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Stammering Therapy from the Inside: New Perspectives on Working with Young People and Adults (Edited by Carolyn Cheasman, Rachel Everard and Sam Simpson)

St John Harris, Joanna Kitchen, Katy Bailey | 01.07.2013

Launched in May at City Lit, Stammering Therapy from the Inside offers an overview of contemporary stammering therapy approaches, with an emphasis on describing the journey and outcomes from the perspectives of both clinicians and clients. We asked a Speech and Language Therapist (SLT) and firstly a service user what they thought of the book.

Book cover: 'Stammering therapy from the inside'One of the purposes of this book is to ‘broaden the discourse and extend the boundaries of thinking about stammering therapy’. Integral to this is the client’s voice, which serves to enrich and breathe lived experience into the theory and complements the equally compelling voice of the therapist. One of the strongest messages I took away from this book is that the success of the approaches looked at is as much about the quality and dynamic of the therapeutic relationship as it is about putting ideas into practice. This is, I understand, a far cry from more traditional accounts of speech and language therapy, which privilege the perspective of the expert clinician, who applies their theory and assesses results based on an objective evaluation of the feedback of their clients. This rebalancing of power, and the introduction of the client’s (and therapist’s) personal view of what makes sense for them, succeeds in opening up new vistas beyond the narrow confines of the so-called ‘medical model’ of disability, according to which the clinician is first and foremost seeking to ‘normalise’ the client, i.e. enable them to achieve fluency. In fact, this book shows vividly and movingly how what Walt Manning calls ‘chasing the fluency god’ is often part of the problem.

Indeed, Professor Manning, from The University of Memphis, notes tellingly in his foreword, “Several authors mention how their clients, predominantly at the outset of therapy, have an overriding desire to achieve fluency. They also often hold firmly to the inflexible and categorical view that stammering is ‘undesirable’ and fluency is ‘desirable’. Each author illustrates how, with a more comprehensive view of stammering, the client begins to expand their understanding of goals that are more important and meaningful.”

St John HarrisEach chapter is devoted to a particular approach, many with ideas in common. Through such techniques as desensitisation, imagework, Gestalt theory, cognitive behaviour therapy, neurolinguistic programming and narrative therapy, both clinicians and clients embark on a shared journey of discovery, revealing new ways of feeling, thinking, doing and being, that demonstrate how people who stammer can make peace with their dysfluency themselves and get on with life. Inspiring stuff; and it’s not just for SLTs.
St John Harris, City Lit service user and book contributor

I started the book in the middle, being immediately drawn to the chapters on mindfulness and acceptance and commitment therapy, as both are approaches I've grown more and more interested in recently. The first thing I noticed was the use of the first person. It struck me as an unusual style for a textbook, which are usually written in a very formal way, giving a prescriptive set of procedures and principles to be followed. The style here allowed me as a reader the privilege of sharing another SLT’s reflective process. The fact that it’s written in the first person gave a sense, when client experience was also shared, of the equal partnership between client and clinician.

It was a delight to find that when I went to the beginning of the book, each chapter was not simply a description of an intervention or approach, but a narrative showing how thoughts, feelings, attitudes and approaches to stammering had developed.

I found myself reflecting on the apparent paradox of acceptance vs. fluency management in the 'Integrated Approach' chapter by Rachel Everard. Rachel’s chapter provides clear evidence that this approach is working with clients at City Lit and provides an excellent contribution to the dialogue between researchers and clinicians, who in some cases continue to advocate just one approach or the other.

Unusually, ‘interiorised stammering’ was dealt with in a chapter in its own right, and the literature review was very useful. I believe that introducing interiorised stammering in this way is an important step to developing a body of evidence for work with this group when fluency measures remain the predominant outcome in published literature.

This is an important book. It presents the type of evidence commissioners of services want from the speech and language therapy profession: research evidence which demonstrates change and can withstand statistical scrutiny alongside detailed descriptions of client experience and personal narratives. It also invites the reader to reflect and be challenged. I know it won't be far from my desk over the next few months as I draw on the experience in each chapter and share it with my clients.

Joanna Kitchen, Speech and Language Therapist, The Stammering Support Centre


Book launch at City Lit

Carolyn Cheasman, Rachel Everard and Sam Simpson, with Ed BallsThe book launch for Stammering Therapy from the Inside was part of a study day at City Lit, which was attended by over a hundred SLTs, students and people who stammer. In the presentations there was a focus on the therapeutic space between client and therapist, eloquently explored by Trudy Stewart using the metaphor of bridges. The editors gave an insight into the process of writing, and indicated that the book has challenged traditional ideas of developing knowledge about stammering therapy. Ed Balls MP stole our hearts with a spontaneous reflection about how his initial reluctance to talk about his stammer has turned to relief. His openness was inspiring.

The book breaks new ground by discussing stammering and the ‘social model of disability’, a theory developed by disabled people. In our talks, St John Harris and I both referred to its resonance with our own experience of stammering and coming to a point of feeling more liberated.

Many participants said they were looking forward to sharing what they learnt with colleagues, so the discussions will reach many more people than were present.

Katy Bailey, book contributor

From Speaking Out, Summer 2013, p.22-23