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Episode
Kate Grandbois: [00:02:00] Hello all. Welcome to SLP Nerd Cast. We are really excited. This is, uh, the second episode in our seventh season. And we are here today to tackle a topic that we've kind of talked about before. We have discussed stuttering on this podcast in several previous episodes. However, today's episode is about stuttering with a, a new lens that I know absolutely nothing about.
I am joined today by our own, Dr. Anna Paula Mui and Daniel Shaw. Welcome, Anna, Paula and Daniel. Thank you. Thanks. Would you all like to start by telling us a little bit about yourselves?
Daniel Shaw: Well, I live in Minnesota. Uh, I own a potato farm. And, uh. I like to say these things because, uh, I'm with Anna, Paula, and, uh, it's just, it's fun to make things up. So, um, so I live, I live in Tennessee. I live in the Nashville area.
Kate Grandbois: I [00:03:00] was, I was like, wait, you really own a potato farm? This is the coolest thing I've ever heard.
This is waiting for the punchline. This is great, great start.
Daniel Shaw: Uh, so I, um, I'm a primarily a, a pediatric therapist. Um, uh, I work at Vanderbilt University and I largely work with young children with autism, uh, but also have the privilege of working with individuals who stutter across the lifespan. So that's the one area where our pediatric clinic is not pediatric because there is, uh, there's no one else in the area who, who does that specifically.
Ana Paula Mumy: , I am Anna Paula Mui, and I am a, uh, program director and, uh, professor at a small private university. And I'm also the, uh, president of Sparrow Stuttering, which is a nonprofit, um, that we work to equip SLPs, um, to, um, work with people who stutter, but then also to, um, advocate for and support families.[00:04:00]
Kate Grandbois: I am very much looking forward to this conversation. I was saying before we hit the recording button, that I always learn something new. Um, and like many of our listeners know, I know very little about, um, about stuttering in general, having never done it in clinical practice and looking at stuttering, uh, and the combination of, of what is called bibliotherapy, which I'm, we're gonna look at what that means, um, is really exciting and, and a very new and different spin on things.
So, uh, I'm gonna quickly read our learning outcomes and then we will jump into it. So, after completing this course, participants will be able to self-report knowledge gains related to bibliotherapy and the way this practice can be integrated into a treatment plan. Participants will also be able to self-report knowledge gains relating related to ways in which a book can be used in therapy sessions to address thoughts and feelings.
Disclosure
Um, all of our financial and non-financial disclosures can be found in the show [00:05:00] notes.
Kate Grandbois: Okay. Now that that's behind us. Uh, what is bibliotherapy? Let's just start there because this is a term I love the title of this course. This the $20 word I was saying. I was chuckling when I was reading the title because I had to say it very slowly to make sure that I was pronouncing it correctly. So what is it?
So
Ana Paula Mumy: I'll start with just giving our working definition of this. Um, and it's essentially the therapeutic use of carefully selected books that, um, involves reading the book, um, based on their themes, um, reflecting on their content and then engaging with them in a structured therapeutic setting. Um, and this, we've used it.
Um, I know for me, um, I've used books for. Years and years and years, and I didn't know that there was a term for it. Um, so I think, you know, in some ways it was somewhat intuitive in, uh, my practice to utilize books in different ways, um, to help people understand their own conditions [00:06:00] or to connect with characters in a certain way that maybe were facing similar challenges, um, or maybe gaining insight in, um, working through a challenge or, um, building their, you know, belief about something.
So I just, um, I have used, um, books for some time and I've seen the power of books, um, just in terms of getting, uh, children especially to open up or to be able to talk about difficult topics. And so, um, that is essentially what bibliotherapy is. And so I'm gonna turn it over to Daniel just. If you can talk a little bit about just how, um, did you come upon this and, um, how long have you been using it and just how the, how did it surface for you?
Daniel Shaw: I think I came about it a little differently. Um, there are a lot of different media that I've used in the past, um, and it just kind of come pieces here and there [00:07:00] using video in different ways. Um, making little mini movies to sort of express or capture something that, um, kids were maybe not able to put into words.
Different, uh, mediums of art, um, creativity using, um, like cartoon bubbles. Uh, lots of different ways that you can help kids to access things that are difficult for them to verbalize or maybe things they don't really have the language to express yet, but it's there. You can see it, you can read it, you can hear it in their voice.
Um, and so what I found that I, I've really enjoyed about. About bibliotherapy, um, on this side is that I've, I've already done a lot of the stuff that Bibliotherapy does, kind of like you and Apollo, and this is just another vehicle. And so, um, that, that's something that I've really, I really feel passionate about in, in terms of therapy.
I think we get really focused sometimes on what your activity is gonna be or [00:08:00] what it, whatever it is that you are thinking you have to have. And in my mind, you need the principles. You need a framework for how you're approaching, and you need to be able to scaffold within that, within that framework. And if you can do that, then everything else is just a vehicle for getting there.
So if you have, uh, let's say if you did something, uh, slightly differently than stuttering therapy, um, you have a circle time activity and you're thinking, what's the perfect activity? Well, the, the perfect activity is the activity the kids like and wanna engage in and. And that you can just fold in whatever you're working on into that song or into that activity or, you know, flying the parachute, um, whatever it is, it's just a vehicle.
And so the book to me is, is just that. Um, it is a very useful, because you can't just pick any book necessarily, but the book is a great starting point for where you might want to go. And so if I have a book that, um, as I'm reading with kids has this [00:09:00] character's perspective about his stuttering and how he feels about it and what he does when he's stuck, or maybe how he's coping and how he describes his stuttering and maybe some of the colorful metaphors and similes they're using in the book.
As I, as I read through that with kids, I have 20 different things we could talk about. And so I just have to know that kid. To pair up what, of, what of that book would be useful for them and where they're able to access it. Um, and of course that's just being a good therapist. So I think it's not that learning bibliotherapy is pointless because then this podcast would be pointless.
Um, it's to me just kind of broadening out and saying sometimes, uh, therapists like me, um, and maybe listening, you're like me, um, get in your head about things and so you think, oh, bibliotherapy. And, uh, the funny thing is when you search bibliotherapy, there just isn't that much out there. Um, if you look in, in other, uh, fields.
