Empowering Clients with Dr. David Luterman

[Music] Hi everyone and welcome to the Stuttering Foundation podcast. This is your host Sarah McIntyre, recording from Philadelphia. We're kicking off season 7 with a very special returned guest, Dr. David Luterman. Hi David and thanks for being with us today. Hi, I'm happy to be here. I'm going to read David's bio and then I'm going to pass things over to him to get us started. [Music] Dr. David Luterman is a professor emeritus at Emerson College in Boston, Massachusetts and director of the Thayer Lindsay family centered nursery for hearing impaired children. He is the author of many articles and several books including his seminal book called Counseling Persons with communication disorders and their families now in its fifth edition. He has done several podcasts and a DVD through the Stuttering Foundation called Counseling People Who Stutter and their families. In addition to authoring many books, he is a well-known teacher, researcher, consultant and lecturer. Dr. Luterman is a fellow of the American Speech Language Hearing Association and recipient of the Frank Kleffner Clinical Achievement Award. Well, I'm going to pass things over to you David to get us started. Okay, well thank you. The topic today is going to be on establishing responsibility, client responsibility in the therapeutic endeavor. You know, the goal of Counseling is to empower the client so that the client no longer needs you. It's not to necessarily solve the each problem with the Stuttering Problem here, but it is to make the client as so sufficient as possible. This is often complex, unfortunately, with what therapists often bring to the situation. The client generally comes expecting you to solve their problem and save them or rescue them from their problems. The therapist should be empowering to be convincing you that you have the skills and helping you with obtaining those skills to be independent of therapy. A lot of therapists, and we have data on this, have a strong need to be needed. And this can very often get in the way of empowering the client, not only as other clients expectations in the way, but as the therapist, "Oh, and strong need to be needed," but the best example of this. I used to use this all the time and everybody knew what I was talking about, but I found later years the movie, the book, and actually the play called "The Miracle Worker," which was the story of Helen Keller, a deafblind woman, and her therapist, Annie Sullivan, actually her teacher, Annie Sullivan. And the title was "The Miracle Worker," because Annie Sullivan was a teacher who came down from Boston to help the Keller family, Mrs. Keller, and the boyder at the recommendation of the principal of the. go home where Annie actually grew up among deafblind or deaf students in Boston. She came down to help Mrs. Keller with her deafblind daughter, Helen, who was at that point an eight-year-old. And Mrs. Keller had been trying to manage her. There was no therapy available in Alabama where they lived. And so she was desperate for help. And Annie came down, and there is in the movie an opening scene that's very critical. And this is where the table is set for a munching. And Mrs. Keller comes in with Annie, and Annie is totally disruptive. And disrupts the meeting entirely. The father leaves with a huff and the older brother leaves with a huff and. there is Annie sitting there amidst all the wreckage of the. flunch and looking at Mrs. Keller, who has this look of total desperation on her face as she's holding and restraining this eight-year-old who's just kicking wildly. Not understanding where she is or why she's there. And Annie has. this is a crunch point, a therapeutic crunch point. Annie has a choice. Annie can work with Mrs. Keller and teach Mrs. Keller how to manage Helen. But if she does that, she not going to be famous. And she not going to get the credit, Mrs. Keller might. Instead, Annie, who had a lot of gaps and a lot of holes in her life, he grew up essentially in an orphanage and in the school for the deaf Massachusetts with no family. She couldn't really make that choice personally. So instead, she took the child unto herself. She established a separate place on the property, where she lived with Helen for a month. And literally, she strapped Helen to her at night. So, Helen became totally dependent on her. And after the month was up, the deal was that the killers were not anywhere near the cabin. Where Annie and Helen were. Annie emerged with Helen Keller in tow. And the kid was a docile and they had established a communication system with Annie writing in her palm of her hand. In the first words, out of Mrs. Keller's mouth were exactly that. Annie, you are a miracle worker. And the result of that was that Helen became a charge of Annie. Annie assumed a maternal role. And Mrs. Keller was reduced to, and was happy to be an aunt now. Loving aunt, lying support, but she didn't have primary responsibility for managing her daughter. And Annie took Helen up to Boston and they became famous. People wrote stories about them and they traveled wildly and she lectured, including going to the White House. And was at one level a success. And that Annie was referred to as the miracle worker. She had been able to create this child. Now, kind of genius, to communicate what she learned to talk and communicate. But Helen never learned to be independent. When Annie died, she went through a whole succession of eight companions and she complained about all of them bitterly. Mrs. Keller was, he skilled, the was there as much as she could, but she was very peripheral to the hell most likely. So the end result, while it was a miracle, was not really from a therapeutic point of view. Not really helpful. Annie had too many holes. Any needed external validation. If you are, together as a therapist, if you have dealt with and know, know what's about you need to be needed, then you have an internal, cost of validation. You know you're doing a good job and you're letting other people get the credit. That is a good therapist