#030: How to Address Communication Attitudes with Children who Stutter

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In this episode, I sat down with Kristin Chmela to talk about a role that we take on as SLPs: Counselling. Many listeners have reached out about this topic, because it’s something that we end up doing even if we aren’t really comfortable with it.

Clearly, it’s time for some education. 🤓

Thanks to a recommendation from fellow SLP Lauren LaCour, I knew that Kristin was the right person to break it down for us. She is an SLP, and also a board-certified specialist in fluency who spends the majority of her time working with individuals of all ages at her clinic — the Chmela Fluency Center in the suburban Chicago area.

Kristin has lectured on the topic of childhood stuttering around the world, is Co-Founder and Co-Director of Camp Shout Out, and has collaborated extensively with the Stuttering Foundation throughout her (very impressive) career.

I’m so grateful for everything she shared during our conversation!

So grab your beverage of choice (I’ll have a chai latte!), put your feet up, and listen in.

Key Takeaways

– Why counseling is so important for children with fluency disorders
– The top three tips for SLPs who are unsure of where to start when addressing communication attitudes
– Three examples of what “counseling” looks like in practice
– Camp Shout Out: What the program is, and how Kristin incorporates counseling in that setting
– The role parents and caregivers play in helping children develop healthy communication attitudes
– How we can set parents up for success throughout the treatment process

Links Mentioned in the Podcast

ChmelaFluencyCenter.com
The Stuttering Foundation
Basic Principle Problem Solving, Working with School-Age Children Who Stutter
The Stuttering Foundation Workbook by Chmela and Reardon
OASES (Overall Assessment of the Speaker’s Experience of Stuttering)
How to Talk So Kids Will Listen and Listen So Kids Will Talk by Faber and Mazlish (affiliate)
Counseling Persons With Communication Disorders and Their Families by David Luterman (affiliate)
CampShoutOut.org

Transcript

Marisha: Hi there, and welcome to the SLP Now Podcast. I cannot wait to introduce our guest today. Several listeners submitted questions related to a part of our roles that many of us frankly aren't as comfortable with. That role is counseling, particularly when it comes to counseling students who stutter. When these questions were coming in, I thought of Kristin Chmela. She was recommended actually by Lauren LaCour from Busy Bee Speech, because we were just chatting about like who could help break this down for us?

Marisha: So I cannot wait to dive in and ask her all of the questions that you have been asking. But before I do that, I just wanted to tell you a little bit more about Kristin. She is an SLP and she is also a board certified specialist in fluency. She spends the majority of her time working with individuals of all ages with fluency disorders at her clinic, which is the Chmela Fluency Center in the suburban Chicago area.

Marisha: She has lectured on the topic of childhood stuttering around the world, and she is the co-founder and co-director of Camp Shout Out, which is a therapeutic program for school-age children who stutter and a hands on training opportunity for professionals and graduate students. She's been very busy because that's not all.

Marisha: So throughout her career, Kristin has collaborated extensively with the Stuttering Foundation on training videos, conferences, publications. She's also the lead author of Basic Principle Problem Solving, Working with School-Age Children Who Stutter. So you've probably seen some of her work around there especially related to the Stuttering Foundation.

Marisha: Yeah, I cannot wait to dive into all of the practical tips and strategies related to counseling. But before we do that, Kristin, I'm really excited to hear a little bit about your experience as an SLP, and just getting to learn a little bit more about how you came to specialize in this area.

Kristin Chmela: Well, first of all, Marisha, I want to thank you for inviting me to be on this podcast. This is a wonderful opportunity for us to have a conversation about children who stutter, and of course, for us to reach many speech language pathologists who are helping children who stutter. Well, I can tell you that I graduated with my masters about 32 years ago, and I had no intention of working with people who stutter.

Kristin Chmela: I had started my own therapy when I was an undergraduate student at about the age of 19 for my own stuttering, and I became interested in the field, but I had no intention of going into stuttering. I took my first job in the schools and enjoyed it very much. And also got married and then started my family, and so I worked in the schools for a couple of years, first full-time and then part-time and I realized that I really wanted to know more about helping children who stutter.

Kristin Chmela: And so I went to my principal, and I said, "I think there's a need, and I would like to help fill it. And I'd like to learn more about this and be available for different therapists in the district if they need help." And so they asked me to do a workshop. I'll never forget that workshop. It was three hours long. And I thought, how am I going to do this? I've never even given a speech for five minutes.