So I, I did some [00:10:00] research for this. And let me just say I didn't learn a ton. Um, and not because there isn't much to be learned, but there just isn't that much out there. Um, and, and there are meta-analyses that say, um, it's inconclusive and it's helpful for, uh, teens who have, uh, depression, but it's not been helpful for children with anxiety.
And I come away from that article saying that's terribly helpful, um, sarcastically. So, um, I just, I'd really wanna emphasize that idea that, um, you really wanna know your kid and, um, and as you access the books, I think as you read and reread those books for yourself, you'll start to find some of those themes.
If you're thinking about. The child in front of you and you're, you're tapping into what's important to that child and the things the, the, the fears or the, the hopes that child has or some of the struggles that he or she has. Um, then the book is just gonna help you access that and talk about it in a way that maybe [00:11:00] isn't as intimidating for them.
The, you know, if you came at it directly and said, Hmm, tell me about, tell me about those anxious feelings. And, and I've worked with plenty of kids who will just kind of look at you and go, no, we're not going there. Um, or kids that have said something to me that then I'll just reflect back and say, that's really interesting.
So sometimes, sometimes you get a little nervous when you're talking, and that's literally as far as I took it and the child would backpedal and qualify it and kind of retreat from that statement. And so, um, so bibliotherapy can be another way in addition to the arts and many other. Di many of their activities, um, to help kids tap into, um, things that can be hard to talk about and, and hard to do because it's real life.
Kate Grandbois: I wonder if you could, as a person who is not at all familiar with this approach. You know, I, I started this conversation with an emphasis on not knowing a lot about, about stuttering and stuttering approaches, but this is [00:12:00] obviously something much larger than that, um, and can be used across a variety of different presentations.
How do, do you feel as though bibliotherapy is something that you choose for a kiddo who particularly likes books? I mean, just going back to your original comment about, you know, the right activity is what the kid likes. Is this something that you have found to be successful with a wide variety of kids, or is this something that, you know, you happen to have a kiddo who loves storytelling or loves narratives or has a particularly favorite character that they gravitate towards?
Daniel Shaw: That's a great question. I would say generally a lot of kids are open to it. Some kids may gravitate more easily than others. Um, but I'll try it with most kids and I'll just gauge their reaction. And I've definitely had, um, boys, some boys for instance, who are just not interested. Or some may, in some cases it may be that I just didn't [00:13:00] choose the best book for them.
Um, you know, if I'm, if, if they're not really open to talking about stuttering and or maybe don't have a lot of insight into it, but generally are kind of closed off, if I read a story that's front and center talking about stuttering and describing it and there's some struggle in there, some kids may be maybe not open to that, which is okay.
And, and I think you have to be willing to try some stuff in a session to figure out where that kid is and, um. You know, it's, it can be, that's one thing I love about groups. If you have one kid who maybe isn't as open, and this is true a lot of the time, um, but you have one or two kids who are, they can be great examples for that openness.
And so one of the reasons why I love pairing kids is because you have kids in different stages of readiness. And if I, if I have you one-on-one, I'm gonna do things differently than I would in a group. Um, I'll try some, some things I'll, I'll push a little bit more in a group because [00:14:00] the, the group will have its own value system and you can help shape that.
Whereas individually, you're really looking at their value system and you're helping shape it, but it's in a different way. Um, so I, I would try it with a lot of, uh, a lot of different kids, um, without being too quick to sort of pigeonhole. It has to be a certain type of kid, um, because you can always pair things with books.
Mm-hmm. So if I have a book. And we're touching on some interesting topics. Some kids may not really just wanna talk that out, but you can take that then and say, let's draw it, or let's make something, or let's act it out. So there are a lot of different ways that you can connect their interests to that story in a way that that's more dynamic and maybe engaging for, for them.
Ana Paula Mumy: No, I would just add when I have had instances where a child maybe wasn't as excited or prone or, or maybe ready for those kinds of dis discussions based on a book, um, with a character who [00:15:00] stutters, um. Sometimes they're open to reading it on their own and just engaging with the book. And then I'll say, Hey, at any point if you wanna chat about it, you know, and just make it available.
Um, and I, there's one instance that I'm thinking of where, um, this particular teen, uh, read a book on his own. And then, um, I sent him the, the author happened to be doing this like q and a, um, little. Um, you know, meet the author, um, virtually. And I really didn't think that he would join. And he did, and he didn't say a word, but he actually like, contributed in the chat.
And it was just so like, oh my goodness. You know, 'cause I just wasn't expecting the return and there was a return even though he did it completely independently. But I was able to at least like, plant enough seeds and say, you know, here's something that you might consider and here's why I think it might be [00:16:00] interesting to you.
Um, and so it doesn't necessarily always happen within the therapeutic space. Um, but it's certainly an option that we can offer, um, especially for those older students or children.
Daniel Shaw: Yeah, that's, I love that point, uh, because I think it goes back to that idea of scaffolding, um, and adjusting your expectations.
So if we think that it's our job to do all of the changing or to get the child to answer a question or. To discuss something openly or to be okay with stuttering. Um, then I'm gonna, I'm gonna be pressed as a therapist. I'm gonna feel a lot of pressure as well to make something happen, to generate something.
Um, but if, if, if I'm willing to, to scaffold back a little bit and say, okay, well, we tried that, or I, I kind of pitched out there and, and the, the child or the teen was just not interested, then I could think, well, what would be another way in What would be a small victory [00:17:00] in terms of steps toward that?
And so being willing to hold the book or take it home or even think about the book could be a great first step. And just a willingness to encounter something that they're not ready to encounter in a more, uh, social or verbal way with another person. Mm-hmm.
Kate Grandbois: So when you are, I'm just thinking about everyone who's listening who might want to begin exploring this concept.
It seems to me like it's widely applicable cross presentations. It gives you a bridge or a vessel through which to touch on things that might be more sensitive or, you know, get into some of this more emotional counseling work that we do as therapists. How do you begin? I mean, is it as easy as just picking a book that you think the kid would like or are there other variables that you need to consider?
Uh, prior to [00:18:00] getting started.
