asha disclosure statement

“Counseling Skills for SLP’s Working with Children With CAS,” Presented by: Amy Skinder-Meredith, PhD, CCC-SLP, October 20, 2015, Sponsored by: CASANA

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ASHADisclosurestatement• My name is Amy Skinder‐Meredith. I am an Associate Clinical Professor employed by Washington State University in Spokane, WA.

• Disclosure:

• Financial‐ I provide workshops for CASANA and receive an honorarium for these workshops. There is no honorarium for this seminar.

• Nonfinancial‐I am on the CASANA advisory board.

CounselingSkillsforSLPsWorkingWithChildrenwithCASAmy Skinder‐Meredith, Ph.D., CCC‐SLPWashington State University‐SpokaneDept. of Speech and Hearing Sciences


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TimedAgenda• 10 minutes –Introduction to the many meanings of ‘counseling’ in the profession of speech language pathology while being mindful of our scope of practice

• 10 minutes‐ The art of listening

• 15 minutes – How to empower caregivers of children with communication disorders

• 10 minutes‐ Introduction to the Wellness Perspective and the PERMA model and how it applies to children with communication disorders

• 5 minutes‐ Role of neurotransmitters and how to set an environment where decreased stress and better learning can occur

• 20 minutes‐How to empower the child with the communication disorder

• 20 minutes for Q and A.

LearningObjectives

• Attendees will be able to explain three roles of counseling in communication disorders.

• Attendees will be able to explain the PERMA model and how it relates to helping children with communication disorders.

• Attendees will be able to explain two ways to help empower families and their children with communication disorders.


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Alittlebackgroundaboutme:

• Exposure to mental health issues before having the tools

• Commitment to becoming comfortable with the uncomfortable

• Belief that suffering is part of life and it is our job as humans to help reduce the suffering (Dali Lama)

Counseling‐ASHAScopeofPractice(2015)• SLPs counsel by providing:

• Education

• Guidance

• Support


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Counseling‐ASHAScopeofPractice(2015)• Individuals and their families and caregivers are counseled regarding:

• acceptance

• adaptation

• decision making about communication issues and related disorders.

Counseling‐ASHAScopeofPractice(2015)

• The role of the SLP in the counseling process includes interactions related to:

• emotional reactions

• thoughts, feelings, and behaviors that result from the communication disorder


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Counseling‐ASHAScopeofPractice(2015)

SLPs are expected to engage in the following activities in counseling persons with communication and feeding and swallowing disorders and their families.

• Empower the individual and family to make decisions related to communication issues.

• Educate the individual, family, and related community members about communication disorders.

• Provide support and/or peer‐to‐peer groups for individuals with disorders and their families.

Counseling‐ASHAScopeofPractice(2015)• Provide individuals and families with skills that enable them to become self‐advocates.

• Discuss, evaluate, and address negative emotions and thoughts related to communication disorders.

• Refer individuals with disorders to other professionals when counseling needs fall outside of those related to communication and feeding and swallowing.


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• Counseling= • present, here and now strategies for coping with life and current problems,

• learning model used to help client understand self, beliefs, feelings, and how these things affect behavior, adjustment to a specific situation or circumstance

• Psychotherapy=• Attempts to restructure personality; sees client as being ill

• We are NOT psychotherapists

DistinguishingbetweenCounselingandPsychotherapy(Shames,2000)

Howcounselinghasbeenusedinspeechpathologyandaudiology‐Luterman


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Counselingbyinformation

Typical CD model is from the medical model

Get information to make diagnosis and then give information on what diagnosis is and what to do about the CD

What does this imply about dealing with feelings?

