Liberating Ourselves as Clinicians: The Care and Feeding of Us and Our Clients
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About the presenter: Catherine Montgomery, CCC/SLP is the Executive Director and Founder of The American Institute for Stuttering in New York. She is Board Recognized Specialist in Fluency in Disorders has been a speech-language pathologist since 1973, primarily focusing on the study and treatment of stuttering. She has worked with over 3000 individuals who stutter from 30 states and 18 foreign countries. She is currently Chair of the Specialty Board on Fluency Disorders and an adjunct instructor, providing graduate student internships, with many universities around the U.S. Europe and Canada and has been a speaker at many national and international conferences. |
Liberating Ourselves as Clinicians: The Care and Feeding of Us and Our Clients
by Catherine Montgomery
from New York, USA
I am now beginning my 28th year dedicating my professional life to those who stutter and I'd like to share some life lessons I have learned along the way that have transformed my life and ultimately helped me to do the same for and with my clients. Going through some serious burn out many years ago was only one reason I set out on a personal journey. Another major reason was to find better ways to work with my clients on what I affectionately call the 'head stuff': the affective and cognitive aspects of Cooper's "ABC's of Stuttering".
The accumulation of experiences has led me to some wonderful freedoms and, I believe, have made me a better clinician. These are all ideas that I weave into work with my clients also which can be applied to just about any area of life for us all.
Whose Responsibility Is It Anyway?
An issue that comes up often for those of us in the helping professions is the extent of our responsibility for our clients' progress in treatment and ultimate well being. Where do we leave off and they begin?
I had been taught as a young clinician that my clients' progress was pretty much 100% my responsibility. This created my burn out and a neediness on my part for them to do well. If they did well, then I was OK. It meant I was a good clinician. This sense of neediness undoubtedly set up a dynamic in the clinical relationship that was not healthy for me or for them.
I now believe that for most of our clients who stutter, from school age on up, that one of our primary jobs is to facilitate their independence and empowerment. Thankfully, I learned how to let go. I now know to develop a partnership attitude with each client, that I am here to do the very best I know to do for and with them, but that there has to be a point where I step back and let them take over. You know, " you can take the horse to the water....".
What accompanied this shift has been a respect for each individual's own journey and an appreciation for them taking whatever I have to offer and do with it what they will. And that I am, of course, there to continue to be a support whenever they need or want it.
This attitude has since been validated over and over again in many ways from my clients as well as so many of my colleagues' personal stories. In finding their way to managing their stuttering successfully in their lives, the continual theme that emerges is one of process and that one clinician or one program, in most cases, did not do it "all" for these individuals but rather it was an accumulation of experiences, growth and learning over time that resulted in their achievements.
Some of my colleagues have written about this and there have been excellent panels at the IFA Congresses on this very subject. I not only feel very comfortable referring to a competent colleague when needed, but I now feel it is a responsibility. I have "shared" many clients with other colleagues over the years.
It is liberating to know that I don't have all of the answers for an individual and to encourage their exploring others who may have the perfect words or strategies for them at that point in their process and in life. And of course, it may well be someone other than an SLP.
Is Relapse a Bad Thing?
As a culture we have an unfortunate inherent belief: mistakes are bad, and failure is a bad thing. We are taught from a very early age that we must do everything we can to avoid making mistakes. Remember those spelling tests in grade school? You had to spell 100 words and when you got it back, what did it say at the top of the page? Usually 1X or 3X. "Congratulations, you got 98 correct!!" was never written, was it? The focus seemed to be on the negative, the mistakes. So instead of celebrating 98 right we bemoaned the fact that we got 2 wrong.
This belief permeates our lives in so many ways and we have learned to use discomfort as a way to motivate ourselves. We've learned to get angry about a bad grade, throw a tantrum until we get what we want, hate the way we look or hate our stuttering. Frustration, anger, self-hatred, anxiety, guilt etc. are emotions that take a toll and also require a lot of energy. The question is: does it work to get us what we want or do we end up even more miserable? It may work sometimes, but at what cost?