Ana Paula Mumy: Well, I'm gonna share about one resource that we developed just to start us off, and then I'm gonna turn it over to Daniel. Um, so because we do work with sometimes heavy topics or just difficult things to talk about or to discuss with kids who stutter, um, Daniel and I, um, started talking about, um, you know, what are the books that you use?
And, you know, just more as an exchange of like, Hey, what book are you reading right now? Right. And, and so, um, we were talking about, you know, what are the books that SLPs, that we know and trust are using with kids who stutter? And so we, um. Emailed a few people and just said, Hey, let's, you know, talk through this and, and like, what, what are some of your go-tos?
And from that discussion, um, and just our collective learning of just, you know, talking through and, and figuring things out together, um, we came up with a resource called Story Stream, um, which is really just a collection of books that were selected [00:19:00] by select SLPs that are doing a lot of work with kids and teens who stutter.
Um, and we, um, came up with just a format where we have the book title, a basic description or like synopsis of the book. Um, and then we also, um, together came up with like what are some themes that potentially one could address based on this particular book. Um, and then we had some. What we call like extension activities.
So what are some potential ways that you could, or, or places you could take this book? Right. So whether it be, um, an art activity or just a discussion in a certain way, um, that's structured or, um, whatever the case may be. But we just had some ideas, um, that we presented for each of the books. Um. And then, like I said, some of the themes that maybe could be addressed.
And again, um, we're very clear at the beginning to say, you know, the child may not be ready for this discussion. Um, certainly [00:20:00] the therapist needs to read the book for themselves, make sure that it is appropriate for their child because they know the child that they're working with. We don't, um, and then just, um, doing their own, um, you know, vetting of the book for that particular child.
Um, but it at least gives you some ideas and a starting point. So then, and then you also know like, oh, here's a listing of some of the tried and true or, you know, like the, um. Ones that SLPs who are doing the work with kids and youth, you know, who stutter, um, are, are going to on a regular basis, right? So instead of just randomly going to Amazon and saying, what are, you know, doing a search, um, for, for some random book.
So we, um, came up with that resource, um, which is available on Sparrow Stuttering's website and it's a free download. Um, so that is just at least a starting point for someone who maybe hasn't done this at all because they could look through and see [00:21:00] like, oh, okay, here are some of the themes that might, you know, come up and here's a direction I could go with it.
Um, but like we've said already, you know, this is. Use or it's, um, of utility to, you know, many children, not just kids who stutter, right? It could be any, um, communication challenge or any situation where, um, maybe you're wanting to present, you know, in another view or to springboard a conversation about something that might be challenging.
Um, but then through a non-threatening way, which is a character instead of directly asking them. So it could be anything, right? Um, anything, not just stuttering.
Daniel Shaw: Yeah. I wanna, um, I want to go through a couple of these, uh, couple examples. Anna, Paula, um. Because the way that it's laid out, if hopefully in describing it, it'll give you a sense of what you would find if you did look for it.
Um, [00:22:00] so I just pulled up, uh, not quite naral. Um, it's a book, not about stuttering and, uh, what it has in here. It'll tell you the title of the author and, and the age range on there. So you'll have a sense of who it could be appropriate for. And then you can, of course, can make the judgment if you might stretch it one way or the other.
Um, it has a book synopsis, which just gives you a sense of what the story's about. And then, um, the therapy ideas, extension activities, which Anna Apollo was just describing. And at the bottom, uh, this was something that I, I really like about it, is that it has, um, themes to explore or potential themes.
'cause of course, Anna, Paula said, these are suggestions you may read with them and in your judgment, think I really see something in there that we could really launch into. And that's perfectly, uh, valid. So an example for this book, uh, potential themes are self-acceptance, discovery, discovering community, just helping to know that you're not alone.
Positive disclosure. So openly talking about stuttering. And then, uh, the last one is navigating dual communities and being, [00:23:00] being yourself. Uh, so those are just examples that if you were, if you had an idea as a therapist of what you might wanna tap into, um, then each of these you could scroll through and just kind of see if there's a theme that says, yes, this, this might be a book that I could look into.
And then you could look into more, more of the book and, and exploring it. Um, and, and as far as, there are a lot of ways you could go about it more broadly, I would say a good assessment will, will help you. Um, but as therapists, we're doing ongoing assessment on, on a session by session basis. So we're constantly gauging where kids are.
Um, so you may come in. With, uh, with an idea of what the session's gonna look like, which is great, you're planned. Um, and then the child says something that you say, wow, it sounds like this is really what we need to talk about today. Uh, and so the other stuff is there if you need it, but you're, you're going the direction that the child needs you to go.
Um, and [00:24:00] so today, um, actually just in the last hour, uh, I saw an elementary aged guy. Um, and the beginning I was, I was, I ask in different ways, but I, I'll ask him, you know, how's talking been? Or, um, you know, what's a risk that you took this week? Or what's something you're proud of? So, different ways that kind of gauge, um, ways that he's moving forward where and toward the stuff that he wants to do.
But I also wanna leave room for the hard stuff because, um, I've known enough kids that. After a while, figure out, hey, it really, it's Daniel thinks it's okay to stutter. And, and so maybe not making a lot of room for the, the hard things or willingness to talk about 'em because maybe they think that's not okay.
Um, so knowing that a, it's, it's all okay. It's okay to stutter and it's okay to not be okay with stuttering. Um, you know, that's, that's that changing and developing relationship that someone has with their own stuttering, and that can be moment by moment. Mm-hmm. Um, [00:25:00] so with this guy, uh, today, I said, you know, where's your brave meter?
Um, so when you, when you stutter, when you get stuck, what's your brave meter for staying with that word or, um, or going ahead and saying what you wanted to say. And he said, zero. And so I said, okay, zero. And he just kept talking. So again, that's one of the great things about counseling is you don't always have to have a perfect question.
Sometimes you just acknowledge that you heard them, you make some space, and they just keep talking. Um, that happens a lot. And so, um, he talked about how he'll say, um, you know, I'm so sorry for stuttering. Hmm, interesting. So something that, and, and in my, in my own data, I often write down quotes like that.
So I wrote down just that he's apologizing for stuttering, something we might revisit. Um, and then later he said, uh, 'cause he was talking about the word stuttering, and he said [00:26:00] that, that he, he stutters when he says it. And then he was giving me examples, but he kept saying it and he didn't stutter. And they're like, Hmm.