Kristin Chmela: I really thought I was crazy when I got there that day and how I got myself into that, but I sat down and I started thinking well, what is it that we need to know and how can we help clinicians who don't feel comfortable with this disorder. This was the same back then as sometimes we hear now. And so I began doing some workshops, and I began consulting within my school district. I didn't know very much about stuttering, but yeah I think, because I grew up stuttering and I went to Northwestern University, which was a very well recognized university for fluency and stuttering at the time, I think people thought that I could share something.

Kristin Chmela: So, once I had a family, I started with the clients on my living room floor. And now as you've said in the introduction, I do run the Chmela Fluency Center and we do service probably about 60 to 70 fluency cases a week. So I've been really deep in this for a very, very long time. I think that I remember talking to my mentor, Dr. Hugo Gregory at the time, when I was a young clinician, he gave me a couple pieces of advice.

Kristin Chmela: One was, he said you can't really specialize in stuttering. There isn't enough work. I thought that was so interesting. So I began putting myself in positions where I got the clinical experience. And of course, now that's quite different. We can work in various settings where we do service more of this population. And the second thing he said to me was early in your career, you might be doing some things that perhaps people ask you to do, and there may not be great monetary value in that, but it will always come back to you.

Kristin Chmela: I will never forget that advice. I began providing some in service training and some collaboration for different organizations. And certainly, that was some very good advice that he gave me. So I was so interested in stuttering, I just got more clients and pretty soon that's what I was doing. I will say that I became a specialist over the years of work that I had put in before we even had specialty certification.

Kristin Chmela: I will say that my ongoing relationships with my mentors and various colleagues that I learned so much from when I used to teach for the Stuttering Foundation, those relationships really supported my skills as a specialist and the development of that. The other thing I want to mention is that many people think that I do a lot of lecturing and I was giving a seminar once and there were some women in the bathroom and I heard them talking and they said, "Oh, she doesn't do therapy. She goes around and lectures and teaches and publishes."

Kristin Chmela: And really it's the exact opposite. I spend the majority of my time at my clinic. I probably do at least 25 sessions a week by myself with clients. The other piece of advice that Dr. Gregory gave me was never stop treating the client. Never stopped doing the diagnosis and the therapy. Always keep your hand in it so that you can talk with people about how you are evolving as a clinician, all our latest clients, right? So I think that was very good advice as well.

Marisha: Wow, what an amazing mentor and what an amazing wealth of knowledge that you've just acquired over your career so far. It's kind of encouraging because you're here now and you have dedicated all of these years of experience to really learning so much about fluency. But you started out just like us, and you just kind of got on those bootstraps and just started exploring and figuring things out. I think that's encouraging because that means we can figure it out too. You're just an amazing guy to help us through that now.

Kristin Chmela: Sorry, Marisha. I thought you were done. The one thing that I firmly believe is that we can make a choice to keep evolving. I have felt that way about myself as a communicator, and I have felt that way about myself as a clinician. There's always things we can be learning from others. I won't stop evolving until I'm done, I guess my time on earth is done. Because I feel so strongly that we all have the potential to do that. As long as we keep doing the next thing and perhaps pushing ourselves maybe just slightly farther than we think we're capable, that is the makings of a great career, I think.

Marisha: Yeah, I love that, and that makes so much sense. And I could not agree more. So let's dive into all things counseling now. Before we talk about some more of the logistics, I'm curious, from your perspective, why is this such an important part of therapy when we are working with children who stutter?

Kristin Chmela: Well, the first thing I'd like to say is that counseling is important for all the children that we serve, all the clients that we serve. Because in order to provide genuine reinforcement, to help someone facilitate behavioral change, attitude change, we have to have a positive relationship. The definition I think of counseling begins with establishing that positive relationship.

Kristin Chmela: I do think that whenever we're helping any individual create change, that's our first priority. With that said, children who stutter, perhaps they can ... They do have a unique experience in that, number one, they're coping with a problem that is variable, and it doesn't always present itself. Some days are harder, some days are easier. The research shows that a very high percentage of children I want to say it's about 85% of children who stutter experienced some type of bullying, teasing, mimicking prior to the third grade. We also know from research that it is common for children to have more negative attitudes and emotions around themselves as communicators.

Kristin Chmela: The other reason why I think it's so important deals with the landscape of the problems. So there are external things we can observe with children who stutter. We can see them stuttering. We can see them starting to say a word, stopping, and then saying another word, or perhaps retreating from a situation. But there are also many internal aspects of the problem. The thoughts and the feelings, the amount of time, the child may be wondering if they can say the sentence on the paper that's coming, say the teacher is calling on children around the room, and they're already glancing down and wondering if they're going to be able to say it or not.

