CLIENT CENTRIC FLUENCY EVALUATION AND STUTTERING THERAPY
Dr. Karin Wexler’s Treatment Model
In Client-Centric Fluency Evaluation and Stuttering Therapy, Dr. Karin Wexler’s treatment model, she strives to adhere to the following principles:
The therapy emanates from the client. Maximized input from the client and from family/significant others is sought in the evaluation and in all aspects of treatment design and therapy process. To conceptualize the client’s problem and to treat the client, Dr. Wexler tries to employ the following:
- Empirical evidence (findings on the specific client, as well as research on normal and disordered anatomy, physiology, and psychology) and other literature;
- Established theories and methods;
- Clinical experience (that of other clinicians as well as her own);
- The experience of persons who stutter and those close to them; and
- Her own creativity.
Bodies of literature she draws on include those of speech and language pathology, anatomy and physiology, psychology, other fields involving communication, learning, problem solving, and the stuttering self-help/mutual aid movement.
Goals are developed with the client, for the client. The approach (including methods and techniques) will also be chosen or created in a partnership with the client or the parents.
Whether or to what extent the approach jointly chosen involves fluency shaping or stuttering modification, in terms of speech-mechanics, there is a general goal - to speak easily, in a relaxed and natural way, without disfluency interfering with the communication process.
The client is treated holistically, with attention to all aspects of the stuttering problem. For example, evaluation methods (including observations by everyone involved with behavioral descriptions and use of assessment tools), goal setting, treatment methods, and progress measures are to reflect all facets of the stuttering problem, within a view of the person a whole, not only fluency/disfluency.
Therapy is success-oriented, minimizing risk of failure and expansion of the problem. Risks are minimized of causing reactive behaviors, emotional reactions, or thought pattern reactions. Treatment goals are therefore to be realistic to minimize risk of failure. Therapy methods are used that are expected to be as effective and safe as possible. For example, a fluency goal might be “easy speech” (i.e., easy-flowing, relaxed, natural-sounding speech that does not affect the flow of communication) rather than perfect fluency (since research and clinical experience show that there is no stuttering therapy that can claim 100% fluency for everyone in all situations for life).
Interpersonal processes that may facilitate changes in behavior, in thought patterns, and in emotions are used. For example, Dr. Wexler focuses on engaging in a strong therapeutic relationship with the client and his/her family (or significant others); valuing and accepting them; building a high degree of trust and safety; encouraging expression of emotion and unspoken thought; showing accurate empathy through empathic attunement; facilitating open communication, including through active listening; questioning own assumptions; and being genuine. Counseling skills are used as needed to deal with the stuttering problem.
Treatment is strongly self-related and in line with personal dreams, with language used for speech practice and topics from the client’s daily life — personal, educational/academic, and/or professional.
Therapy is aimed from the beginning at gains to be made in the real world and maintained long term. Focus on progress outside of the therapy room is seen as even more important than focus on progress within the room.