Use of Helpful Counseling Techniques for Fluency Therapy

About the presenters: Michael Sugarman was co-founder of the National Stuttering Project (NSP) in1977. He became the Executive Director of NSP 1978 -1981 and again in 1995 -1997. Published numerous articles on self help in academic journals and other publications. Recently, named to the Stutterers Hall of Fame. Currently, Chair of International Fluency Association's Support Group and Consumer Affairs Committee.

J. Scott Yaruss is an assistant professor at the University of Pittsburgh and Co-director of the Stuttering Center of Western Pennsylvania. Yaruss's research focuses on the development of stuttering in children, including analysis of linguistic and motoric factors that affect children's fluency. Yaruss also studies the evaluation of treatment outcomes for adolescents, and adults who stutter.

Use of Helpful Counseling Techniques for Fluency Therapy

by Michael Sugarman and J. Scott Yaruss
from California, USA and Pennsylvania, USA

Counseling is a process that helps people living with stuttering (PLWS) work though the many personal issues that may affect them because of their stuttering. By incorporating appropriate counseling techniques along with fluency therapy, Speech Language Pathologists (SLPs) may improve upon the resolution of stuttering for PLWS. As a result of their partnership with the SLP, PLWS will gain increased awareness, independence, and effectiveness in the pursuit of personal goals.

Scope of Practice. Sometimes, SLPs are reluctant to try to use counseling techniques because they feel that it is outside their scope of practice. It is important to recognize, however, that many of the techniques involved in counseling primarily represent good listening skills that will help to develop the partnership between the SLP and the PLWS. The SLP is not using these techniques to uncover dark secrets or pry into the lives of PLWS. Instead, counseling strategies such as paraphrasing, reflecting, and empathetic responses become tools that SLPs can use to help PLWS explore their experiences and their feelings about their stuttering. Of course, SLPs are ethically bound to restrict their scope of practice to areas where they have sufficient competency to be able to help PLWS, so it is up to you to ensure that you are prepared to use the techniques described. This preparation will only come through practice.

The Important of Practice. If a PLWS is aware that the SLP is using a counseling technique, then the technique is certain to fail. Strategies such as reflecting and reframing can sound "canned" or artificial if not used appropriately. Such appropriate use comes only with practice. Try some attending, empathy and listening skills with your friends and colleagues you will notice that at first, it sounds stilted or unnatural. With practice, however, you will find that you are able to identify your client's core messages with relative ease and accuracy and your responses will become increasingly natural and appropriate. The only way to improve is through practice. Realize that you will make mistakes while you are learning to use these counseling "microskills" and you will have an easier time trying them out.

Some Basic Counseling Skills. Listening and communication skills make up a major part of good counseling. The next section of this article contains a brief overview of basic counseling techniques SLPs can integrate with their fluency treatment to help PLWS in their pursuit of better communication skills. It is important to recognize that this article only provides an overview of these techniques. We hope that the specific suggestions offered in this short paper will generate some comments on the ISAD threaded discussions that can lead to a more thorough exploration of the relationship between counseling and fluency therapy.

Open-Ended Questions

Open-ended questions keep the conversation moving and probe deeper into topics and feelings raised by PLWS. A closed question can be answered yes or no, or involve a simple statement of fact, while open-ended questions, require other information to be provided. Closed questions do not encourage the PLWS to share with the SLP and may limit his/her ability to contribute to the discussion.

Examples of closed questions:

  • "At what age did you first stutter ?"
  • "Do you stutter on your name?"
  • "What was the name of your antagonist in grammar school?"


Examples of open-ended questions:

  • "What was going on in your life when you first started to stutter?"
  • "What situations or words give you more difficulty with stuttering?"
  • "How did you react to teasing in grammar school?"


