored to help de stigmatize this verbal diversity. And that, that term came, um, from me. When I was thinking about the neurodiversity and the whole diversity movement that was happening back in 19 and 20, that it, it became apparent to me that if we look at stuttering as verbal diversity, it's just another way of talking, which we've been saying for generations, but nobody got.
And now people are looking at it going, Oh my gosh, that's exactly what this is. [00:46:00] There's a famous line from someone who did from Bill Wade, who did a keynote, he told us about the time that it became apparent that his stuttering was his accent. And it's like, you know, your head just explodes and it's like, wow, but does society accept.
You know, stuttering the way they accept accents, probably not. So we have a lot of work to do to turn the tide and there's more responsibility to the listener in the social relational model. It's not all what the stutterer has to do to fit in, which is the masking part, right? Which we've learned it's about.
working together to understand that this is a valid and acceptable form of communication.[00:47:00]
Amy Wonkka: I'm looking at this, um, ASHA landing page about the assessment of fluency disorders in the context of the WHO ICF framework, and there's just So many nice components in here that are so much more broad than this hyper focused lens on fluency. I wonder, because part of, part of what they're talking about in here is just activity and participation restrictions, the importance of the environment for those.
People who are working in a school environment, what are some, what are some strategies and things that school based SLPs in particular can do to kind of help shift some of those environmental barriers that don't need to be there?
Nina Reeves: Yeah. Um, oh, I'm going to be a broken record. Um, teach other people about the ICF and its concepts.
Do I take the ICF model related to stuttering [00:48:00] to my IEPs and my parent meetings? You bet I do. And this is the broad base. This is what we understand about the experience of stuttering, not the moment of stuttering, which we've been hyper focused on, as you said. So this is about the experience of stuttering.
I'm looking at your child as a whole child. What parent is going to go, Oh, don't do that. I just want you to fix their stutter. Like, okay. Let's, let's get to the fact that we do have aligned, um, expectations and understandings of this. It's, it's, let's see this child as a bigger picture when, when parents, teachers and others are afraid, they hyper focus because fear makes us do things that when we have a presence of mind, we wouldn't do.
So we try to open up the perspective to the experience of stuttering and the communication goals. And that [00:49:00] does help to begin the process of alleviating the environmental impact. Now, um, another thing that I think, and I'll reference, um, an article that I co wrote with, uh, two guys who stutter. Um, one's a speech language pathologist in the public schools, and one is, you know, like, works for SpaceX.
I'm not even sure what he does. It's probably secret. So he's, you know, these brilliant people and I got together in that forum from language, speech and hearing services in the schools, January 2023. The entire issue was focused on ableism. and school based therapy for stuttering and autism. Bam. Boom.
Because they're, you know, you can just change the word, you know, back and forth, autism, stuttering, and it probably is applicable in terms [00:50:00] of ableism and what society expects and how society has to change. Um, so those Institutional roadblocks are discussed in, in that whole issue, but also in, in our, um, our article in specific, we addressed all of that idea.
We outlined neurodiversity and understanding, and then we went into case studies. Of what was being done and how the neurodiversity affirming therapist changed it. So I think it's almost like a mini tutorial doesn't give you everything you need to know, but it starts the process of. looking at the institutional structure of school based therapy, um, and saying, okay, these are the barriers and roadblocks, and this is how I'm going to go around them.
I'm going to get creative and I'm going to find ways. And [00:51:00] I'm just going to go, oh no, you can't do that in the public schools. I'm not going to do that. I'm going to say, how do I do it in the public schools? How do I do it better? Because any step along the process of increasing or like raising the bar.
is better than no steps at all.
Kate Grandbois: Earlier, you talked about how you were afraid that you just, you know, went on and on, and it wasn't helpful, and I'm just here to tell you that that was nonsense, and everything you're saying is extremely helpful. Um, And I, I think one of the things as, as a working SLP, you know, thinking about the intersection of, of this paradigm shift in conjunction with our everyday responsibilities, the stress we carry, the caseloads we carry, the lunches that we don't take, et cetera, et cetera.
But thinking about realistic changes that we can make and action steps that we can embrace that will make a difference. And I think you've hit a, You've hit a bunch of them just to summarize a [00:52:00] few and reflect this back to you is talking about things differently thinking about things differently and just talking about them differently.