So I made a note about the variability of stuttering. That's something we can talk about. Um, and we talked about, uh, and, and then if some point he was like, I said it right. Without stuttering. And I was like, okay. So I just made a little note of that. 'cause again, it's totally okay. That's where he is. Um, for the most part, I've worked with him for a while.
He gets that it's really okay to stutter and, and he's okay with that. And he's also in this place where there's this developing relationship with his stuttering. He's getting older, he's maturing, and he's starting to track people's opinions a little bit and kind of maybe noticing that, that he's different.
He's standing out because he talks differently than them. And that's something that as he's maturing, he hasn't really dealt with in that sense until more recently. So there are a number of things right there that we can tackle. So for myself, I wrote down, okay. Um. We can talk about [00:27:00] self-disclosure. And so we pulled up some Frankie Banky comics, um, which if you don't know Frankie Banky, you gotta know Frankie Banky.
Um, uh, Danielle Rossi, um, is a, is a, a guy who stutters, who, uh, is a cartoonist and, uh, an advocate. And I think he, he speaks and does a lot of amazing stuff in this world and has a website. And so in addition to books of his that you can buy, he also has things on his website that you can access for free.
Um, and so we were on there today, I shared the screen 'cause we were, uh, doing telehealth and let him look at that as well. And we went through these different ways of disclosing and he had a little, like a little name for it and then just kind of a little cartoon strip of like two or three boxes that would just give an example of kind of what it looked like and then we could discuss it.
So it was a great launching point for talking about that. And it wasn't me just saying, Hey, you could do this or you could do this. It was much more interesting to him and, and led to some great discussion. Other things that I looked at that I thought we might talk about are, so there's [00:28:00] that idea of oh, oh.
And so I asked him too when he said, I said it right without stuttering. And so I waited a second and I said, what makes it right? And he said, um, I don't want every, every, anybody thinking I'm weird. I was like, okay, I also wrote that down. 'cause again, that's much more useful data than ticking off some something.
So I thought that that's useful information that tells me a lot more, um, about where you're at and how you're thinking about this. And so, uh, a couple of the books that came to mind right away are perfectly Norman, um, which I can't remember, Anna, Paula, is that on the story stream list?
Ana Paula Mumy: It is.
Daniel Shaw: Okay. Um, so that's a book about, uh, this kiddo who has wings, but he does not wanna show them because nobody else has wings.
And it takes him a while, uh, of, of hiding and trying not to show that. And all the work and the effort it takes to wear a coat outside when it's hot and he's sweating, um, to the end when he [00:29:00] finally says, you know what? I'm just gonna let that go. And he starts to realize that he is not the only one with wings.
Um, and so it's this great story about being different. Um, the, the unicorn, uh, story was about that too. Um, there are multiple stories about that. And, and so not only can you use these types of books with a lot of different kids, but. You can use many different books that have nothing to do with stuttering, but touch on the themes really effectively.
Um, so that's a good one. Uh, there's one that I read a while ago, uh, with him and I've read with other kids, especially when I'm on the early end of realizing maybe there's a little anxiety for them or maybe there's a little stress around communication, moments of stuttering, um, people's reactions, variety of things, um, is the story.
Um, oh, it's, it's, uh, about a little girl's worry. Uh, Ruby's worry, Ruby finds a worry, uh, is the title. And in the beginning of the book, she's, uh, she's [00:30:00] perfectly happy being Ruby. And then early on she discovers a worry. And this, it, it gives you this little, um, yellow fuzz ball that over time gets bigger and bigger and bigger.
So, and it even points out that. She can see it, but no one else can see it. So then she pretends like she can't see it too. And, and so this idea, this concept of the worry getting bigger and bigger, the more she sort of tries to stuff it or tries not to acknowledge it, um, is beautiful because as you're going through, so this is maybe a good example for maybe how to, how to use a book like this is, um, it, it builds in several really helpful concepts.
So one is just the idea of like a worry. And so you can kind of talk about that with them, you know, well, what's a worry if you ever, have you ever felt a worry? Uh, so it helps them connect to that. If they're not there yet, then they can just kind of learn through Ruby. Um, and this was something that, um, that Anna Paul was, was, uh, mentioning earlier, [00:31:00] is that, uh, that vicarious learning that you, you may not directly address something, but they're able to tap into it because even if they can't relate it to themselves.
Um, kids often project. And so, um, there are a lot of types of therapy that allow kids to express themselves without saying, tell me about you. But what they're doing tells you exactly what's going on inside. And so, um, this can be really helpful because rather than having to tap into themselves or have insight into themselves, they're able to kind of learn through this child to identify with the character.
And so, um, the worry is getting bigger and bigger, and it's there everywhere. It's behind her cereal and it's, um, brushing her teeth. And there's a great picture of her furrowing, her brow. Like, I really don't like you worry. Um, but as you go through it touches on some other things. So it's, it's always there.
And she wondered if it would ever go away and like, what if it didn't? So there's that idea of, of worry being attached to like these what [00:32:00] if questions for a lot of people. What if this happens? What if this bad thing happens? So that's a great way that I often define worry is what if, what if, um. So trying to carry on if, if everything is normal.
Um, so there's this idea of, of necessarily maybe trying to hide it. So, or that maybe it's not normal to worry. Uh, she wonders if, if anybody else worries. So that's a theme in there that, you know, uh, with some of the other books that you're not alone when you worry. Mm-hmm. Um, so there's some normalizing there.
Uh, and then toward the end, it, it gives, uh, a couple really simple solutions that aren't saying, they're not prescriptive. They're basically saying she finds this other boy and she realizes, uh, in talking to him that he has a worry and he starts talking about it and it starts to get smaller. And she's like, then she realizes that actually the best thing you can do is talk about it.
And so now, now you're building into this story, the idea that. Worrying is normal [00:33:00] and doesn't make you weird. And that talking about it is really helpful in some form or fashion. Talking about it, getting it out there rather than kind of stuffing it or having to keep it private. Um, and then at the very end, I love the idea that it says, of course, that wasn't the last time she ever had a worry.
