Working as a speech and language therapist for over 15 years, I had some awareness of the social model of disability, but it’s fair to say that most of my training taught me to view communication differences from a medical model perspective. There isn’t anything too unusual about this as a speech and language therapist. In 2017, I attended some training exploring the social model and its implications for speech and language therapy; I began to think more about the relevance of the social model for my clinical practice, in particular, working with children who stammer.
The first thing that struck me was the power behind language used every day in clinics, schools and homes when talking about stammering. It can be fairly routine for a family to come to clinic talk about ‘good days’ (no stammering) and ‘bad days’ (lots of stammering). In the past, I myself would have talked about stammering severity asking for a number from 1 to 10 where 1 is the ‘best’ your speech has ever been and 10 the ‘worst’. Thinking about this with the social model in mind made me realise that this kind of description reinforces the message that stammering is ‘wrong’ or ‘bad’ and fluent speech is ‘good’. If the speech and language therapist talks about stammering in this way to parents, children and teachers, how can others be expected to view stammering as a different way of talking, rather than as something ‘wrong’ with a child’s communication?
I set an aim to modify my own language – talking about stammering in terms of quantity (from ‘no or very little stammering’ to ‘the most stammering you might have’ for my 1-10 scale) rather than assigning a ‘good’ or ‘bad’ description. This felt more comfortable. I would also model these more helpful terms for others. If a parent or teacher described a ‘bad speech day’ I might repeat back, “So there’s been a lot of stammering today?” which would often lead to a mirrored adjustment of language. I looked to educate my colleagues within speech and language therapy locally. I shared my learning about the social model and its implications for people with communication differences at a team meeting. I monitored language used during discussions about children with colleagues in a similar way to my conversations with parents and teachers. Changes were made to written prompts on assessment paperwork so that therapists no longer ask families to describe when their child’s stammer is ‘worst’ or their speech is ‘best’ but instead talk about times of ‘more’ or ‘less’ stammering when exploring patterns of communication.
I would say that as a department we are now more aware of the language we use when talking about stammering. I developed a leaflet for parents and families explaining why it is important to be aware of the way stammering is talked about, giving some examples of alternatives instead of the traditional ‘good day’ and ‘bad day’ descriptions. This can be shared with families at their first appointment.
This all feels so much more comfortable. It feels like a first step towards supporting children who stammer by ensuring people in their immediate environment talk about stammering as a difference, rather than something ‘wrong’ to be ‘fixed’ in therapy. A first step towards changing stigmatised and stereotyped views of stammering so the child can grow in an environment that accepts and celebrates stammering as part of a world where we are all different in many diverse ways.
There have been other changes to my clinical practice as a result of increased knowledge of the social model. These include adjusting therapy focus and setting clear, collaborative goals with families so it is understood from the outset of therapy that confident communication is the aim rather than fluency. This has taken more reflection and remains an ongoing process.
I’m still learning – aren’t we all! I don’t think I necessarily always get things ‘right’ but if I could recommend one step to other speech and language therapists, I’d say just take a moment to think about the language you use talking about stammering. I think you’ll find, as I did, that it’s worthwhile.
Jenny Packer
Highly Specialist Speech and Language Therapist
Essex Partnership University NHS Foundation Trust
@EPUTchildrenssltservice