Counselingbyinformation

Advantages for the clinician:

Makes us sound professional and smart

Safe‐we can control the interaction

Avoids feelings that are unpredictable and messy

Disadvantages for the families/clients:

All of that information can be overwhelming and clients remember little of what was told to them

What they do remember is the emotional tone set by the clinician


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Counselingbypersuasion Assumption‐ we know what is best for the client and can

make a better decision for them than they can

Advantages for the clinician

Control

Get people to see things our way and do what we want them to do

Disadvantages for the family/client

Validates their feelings of inadequacy

Prevents them from owning the problem and the solution

They’re inclined to leave things to the experts

Counselingbylisteningandvaluing

The client is viewed as a capable human being, able to make healthy decisions for him or herself

We help the family/client become more congruent with their intellect, feelings, and behavior

Risky/scary part: invites clients and their families to express their feelings


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TheArtofListening

• The majority of counseling revolves around listening.

• We listen in different ways at different levels and we communicate to other persons that we’ve heard them.

Roger’sandSullivan’sFiveLevelsoflistening1. Pre‐occupied – mind is elsewhere 2. ½ listening and ½ answering before speaker is

finished, we begin to talk 3. Listening and evaluating from our own frame of

reference 4. Listening and evaluating from other’s frame of

reference 5. Listening and attempting to communicate that

we’ve understood.• Let’s the person know we’re with them and are trying to understand

•Requires withholding judgment


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Kroth’smodeloflisteningA. Passive listening ‐silent, minimal encouragers‐

they’re paying attention and are engaged.

B. Active listening ‐fully present and engaged, reflects feelings, offers clarification, but does not try to solve problem for person.

C. Passive non‐listening ‐hear the words, but not the underlying message; mind is elsewhere.

D. Active non‐listening ‐pick at threads of conversation but avoid central issue; different agendas; may wait politely till person finishes their statement then say what they wanted to say; may interrupt and pick up on incidentals.

FACILITATIVEINTERVIEWINGBEHAVIORSANDLISTENINGSKILLS(SHAMES,2000)


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BeginningtheConversationOpen Ended Close ended

• Open ended questions and instructions provide the client with maximum latitude on where to begin talking and what to say.

• They are excellent tools for starting an interview and encouraging the person to tell their story because they allow the client to begin with whatever is foremost on her/his mind.

• They are non‐directive strategies because the clinician makes no assumptions about what topic to choose or in what direction the conversation should go.

BalanceofOpen,thenCloseEndedQuestions• Direct questions that ask for specific pieces of information from a client.

• Closed questions have their greatest value when we need to obtain facts and specific pieces of information.

• When paired with open invitations, closed questions can help to define a topic and the open question can elicit more information on that topic.

– Examples?

• Go from closed to open, rather than from open to closed.

• Also note that we wait for the client’s response before asking our follow‐up question.


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SilentListening

• Silence in a therapeutic relationship has many meanings and can be a valuable tool.

• Sometimes the best help we can give someone at a particular moment is to say nothing and to keep listening.

Activity• Begin with an open ended question to get your partner talking, such as: “Tell my what your day has been like.

• Once your partner starts talking, limit yourself to nonverbal listening behaviors such as eye contact, head nods, and facial expressions.

• Once your partner has run out of things to say wait 5 seconds before you may ask another question or make a brief comment. This will force you to wait just a little longer in case your partner has more to say.

VerbalFollowing

• Verbal following combines silent listening and repeating verbatim into one very effective listening tool.

• With verbal following we listen carefully to what the client says and then repeat back a few words of the message.

• This strategy

– helps us pay attention and follow the content of the client’s message;

– shows respect for the client’s ideas, feelings, and language of expression; and

– encourages the client to keep talking.


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MinimalEncouragers• Minimal encouragers accomplish what the name implies: they encourage a client to talk with minimum interruption or influence by the clinician.

• Once the client begins to talk, the clinician uses well placed comments that do not interrupt the client’s thoughts, yet encourage the client to reveal more.

• Common encouragers include “um‐hm, hmm, I see, yes, I’m not sure I understand, Tell me more about that.”

• We really need to be listening to provide the appropriate response.

ParaphrasingContent• With paraphrasing content, the clinician repeats in her/his own words, something the client just said.