Kristin Chmela: I think that that piece of it makes it very complex, and yet I think if we think about many problems that people have, of course, there are internal features and external features to those. You will notice that as we talk about this, I tend to prefer to describe behavior than I use say labels for certain things. So, many individuals will say, well stuttering can be overt or covert. That person is a covert stutterer, meaning they hide the stuttering and they avoid and they don't communicate freely, whereas overt is the person that doesn't tend to do that.

Kristin Chmela: I really try to stay away from those labels. I think there are so many nuances to each of us. So, I do believe that counseling since I have started my career and have been in the field, I do believe that Dr. Gregory would be thrilled to see the progress that we've made in terms of talking about this, supporting children. It was a long time I think before we were able to recognize that these needs were just as important as the need to help children modify some communicative behaviors if that's what they wanted to do.

Kristin Chmela: I do believe and Dr. Gregory always told this to me that as professionals, we are the ones, speech pathologists are the professionals that can obtain and commit to getting trained in these areas and to best service these children. We are the profession that understands stuttering the most, and I'm not making a blanket statement stating that every professional in speech language pathology has the skills and the ability to do this, but we have the opportunity to develop those skills and to get that experience, and that we really are the ones that need to be addressing these issues unless they are out of the circle perhaps of what we would deal with.

Kristin Chmela: I had a client, for instance, whose father was so distraught because his son was stuttering. He also was a person who stutters, and the mother sent me a text. This is several years ago, and he had written a suicide letter and she had found it before it happened. And so obviously, that was something that was out of the realm of my scope of practice. And so of course, I made an immediate referral so that he could get help from another professional who was trained to deal with something like that.

Marisha: Yeah. Wow. I think that's part of what makes it a little bit scarier, because there are so many of those emotions and just different those negative attitudes that can be so incredibly strong. And so it makes it a little bit scary sometimes to start navigating that.

Kristin Chmela: One thing I want to say, Marisha, that is so important is that the more we learn about children, and what is a child who is eight years old, what is that child about? What is a 12-year-old child about? The more we read and understand the nature of the developmental stage of the child, I think the more successful we can be.

Kristin Chmela: I think that all of us come to this realization as we are helping counsel people, that emotions are normal and they are real and they are universal, and that a big part of our ability to approach this counseling aspect of our work is to also be working on our own feelings about things. The healthier we are, the more we can bring to the table that availability to create that positive relationship.

Marisha: Yeah, so powerful. Thank you for sharing that. I think you were starting to get into some tips that SLPs can use when they're starting to navigate this. So, let's just pick your three top tips. What three tips would you give speech language pathologists who are unsure of where to start and navigating that? I love what you said about kind of checking in with your own attitudes, like whether your own emotions, just your own emotional health in general, but I assume that applies to your attitudes about stuttering as well.

Kristin Chmela: Sure. Well, my first top tip would be to invest the time in the proper evaluation. What I mean by that, and I'm going to really address this more for the school-age child who perhaps is continuing to stutter, because we do exploration of these things differently for a school-age child and a teenager, but certainly for a young child as well. We take the time to understand, what does the child think about this? What do they think is going on?

Kristin Chmela: We usually begin that with some very informal questions as we're interacting. Do you like talking? Who do you like to talk to the most? What do you like to talk about? Is there anything about your talking that you think is not easy or is easy? Is there anything about it that you wish would be different? Many times, we get information from a child just through an informal, very non-threatening conversation, usually while we're doing something else. And then we may use some informal pencil paper tasks. These come from the Stuttering Foundation workbook, Chmela and Reardon, it's a nonprofit book.

Kristin Chmela: It's a very basic way of looking at some of this information. There are also some wonderful standardized measures for looking at the attitudes and feelings of children. One would be the OASES, so the Overall Assessment of the Speaker's Experience of Stuttering. There are different stages of development that OASES is appropriate for. There's one for elementary school children and then for teenagers, on up through adults. So the point is, and this is something that I continue to ask myself even to this day, do I know that about that child or am I making an assumption? Do I know that or is it an assumption?

Kristin Chmela: Many times a child will come in and have a particular situation that has happened or I will get wind of something from a school therapist or teacher, and I'll immediately assume the child might be thinking about that, worried about that, upset about that. When I talk with the child, it's completely the opposite. So it's taking the time to understand where that child is in terms of these perceptions and attitudes, as well as the parents' and others involved in the situation in the therapy process. That's number one.

