Speech and language therapy and the social model: Out at sea and lost?

In the new book, ‘Stammering Pride and Prejudice: Difference not Defect’ (Campbell et al., 2019) Chris Constantino writes about the need for new narratives in stammering. He holds up the social model as a tool to help people think outside of the box, yet poignantly adds that the real challenge is that people who stutter need to take the responsibility, ‘to be naked, to embrace our vulnerability…allowing our stuttering to exist as it is, exposed, helpless and nude’ (p.223)

The question arises, ‘do people who stammer need speech and language therapy to reach this naked, stuttering state?’ I argue yes. However, in order to support people who stammer to do this I would like to suggest that we as speech and language therapists need to be more naked and open too.

I am wondering how you responded to this proposal… did you feel uncomfortable or are you curious to know more…? If you are still reading… great as I really want to talk about the challenges of being a speech and language therapist who works with people of all ages who stammer and their associates in life and the growing use of the social model in our practice.

Over the past few years I have embraced the social model as a way of working at Bradford District Care Foundation Trust. This hasn’t been easy. At times I have felt alone, vulnerable and scared on this journey. I have felt as if I am swimming naked against the rough tide of self-stigmatising expectations that many people have when they first come through my door, and also the pressure to use more traditional stammering therapy models. For a long time, I hid the new way in which I worked with the families of younger children who stammer in speech and language therapy networks for fear of exposure and ridicule. I still occasionally succumb to the conventional under-tow and put my old clothes back on. When I do this, I feel ashamed. I am certain now that sometimes I don’t even realise that I am swimming in odd bits of clothing that I find hard to remove; they are comfortable because they are so intrinsic to speech and language therapy and I was trained to wear them well.

Lately, I feel more supported and less isolated.  I have discovered other stronger swimmers and have started swimming alongside them. Quite a few people in fishing boats (fully clothed) have started to follow us. Swimming is tiring and invigorating. Sometimes on route I get cramp. I am cold or hungry. What has been my anchor is the discovery of a bigger ship; a growing body of people from the stammering community and their allies who are actively promoting and encouraging the growing use of the social model for all ages of people who stammer and challenging more oppressive therapy approaches that focus on reducing or stopping stammering.  I feel as if the tide is turning.

I am absolutely on course on the route of my swim. I have a draft map (which I constantly re-draw or amend). I am heading to new horizons towards a world that embraces stammering as a different speaking variant and where people are empathetic and understanding and able to make adjustments depending on each person’s needs.  I am ready to brave ghost-ships of the past and defy more seemingly conventional vessels from home and abroad. There are always waves and currents to deal with which can drag me off course.

Sometimes my swimming style is affected. At these times I value support and advice to use more helpful strokes. One of the strokes I find it particularly difficult to maintain consistency in is regarding the freestyle language I use to talk about stammering. The water around me is surrounded by gnarly sharks and ancient mines from old wars.  I can’t help going back to old habits; using oppressive, judgemental, gently-biased phrases.  I do it on automatic pilot, without thinking.  Words are so deeply tattooed into our skin that even clean new waters make them hard to erase.  When I use such unhelpfully biased language in the moment, especially with more accomplished swimmers, I momentarily feel like I am drowning.

A kinder voice pulls me out of this negativity and tells me I am a product of my time. I am oppressed by the very same attitudes and beliefs that impact stammering. Even in utero, in my mother’s amniotic water, my brain was influenced by chemicals, smells and sounds from outside. What happened next affected my attachment to others in the world. Outside the beliefs and attitudes in the form of images, words and actions continued to shape me. I was taught to swim by my family, teachers, friends and colleagues. They too were taught using the language of their forefathers.  I am aware that I need to practice my language stroke a lot more; I need to be more mindful of my spoken and written language.

The best and yet most petrifying way of practising is in waters I am unsure of.  At work I swim in a pool of comfort. There is danger here of re-clothing myself and not having a coach to guide and question me. I need to dive into the learning zone. This is terrifying, yet I know that despite the discomfort and possibility of making mistakes that I am growing and learning to be a stronger, more wild swimmer; one who can deal with whatever challenging wave hits me.

I often don’t want to leap in the water at all. I try to hold back, but something always makes me jump. Initially, when I ‘belly flop’ I wish I had never dived in, but after reflection I am glad I did as I always learn something new from the experience. It increases my resilience and knowledge to charter new and undiscovered waters with the people that I work and live with.

In these new waters there are, as I have said already, a few speech and language therapists swimming and exploring in boats. I invite those in boats to jump in, may be in a costume at first, but just jump! We need more people swimming the new social model way. We ask people who stammer and their families to fight stigma and prejudice daily. Surely as their therapists we need also ‘to be naked, to embrace our vulnerability’. It is okay to feel uncomfortable, that pre-cursor to change.

In Crete two summers ago, I swam naked in a secluded cove with my partner. I love doing this. I feel like a mermaid with the silky water surrounding me without the oppressive barrier of fabric. My skin can breathe. This summer I swam off a bigger beach with other naked swimmers. I felt more comfortable. It is okay to be vulnerable together as speech and language therapists. To question, to give opinions to be confronted. Some of my colleagues that I hold most dearly are the ones who support me, but also constructively criticise. It is through their energy and supervision that I learn and grow. I now personally don’t like it when the water in discussion is calm, silent and un-moving as it suggests to me an awkwardness and stagnation which shows a fear of growth.

I still catch myself in my one-to-one and group sessions at work putting on my pants or the odd sock or glove. We owe it to ourselves, the people we work with and the students we educate to encourage a growth mindset. I had a student last week and told her about the new waters I was navigating. I was able to provide more detailed maps this time, but honestly said that sometimes she will see me have to re-navigate how I speak about stammering.  What I am happy and no longer ashamed about is that I am aware of my oppressive re-dressing and I address it openly, humbly and apologetically.

The more I swim naked the more liberating it feels. I am not a perfect swimmer, communicator or therapist, but I no longer feel so out at sea and lost. I want to inspire and empathise with the people I work with and it’s important for me to feel what they feel and to understand their daily challenges. Consider Dunkirk. There would have been a very different narrative if courageous people had not taken their boats out into terrifying waters due to fear. If you can’t swim? A parent told me last week that whenever she was young and said, ‘I can’t’, her grandad used to ask her to spell it. She would spell out the letters, ‘C…a…n…’…t’ and he would say, ‘No! It’s t…r…y…TRY!’

So, let’s all try to be bold, beautiful and embrace change through the social model together, however striking or surprising it might be. As Constantino (2019) says let’s, ‘celebrate and sing our naked [speech and language therapist] and stuttering selves together.’

Kathryn Bond


Campbell et al. (2019) Stammering Pride and Prejudice: Difference not Defect. J & R Press Ltd, Croydon