The Cooke Book Approach Individualizing Therapeutic Procedures for People who Stutter
MSHA Conference - March 23, 2013 Presented by: Paul Cooke, Ph.D. Michigan State University Contacts: email -
[email protected] phone: 517-353-8788
Learning Outcomes • Identify therapy principles and strategies • Identify 2 examples from each principle/strategy • Identify the decision making process to individualize therapy for people who stutter
• Work through several examples of this process
Unofficial Learning Outcome Identify aspects from this presentation that are useful for other clients on your caseload
Underlying Principles • • • • • •
Clients are people with particular conditions Various factors contribute to those conditions Variability of current and previous behaviors Holistic approach (NOT one size fits all) Each client is a clinical research subject of 1 Many techniques, narrow them down to fit the needs of the client
Goals for Therapy • Client moves to the next communication level • Increase probability of improving communication in meaningful speaking situations • Increase probability of client becoming their own clinician • Increase client’s control of speaking situations • Decrease the adverse influence of the condition
Keys to Clients Moving Toward Those Goals • Clinician-Client relationship built on trust: empathy self-congruence unconditional positive regard • Empowerment • Motivation • Therapy Format • Therapy Principles • Decisions to individualize therapy program
Fundamental Concepts • Every stuttering episode – excessive energy
• Speech is a complex motor skill • Client can only implement 1-2 concepts
Therapeutic Categories • • • • • •
Environmental Changes Fluency Shaping Stuttering Modification Stress Management Transfer and Maintenance Attitude Adjustments
Environmental Changes • • • • • • • • •
Improve communication skills Use child-directed speech Be a parent Emphasize client’s strengths Forward looking, not past blame/regrets Encourage communication Balanced reactions to difficulties Make talking fun Transition times
Fluency Shaping Techniques • • • • • • • • • • •
Smooth vs. Bumpy Speech Diaphragmatic Breathing/Shorter Breath Group Stretched/Prolong Speech Easy Onset Continuous Voicing Light Contact Passive Airflow Exaggerated Movement Mouth the words/Add Voicing Focus on Word Endings/Say all Syllables Electronic Devices
Stuttering Modification Techniques • • • • •
Reduce Secondary Behaviors Reduce Muscular Tension: Pull Out/Bounce Control Stuttering Preparatory Sets Reduce Avoiding Behaviors
Stress Management Strategies • • • • • • •
Stress Reduction Before Speaking Stress Reduction During Speaking Feeling Rushed/Pressured – Use the Flam Dealing with non-changeable information Dealing with the telephone Dealing with oral presentations Time Management Strategies
Transfer and Maintenance • • • • • • • •
1-2 key concepts at a time Get off to a good start Start small Start big Integration of practice into everyday activities Next level as a communicator: SMART goals Using Tactile, Visual, and Auditory Prompts Improving Pragmatics Skills
Attitude Adjustments • • • • • • • •
Paradigm Shift: changing a hub to a spoke Acceptance Assist others Teasing/bullying Positive self-talk Locus of control Proactive communicator Journaling/Drawing/Converse with pets
Individualizing Therapy Plans • My examples
• Youtube examples • Audience examples
Summary and Conclusions Review Learning Outcomes & Unofficial Learning Outcome • Identify therapy principles and strategies
• Identify 2 examples from each principle/strategy • Identify the decision making process to individualize therapy for PWS
• Work through several examples of this process • Identify aspects from this presentation that are useful for other clients on your caseload