Benefits of open-ended questions include:

  • Helping the PLWS explore issues in a more meaningful way
  • Allowing for more people-centered work
  • Involving the PLWS more actively in treatment
  • Opening up difficult or challenging issue that needs to be addressed


Active Listening - Basic Techniques

Active listening techniques include engaging and responding to the PLWS based on something expressed, either in words, or in non-verbal actions or behavior

Attending Behavior

One of the most basic aspects of good listening and communication between PLWS and SLP is attending. Attending refers to how the SLP communicates to the PLWS that she/he is listening to her/him and interested in what she/he is saying. Attending skills involve eye contact, posture, and verbal and non-verbal cues. Eye contact may vary from person to person, so you cannot assume that just because a person does not look you in the eye, it means that she or he is hiding something.

Some questions about attending. What posture should a SLP take? Whatever posture is comfortable for you. Be you. Are there verbal and non-verbal cues SLP’s can use? Try, huh or hmmm. Other non-verbal cues include smiling, looking puzzled, nodding, or leaning forward in interest. Be you.

Showing Interest

Expressing genuine interest in the circumstances of the PLWS will help him/her better understand his/her own experiences and create an opportunity to share more with you.

PLWS: "When I’m about to speak I get excited and stutter. It really upsets me."

SLP: "Help me understand what it is like for you when you go through this experience. Can you give me a picture of what a typical stutter would be for you how you feel when you starting thinking about speaking, what happens once you’re aware of these thoughts or how do you feel upset?"

Empathetic Responses

The empathetic response is a technique that demonstrates to the PLWS that the SLP had carefully attended to what he or she was saying and truly listened to the message. Aspects of the message that can be addressed include experiences (i.e., what happened to the PLWS), behaviors (i.e., what the PLWS did), and feelings (i.e., how the PLWS reacted, either to the experiences or the behaviors). Often, empathetic responses can take the form of statements such as You felt (feeling) because of (experiences or behaviors) . It will be important to use your own words to summarize the PLWS’s feelings, behaviors, and experiences, and not to be dismissive in your summary. As with other counseling skills, this will come with practice.


Paraphrasing involves repeating core aspects of the client’s message back to him or her using your own words. Simply repeating the same words the client said should be used sparingly, since this is not actually an active listening technique. Repeating does not give a client a sense of being listened to. Paraphrasing, i.e., saying what the PLWS has said using different words, can be much more effective because it helps the client see his or her experiences from a different perspective and may help them recognize feelings or behaviors they did not previously see.


PLWS: "When I’m about to speak I get excited and stutter. It really upsets me."

SLP: "It’s very distressing."

Not recommended:

PLWS: "When I’m about to speak I get excited and stutter. It really upsets me."

SLP: "This just really upsets you."


Counseling is an interaction that focuses on the issues and realities for the PLWS. It is important for the SLP to ask the PLWS about how stuttering plays a role in his or her life to determine the extent to which fluency affects goals, ambitions and quality of life. Speech alone cannot always be a fair indicator as to how severely stuttering is affecting the PLWS. Therefore, SLPs must also be willing and able to focus on the clients’ feelings about their speech and stuttering. By actively using counseling techniques such as those outlined above, SLPs will be better equipped to deal with life issues of the PLWS. This, in turn, will greatly enhance the efficacy of fluency therapy.

We hope that this brief outline of some basic counseling techniques will lead to discussion of the relationship between counseling spark discussion on the ISAD discussion

Some Helpful Counseling Resources

Chopra, D. (1989). Quantum Healing. Exploring the Frontiers of Mind/Body Medicine. New York: Bantam Books.

Corey, M.S., & Corey, G. (1998). Becoming a helper (3rd Ed.) Pacific Grove, CA: Brooks/Cole Publishing Company.

Egan, G. (1998). The Skilled Helper (6th Ed.). Pacific Grove, CA: Brooks/Cole Publishers.

Faber, A., & Mazlish, E. (1980). How to Talk So Kids will Listen & Listen So Kids will Talk. New York: Avon Books.

James, M. Born to Win: Transactional Analysis with Gestalt Experiments, New York Addison-Wesley Publishers. 1973.

Luterman, D. (1996). Counseling the Communicatively Disordered and their Families. (3rd Ed.). Austin: Pro-Ed.

September 10, 2000