Acceptance & Change
So here is an alternative. Let's stop fighting with ourselves and begin with acceptance. The notion of acceptance is an interesting one and we first need to examine what we believe about acceptance.
Many believe it to be a passivity, a giving in or giving up: "If I accept my mistake (bad grade, weight, stuttering) then I won't want to do anything about it." Again, non acceptance (anger, frustration,etc.) is used as a motivation to change. Many people believe that it's an either/or situation. Either I accept it OR I do something about it and people even fear acceptance because they believe it renders them passive.
Well, I think that more and more are discovering that an extremely powerful model for change is to do BOTH: we can accept AND take action. These notions need not be mutually exclusive. Think Alcoholics Anonymous.
In keeping with this thinking and appreciating the notion of process, I have learned to view relapse or failure not as a bad thing but that it can be viewed simply as feedback. When something isn't going the way one would hope or expect then let's learn from it, analyze it and move forward instead of focusing on anger or frustration. Let's make it constructive rather than destructive. I have observed over and over again that it is the very 'failures' from which a client will learn the most. Stuttering is a disorder of many complexities as is treatment and mistakes are essential in any learning process. My biggest "failures" in life have yielded my greatest gifts!
As I've learned to think this way (and I'm far from perfect, whatever that means?!) and if I'm not focusing on how annoyed, upset, frustrated I am, then I have more energy to actually become more productive and creative and have greater clarity to find solutions and answers. It's been quite amazing and freeing.
Let's take a look at the notion of 'perfect' for a moment. Does anyone know anyone who is 'perfect'? As I said above, I don't even know what that is. Yet we strive for it...which is not a bad thing BUT when we don't achieve whatever our notion of perfect it, the question is, do we get non-accepting/uncomfortable in some form? Here is a belief that has helped me a lot with this one: that we, as mere humans, are 'perfect in our imperfection'. Ah yes, I am after all, simply a work in progress!
The Care & Feeding of Ourselves
Sometimes we feel 'selfish' doing things for ourselves like take a yoga class, a painting class, or simply sit and do nothing at all, but I've found I need to self nurture. Think of 'selfish' as 'self-ish' or simply about oneself. Take the negative connotation away. When I'm happier, more relaxed, more at peace, my work is better and everyone in my life including my clients benefits. Think of a goblet that's full...when we keep pouring, giving and pouring and giving soon the goblet is drained and so are we!
When I continue to fill that goblet and support myself, it overflows and there is so much more for me to continue to give! OK, one more metaphor: you know what they tell you're on a plane traveling with a child...if the oxygen masks are deployed, what should you do? Put it on the child first? No...YOU put it on it first and then you'll be there to help your child!
Bringing it Together
So, my current thinking is this. I still love what I do after all these years. In fact, I actually love it more because I've learned to relax and enjoy my interactions with my clients. And what I've discussed in this article is, in great part, why. Experience can also be a great teacher and a great liberator!
I care a great deal about my clients' well being...that's why I do what I do. But instead of getting myself tied up in knots or upset to show that I care, I can show that I care by being centered, focused and peaceful and be truly present with them. I show my caring by doing the best that I can with them. I also show that I understand and care by letting go and trusting them to know their own path.
I ask my clients to draw their stuttering at the beginning of treatment and then later to draw how they now feel. A beautiful young woman, an artist chose to do hers in watercolors. The first is a painting of raw and bloody hands as they reach through barbed wire toward the illusive fluency. The last is a beautiful angel standing on the edge of a cliff, overlooking the canyons and mountains, with wings ready to fly. She told me that I had given her those wings and yes, she was now ready to fly.
References
Cooper, E.B.& Cooper, C.S. (2003). Cooper Personalized Fluency Control Therapy, 3rd Editions (PFCT-3) for Children and for Adolescents and Adults. Austin, TX: ProEd.
Healey,E.C. & Peters, H.F.M. (Eds.), (1997) 2nd World Congress on Fluency Disorders: Proceedings, Section 13: Various Paths to the Recovery of Stuttering.
Kaufman, B. (1991). Happiness is a Choice, New York: Random House.
September 15, 2006
