More psychologists should work with people who stammer

Image

Caption

Silviya

Psychologist Dr Silviya Doneva argues that closer ties between her profession and speech & language therapists would give people who stammer better support.

For a long time, stammering has been understood primarily as a speech difficulty, with support traditionally sitting within the speech & language therapy profession. Therapists have developed extensive expertise in understanding stammering, supporting communication and helping people tо explore different ways of speaking.

However, stammering is highly complex, and what is seen on the surface is only part of the picture.

With stammering having been recognised more recently as a neurodevelopmental condition, it is also starting to be understood as a legitimate form of speech difference. One that needs to be acknowledged and respected. This broadens the focus from how to make speech more fluent, to educating others, fostering stammer-friendly environments and considering how it impacts on the person beyond their speech.

Psychologists are increasingly supporting marginalised voices as allies, collaborators and advocates for social change.

So, if the field is moving in this direction, it raises the question: why aren't more psychologists working in this area, including alongside speech & language therapists?

1. Stammering can take a real toll on mental health

There's a growing body of research showing that stammering can negatively impact on one's mental health. People who stammer might experience a range of negative emotions on a daily basis including fear, shame, guilt, anger and hopelessness. Stammering is also associated with recurrent patterns of negative thinking, suicidal ideation and conditions like anxiety and depression.

However, you don't really need research to understand why.

Constantly anticipating speaking, wondering how it's going to come out, monitoring yourself and trying to manage other people's reactions can take its toll. Additionally, one might start avoiding situations, holding back, feeling on edge before speaking, or experiencing negative emotions after stammering.

Speech & language therapists are often attuned to these experiences. However, it's important to note that the strategies they use are tailored to the client's communication goals. For example, offering support around speech-related anxiety so that the client can use a particular speech technique more confidently.

A psychologist, instead, is a highly trained mental health professional who works on reducing a client's psychological distress and promoting their psychological wellbeing. Psychologists can assess and treat a range of conditions such as anxiety, depression and trauma, support clients through emotional and relational challenges and help explore their deep-seated patterns using evidence-based, person-centred techniques. 

It is brilliant to see that more people who stammer are talking openly about the benefits of accessing psychological therapies. For instance, John, in his article 'How psychological therapies help with my stammer'. 

2. The problem is not just the speech, but also the social world around it

People who stammer are not only navigating differences in speech, but also a world that expects communication to be fluent, quick and effortless. And that matters more than we often acknowledge.

Research has shown that many people who stammer experience stigma, reduced employment and educational opportunities, and financial difficulties. Many also describe experiences of being interrupted, feeling misunderstood and being perceived as less capable. Lots find themselves avoiding opportunities altogether.

It is a common misconception that psychologists only work in mental health services.

This is where a social justice-informed perspective becomes important. The social model of disability helps us recognise that the difficulty does not sit solely within the individual. But that is also shaped by societal expectations, norms and reactions around the person who stammers.

Importantly, psychologists are increasingly supporting marginalised voices as allies, collaborators and advocates for social change, including within the neurodiversity-affirming movement.

Given this, it would be highly beneficial for psychologists to join speech & language therapists in working collaboratively to promote more inclusive communication environments, challenge systemic barriers and help dismantle stigma around stammering.

3. Psychologists already do this kind of work, just rarely with stammering

It is a common misconception that psychologists only work in mental health services. In reality, Clinical and Counselling Psychologists across the NHS routinely support people living with:

• long-term physical health conditions
• neurological conditions
• neurodevelopmental conditions.

In all of these areas, psychologists often work collaboratively with other professionals to help people and their families make sense of their experiences, manage distress, build resilience and improve their quality of life.

There is an opportunity to think more broadly about the needs of people who stammer.

In the context of stammering, psychological input can sit alongside speech & language therapy to ensure care is aligned with the person's wider needs, beyond communication. Together, professionals can help individuals expand their lives around the stammer, reconnect with their values, and build on their strengths to support their confidence and self-expression (even when they stammer).

Interestingly, individuals might also start seeing positive changes in their speech as they begin to feel more confident and more at ease with themselves.

Final thoughts & call for collaboration

As we are entering a new era for stammering therapy and research, one that is gradually moving away from a sole focus on fluency, there is an opportunity to think more broadly about the needs of people who stammer.

This includes advocating for social change, challenging unhelpful societal norms, and paying closer attention to the mental health and wellbeing of people who stammer.

I believe psychologists have a lot to offer in all of these areas, and I hope for psychological input to become more routine in the field, as it has for many other conditions.

Speech & language therapists bring essential expertise in communication and stammering itself, while psychologists bring complementary expertise in emotional wellbeing, neurodiversity and systemic thinking.

This piece is also a call for collaboration between the two professions, so more people who stammer receive the holistic support they need.

Dr Silviya Doneva is a UK-based Clinical Psychologist offering specialist psychological support to people who stammer. She is also a person who stammers and a Senior Lecturer in Clinical Psychology at the University of Hertfordshire (views expressed here are her own). If you would like to contact Silviya, email us at editor@stamma.org and we'll pass your message on.

Read more Your Voice articles. 

Would you like to write an article? See Submit Something For The Site or email editor@stamma.org for details.