Everyone gets them from time to time. So again, normalizing. But it also lets, you know, it's not like this one hill battle. Um, but you know, you may experience it again. And, and if you know to expect it, it's kind of like stuttering being variable. If you know, stuttering's variable, um, to me that's half the battle and just mentally, uh, gauging what's going on, what's happening, what did I do?
You know, and it's like, well, maybe nothing. Maybe I'm just stuttering more today. Or maybe I just happen to be stuttering less today. But knowing that it's normal to, uh, to stutter more and less that it's variable can be really empowering for people just to know how to gauge what's happening in their own bodies.
Um, that would be in, in my mind, one simple example for using [00:34:00] that. Um, and Apollo, do you have any particular favorites?
Ana Paula Mumy: I do have some favorites, but I wanna say something that came to my mind, um, just in relation to, um, the vicarious learning. Um, that is also available for family members and parents, right?
Because sometimes, um, half the battle is also getting parents or caregivers to be on the same page, right? And for them to understand. So even like thinking about the variability of stuttering, if they understand that it's variable. Because sometimes parents will say, oh, but he was so fluent yesterday.
What happened today? Or, you know, and they don't see that variability as normal. Um, it is helpful if you are walking them alongside. As well, um, with kind of the same information or whatever it is, whatever discoveries that you're making, right in therapy with the books or whatever, um, you're using that the parent is also, um, being brought alongside, you [00:35:00] know, the child and also understanding and, and gaining, you know, more insight into the experience because that's really what it's all about, is helping them understand the experience and either normalize some things or make some things a little bit easier.
Um, and so on. So just, um, something about my curious learning that I just wanted to mention. A favorite, um. What is it? Uh, the, the Ben book. Ben, what is it called? I, the, the title just esta escaped me. There it is. Ben has something to say. Um, so the story is just about a little boy that, um, sees a dog that's being mistreated or at least neglected, and he so wants to take this dog home.
Um, and his parent or his dad, um, basically, you know, um, encourages him to, um, talk to the owner and see whether or not, you know, um, he may be able to adopt this [00:36:00] dog or something to that effect, you know? And so, um, but it just walks. The, the storyline is essentially, you know, like how, um, this was something that he really, really wanted, right?
He wanted this dog. Um, so how could he overcome his fear of talking in order to then, um, make this request or, um, talk about this desire, you know, with the owner. Um, and I, I forget now, it's been a bit since I've read it, um, at the end, but the, I think the owner says, like, what would make you a good owner?
Or like, what would make you, or like, or something to the effect of like, why should I, you know, let this dog, like how are you gonna care for it? Or something to that effect. Um, and, and so again, like it just gives him an opportunity to talk and to make his desire and his, his thoughts known, right? And so, um, I just love how it just provides, um, a springboard for talking about, you know, what are the ways that you're not talking, or are there things that you're [00:37:00] withholding or are there ways that you're not, you know.
Um, participating right in, in conversations or whatever, um, because you are afraid of your stutter or you're afraid of how they're gonna react. Um, and so that might be one way, right, that you could take this book. Um, and, and, and then also just, you know, talking about similar feelings that Ben had. Um, have you experienced those, you know, feelings like that or, or, um, you know, being able to just gauge which direction to go.
And that's one thing maybe Daniel you could comment on is, you know, how do you decide what, um, potential themes to tackle or what are the questions that may be important, uh, which I know that's a big question because we don't have a child in front of us, but, um, do you have. Any, um, insight on just, you know, how do you decide like, what are the right questions or, or maybe there aren't the right questions like you mentioned before, you know, you [00:38:00] kind of have to just see where the child takes it, but any thoughts on that?
Daniel Shaw: Yeah, you know, it's, I mean, it is a really good question and it's, and it's a hard one to answer. Um, maybe, maybe it'll encourage people. 'cause I, I, I totally agree with you that there isn't necessarily a right question. Um, but I think the spirit of it is curiosity. So there's, there's a sense in which I, I'm grabbing this particular book because I wanna help you process certain things, or I want to kind of maybe open your perspective to something else.
Um, but I also wanna be careful that I don't choose this book with such, um, with such a strong agenda that maybe I missed some of the opportunities. As we're talking together. And so when I'm talking with someone, I'm, I'm also just asking curious questions. Um, I really love that idea in, in counseling, well, at least certain counseling approaches that have this not knowing approach.
Like I'm asking the question and [00:39:00] even if I think I know the answer, I really try to remind myself that I don't know the answer. Um, and sometimes, sometimes I, my sense was right and sometimes I didn't know. And so, um, but that sort of approach really invites kids to be more open in sharing if, if they feel like they're just answering quiz questions about a story, um, rather than being immersed in the story that, um, that could be, that could be less inviting for some kids.
Um, one thing I found that might be helpful is in a, among the stuff that I read, there were pieces here and there that were, were useful. Um. One that I thought was particularly helpful was this article on using bibliotherapy to teach problem solving, and it's by James Forgan. And, um, first of all, he used, he defined bibliotherapy really, really simply as just the use of books to help solve problems.
And so I liked that idea because it, it was using books as a [00:40:00] problem solving approach and helping people, um, both directly and indirectly to do that. Um, we kind of alluded it to it earlier, but um, for some kids it's a lot easier to answer the question, what would you, what would you tell to your friend to do in this situation?
Then what do you think you should do? Um, what advice would you give them? And so sometimes taking that less direct approach. Um, other ways of asking that question, um, are what do you think your dad would, would tell you to do? Or what do you think your mom. Might want those kind of perspective questions sometimes help people shift away from this sort of stuck, um, sense of like, what's the right answer, or, well, I came to you and I came to you not knowing the answer, so now you're asking me to tell you the answer and that's why I'm here.
And so shifting that in different ways can be helpful. So when you're talking about characters, you're trying to connect with the character, what do you think they're thinking right now? What do you think they're feeling? Um, it all depends on your goal. So if, [00:41:00] if for some kids I'm thinking, well, I'd love to help them develop emotional vocabulary and awareness, it may just be helpful to sort of dip our toe into those sorts of waters with a story.
How do you think the character's feeling? Why do you think he's feeling that way? What do you think he might do next? Um, and I'm just trying to help them take on some perspective and, uh, and we can introduce vocabulary that way as well, even if they aren't part of the book. Um, so anyways, I, I like it. And then part of what it suggests doing is it.