I is a is a very doable action step. So, uh, talking to teachers, talking to parents, bringing these these models to meetings, reviewing them. I know we don't have a lot of spare time, but, you know, reviewing these ICF models. Um, Not thinking about the goals as the end all and be all really focusing on the quality of the therapy and the important and meaningful things that we're doing all of these things are doable.
All of these things are action steps that we can bring into our workplaces tomorrow. I'm wondering about any, I know you're full of pro tips and I don't want to, I don't want you to empty your well of pro tips, but how else our roles have changed. How else are. Action steps might change in a realistic, doable way to help shift these paradigms because I have [00:53:00] to assume that this paradigm shift isn't just about how we think about things internally, but it's also working to shift these paradigms in our workplaces, right?
I mean, it's, it's really kind of Embracing a whole new lens everywhere, which is a big task, but it starts somewhere with very realistic doable things. So tell us more.
Nina Reeves: Okay, Renee Brown, I'll tell you more. Um, say more words. I'm gonna say that. Can I just do the, uh, the ideas around verbal diversity and what it doesn't mean?
Because people get very confused. Okay, but this is if it's okay to stutter. This is one of the blogs I'm working on. If it's okay to stutter, then what do I do in therapy? How am I going to tell the parent that it's no longer fluency? How do I explain this? So these are things that we're working through and getting out there to support clinicians.
Um, but one of the things that got very confusing right away. Was the idea that oh, then we don't have to [00:54:00] work if it's if stuttering is verbal diversity. We don't have to work with kids who stutter like yeah, that was cute. That was an adorable idea. Nope, no such luck there person who's really afraid of stuttering therapy and wants to get the kid off your caseload.
Um, which of course nobody ever does, but they might think it in their head. Uh, so it does not mean that there's an eligible eligibility change. IDEA reauthorization of 2004 still applies. Does the child have adverse impact in academic, non academic, or extracurricular areas? Which means academic, social, and functional communication.
It's all of it. So, If we do a correct assessment of all of the areas of how communication, uh, impact happens for kids who stutter, then they're, they're aligned and they have eligibility. So, they are eligible most, most, most. Kids who [00:55:00] stutter are eligible for therapy in the public schools. Um, we, we do not shift away and give this to counselors or psychologists.
SLPs are still the people to work and help align with neurodiversity affirming principles. This is, you know, if, if a child has An identified anxiety disorder, generalized anxiety, that's for the other person. If the child is anxious because they stutter, that's us, alright? Um, unfortunately, there's not, um, verbal diversity doesn't give you a script of what to say, like it doesn't give you a goal bank of what to write.
If you change the mindset, how you say what you say, if you say it, and when you say it becomes very apparent. And I, I start my, [00:56:00] my presentations now with the idea, give yourself grace, because if you say something or do something that you think, Oh my gosh, what was that? That was from the old thinking.
There's the lovely idea of repair. You can repair communication, which I'm going to talk about to give you that pro tip in a second. Okay, so it changes the idea that fluency percentages are gone, but support still happens, and it's documentable support participation goals, um, you know, are they raising their hand?
Are they doing what they need to do to access the curriculum? I'm using a lot of IDEA language, by the way. Okay, and that we continually verbal diversity means we as professionals get aligned with the voices of people who stutter and don't just stay out here on our little island of, you know, we know everything about how to help people who stutter.
They don't need [00:57:00] saviors. They need allies. The idea of how can we change the environment as well in the schools, in the home, in society, because that's part of our role in allyship to be a part of that process to raise self advocacy with our kids who stutter and also be advocates.
Um, aligning with that. So the idea of how to help other people understand it is not just the ICF model. But that entire refocusing of us, when we refocus our mindset, then we can talk with other people about how that mindset has shifted and how it has been told over decades to be the appropriate mindset and the workable mindset of supporting people who stutter [00:58:00] instead of trying to fix them.
It's It's so obvious when we start to do it, but the people around this child are not in this process with us, right? We're talking about it in professional ways and in, in, you know, this academic way, but we have to be able to say it out loud in functional ways for the parent, the teachers, you know, what do, what do they think fluency will get their child or their, or their student?
What are, same thing we started with. In this podcast, what is it about fluency that they think is going to fix whatever they think is broken? What do they think is broken? And what are they worried about? What are they concerned about? Many times it's about their own ability to handle this. They just don't know it.