and is a mature therapist. And so that's one of the stumbling blocks that prevent sometimes that empowerment of the client that we must have and to achieve. So a good result. And we can see this all over. I see this. My field has been deafness. Although, way back when when I was in grad school, I was a speech therapist and I did work with some of my friends. I'll talk about that a little later, not only in families, but I have worked with I-Tender and Therapists. These are the teachers of the deaf who are going into homes and working with families of newly diagnosed deaf kids. They're really on the line. These are families in which they've just been diagnosed as deaf. And in England, in particular, they had no programs for young deaf kids. Other than this home visitation program, the teachers would go into the homes and work with the kids. And I spoke to a group of these therapists who are, again, interested in mis counseling, empowerment issue. I said, "How many of you think the parent is the most important person in this scenario? Everybody raise their hand." The parents are important. Never going to hear any difference to that. Anybody to argue with you on that account. Yet, the one I next asked them, "How many of you go in with a bag of toys? Everyone raises their hand." And I said, "Why are you bringing toys to the mother?" And they all have a sheep's grin and they just said, "Well, this is good for the kid." But if you really are parent-centered, then you need to be working with a parent. You need to go in with what the parent has to work with. Leave your career in your toys in the car. One therapist, I remember raising their hand, said, "Well, can I bring in one toy?" Well, yeah, that was her transition object. But no, just come in with who you are and talk to the mother. Become a collaborator with the mother. What these therapists were doing was doing the opposite of empowerment. They were going in with their bag of toys. And the kid was waiting for them. He was a stranger that come in to play with them. And they would have the mother watching. And they would do their thing and the kid was generally engaged because they knew how to do it and be there with novel. And the kid was interested. And then they would say to the parent, "Okay, now you follow through on this, the week and I'll be back in a week." Well, what they started to do was to really he skilled the parent. As the parent would try to do what they did, what they saw the therapist doing. And failed and failed miserably at it because they, they and the child had all this history. And the mother was distracted and her home and had many things to do. And didn't have the knowledge or the skill level that the therapist had. So she became less empowered. It was an interesting study that was done in England. It was after I'd talked to this group, but I wish they had gotten it. They did a study on which they were parents in remote areas. They only saw a therapist once a month as the kids, families in which they were urban. And they got to visit once a week. And they looked at the gains that the kids made. And they found that the kids in the remote areas made more gains than the kids in the, and the, the bourbon urban areas. And the reason for this therapist found out is that the therapist had to be parent centered. Had to work at the family level. They knew that because they knew they weren't coming back for a month. And they knew that the parent had 24/7. So they were much more parent centered and the parents were much more empowered as a result. Because they knew they had to do it on their own. Parents on the, more relying on the therapist. They were had to rely on themselves. And that's the key here for a successful outcome, therapeutic outcome, is for the client to not rely solely on the therapist. But to develop that self-confidence, to move and be part of it. So it's right at the outset. It's right at the outset. It's a beautiful study that was done in deafness again by Hildi's flesh and done a number of years ago. It was called the elusive effect that was the title of the article that she wrote. She wrote it about predicting success. She had a group of families, no need diagnosed deaf kids, and followed them for 20 years, 20 families. People don't do this kind of study anymore because it wants to be around for 20 years. But she was. She had an NIH grant and studied these families for 20 years. Looking at success, how did this unsuccessful was defined as whether the kid could read at the third grade level? Those she detected the kids at the third grade level, though who was successful and who wasn't successful, then went back and looked at the family and checked them and things like communication, modality, degree of hearing loss, all the kind of obvious things she would think of, but she had that elusive effect. She measured the elusive theme of the mother. She found that that was the elusive effect. The success of the kid ended on the mother's self-confidence and self-esteem. And I think of you step back and look at it. You can begin to see that that's the critical ingredient for a successful outcome. And so it's the same thing with the direct if you're working directly with a client who is duttering. The more you enhance the client's self-esteem, the better the outcome. And if you're working with the family, the same thing is true. The more that you do to enhance the self-esteem of the parents, you're working at a child level. The better the outcome. And that goes back to my original statement which is the goal of therapy's empowerment. An empowerment comes about a client by enhancing their self-esteem. So the trick here is to not be the savior. If you're the savior and if you're seeing that way and you operate that way and you see your self-esteem that way, you're not going to have a good outcome. What you must do is enlist client. And whether you're working at the family level or at the direct client level, that's a collaborator. You're a coach and this coaching collaborative model will turn out a better client, a better