For those of you in the school system will be very, very familiar with this. But he talks about pre-reading, um, which you could do in lots of different ways. So just kind of glancing through here. Um, you know, how do you help them connect with the main character? Um, there were a couple lists that he suggested.
So there's something by Paric and Paric in 1986 is this list of criteria for selecting books for preschool children, um, and early childhood learning. Um, so that may, I mean, that won't be up to date. That'll be things up [00:42:00] to 1986. So it's an older list. And then there's the Carnegie, uh, Carnegie Library of Pittsburgh, which has a, a website which has a, a number of resources pre-reading also can include that KWL chart, that know, uh, what do you know, what do you want to know and what did you learn?
So it's a great way to just kind of very briefly, and you could do this with lots of activities, um, but what are you already, do you already know about the topic or looking at the cover of the book and sort of predicting what is a story about. What do you think's gonna happen? Um, and then what do you wanna know?
Maybe questions you already have, and then sort of debriefing afterwards. Um, and sometimes an easy way to to ask that is, um, what's your takeaway or what's one thing you wanna remember or think more about? Those are ways that I'll sometimes gauge the end of a session. Um, so then guided reading, so you're reading with them the suggestion for them.
And of course you can do it lots of ways 'cause I don't necessarily do it this way, but I like the idea and I think I wanna try it more, [00:43:00] is reading the book all the way through without interruptions. So you really keep the flow of the story and then you might do an activity or not. And then you might have them journal about it or not, uh, draw something or not.
And then you come back to the book and you go through and ask some questions and, and kind of guide them through that, uh, through the discussion, see what questions they have for the character, which I thought was an interesting idea. Um, and then afterwards just kind of checking in. Uh, this could be great for group discussion as well, um, if, if you were able to do that.
Um, and, and so I really like that. And then one of the other pieces that he talked about was this, um, this, um, what's the word when you have, I think acronym, that's the word. There we go. So it's an acronym. Called I solve. And the way that he put it together is basically I identify the problem, uh, s what are the solutions to the problem.
And Ko this is, this is very CB, Tish, um, you're just kind of talking about all these different [00:44:00] solutions. Okay, great. What's another one? What's another one? So it's, it's very, um, it's very open to, to the ideas. And again, there could be ideas that you're like, I don't think this is the best idea. Um, you know, when kids talk about how they'll respond to, let's say a bully or someone teasing them, um, they might say, I could hit 'em.
And I'm like, yeah, that is a choice. Um, now when we talk about the consequences and, and what potentially might happen that we're gonna sort of work through that, so hopefully that's not the, the avenue you take, but it is a choice. Um, so going through all the solutions and then the o is obstacles. So what are the potential obstacles to the problem?
Um, and you just kind of, again, you're just brainstorming together. You're really just trying to help them think more carefully through what they might do, what might happen. And then, um, the L is look at the solutions again. Choose one, the v, very good, try it. Um, and then e is evaluate the outcome. So [00:45:00] I, I love that it, it's moving into some action if kids are there, uh, or even willing to consider that.
But it's a really simple way. Um, and, and actually. This is, this article is written in terms of kids with a variety of, of needs. So this could be kids who have IEPs as well. Um, and, and maybe not even kids who stutter, but helping them work through this iSolve idea. Uh, doing it enough where it's automatic, where they don't have to think about the process, but it's more, um, endemic to the way that they think could, uh, could be really helpful.
So I love that application outside of stuttering, but also just helping kids think when you're going through a book, you can use this as a way to sort of tackle that book as well.
Kate Grandbois: I'm listening to you both talk about this very powerful tool. I mean, I, I think in most speech language pathologists have books in their therapy toolkit, right?
Literacy language. That makes a lot of sense. Looking at books through the lens of [00:46:00] providing that springboard or providing that bridge to tackle some of these more emotional issues that are not only hard to define or hard for kids to express, but in a lot of other circles culturally, they're not, they're not necess, we don't make space for those things.
Right. Um, and I, I wanna go back and just kind of think about the context and, and I was having a reflection while you were, while you were talking, and I would love your feedback to know if you think I'm, I'm on the right track, just how important the component of rapport is when you are engaging in this type of therapy.
Um, and not only that, but your ability to take qualitative data. And I know that sounds like a very nerdy thing to say, but it's SLP nor cast. I mean, come on. It had to come out at some point, but, you know, I think so many, so much of, uh, our training. Is, you know, measurement and data collection, tally marks, and percent percent [00:47:00] correct.
And there is no amount of tally marks that is going to measure a kid's feelings. That is, that is just not gonna happen. And as you were talking, I'm thinking, I was thinking about when you were saying, oh, so I wrote that down. Oh, and then I, and then I wrote that down. So even just our ability to notice in our rapport, in our interactions, in our natural existence with our clients, notice the things that they say, do you know, doing these little mini, I wanna call them interviews, but it's not, it's talking to a kid, you know, it's hanging out with your client.
It's talking, but just noticing and, and writing them down even as you were, you know, saying as a, as a guide, as kind of a guide for which books to choose, or which things you might wanna tackle or, or which things you're noting, but you wanna put on the shelf. For later. Is that like a, a, uh, somewhat on par?
Am I, am I in the right sphere with that kind of reflection in terms of rapport, but then also that ability to notice and take qualitative data? [00:48:00] Well,
Ana Paula Mumy: yeah. Yeah. I would say absolutely. As you were talking, I thought about, um, this one little boy that I worked with and I honestly cannot remember what the book was or even like, what my target or, you know, kind of what I was hoping, um, we would accomplish with that book.
But I remember, um, I don't think I even gave him that much. Like, to preface like what, you know, I, I think I may have said something to the effect of, you know, um, I, there's a story I'd like for us to read and I'm curious, you know, what you, you might think about it. And so we started, and because we had rapport and because he trusted me.
At some point, like midway through, he looks at me, he goes, I see where you're going with this. You know? And it was like, he was just like light bulb, you know? And he was already making the connections. And we hadn't even like, you know, I was just reading, you know, I was doing the read through first and then we're going to explore, right?
