Group therapy for school-aged children who stutter: A survey of current practices
Highlights
► The study identifies patterns of provision and highlights areas of need. ► Seventy percent of services provide group therapy for CWS, but the level of provision is variable. ► Barriers to group provision include insufficient numbers of clients able to travel to group venues. ► There is a lack of consensus on what the main aims of group therapy should be.
Introduction
Group therapy is widely recommended to Speech & Language Therapists (SLTs) as an effective way of managing stuttering in school-aged children (e.g. Stewart & Turnbull, 2007). In recent years, the evidence base for intervention with young children who stutter (CWS) has increased significantly (e.g. Franken et al., 2005, Jones et al., 2005, Millard et al., 2009). In contrast, studies exploring the effectiveness of therapy, including group approaches, for older children and adults remain more limited. Nevertheless, from a theoretical perspective, there is a persuasive rationale for offering this type of approach. By adolescence, many aspects of an individual's life may become shaped around a negative self-image and fear of stuttering (Guitar, 2006). Addressing affective, behavioural and cognitive responses to stuttering is therefore a critical aspect of the therapeutic process when working with CWS (e.g. Murphy, Yaruss, & Quesal, 2007a). Evidence from psychotherapeutic literature suggests that group approaches may be particularly effective in addressing negative thoughts and feelings by eliminating the participant's sense of isolation and invalidating his ‘heightened sense of uniqueness’ (Yalom & Leszcz, 2005, p. 6) CWS may have difficulty ‘fitting-in’ at school and being accepted by peers (Evans, Healey, Kawai, & Rowland, 2008), and one of the greatest challenges facing many school-aged CWS is bullying (e.g. Davis, Howell, & Cooke, 2002). Group therapy offers an opportunity for peer support which has been identified as having an important role in counteracting victimisation (Boulton, Trueman, Chau, Whitehand, & Amatya, 1999) and reducing children's anxiety about bullying (Cowie, Hutson, Oztug, & Myers, 2008). Furthermore, Hearne, Packman, Onslow, and Quine's (2008) qualitative study suggests that adolescents who stutter have a strong preference for group rather than individual therapy, and Murphy et al. (2007a) suggest that group therapy can play a useful role in therapy for school-aged children.
Whilst there is a strong rationale for believing that group therapy can form a useful element of therapeutic intervention for school-aged children, little is known about the level and nature of this provision or about how group therapy provision operates in practice. In other areas of stuttering research, SLTs’ practices and attitudes have been documented using surveys. These have been useful, for example, in identifying wide variations in practice (Davidson Thompson, Mcallister, Adams, & Horton, 2009) and in highlighting the need for ongoing professional development (Crichton-Smith, Wright, & Stackhouse, 2003). The aim of the present study was to explore the provision of group therapy for school-aged CWS, by investigating current practices of clinicians.
Section snippets
Design
The design of this study was a survey by postal questionnaire.
Procedure
One questionnaire was sent to each of the 205 paediatric SLT departments in the UK. An accompanying letter requested that the questionnaire be completed by a dysfluency specialist or, where this was not possible, by another SLT in the department who had responsibility for providing a service to school-aged CWS.
Questionnaire development
A questionnaire was developed and piloted. A mixed format of open and closed questions addressed the following areas of
Results
Percentage figures are reported to the nearest whole number.
Patterns of delivery
The majority of respondents reported that their service provided some group therapy for CWS, although it should be acknowledged that services that provide group therapy may have been more likely to respond to the survey.
A number of factors that have the potential to influence group therapy provision were identified. Results from this survey indicate that services based in inner city and urban areas are more likely to provide group therapy than those in rural or mixed areas. Research in fields,
Conclusion
Although many SLTs who responded to this survey reported that their services provided some group therapy for CWS, the level of provision varied. It is important to overcome the barriers to group provision, identified by this study, or to explore alternative ways of achieving the benefits that group therapy offers.
A lack of consensus on the aims of group therapy raises questions about how group therapy might facilitate change in the child's experience of stammering, and to what part of the group
Acknowledgements
The authors would like to thank all the SLTs who completed the questionnaire.
Hilary Liddle is an experienced specialist Speech & Language Therapist. She currently works for Doncaster & Bassetlaw Hospitals NHS Foundation Trust, providing a service for children and adults who stutter. She is also a part time PhD researcher at Leeds Metropolitan University, UK.
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Hilary Liddle is an experienced specialist Speech & Language Therapist. She currently works for Doncaster & Bassetlaw Hospitals NHS Foundation Trust, providing a service for children and adults who stutter. She is also a part time PhD researcher at Leeds Metropolitan University, UK.
Dr Sarah James is a qualified speech and language therapist and a senior lecturer at Leeds Metropolitan University. Sarah teaches disorders of fluency, applied psychology and evidence-based practice, in addition to supporting students in developing their clinical and professional skills. Sarah has clinical and research interests in disorders of fluency and psychological aspects of therapy practice, particularly the role of self-report.
Margaret Hardman, PhD, is a Psychology Subject Group Leader at Leeds Metropolitan University, and was previously at the University of Bolton. Margaret's PhD and current research is concerned with understanding the cultural, social and relational nature of children's development, with particular focus on children's collaborative learning in the primary classroom.