• With paraphrasing content, we reflect back the content (facts, events, etc.) of a message, not the feelings that underlie the message.

• This strategy allows us to act as a mirror and reflect back to the client the message s/he communicated.

• When clients hear their own message reflected back, they can amplify, clarify, revise, and confirm the content of the message.

• Additionally clients often gain added clarity and understanding of an event or situation in their lives by hearing it reflected back to them.


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SummarizingContent• While paraphrasing content involves responding to a small chunk of information, summarizing content involves paraphrasing longer segments of a client’s message.

• A summary usually takes the form of a short, succinct rephrasing of a long message.

• Summarizing one topic and then moving the conversation in a different direction is often referred to as “summarize and redirect.”

• A well placed summary lets the client know that indeed, we were listening to their long response and it gives them a chance to clarify any inaccurate information that we might have.

ReflectingFeelings

• With reflecting feelings, we move away from the objective content to the emotional message, or the feeling tone, underlying the content of the client’s message.

• As we reflect the feeling tone, we try to convey acceptance of the client and whatever feelings s/he may choose to express, without judging.

• Reflecting feelings requires us to pay attention to boundaries between the client and ourselves so that we accurately reflect the client’s feelings and don’t project our own feelings onto the client.


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FeelingWords

afraid, ambivalent, angry, confused, cautious, depressed, desperate, disgusted, ecstatic, edgy, embarrassed, failure, fantastic, frustrated, frenzied, gloomy, guilty, haggard, happy, ignored, impatient, inadequate, indifferent, intimidated, irritated, jealous, lonely, lost, mad, melancholy, mellow, misunderstood, nervous, numb, optimistic, overwhelmed, patient, pessimistic, positive, pressured, relieved, restless, sad, scattered, skeptical, stupid, tense, tired, unsure, weary, wistful, worried

Realisticexpectationsoflistening

• We can’t listen actively all the time.

• Listening is hard work and emotionally draining.

• Sometimes all you can give is 5 minutes, but give it fully and it will be appreciated!


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EmpoweringCaregivers‐TheHelpingProcess

CharacteristicsoftheSuccessfulFamily(Luterman,2008,P.177‐178)1. A successful family is one that feels empowered.

• Children do better when families feel the ability to help the child themselves.

2. In successful families the self‐esteem, especially of the mother, is high.

• Find parent friendly programs that the family can do at home and have the parent share their success stories with you.

• When they have the tools, denial, if an issue, will no longer be necessary.

3. In successful families there is a feeling that the burden is shared.

4. Successful families need to make philosophical sense of the situation.


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EmpoweringCaregivers• Motivational Interviewing‐

• MI is about arranging conversations so that people talk themselves into change, based on their own values and interests.

• MI is collaborative, honors client autonomy, is evoking rather than installing

(Bryant, 2015‐TEAM presentation)

• What are the goals for their child and how are you going to guide them get there?

• Case example: I want my child to communicate verbally, but I don’t want them to use AAC or they will never be verbal.

EmpoweringCaregivers• Help them find an advocate. (PAVE)• Provide families for them to connect with and talk to.

• Share CASANA resources!• Help them find meaning and purpose .


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HelperCharacteristicsthatFacilitateGrowthoftheCaregiver(Helpee)(Brammer&MacDonald,2003)

Empathy

Principle route to understanding clients and allowing them to feel understood

• Understanding the caregiver doesn’t do much good unless we communicate back to them that we understand

• With empathy we try to see the world from the helpee’sinternal frame of reference without losing our own identity and objectivity

• Criterion for success of empathy: the helpee can use the helper’s empathic understanding from her/his own self‐understanding and to solve own problem.


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WarmthandCaring

• Warmth=friendliness and considerateness that is communicated through smiling, eye contact, and non‐verbal attending behavior.

• Caring=more enduring and emotionally intense than warmth; showing compassion and genuine concern about the welfare of the client.

• This in turn creates trust.