And then we're going to maybe, um, unpack a few things [00:49:00] or whatever. But it was just so darling that he was like, I see where you're, but he knew and he trusted that it was an okay place for us to go. Right? And just so kind of in that comment, he was essentially saying, I'm okay with this, you know, and so, but yeah, I think rapport is huge.
Um, because their willingness to open up to you, um, is going to of course correlate with how, um, or the relationship that you've built and the trust that you've built, you know, um, so. That I think you can't, um, separate, you know, one from the other. Um, and then as far as qualitative, um, I think the descriptive data that we get is probably the most valuable.
And so I, in the same way am going to, um, make notes about, you know, what are they commenting on, what are they saying, what are the things that, um, or even sometimes, you know, things that they'll say, um, in one [00:50:00] at one point, you know? Um, and then. They'll start talking about it differently. You're like, oh, we're using this terminology now.
Like where maybe initially, let's say, you know, stuttering, um, like some kids will say, oh, well I messed up. You know, or they're, they're using terms where it's, they view it as a problem and then you all of a sudden notice that now they're just saying, oh, I stuttered, or, you know, whatever. So like that the, the language starts to shift and that's huge.
Um, and that is qualitative information, right? That is so valuable when it comes to, um, the data that we are taking. Um, because that means there has been a perspective shift, right? And there is something, um, uh, or at least something in the narrative is beginning to shift and, and change, you know? And so I think that's so important and being observers and noticing, um, that's so key, um, to what we do, especially, um, in kind of talk [00:51:00] therapy.
Daniel Shaw: Yeah, I, um, Kate, as soon as you talked about the, uh, rapport, I was like, all right, I'm about to get nerdy. Um, because it's one of my favorite topics I, that, that therapeutic alliance, uh, which is at least the term that, that, um, researchers use and definitely in the world of, of psychotherapy. And, um, if, if, if you're listening and you haven't heard of the common factors model, it's really worth looking up.
Um, I think it was Lambert in 1992. Um, I can't remember if there's any, I think he was the original that was then quoted and, and others have, have carried on that work. But essentially they were looking at thousands of lines of data in all of these research, um, studies and trying to figure out what brought about change and.
In that analysis, they came up with four primary areas, which I think are now at least five. And maybe that's changed again. Um, [00:52:00] but they're essentially identifying the therapeutic alliances as I think it was 30% of change. Um, double what, um, hope and expectancy are and, uh, double what the actual therapy, uh, is itself, is.
Um, and not that those are unimportant, but essentially you're talking about 15%, 15%, and then 30% of change. And then the last are extra therapeutic factors that 40%, um, are things that the client and family brings in themselves. Um, but 30% of change was attributed to that alliance that we have with them. And so, as an example, I, um, I was with a kiddo, not last week with, no, it was last week.
And, um. And, and he's really interesting. He'll tell me exactly what he's thinking and, and he's not always game. And, um, so I, I think I asked him, we were gonna play a game and I was just like, very first session I said, um, [00:53:00] I asked mom toward, toward the end, and he's just kind of playing on the floor with some stuff.
He's elementary age. And I said, um, I said, do you think he's aware that he stutterers? And he like, looked right up and he said, Nope. And so that was to me, the one piece of information that I got out of that session that was most helpful was, okay, we're aware to some degree, we don't wanna acknowledge it.
We don't wanna talk about it. And so then my goal became, how do I help loosen that up a little bit just to make some room for maybe talking about maybe doing something. Um, a few sessions later, I thought, all right. What if we throw in some stuttering on purpose? Let's just see what he does, if he's willing to do that or not as a, as a big tell for me.
And so I said, um, so we're gonna play, he wanted to play Uno, so we're gonna play Uno, and as we play, we're just gonna, you know, we can stutter as much as we want, or as little as we want. And he was like, I don't want to, I was like, okay, cool. I said, is it okay if I do? And he said, sure. I said, okay. So we played the [00:54:00] game and then partway through, I thought, all right, I'm gonna shift this a little bit more.
Um, and I asked him, so, so, you know, I don't stutter, so if you have any advice for me, any tips to make it better, just let me know. He's like, I, I don't have any tips. Cool. Okay. So we kept talking and later in the game he started saying, you need to do such and such. And I said, okay. And tell me a little bit more about that.
We did that. Um, and then later he stuttered and he said, did you notice that? And I said. Notice what, and he said, I stuttered. And I was like, oh, cool. And, and he started just throughout the game, being more willing to talk about it. Um, where he eventually not only stuttered more, which to me was a big win.
'cause he wasn't hiding that. But he talked about it and he brought it up to me. Big win. So that was, that was a month ago, the last session. Um, we were gonna throw in some stuttering to [00:55:00] a different game and he was like, I don't wanna do that. I was like, okay. And, but he said it was okay that I stuttered and then partway through, he didn't like how I was stuttering and he wanted me to stop.
And I was like, okay. So the rest of the, the rest of the session I decided, I really think we just need to build rapport. I think we, we just need to have some fun. We need to connect. And if we have some time to touch on a book later on, um, we'll do that. But I thought if we're gonna get anywhere, we just have to have that relationship.
And I think that is no matter what therapy you're doing. Is, is a key, key element. If you don't have a relationship with the child, if the child doesn't like you or doesn't wanna be with you, that is step one. And if that changes over time or if there's some new stress, um, kids are willing to engage in something difficult when they had that reservoir of, of trust, uh, and they had that relationship.
So if I have a kiddo who, um, really struggles with something, but we have all of these [00:56:00] positive experiences together, they're more willing to go there with me for a little bit because we have that. Or it's okay if I make them mad about something. Uh, because again, that's not our whole relationship. Now, if I find myself just struggling, struggling, struggling with them, if I have an agenda and they have a different agenda and we just keep clashing on that, it's not going anywhere, I'm gonna have to figure out how to adjust that to really build that relationship back or build it in the first place.
And that I would say. Regardless of what you're doing, that's where you start. If you're working with kids with autism, you have to have a relationship working on speech, sound stuff. Gotta have a relationship. Some kids are easier than others and some, uh, some areas of of work that we do are easier than others.
Um, but, but I, I'm so glad you asked that question. So I. Could nerd out on the nerd cast.
