The Role of Narratives in the Development of Stuttering as a Problem.

Purpose: Narratives are how people make sense of experiences and give meaning to their lives (Bruner, 1990). Use of narrative therapy (White, 2007) with people who stutter to facilitate the development of preferred stories (as opposed to problem-based stories) has been documented in the literature (Logan, 2013; Ryan, O'Dwyer, & Leahy, 2015). The purpose of this research was to explore the role of narratives in the development of stuttering as a problem for people who stutter. This research sought to describe how these narratives develop and to identify the factors that influence this development. Method: Narratives from 6 men who stutter were recorded, transcribed, and analyzed using the "Listening Guide" (Brown & Gilligan, 1992). This is a voice-centered relational method. Results: Findings indicate interaction between participants' narratives about stuttering and their wider self-narratives. Influencing factors identified include relationships, thoughts and feelings, and the dominant stories about stuttering in relevant social structures. An individual's consciousness of these influences was found to be integral to change in their narratives. Conclusions: The findings point to the importance of considering the environment, including significant relationships and social structures, in our understanding of stuttering. They also provide insights regarding intrapersonal and interpersonal processes, which can influence the development of stuttering or pave the way to stuttering becoming less problematic for the person who stutters.

Strategies to optimize the impact of nutritional surveys and epidemiological studies.

The development of nutrition and health guidelines and policies requires reliable scientific information. Unfortunately, theoretical considerations and empirical evidence indicate that a large percentage of science-based claims rely on studies that fail to replicate. The session "Strategies to Optimize the Impact of Nutrition Surveys and Epidemiological Studies" focused on the elements of design, interpretation, and communication of nutritional surveys and epidemiological studies to enhance and encourage the production of reliable, objective evidence for use in developing dietary guidance for the public. The speakers called for more transparency of research, raw data, consistent data-staging techniques, and improved data analysis. New approaches to collecting data are urgently needed to increase the credibility and utility of findings from nutrition epidemiological studies. Such studies are critical for furthering our knowledge and understanding of the effects of diet on health.

Witnessing stories: Definitional Ceremonies in Narrative Therapy with adults who stutter.

BACKGROUND: Narrative therapy (White & Epston, 1990) was developed as an approach to counselling, as a response to the power relations that influence people's lives. Its use with people who stutter has been documented. A basic tenet of narrative therapy is that the dominant problem-saturated narrative is challenged by externalizing the problem, in due course facilitating development of an alternative narrative. Within this process, the definitional ceremony involving outsider witnesses is a key procedure used to influence change. AIMS: This paper describes definitional ceremonies, and their application within a narrative approach to therapy for stuttering. The analysis of a specific definitional ceremony is presented, leading to an exploration of identity as a public and social achievement. METHODS: A definitional ceremony involving a woman who stutters and family members was recorded and analysed using two methods: interpretative phenomenological analysis and Heideggerian hermeneutic phenomenological analysis. Details of the clinical application of definitional ceremonies with this client are described. RESULTS AND CONCLUSIONS: Results from both methods of analysis were found to be similar. Notable results include the fact that the stuttering per se was not presented as the problem; rather, the impact of stuttering, especially the experience of bullying, was a dominant theme. This paper shows how definitional ceremonies can open opportunities for clients to present themselves in a preferred way, forming the basis for a new story and revised identity. Emerging themes can be identified for reflection and discussion with the client for therapeutic benefit. EDUCATIONAL OBJECTIVES: (1) to describe and explain to readers the process of narrative therapy, with special attention to the use of definitional ceremonies; (2) to provide detail regarding the clinical processes involved with a specific definitional ceremony with one client; (3) to have the reader appreciate the specific importance of involving outsider witnesses in the therapy process; (4) to discuss the outcomes of the use of this particular definitional ceremony.

Paying attention to therapy discourse: identifying therapy processes and practice in talk about talk.

Therapy discourse between the client and clinician has specific objectives to ameliorate problems associated with communication and swallowing disorders and is highly specialized. Analysis of this interaction that is the essence of therapy demonstrates the roles played by participants, revealing layers of meaning and assisting clinicians to redefine and refine their ideas about therapy. In this article, the authors analyze a series of extracts of therapy interaction to explore how therapy rapport is coconstructed by participants through talking and how roles are negotiated during the process of problem solving in therapy.

"Cajoling" as a means of engagement in the dysphagia clinic.