• Issue: how to communicate closeness, caring and concern without emotional entanglement.

• Need to gauge amount of expressed warmth and caring according to helpee’s comfort level.

HelperOpenness

• Early goal of helper is to encourage the client to disclose thoughts and feelings freely.

• Self‐disclosure of client is related to openness of clinician and trust is directly related to how open the helper and helpee are with each other.

• Paradox: too much self‐disclosure from the clinician confuses the issue of who is helping whom (boundary issue)

• General guideline: helper reveals only enough about self to facilitate helpee’s self‐disclosure.


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Helperpositiveregardandrespect

• An attitude that reflects deep concern for the client’s welfare and respect for their individuality and worth as a person

• “Unconditional positive regard” = nonjudgmental deeply valued attitude (Rogers)• Most humans are not capable of perfect unconditional

regard

• The key is ‘non‐judgmental’

• Check in with your implicit biases with Harvard’s Project Implicit

Helperconcretenessandspecificity

• Key condition for accurate communication is the attempt to be specific rather than vague and general

• Helper needs to use specific language and encourage clients to use specific language especially when expressing difficult and painful feelings


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CommunicationCompetence

• The act of helping another requires clear communication.

• Through the act of helping, the helper clarifies the client’s sentences, gives them better ways to describe themselves, and provides them with sharper, clearer thoughts about their problem.

HollandandNelson’sWellnessPerspective(2013)Goal: develop optimism and resilience


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FiveThemesofCounselinginCommunicationDisorders:AWellnessPerspective

1. Wellness and Positive Psychology

– Learned optimism vs. learned helplessness

– Making a fulfilling life

– Sometimes includes reframing

2. Living the Catastrophe

3. Who are the Experts?

–Social model: “..the disability itself is hardly a problem of a disabled persons alone; it also is a substantial result of living in disabling societies.” p. 6

FiveThemes

4. The Importance of Stories

– Telling one’s own stories is part of healing

5. Crisis

– Kubler Ross stages Denial, Anger, Bargaining, Depression and Acceptance

– Webster and Newhoff’s terms

• Shock

• Realization

• Retreat

• Acknowledgement


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Client’sfamilywillneedtodothefollowing(Holland,2007)

• Grieve what has been lost

• Understand what has happened

• Develop coping strategies and increase resilience

• Make peace with the disorder

• Make sensible adaptations to the disorder

• Capitalize on strengths

• Live life as fully as possible!

PERMAPerspectives

• Positive Affect regarding:

• Past

• Present

• Future

• Engagement, absorption, immersion, flow

• What activities bring the family joy?

• The challenge is life often revolves around therapies.

• See HAPPY, the movie


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PERMAPerspectives• Relationships‐ involvement with others, sharing kindness, being there

• How can we help the child and family build relationships with others?

• Meaning‐belonging to or serving something bigger than oneself

• Accomplishment‐pursuing and achieving a goal for its own sake

• The child with CAS needs to feel a sense of accomplishment just like any other person.

TheStoryofDannyKeefe

• http://s1.legalinsurrection.com/wp‐content/uploads/2013/11/danny‐keefe‐bullying1.jpg


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TheRoleofNeurotransmitters(Burns,M.(2013).ThethreeC’sofneuroscience:ClinicalApplications)

https://encrypted‐tbn3.gstatic.com/images?q=tbn:ANd9GcRsxo62s8i8sgZ9WGEolsTKIbR_7BRoDCyXbqCkjhdAmBWKCqY8qw

Acetylcholine• When getting a child’s attention, you are essentially

getting an uptake of acetylcholine.

• Children tend to get easily distracted and day dream.

• If we want learning to occur, we need to get their attention.


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NorepinephrineandDopamine• Making things novel helps with increasing norepinephrine and dopamine for the ‘wow’ effect.

• This helps learning.

Dopamine

• Dopamine is the save button on the computer. It says, yes, this was important and you better hold onto it.