Kate Grandbois: I, I love it. It's like you, it's like you came to the right place. Imagine that. That's so great. Um, and I, you know, as you were talking, I'm thinking to myself, well, of, of course you need to have rapport because they're human thinking about myself.
I don't [00:57:00] wanna be pushed to places of vulnerability or in, in an environment where I'm not comfortable, where I don't feel valued or, you know, there isn't some, some feeling of, of safety. Right. I mean, I think that that's a, that's a natural piece of learning, learning on the fringes of our competency, learning, requiring vulnerability.
And if our jobs are to push kids, kids, right, not even full emotionally developed adults. If our jobs are to push kids to that edge in terms of learning, then we have to start there. I, I, I so appreciate, so appreciate that point.
Ana Paula Mumy: I just, um, wanna add, um, if you want to add this to the show notes, um, there's a, an article that I just love that I refer back to often by David Shapiro, and he's a person who stutters, um, an SLP, and um, also a professor, I forget now, which university, but, um, he's retired now.
But he, [00:58:00] um, wrote an article called Away Through the Forest, one Boy's Story with a happy ending and it. Came really from his own experience with therapy and, um, not feeling like he was connecting with his therapist or, or even like, understanding why am I here? What's this all about? And how one therapist finally kind of, you know, won him over in a sense of like being able to reach him where he needed or, or just to, you know, help guide him.
Um, and essentially the story just conveys, um, the power of therapy being less about speech and more about connecting with the person. Um, and it's just really beautiful. And how just, you know, he had identifies different components, um, that helped him the most as a young boy. Um, and I just think we can't say enough about that.
Um, so just a, a blog or, I don't even know if it was a blog. It was an article, um, that was written way, way long ago, but just [00:59:00] something that I go back to again and again.
Kate Grandbois: I've been taking notes the whole time we're talking, so anybody who's listening, driving, running, folding laundry, whatever, there will be a list of references and resources in the show notes for anyone to do any more nerdy reading should they so choose.
Uh, in our last couple of minutes, I'm wondering if either of you or both of you have suggestions for next steps for therapists who are listening, who are curious or, you know, having their own sense of vulnerability about getting started with bibliotherapy. Where, what, what words of wisdom, what suggestions do you have for, um, our listeners who might be new to this?
Daniel Shaw: I would say the, the Sparrow resource is a great place to start because it breaks a lot of it down for you. Um, I still reference it myself, um, when I'm grabbing a book. I'll just kind of, I just wanna have the categories in my head. Um. When I, when I get ready to go, uh, pick up [01:00:00] the, the next person. So I, I think that can be a helpful way, just as a guide.
Um, I, I think that a lot of the way that we learn and, and we all learn differently, uh, but we learn by imitation and then we, we sort of imbibe those things. We become those things and then we eventually make them our own. So when I first, um, really delved into counseling, I was asking questions, I was memorizing questions, I was writing them down.
I was trying to figure out how to guide myself down. Um, 'cause I didn't wanna get the question quote wrong. Uh, over time I became much more comfortable. I didn't need to write it down. I didn't need to because they were just there. And then eventually I found other ways to ask. So. When I asked the question earlier today, uh, about what's your brave meter?
I don't think I've ever asked that exactly that way before, but because I have the structure and some of the, the vocabulary and the the I concepts, then I could just sort of riff in different ways. Um, so you, you make it your own over time. So I, I think it's totally okay to [01:01:00] start there and just, just know that it's, it's hard to really predict where that's gonna go and how quickly it'll go there.
Um, but eventually it'll be your own, you'll be more comfortable with it, and it's just a matter of finding a place to start in a small way. And then if it's helpful, you'll do more.
Announcer: Mm-hmm.
Ana Paula Mumy: I'll just add one resource, um, that could also be helpful. There's one, um, called reaching In, reaching Out, um, which is about just really building resilience, um, and just helping children learn, um, skills that build resilience.
And so maybe, um. Directly talking about stuttering might feel uncomfortable, but everybody can talk about resilience, right? Like, you can talk about how do you bounce back from difficult situations? How do you, um, you know, just get stronger through things that are difficult? And so you could start there if that feels a little bit safer, um, if you maybe don't feel super comfortable.
[01:02:00] And it, um, I, I think they even have a suggested list of books as well, um, in terms of, um, just, you know, having this curated set of books that they recommend for, um, building resilience in children. And, and I think there's, um, some guides in terms of, or, um. Categorized by age and um, so on. So anyway, just another resource that might feel a little bit more comfortable if you are feeling, you know, apprehensive about tackling stuttering directly.
Um, but again, you know, this isn't just about stuttering. We're giving an example that's pertinent to stuttering, but you really could, um, use books with any, um, child that you're working with, um, to tackle, you know, difficult topics or to, um, help them think, um, differently or to expand, you know, their view about something, um, that maybe is impacting their communication.
Kate Grandbois: This has been really a wonderful conversation. I knew I was gonna learn a [01:03:00] ton and I did. No surprise. I so appreciate all of the thought and consideration to the importance of counseling through this discussion and using books as a, as a method. I You use the term springboard, Anna, Paula, and I just think it's such a great analogy.
Um, I hope everyone listening has is, has taken away the same, um, lessons that I have. If anyone, as I said, is listening while they're running, driving, what have you, all of the references will be listed in the show notes. If anyone would like to earn ASHA's CEUs for this episode, there will be a link in the show notes to do so.
Also, a quick shout out to our production team. Uh, this podcast is a labor of love and it truly does take a village. So thank you to our own Dr. Anna Paula Mui, who manages all of our, um, Asha relationships and makes CEUs possible. Tegan or Hern, our production manager who wears a million hats and keeps the project alive.
Darren Lopez, our production assistant who does all of our course materials. Tracy Callahan and Dr. [01:04:00] Mary Beth Schmidt, who both serve as consultants to help with our peer review process, all of our advisory board members who make sure our content is high quality. And of course, our two guests today, Daniel and Anna, Paula, you guys were really, really wonderful and this was a really great experience and I'm very grateful that you were here.
Thank you so much for being here. Thank you.
Daniel Shaw: Thanks for having us.
OutroSponsor 2
Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.
Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at [email protected]
thank you so much for joining us and we hope to welcome you back here again soon.
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