Kristin Chmela: The one thing I will say that I think is very helpful for children, and I've mentioned this, but I'll say it again, is if you talk with them naturally while you're doing something else. You're not going to get a whole lot if you just look at a child and point blank say, "How do you feel about your speech?" Fine, is what they usually say or I don't know or nothing. But if we begin just asking some questions while we're doing something else, many times we will get more information. So, that's my first point.

Kristin Chmela: My second point is, which goes to what we were just talking about before, but a little bit more. If you want to engage in counseling with others, you must spend a little bit of time with yourself every day. The most basic way I can say this is to start your own mindfulness practice. I know the word mindfulness is used often now in many, many ways across many, many professions and disciplines. I am a meditator, and I just completed a 200 hour immersion and mindfulness yoga so that I could enhance my work with people who stutter.

Kristin Chmela: One of the things I think that's made a significant difference for me is committing to a daily 10 minute mindfulness practice that is my own. In doing that, we learn how to be compassionate towards ourselves and how to be perhaps less judgmental. Those are the characteristics or the qualities that we want to bring to the table when we have a child that is suffering, or parents that are suffering. We don't have to fix the problem. What we have to do is make space for it to come out, and we have to be able to validate it. And we have to be comfortable helping the individual move forward when they're ready.

Kristin Chmela: So, the best way to begin is by beginning with ourselves and committing to that 10 minute mindfulness practice. There are many apps and ways that individuals start that. I do think that mindfulness is going to be coming into our field more and more, I'm excited for that. But that would be the second very basic yet complex thing.

Kristin Chmela: The third thing is start with some resources. So, if I were to tell you the best resources that I feel could help any clinician, number one, it would be to read a very well known book by Faber and Mazlish called How to Talk So Kids Will Listen and Listen So Kids Will Talk. That book has been around since I was a very young parent. I studied the skills and concepts in that book. Many of them we adapted in our Stuttering Foundation book.

Kristin Chmela: But part of learning to counsel is learning the skills of how to talk with children, and how to get in with them. And so I would highly recommend that book. That is not a book in speech pathology. It's a book outside of our field. And then the other book that I would recommend is the latest edition of David Luterman's counseling book, which is within our field, he's an audiologist and has made significant contributions in the area of counseling families and others who have communication disorders.

Kristin Chmela: Along with that, the Stuttering Foundation has multiple resources that can assist a therapist in trying to understand where to begin, they have some trainings you can attend that will give you more insight into something called Acceptance and Commitment Therapy, and also Cognitive Behavioral Therapy. Those are approaches that help an individual learn how to relate to the problem in a different way. It helps us learn how to identify negative thinking and what to do about it.

Kristin Chmela: So those three things, I think, investing the time to thoroughly understand where the person is at, starting your own mindfulness practice, and going to some of these resources, those would be the top three. And then I'll just add number four, which is feel free to reach out to colleagues. Feel free to reach out to individuals that specialize in this area. Those of us that do are highly compassionate and passionate about this population and spend a lot of time supporting and assisting other clinicians in doing this work.

Marisha: I love all of those resources and such great places to start. I will share it because you mentioned a number of different resources that people might be able to find. So I'll put those in the show notes so that people can easily find links to those. It'll also give like a quick little recap. So that'll be at slpnow.com/30. So hopefully you are taking notes, but if you miss something, I've got the link for you.

Marisha: But yeah, I love those tips. And just because you've recapped them beautifully, but I just wanted to recap one more time because they were such helpful tips that investing in that proper evaluation is first using just like that informal conversation then some paper and pencil assessments. And then there's also standardized options like OASES, and then spending time with yourself.

Marisha: And wow, a 200 hour immersion sounds amazing. I want to learn more about what you did with that. But it doesn't have to be something crazy like that, we can just do like a daily 10 minute practice. Like you said, Kristin, there are some amazing apps out there that make that really easy to get started with. And then I love the books that you mentioned. Those would definitely help us get on the right track and those would help ... These strategies would help with our entire case load. So I love that that so much practical information there.

Kristin Chmela: Great.

Marisha: Okay, so I'm curious, if you ... Because I feel like we have a good place to start now. I feel like I learn best from just some examples. Would you mind diving into one or two examples of what counseling has looked like for you?