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Serotonin• Serotonin levels are important because they help the child from getting anxious.

• We need to make them feel comfortable and safe for learning to occur

Anxiety• According to BC Mental Health:

• Anxiety is the most commonly occurring mental disorder in children, youth, and adults.

• All anxiety is characterized by intense fear, anxious arousal, irrational thinking, and avoidance

• Types of anxiety disorders in youth

• Separation anxiety

• Social anxiety (school phobia)

• Selective mutism

• Generalized anxiety

• Panic

• PTSD

• OCD

• Specific phobias


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TheCycleofAnxiety

Scary situation

Avoidance

Child is rescued from situation

Accidental reinforcement

Child increases avoidance of scary situation

EmpoweringChildren


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DecreasingAnxietyOften, adults try to save the child from their anxiety by avoiding anxiety producing situations OR we do the opposite, and dismiss their anxiety. We may tell them to ‘buck up.’ The answer is in the middle.

• Instead, coach the child through anxiety producing situations to build their resilience and self‐confidence.

HELPING CHILDREN WITH ANXIETY‐ INFORMATION FROM AIMEE KOTRBA, AUTHOR OF

Selective Mutism: An Assessment and Intervention Guide for Therapists, Educators & Parents

DosandDon’ts• DON’T reassure an anxious child

• e.g., You’ll be fine. You always make friends easily.

• DO validate their feelings

• You look a little worried. Are you nervous about asking her to play? It’s normal to be a little anxious.

• DON’T pass on your anxieties.

• E.g., I always hated reading in front of class. That’s the worst. Are you nervous?

• DO help the child tolerate his or her discomfort.

• E.g., I know this is difficult for you. You just have 5 more minutes to go.


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DosandDon’ts• DON’T be overprotective or encourage avoidance of difficult situations.

• E.g., My goal is to help you get comfortable with being uncomfortable.

• DO cheer them on.

• E.g., Wow, you just said hi to that new kid. That was a brave thing to do.

• DON’T be over controlling.

• DO reward the coping behavior

• Any steps showing progress

• Child could earn ‘bravery bucks’ to purchase a prize

Strengthentheresiliencemuscle

• Label the anxiety or call it the ‘worry monster’, so the child can distinguish it as separate from themselves and fight back.

• Challenge the child to go longer periods of time of doing what is uncomfortable when you feel they are ready for it.

• E.g., You waved at the new kid. Now go over and see if they’d like to play.

• Help the child see that when they do something despite their anxious feeling, that the anxiety eventually settles down.

• Anxiety is physiological and it does eventually quiet


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Usefultools

• Yoga

• Meditation

• progressive relaxation

• use of biofeedback

• Self‐talk

• Cognitive behavioral therapy http://www.cliving.org/biodots.htm?gclid=Cj0KE

QjwtO2wBRCu0d2dkvjVi5cBEiQAMEIVGaF85wDhIdpj9MdxMIYl055tn3TowfE9FZOuWosPjPoaAuV68P8HAQ

EmpoweringPhrasestoTarget• I can do it. (not just, ‘help me.’)

• Do you need help?

• I need more time.

• My turn now?/ Your turn.

• Wanna play?

• Me too.

• Not me.

• Not now.

• I feel sad/happy/mad/afraid/proud.


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Empoweringchildren

• Let them know they are not alone.

• Provide opportunities for them to socialize with other kids with communication disorders.

• Pair with kids whose strengths compliment each other.

TheirJob/OurJob

• It is the child’s job to try.

• It is the therapist’s and educator’s jobs to provide the tools that help the child be a successful learner.


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Good watching Good listening Good talking(clear and slow)

Activity 1

Activity 2

Activity 3

Activity 4

Fill in each space with a smiley face or + sign for when they gave their best effort in that activity for the target behavior and a sad face or – when you know they could do a lot better at the end of each activity. Determine your criteria for them to earn a reward (e.g., anywhere from 80%-100% positive depending on the child.) Rewards can take many shapes (e.g., prizes, play time, etc.). Work with the parents on deciding the most appropriate and motivating reward for the child. Speech is hard work. Modify this form in anyway you find fit for the child you are working with.