functioning client than when you're the expert. You've got to get off the expert model in order to empower the client. That's how you can. You know, any kid only take this one kid the rest of their life. You're carrying around a bunch of kids because you're the miracle worker. It's a burdensome responsibility to always be the savior in the family. You know, there was a poster in my office once that the students gave me from my class. It said, "Give me a fish and I eat for a day. Teach me to fish and I eat for the rest of my life." And that's what we need to be doing. We need to be sure that we're not giving clients just a fish or are teaching them fishing. Teaching fishing is that enhancing the self-esteem. I am so much more helpful to families when they come after they come to me and they say, "What did we go there?" We knew that before we went in there, those people I helped. The ones I didn't help were those who are so thankful and saying how wonderful I am. And they start saying how wonderful I am. And what a miracle worker I am. It's that they're expense. So to get to the practicalities of this a bit, the therapeutic practicalities of this a bit, it starts early. It starts at that, that clients get imprinted very early. So how you introduce yourself, how you conduct yourself in that initial encounter. therapeutic encounter is key. And I think it's a hold on of you. The asked questions, when list is a collaborator, to be saying, what is it that you find working? To say to a parent, and I look back at a long life here, and therapeutic life, and I put my teeth. But I think that's part of your growing, is look back and say, wow, why did I do that? I remember I was a grad student, and I was a beach therapy grad student at that point. And I thought it was a hot shot. I was working with Stuttering, and I remember having mother and a grandfather come in with their 809-year-old kid who was non-fluid. And they were doing all the wrong things. I just sat back and watched them for a bit. And they were doing all the wrong things, telling the kid to stop, think, take a breath, things you would not recommend they do. And I dealt with them at that level, saying, that wasn't that's not the best way to do it. I thought it was being nice and bright. But what I was doing was deskilling them. I was looking back on what I was doing just the opposite of what I've been talking about, what you need to be doing now to help clients. I needed to have said the counseling response to say to them is, it must be so hard for you to see your son, struggle, speaking, and then to take it from there. And I know you're being hopeful. But how do you think he might be responding when you're telling him this and that? So we can go from that empathetic response. So it must be so hard for you. It was a collaborative response of figuring out what may be the best way of dealing with those non-fluid ones. And the same with the child, the elders, you know, developed all kinds of strategies. Many of which are not helpful. But we need to elicit those. We need to talk about them. We need to say what we can do. And it's the we. The we that's really important in here. So we, you're always using we for not me. And you, it's a we, a collaborative relationship. And once you establish that collaborative relationship, I think all sorts of good things can stem from that. But you've got to be real about this. This is not a play. You've got to see this as an actual event. That therapeutic alliance is a joint one. And you're not there to be a miracle worker. You're there to supply your information and support when needed. And your goal always, goal always is to empower and enhance their selfish team. And that gets you in a much better result. And I think a quicker result. And so initially it may be, may take you a while to establish that alliance. Okay, Sarah, what would you like to know? Yeah, well, thank you, David. I was just writing so many notes as you were talking because just the way you phrase certain things is, yeah, so hopeful. In terms of speaking specifically to working with families of children who's daughter or young people who's daughter. I wrote down when you were talking a little bit about enhancing the clients, the family self-esteem and that the goal of empowerment and see your role as more of a coach and someone to pull things out rather than tell. One of the things that bosters or helps to foster independence and clients and kind of being their own clinician and supporting their own journeys is developing what is already helping them. What's going well, what's supporting that. And then they're left to think about in their eye formation of what they're doing or what they're thinking. Could you give us an example of if you were to talk to a client in that initial conversation in a session of brainstorming together collaboratively? Yeah, well, it's what's working for you and is that working for you? Is this accomplishing? I would start out with saying, you know, what is it that you want to have in therapy? What is it you want to accomplish in therapy? The way I would start out with, I mean, studying client always. I'm always asking that. Any kind of group structure, one of the ways the client is coming from and what is that they need. And it goes from there. I had started to see how the scenario plays out because very often I'll make empathetic or kinds of responses like, it must be so hard for you. And that must be painful when you are doing this and what seems to work for you and does it work long term. So I'm doing either more commenting on what it is or she's doing and also getting at the feeling though, which I think is really important, particularly in those initial stages. This is so much feelings right up with the inability to communicate and the challenge of communicating. There's so much frustration in there. There's so much in there. Because there's a loss of the comfort blocking that I would want to get that out. You need to get that out and the person needs to be seen as somebody non-threatening, somebody who's listening and valuing