It's all focused on the child. But, um, denial is a crisis of confidence. [00:59:00] David Luterman, I know you guys are Luterman fans, right? Denial is a crisis of confidence. Denial that the idea that it's okay to stutter is a crisis of confidence of being able to walk with that child over their lifespan and handle the things that are going to come at the teacher and the parents about you aren't doing enough.
You aren't enough. You are not fixing this. Did you try this? Did you try that? That that does not just happen to people who stutter. It happens to the people around them, especially the caregivers. So we have to help them with their process as well. But we do it in the same ways that we help our process, help the students process.
We can use those same ideas and concepts to help society.
Kate Grandbois: You're a brilliant genius. I've
Nina Reeves: just [01:00:00] been doing this a
Kate Grandbois: really long time. It's, it's just, it's wonderful to hear you, to hear you, I don't know, say all of this in such an organized, passionate way. We do love David Luterman. Um, I love the concept of it being a crisis of confidence. I mean, again, I'm not, I don't work in stuttering clinically, but I'm thinking about this and applying it to my own, to my own caseload.
Um, in our last few minutes, do you have any Any last, not last words, that sounds very doom and gloom, but any, any parting thoughts, any, any final words of wisdom for our audience?
Nina Reeves: You know, the top of mind that always comes when people say, you know, sum this up is the idea to give ourselves grace, but don't give yourself too much grace.
Sorry, that just came out. Um, give [01:01:00] yourself grace that this, if this is new for you, then it's okay to have your own process. Like I said before, we can't flip a switch. Okay. Well, it's okay to stutter. So what the heck am I doing in therapy? We've got to be, you've got to be able to tell yourself, I'm going to take small steps along a hierarchy of difficulty.
See how stuttering therapy is life lessons. Like we use hierarchies in all kinds of our therapy. articulation language. We use hierarchies every day. How about we give ourselves a hierarchy of extra learning, finding appropriate places to get this information that is based in evidence, right? And also based in client values, which includes not just the person in front of you, but their entire family and the stuttering [01:02:00] community.
Like there are values out there that we can learn from them. If you've met one person who stutter, you've met one person who stutter. Okay, that's a zeitgeist like in the National Stuttering Association. We talk about that all the time because these are individuals. So just because you did therapy like this with one kid who stutters doesn't mean that's the kind of therapy you'll do with all kids.
And that's why we are going to write How to Be a Savvy Consumer of What You See on the Internet. Because, you know, everybody's, you know, looking for that quick fix because we don't have time. So first pro tip, give yourself grace. How to When I said, don't give yourself too much grace. That means you've got to develop a hierarchy of how you're going to go about getting this information and learning to apply it a little at a time.
Do no harm because sometimes a little information is deadly. So make sure that you're putting it in context with the entire [01:03:00] experience and not just one activity on one day. And then just make certain that your work feels,
feels like it resonates with you. Because I think we've been for decades, we've been doing work that never resonated with most of us. Yes, there are people that believe behavior is behavior and you just fix the behavior and you'll never, you'll never be worried about it, except that doesn't work because people who stutter have a neurologically based difference in communication.
So make certain that it aligns with what you understand and that then can help you align the people around you patiently and persistently.
Kate Grandbois: There's nothing that can be said to follow that up. So I, I [01:04:00] think the only choice is to just thank you for coming.
Nina Reeves: Oh, you guys are so fun. Oh, you're so welcome. And, um, you know, Well, I'll try to summarize. I'm not sure what I said anymore. You know, my notes were gone like 40 minutes ago.
We took our I'll make show notes and give those citations and make certain that people can get more information that's based. in, um, stutter affirming and evidence based. You're the best. You are the best.
Kate Grandbois: We will put all of this in the show notes. We've been taking notes the whole time as well. Uh, we will also put a link to everything that stuttering therapy resources has to offer.
You guys have lots and lots of free help, so much free helpful content on your website. So we will definitely link that as well. Thank you again so much for being here. You are the [01:05:00] best. One of our, one of our most Our most prized guests.
Nina Reeves: So yeah, you know, we were together back in the day, right in those early way that we're developing all of this.
It was, it's been fun to watch you guys succeed and you do good work and I'm happy to be a part of it.
Kate Grandbois: Thank you so much.
Nina Reeves: All right.
Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.
Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com
thank you so much for joining us and we hope to welcome you back here again [01:06:00] soon.
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