Kristin Chmela: Sure. I think that when we think about this notion of, how do we do counseling, what does this look like just like you said, the best way that I could create a picture of this for you is that the child is sitting in the room and perhaps it's a group of children, or it could be just one child, and I'm in the room. I usually never put anything in between the client and myself, so I never sit across from the table. I usually sit to the side and there's space to talk about things.

Kristin Chmela: I'm going to give you an example. We had a client that came in after he'd been gone for the summer. And he shared a story how he had been surfing, taking some surfing lessons, he was in about fifth grade. And the instructor began mocking his stuttering and called him a couple of names in addition to it. Our client was relaying this experience. First of all, this was not a child who was bullying a child. This was an adult who was bullying a child.

Kristin Chmela: He talked about this for about five minutes and he got very upset. And one of the most powerful things we can do as we're listening to a scenario like that, is make sure our arms and our legs are not crossed. And usually your feet are flat on the floor and your knees are bent, and you're just leaning a little bit forward. Sometimes your hands are in your lap, but they are open. When your palms are up, that is a very receiving body posture. Carl Rogers talked about this as joining, it's a joining body posture, which is communicating that you're not afraid of what's coming at you, and that you can handle it, and you're allowing space for the person to share it.

Kristin Chmela: When he was done sharing this story, and he was emotional, and of course on the inside, I'm absolutely furious at what I'm hearing, what I said to him was the first thing I want to say to you is how sorry I am that this happened to you. That is probably one of the most powerful things we can say to any person who was in distress and sharing an experience is how sorry we are that that happened and just allowing some silence.

Kristin Chmela: So sometimes when there's a situation that suddenly comes up, and we don't know what to say or what to do, most likely, it's because we're not supposed to say anything except listen and just be comfortable with that moment and just say how sorry we are. After that, I think we talked about what kinds of feelings really came with this.

Kristin Chmela: With children, one of the things that's so powerful and I learned this from Faber and Mazlish, if you give them some options, they will tell you exactly how they feel. Were you mad? Were you sad? Were you disappointed? So, he was able to share what those emotions were. For us just to validate those, it's okay to feel that way. That's very normal. That's very normal. So, that is one example of what counseling might look like.

Kristin Chmela: Another example is, I had a high school client come back, and we start ... She's really struggling, really thinking a lot about her speech during the day, not wanting to participate, not feeling comfortable talking in her classes. So, sometimes a piece of counseling is gathering information and getting some education about something that's going on. So we just made a list on a piece of paper. I said, take me through your schedule. Okay, the first class is this, your second class is this.

Kristin Chmela: She named all the classes, including lunch and whatever else. And then I gave her a rating scale. I said, okay, on a one to 10 scale, how much are you talking in each of these classes? We went through that. And then I said on a one to 10 scale, how worried are you about talking? And then she made the ratings. And so we were able to identify, I'm sorry, let me add one more thing after that. I talked about a rating of how comfortable are you with the teacher in these different classes?

Kristin Chmela: We came up with two different classes where she felt she had a high level of comfort with the teacher. And she also felt she had a peer in the class that was supportive, and we were problem solving and deciding, okay, how can we honor what you're feeling right now and be moving in the direction that you want to be moving in, which is to talk when you want? There's such a psychological ramification of an individual wanting to share something and holding it back, wanting to share something and holding back. That's that fight or flight response that we do not want to be conditioning over and over again in the brain.

Kristin Chmela: So we came up with one particular class. And again, we took the time to have this conversation. And so what was decided was that she would go ahead and email the teacher and let the teacher know how uncomfortable she is still feeling and with the teacher meet with her for a few minutes each week and talk with her individually to help move her in the direction of participating in the class like her peers are doing. That's another example of counseling.

Kristin Chmela: One of the things that we talk about with children and that we also work on ourselves is refining the ability to notice versus evaluate. So when we're evaluating, when the child is evaluating, the parent is evaluating, that's a judgment. It's what we think about something and it's good or it's bad, versus noticing behavior. For example, we may engage the child in some type of speaking situation that they're working on within the therapy room. And then we're asking the child to give his or her own feedback.

Kristin Chmela: We're giving feedback and we've made a rating scale, and we will use this language often, what is it that you want me to notice? And how can I give you that feedback? So we talk a lot about noticing what went well, and then noticing what the child might want to consider feeling a little bit more in his or her body or hearing as they're communicating. And we talk a lot about, it's hard for anyone to identify their thoughts around something.

Kristin Chmela: I think lots of times the emotions come first, and then we can get to the thinking around it. We talk a lot about the difference between that thought where I was evaluating, I stuttered, I didn't do a good job, versus what were you noticing about what it looked like and how would you want it to be different. So, those types of conversations are also pretty typical.