them without judging them at all. So I always stress the positive, not the negative, but I will ask them, does that work for you? This is how you establish what's called a therapeutic alliance. They create the kind of relationship that people don't feel judged. They feel that they can talk about how they feel and they are listened to their heard. No, there's a lot of grief and loss in suffering. People are given permission to cry or to talk about it. I remember in one group I was and these were parents of a deaf child and mother. She said, "I don't want to be a stranger to me." They're going to make me cry and I say, "No, I'm just going to give you permission to cry, start to cry." We don't give people permission to do that. The early stages, I'm always looking at, I feel I'm not ready to work and I shouldn't be working right on the speech right away. I'm really establishing that relationship, that listening relationship, that collaborative relationship, it's always a wee overnight. So we'll put the one area that I was thinking in relation to stuttering. This might be maybe not during that immediate initial stage of a therapeutic relationship, but the client really exploring the response of others to stuttering as being at the crux of what drives some of their choices and drives some of that feeling of shame or embarrassment or fear. How would you guide a client through unpacking that listener response relationship? Well, for me, it's always that non-judgment listening. So you can talk about the feelings of embarrassment and that's okay. You can cry, you can talk about pain that's, that ring has been for you and the struggle. The struggle of it. And that's okay. O judgment here, this having an opportunity. to be able to talk to somebody who's not trying to make you feel better. But it's listening and it's understanding how hard that is, and what a struggle it is that you're undergoing. Release a lot. There's a loneliness. There's a real loneliness. And it's not just in stuttering, it's in any kind of thing that sets you apart from everybody else. When people are trying to make you feel better, or even ignoring the fact that you're stuttering and that you're struggling, what that creates is loneliness. And being able to be talking to somebody about how you're feeling, and have that being accepted, but that the person trying to make you feel better by telling you you shouldn't feel that way. The worst thing you can do for somebody is to alleviate that existential loneliness, that client's feel. One of the greatest gifts you can give, and then the therapeutic alliance is, "Yeah, I understand this. I'm trying to understand." And if the way you can't work on this together, it's a huge wow. It happens in the first or second sessions. It should. It doesn't. You're not getting it. The client needs to feel, "Wow, I've been hurt." Somebody is here listening to me because the parents are so busy, that they're only with a child, they're so busy. Having the kid be fluent, that they're denying the kid's difficulties. And telling them, "You shouldn't be feeling that way, and you shouldn't be behaving that way." Nothing more, let them finish the self-esteem than that. So, it's that existential loneliness you can really get to in the first encounter, and it needs to be there. What would you say in the instance where the young person who stutters is either not really wanting to be dealing with or talking about or kind of going there? Yeah, I'm just wanting you to speak on that scenario where the young person almost feels a little angry that they're there. Yep, I could comment about that. And I would comment about that. So, it seems like you feel like you've gotten pushed into coming to see me. It might be something I might say to them. And I can set the ground rules and say, "You can come and talk or not, and I'm happy to just sit here with you. I'd like to know you better. I'd like to know what's going on with you. And I just want to know I'm here for that." And no judgment. And create a place where they can talk, and if they don't want to and don't want to be there, I don't insist, "Okay, you're not ready." And now, that's okay. It has to be a mutuality. You can't impose therapy on anybody. Never. Not to be successful. Not this kind of therapy, anyway. You can't impose it. So, it needs to be voluntary. It needs to be safe. It needs to feel that I'm safe. That you're not angry because they're not talking to you. That's okay. You don't want to talk to me. It's okay. That you're sitting quietly. But I do want to know more about you. Can you tell me some things about you? And it doesn't have to be about the stuttering either. It's okay. That's the view of your mind. If you don't want to talk, it's okay. You know what I'm talking about? Just stuttering. It's okay. But what would you like to do? And I would like to know more about you. So, could you tell me some things about you? I don't want to ask specific questions. That's a mistake. You don't want to ask how old you are, what school you go to. But I just want to invite you. I'm always forcing the client to take some initiative. So, that's why I don't ask specific questions. I ask general questions. Can you tell me something about you? The client always has the choice of what they want to reveal or not reveal. And then I can go down that. The client always sets the topic up. Let me ask part of the empowerment. Keep part of the empowerment. Because you start asking questions, specific questions. And you're taking it away. It's all about you. It's not about the client. So, it's what the client wants to do. What I want to talk about, but the client's needs are. And that has to emerge. And the therapist has to let that happen. That's how we empower. Yeah, right. Well, this was the most enjoyable morning, David. Thank you for sharing all that you shared with listeners and kicking off our new season. Okay. Well, I'm happy to do that. And thank you for asking me. Sure. And thank you to listeners for tuning in looking forward to being with you all again next month. [BLANK_AUDIO]