Indicators of Successful Change CHAPTER 12 Indicators of Successful Change Following Treatment 1 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

Recovery or successful management? Recovery for children Successful management adults Continued vigilance and practice High levels of success Appreciation of earned fluency Lessons learned from coping Self-directed therapy Changing core constructs Forgetting to be a PWS ! Cognitive change catching up 2 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

Problems with transfer and maintenance “The essence of effective therapy is transfer” (Gregory, 1995, p.199) Speaker understanding the change process Begin at the outset (monitor/modify beyond tx) Bring in others, objects to tx Huinck et al. (2006) and importance of change in cognitive & emotional features 3 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

The possibility of relapse Relapse the rule rather than the exception Relapse rates as high as 70–90% (but often temporary) Part of the human condition Similar for many problems/conditions (Van Riper, 1973) (Craig & Hancock, 1995) (Sheehan, 1970; Perkins, 1979; Manning, 2001) 4 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

Signs of relapse Frequency a poor (& not the first) indicator More than 2–4% SS? Fear and avoidance A lapse or a relapse Temporary & shallow or more serious? Not acceptable for a week? 5 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

Possible causes of relapse Entropy (Egan, 2007) Speaker leaves treatment early Techniques are unnatural Speaking in nonhabitual manner Loss of spontaneity, detract from communication May prefer old stuttering to the new fluency Requirement of continued vigilance & effort Neurophysiological loading (genetics) for some speakers 6 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

Possible causes of relapse (continued) Instability of the new (fragile) fluency Failure to practice to level of expertise “The old patterns are always the strongest” Overemphasis on fluency (Yaruss, et al., 2002) Adjusting to the role of a fluent speaker Feeling uneasy Deceiving self & others Not being honest with others Listener adjustments to the new speaker 7 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

Predicting success Less severe at outset (Hunick, et al., 2006) Andrews & Cutler, 1974: Good attitudes about communicating (S-24 Scale) Internality on the LCB (inconsistent findings) (Langevin, et al., 2007): Maintainers had: Higher scores on S-24 Higher scores on SESAS-Approach Less struggle, avoidance, and expectancy 8 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

Responses to relapse Speaker: self-diagnose & prescribe The value of support groups Attendance by SLPs Increase in the 1980s (consumerism) Support for each other (& parents too) Decrease in isolation Advocacy 9 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

Only 6.1% of the participants indicated no effect. Yaruss, J. S., Quesal, R. W., Reeves, L, Molt, L., F., Kluetz, B., Caruso, A. J., McClure, J. A., & Lewis, F. (2002). Speech treatment and support group experiences of people who participate in the National Stuttering Association. Journal of Fluency Disorders, 27, 115-134. NSA attendees indicated that participation had “very positively” affected their self-image and acceptance of themselves. Only 6.1% of the participants indicated no effect. No respondent indicated a negative impact. 10 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.

Guidelines for successful management by adults who stutter (Spontaneous fluency is a realistic goal for many) no longer chasing the fluency god obtaining treatment as necessary living without constant fear of uncontrolled stuttering, using the telephone without fear speaking without scanning for feared words and situations initiating conversations rather than choosing to be silent speaking for herself rather than relying on others choosing to speak even if she believes she may stutter selecting leisure and career options that require talking without worrying about the possibility of stuttering stuttering gently without avoidance or shame 11 Copyright 2010 Delmar, a part of Cengage Learning. ALL RIGHTS RESERVED.