Kristin Chmela: The one thing I want to say is there are many children that really have a resilience about themselves as well as perhaps a different ability to monitor internally and also those social cues. They may have some moments of frustration, but they may not present as other children who have a significant amount of anxiety around their inability to communicate at times, and that's why it's so important that we ongoing check in with children.

Kristin Chmela: Sometimes I'll use a little wheel or I'll make something up on paper just checking in or any situations, did you feel something was a big success this week? Did you worry in a situation? Did you find yourself not talking as much as you wanted to? So, we may also have some conversations like that. Often, I've learned over the years, one of the greatest ways to get in with kids is to do things they don't expect. So lots of times I'll use material that they wouldn't expect, and do something sort of creative.

Kristin Chmela: Nothing spectacular, but I tend to I know this is giving away my age, I tend to not really use technology when I do therapy, because I really want the child to connect with me and connect with my face and to connect with, I want to feel that from their body. So I tend to use things that are real that we can touch. We do a lot of art sometimes if I have a child that likes art.

Kristin Chmela: I'm thinking of another child I worked with. She really started developing some fears about talking. She's a third grader and I knew she loved art, so we started during the session doing a little bit of painting. While we were painting in a very organic way, she started telling me something and I noticed her have a moment of stutter and she sort of turned away and kind of covered her mouth with her hand. I just very gently said, "It's okay. It's okay. It's okay for you to talk any way you want in here. And it's okay if you stutter. And perhaps as you're talking, if you feel a little bit of tension, see if you can hold on to my face with your eyes. Just try it. You'll get bigger than the stutter."

Kristin Chmela: She sort of looked at me and she began doing that, and her whole reaction to the stutter had changed. This is a bit of what we call desensitization. Every time it happened, I reinforced her. I love how you're just talking, we don't teach these children skills, and then they apply them and it's fixed. That's not how the game works with this disorder. And that's the most probably confusing part about it. What we want is for the body to experience things over and over.

Kristin Chmela: In my yoga training, we call it japa, the word japa, J-A-P-A, doing a little bit of something every single day over time creates something different in the body. It's experiencing how does it feel to let a stutter happen, but let go of the reaction and just observe it. That's so desensitizing. Over time, how does it feel to hold on to my face and what courage that took? I ask children often and this is part of counseling.

Kristin Chmela: I have a high school client, I said to him, "Do you have the courage? When you're in a block that's bigger than you want it to be, do you have the courage to stop for a second and hold the space? You're the one in charge in the conversation box if you're talking. Do you have the courage to do that and just feel, get in your body and then move on." It's this idea of how can we separate that emotional action to the moment of the stutter? And over time, how can we counter condition that fight or flight response in the brain?

Kristin Chmela: That's also what counseling looks like. Boy, I have so many situations every single day. One of the things that I will tell you, another part of counseling is making sure to set the child up to be successful. And if something happens, problem solving it, so it's understood by the child. Let me give you an example. So I had a particular client, who was not receiving services through an IEP, and the teacher wanted the child to do a reading fluency exam for comprehension. And the child said to this teacher, this is a child who's in fifth or sixth grade said to this teacher, "Oh, I can't do that. I can't read fast like that. I stutter."

Kristin Chmela: The teacher sort of brushed it off, and said, "There's no IEP saying that you don't have to. So you have to." And the child did this measure and did not have a positive experience. So what had to happen after that, that that was not okay. Because to the child, the child was put into a situation where she felt completely powerless, and was very upset after it happened. And so what we had to do then is go back and have a meeting with the child and the teacher and say, "Well, probably you weren't aware, but that's a measure that we will not be using, unless the child wants to."

Kristin Chmela: We had to have some kind of repair because the teacher didn't do it maliciously, she just said there was no accommodation in front of her and so she moved on. And so when situations occur, we go back and we problem solve with the adult in front of the child, if the child is comfortable, so that the child learns how to advocate for him or herself. That is critically important and it's a part of counseling as well.

Marisha: I love all of these example. It's so incredibly helpful and you just describe it in a way where I feel like I could imagine you and the student and the whole situation so incredibly powerful. Thank you for giving us some insight into your therapy space. So I'm curious too, because you do a lot more with therapy than one on one sessions.

Marisha: You also have this thing called Camp Shout Out, and I'm curious. I'm just curious in general about learning more about that program. I'm curious if you incorporate ... How you incorporate those elements of counseling in more of that group setting or is there a mix?