Rapport and cooperation are key features of many clinical interactions including those of speech-language pathologists (SLPs) and clients. A desirable by-product of rapport can be described as "engagement" where participants share a mutual focus while working toward a common goal. Through an analysis of clinical discourse, this article maps the trajectory of engagement as manifest in interactions between a SLP and a client with right hemisphere damage and dysphagia. The analysis shows that, in response to some apparently inappropriate comments made by the client, the SLP responded with teasing or what she called "cajoling" behavior. Cajoling accompanied by humor and laughter became the SLP's way of gaining and maintaining cooperation in this context. Instead of such behavior being viewed as "unprofessional," careful mapping of this behavior across several interactions served to demonstrate its value in the ultimate joint achievement of goals. Implications for how such constructions of engagement may be manifest through talk in the SLP clinic are discussed.

Multiple voices in Charles Van Riper's desensitization therapy.

BACKGROUND: Charles Van Riper (1905-94) author, researcher and practitioner, was one of the major contributors to the field of stuttering in the 20th century. His series of Action Therapy videotapes provide a useful model of how therapy was implemented by a master clinician. AIMS: Van Riper's session with a client is analysed to reveal how voices are used by these two participants during desensitization therapy, and to demonstrate how Van Riper's expertise manifests itself during the session. METHODS & PROCEDURES: Interaction between Van Riper and a client during the desensitization stage of therapy was transcribed, annotated, and analysed using Goffman's (1974) frame analysis. Elements in the extensive discourse (about 4800 words exchanged) were chosen to illustrate a range of distinctive voices used by Van Riper and the client during this 'crucial' stage of therapy. OUTCOMES & RESULTS: Van Riper shifts his voice throughout the session. His comments are sometimes directed to the viewing audience, at which times he tends to use the voice of an exegeter. When directing his comments to the client, he uses two voices: an authoritative one and one that aligns with the person's feelings. The voice of the client is often silenced, especially when Van Riper is being authoritative. Sometimes Van Riper uses his expertise by speaking through the voice of the client. This is especially true when summarizing what the client might be feeling. The true voice of the client emerges only occasionally. Detailed discourse analysis focusing on the roles played by participants as revealed through footings taken by speakers show complexity in the interaction that is not obvious at surface level. CONCLUSIONS: By using discourse analysis, the multiple voices that Van Riper uses to achieve the complex tasks involved in desensitization can be specified.

Judging stuttering in an unfamiliar language: the importance of closeness to the native language.

In order to test the hypothesis that closeness to the listener's native language is a determining factor when identifying stuttering in an unfamiliar language, three panels of different linguistic background were asked to make judgements of stuttering in a sample of Dutch speakers. It was found that a panel speaking Dutch and a panel speaking English (both West Germanic languages) performed better in identifying Dutch people who stutter and people who do not stutter than a panel speaking Brazilian Portuguese (a Romance language) thus confirming the existence of a closeness of language influence. Further analysis showed that when the native language is more remote from the unfamiliar language there is the possibility of a higher risk for false positive identification.

Changing perspectives for practice in stuttering: echoes from a Celtic past, when wordlessness was entitled to time.

Changing perspectives for practice in stuttering therapy are informed by the changes in knowledge, social values, and belief systems of a society. The International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) has a sociological emphasis with a focus on the ability and functioning of the person, and it is currently fostering changes in perspectives for working with those who stutter. These perspectives are reflected in Irish social mores in the 7th and 8th centuries, when social and legal codes enshrined the rights of people with speech disabilities in law and recognized the dignity and integrity of people with such disabilities. The society of the time showed awareness and acceptance of people with disabilities, and it provided the supports to enable their participation in society. To a large extent, these principles contrast with the predominantly impairment-based focus that has been the heritage of the speech-language pathology profession in the 20th century. In order to review changing emphases in stuttering therapy and to consider applications of a sociological approach to stuttering, an outline of historical perspectives of the profession of speech-language pathology is presented. The evolution of the ICF is also outlined, moving from an impairment-based focus to a more sociological perspective. Both perspectives provide a historical context for consideration of approaches to working with stuttering, reflecting the ICF and echoing principles that were practiced in an ancient Celtic society.

Therapy talk: analyzing therapeutic discourse.

Therapeutic discourse is the talk-in-interaction that represents the social practice between clinician and client. This article invites speech-language pathologists to apply their knowledge of language to analyzing therapy talk and to learn how talking practices shape clinical roles and identities. A range of qualitative research approaches, including ethnography of communication, conversation analysis, and frame theory, provides a background for the case presentation of a 13-year-old girl who stutters. Asymmetry is a feature of the therapeutic discourse presented , with evidence of recognition of the client's communicative competence emerging. Applications of analyzing therapy talk are discussed, illustrating the relevance of this approach for clinicians.