The Cooke Book Approach

1. The Cooke Book Approach Individualizing Therapeutic Procedures for People who Stutter MSHA Conference - March 23, 2013 Presented by: Paul Cooke, Ph.D. Michigan State University Contacts: email - cooke@msu.edu phone: 517-353-8788

2. Learning Outcomes • Identify therapy principles and strategies • Identify 2 examples from each principle/strategy • Identify the decision making process to individualize therapy for people who stutter • Work through several examples of this process

3. Unofficial Learning Outcome Identify aspects from this presentation that are useful for other clients on your caseload

4. Underlying Principles • Clients are people with particular conditions • Various factors contribute to those conditions • Variability of current and previous behaviors • Holistic approach (NOT one size fits all) • Each client is a clinical research subject of 1 • Many techniques, narrow them down to fit the needs of the client

5. Goals for Therapy • Client moves to the next communication level • Increase probability of improving communication in meaningful speaking situations • Increase probability of client becoming their own clinician • Increase client’s control of speaking situations • Decrease the adverse influence of the condition

6. Keys to Clients Moving Toward Those Goals • Clinician-Client relationship built on trust: empathy self-congruence unconditional positive regard • Empowerment • Motivation • Therapy Format • Therapy Principles • Decisions to individualize therapy program

7. Fundamental Concepts • Every stuttering episode – excessive energy • Speech is a complex motor skill • Client can only implement 1-2 concepts

8. Therapeutic Categories • Environmental Changes • Fluency Shaping • Stuttering Modification • Stress Management • Transfer and Maintenance • Attitude Adjustments

9. Environmental Changes • Improve communication skills • Use child-directed speech • Be a parent • Emphasize client’s strengths • Forward looking, not past blame/regrets • Encourage communication • Balanced reactions to difficulties • Make talking fun • Transition times

10. Fluency Shaping Techniques • Smooth vs. Bumpy Speech • Diaphragmatic Breathing/Shorter Breath Group • Stretched/Prolong Speech • Easy Onset • Continuous Voicing • Light Contact • Passive Airflow • Exaggerated Movement • Mouth the words/Add Voicing • Focus on Word Endings/Say all Syllables • Electronic Devices

11. Stuttering Modification Techniques • Reduce Secondary Behaviors • Reduce Muscular Tension: Pull Out/Bounce • Control Stuttering • Preparatory Sets • Reduce Avoiding Behaviors

12. Stress Management Strategies • Stress Reduction Before Speaking • Stress Reduction During Speaking • Feeling Rushed/Pressured – Use the Flam • Dealing with non-changeable information • Dealing with the telephone • Dealing with oral presentations • Time Management Strategies

13. Transfer and Maintenance • 1-2 key concepts at a time • Get off to a good start • Start small • Start big • Integration of practice into everyday activities • Next level as a communicator: SMART goals • Using Tactile, Visual, and Auditory Prompts • Improving Pragmatics Skills

14. Attitude Adjustments • Paradigm Shift: changing a hub to a spoke • Acceptance • Assist others • Teasing/bullying • Positive self-talk • Locus of control • Proactive communicator • Journaling/Drawing/Converse with pets

15. Individualizing Therapy Plans • My examples • Youtube examples • Audience examples

16. Summary and Conclusions Review Learning Outcomes & Unofficial Learning Outcome • Identify therapy principles and strategies • Identify 2 examples from each principle/strategy • Identify the decision making process to individualize therapy for PWS • Work through several examples of this process • Identify aspects from this presentation that are useful for other clients on your caseload