Kristin Chmela: Well, Camp Shout Out is, I smile when I think about it, we're going into our 10th year.

Marisha: Wow.

Kristin Chmela: The camp began when a parent approached me and a special recreation organization actually began in the Chicago area and then I moved the program to Michigan with a colleague to collaborate with her. But I was called and they asked if I'd be willing to do a camp, and I'd never been to camp, I've never thought about camp. I was always too afraid to go to camp. I was afraid to go places where I didn't know people, because they wouldn't know that I stuttered.

Kristin Chmela: And so I said yes. I think I was recovering from major surgery when they call me. And I said yes. And then I said, "I'll do a camp. And if I'm going to do it, I'm also going to make it an opportunity for clinicians and students to learn more about stuttering." That's how it began. This camp has evolved incredibly, and I think that if anything, any colleague that is involved in this camp, and that has been for the past several years will attest to the fact that perhaps I model what we teach, which is that we all can keep evolving.

Kristin Chmela: This camp brings together about 60 children from across the world who stutter, ages eight to 18 and then as well as the trainees from grad schools and also speech pathologists. I have about 11 people on my leadership team that are all highly immersed in fluency work that come to act as facilitators and we interact with the children in a regular overnight recreational summer camp environment. We all stay at the camp.

Kristin Chmela: What we do basically is we take, we create and utilize multiple opportunities every single day to set children up to feel power as communicators. That's really what we do. We obviously approach the therapeutic element a bit differently for the younger children versus the older children. But we do talk about what I call the five areas of focus of a competent communicator. These are all action related.

Kristin Chmela: They are starting with our thumb attentive, assertive, confident, effective and proactive. We often use the hand as a symbol for those. I'm actually working on an eBook right now about these five areas of focus. But what we do is we create opportunities for children to communicate, and they identify and work on speaking situations. The older children run the whole camp basically, when it comes to what do we need to do to get this day to work, all the announcements, they do presentations.

Kristin Chmela: So, there are multiple opportunities to stretch themselves as communicators. We also have the opportunity as many organizations do, and of course, there are many good things out there for children who stutter now, we have the opportunity for children to meet other children who stutter and to feel like they are not alone, and that they come to camp and they feel normal. They feel like it doesn't matter if they stutter or not. There are some kids that stutter more than them. Some kids that stutter less. I think that in itself has a therapeutic element.

Kristin Chmela: Throughout camp, we also engage in very specific activities to help children learn about emotions, about communicating emotions, and having those validated. I'll give an example once with the younger children, we had a huge canvas and we drew a silhouette of a body on the canvas. And then all the children gathered around the canvas and we were talking about how when we experience different emotions, usually they're somewhere in our body and where do you feel?

Kristin Chmela: We talked about a different emotion, let's say, anger, where do you feel that in your body and then they would place something on the part. We also talked a bit about how emotions can feel like they're a certain shape and a color. What might that be for you and about the importance of breathing in to difficult emotions. And some of this comes from Acceptance Commitment Therapy. Jane Hurley from the Michael Pollan Center runs a wonderful conference at Boston University, teaching clinicians about some of these ACT concepts.

Kristin Chmela: So, that would be an example of an activity. We had a very riveting discussion group this past summer with our older campers about what we call the imprint experiences, what was something that has happened to you that you think you'll never forget that was either really positive or really difficult around your stuttering? That was a very eye opening conversation. It was so intense that when it ended, nobody moved. So I got up and I realized no one's moving. So I just sat back down on the grass.

Kristin Chmela: What was incredible was to watch the children and how they shared, and then they supported each other and allowed each other the opportunity to be emotional just to say, basically, we've got your back. I think that's really powerful. When you can bring together a group of people and create this general community of reinforcement that is so powerful, this makes a big difference in terms of counseling children.

Kristin Chmela: The other thing that we stress in a very highly energetic and positive way, is the importance of cultivating a mindset around this disorder, and that you may stutter sometimes and it is a really smart idea to keep evolving as a communicator. That's what every smart person does, whether they stutter or not. And so we try and bring this concept as well, which I think also is a counseling aspect of dealing with this disorder.

Marisha: Wow, that sounds like such an amazing experience. Yeah, I'm excited to learn more about that. We are running a little bit close on time, but I really wanted to squeeze in this last question if that's okay with you.

Kristin Chmela: Yeah, of course.

Marisha: So, what role do parents play in like, how you bring in your patients' or your clients' parents, and if you have any suggestions in terms of how speech therapists might be able to do this in the schools?

Kristin Chmela: Yes. Of course, parents play an essential role. Whether it's a parent, it's a caregiver, it's someone else that is important in the child's life or it's someone else working at the school that you can engage in the process. There are times where in the school setting we don't get the parents in. But I think engaging with another adult can make a significant impact on the child and in the child's life.

Kristin Chmela: I think what's important is that we invest the time in allowing parents to talk about what this is like for them, and how they are feeling and to be able to also let them express those feelings and emotions and validate those coming from the parents as well. I think that there are different opportunities for parents to meet other parents. I have known clinicians that have gone the extra mile and started a parent group right in their school district and had all the parents of children who stutter from the different schools come together once a month.

Kristin Chmela: I think providing them education is very important not just sending them to a website, but giving them something or exactly what you want them to read, so that you're comfortable with the philosophy of what they're reading and what it says is very important and also helping them understand that it's okay if their child is experiencing some discomfort or they're having a hard time and modeling for them how to sit with the child, or how to respond.

Kristin Chmela: We have obviously in private practice, if someone is bringing the child, sometimes it's tricky to get parents and believe it or not, I do a lot of tele practice work as well and sometimes I do set up individual meetings with parents just so I can make sure that I'm aware of what's going on. I think that their approach to the problem models for the child how this is basically. It takes an awfully strong parent to walk into the ice cream store and stand right next to his or her child and watch them stutter and finish, and stand there proud.

Kristin Chmela: I think we take clients out to do these different speaking situations and we often model for parents how they can do that, and I think helping them keep the lines of communication open with their child talking about the speech sometimes. Every parent I think wants the best for their child and helping them recognize they're doing the best that they can. And I have to remind myself often to praise and reinforce what the parent is doing, because they need that reinforcement just as much as the child does.

Marisha: Yeah, I love those points. So, some of the takeaways there for me were just investing the time in those relationships and leaving space for the parents to talk about what it's like for them, expressing their feelings, validating that, providing opportunities to meet other parents, providing education.

Marisha: I love just the little insight that you gave with modeling how to sit with a child and just how a parent can model to their child about what that experience is and what that means, and then always praising and reinforcing. I think those are some really amazing takeaways. So, we are wrapping up on our time together. I'm curious if you had any last pieces of wisdom or anything that you wanted to share that we didn't get to yet.

Kristin Chmela: I think the last thing I'd like to say is that I believe that I have developed the counseling skills that I have through going through my own personal counseling, through attending and learning and doing different courses that focused in on counseling, and also through self-reflection. Self-reflection is something that's hard to do, and it's the greatest learning opportunity.

Kristin Chmela: So, when something would happen with a child, a client, a teacher or a parent, I would sit back and at first sometimes I would be saying something about the other person as we so quickly can do. And then I would step back and I would say, what was my part in that? What was it about that that caused me to react this way? And what am I going to do differently next time?

Kristin Chmela: That's probably the best piece of advice I could ever give anyone. When we begin to self-reflect, we understand our responses and we become more compassionate towards ourselves. It allows us to show up for the other person. I really enjoyed this, Marisha. I could talk with you for a long time about this. And of course, I so appreciate you committing this time to helping children who stutter.

Marisha: Yeah, and thank you for all of your wisdom and advice. I know I definitely took a lot of notes and I'm excited to be able to implement and start practicing some of these strategies myself, and I know that the other SLPs listening will be in the exact same boat. And then before we officially wrap up, where can people find out more about you?

Kristin Chmela: Well, they can go to my website at chmelafluencycenter.com. They can also go to campshoutout.org. Those would be some good places.

Marisha: Okay, perfect.

Kristin Chmela: I do need to probably learn more about these types of mediums and the social media and the things that the young person is using so much now. As soon as I stop working so much, I'm going to devote some time to that.

Marisha: Yeah. Well, if you ever want to chat, I'm happy to dive into all of those things. Yeah, you've provided so much wisdom and advice here. Like I said before, I'm so incredibly grateful and thank you for taking the time out of your busy schedule to share that with us. And yeah, that's all that we've got for today. So if you want to, head to slpnow.com/30, that's where you can find all of the show notes and resources that Kristin mentioned during our conversation today. And yeah, we'll see you next time. Thank you.

Kristin Chmela: Bye-bye.

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Hi there! I'm Marisha. I am a school-based SLP who is all about working smarter, not harder. I created the SLP Now Membership and love sharing tips and tricks to help you save time so you can focus on what matters most--your students AND yourself.

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