Somekidsneedalittlemoremotivation

Assessstrengths,character,andvirtues• How would you feel if every assessment report you read only listed your child’s deficits?

• VIA Institute on Character‐online test• http://www.viacharacterblog.org/on‐using‐via‐strengths‐to‐help‐your‐child‐succeed‐in‐school/

• Authentic happiness‐University of Pennsylvania• https://www.authentichappiness.sas.upenn.edu/questionnaires/brief‐strengths‐test


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CHARACTER STRENGTHS AND VIRTUES(Holland,2014,p.44)

• Strengths of Temperance

– Forgiveness/mercy

– Prudence

– Humility and modesty

– Self‐regulation

• Strengths of Transcendence

– Appreciation of beauty and excellence

– Gratitude

– Hope

– Humor and playfulness

– Spirituality (religiousness, faith, purpose)

Can we focus on what is right about the child versus what is wrong? Here is a list of strengths to consider.

CharacterStrengthsandVirtues

• Strengths of Wisdom and Knowledge

• Creativity

• Curiosity

• Open‐mindedness

• Love of learning

• Perspective

• Strengths of courage• Authenticity

• Bravery

• Persistence

• Vitality

• Strengths of Justice• Citizenship

• Fairness

• Leadership


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Perfectionvs.Excellence• Perfectionism is NOT a healthy character trait.

• Working hard, learning from mistakes, and a willingness to move forward is.

• Promote films like Meet the Robinsons, that make this message clear

http://bplusmovieblog.files.wordpress.com/2012/07/meet-the-robinsons-5.png

EncourageInternalLocusofControl• Locus of control=another way to look at responsibility

• People with inner locus of control assume responsibility for own behaviors, feelings, and happiness.

• People with external locus of control see fate, luck, others, higher power, etc. as responsible for their own behavior, feelings and happiness.


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Intrinsicvs.ExtrinsicGoals

• Intrinsic Goals ‐have to do with one’s development, more spiritual in nature, developing a meaningful philosophy in life

• Extrinsic Goals ‐have to do with wealth, status, and good looks

• Which one is more apt to be happy in the long term?

• Interesting blog from Psychology Today: https://www.psychologytoday.com/blog/freedom‐learn/201001/the‐decline‐play‐and‐rise‐in‐childrens‐mental‐disorders

LocusofControl• “One thing we know about anxiety and depression is that they correlate significantly with people's sense of control or lack of control over their own lives.

• People who believe that they are in charge of their own fate are less likely to become anxious or depressed than are those who believe that they are victims of circumstances beyond their control. ” (Peter Grey, 2010)

• https://www.psychologytoday.com/blog/freedom‐learn/201001/the‐decline‐play‐and‐rise‐in‐childrens‐mental‐disorders


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BullyProofing(Yarus,2015)• Kids with communication disorders are more likely to experience bullying that other children (Hughes, 2013)

• Some key points include:• Educating the child and their community about bullying

• Allow the child to educate his classmates about his communication disorder

• Teach the child to own their communication disorder and be unapologetic about it so that the bully doesn’t get a rise out of them. Work on scripts to help the child respond to bullying.

• For example, “Yeah, so I have a hard time talking. I know.”

• “I have apraxia, but it doesn’t have me.”

• (http://apraxia‐kids.org/webinars/view/48/Helping_Children_with_Communication_Disorders_Minimize_Bullying)

CreateaCulturethatAccepts,Supports,andEmbracesDifferences

• It is not always an option to be 'different', to feel this way or be perceived this way. How we respond to these differences is.

• If we can connect with others with an open mind and heart the disease of loneliness will be greatly diminished and our souls will be enriched.


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InConclusion

• Our role is to be a collaborator, advocate, listener who empowers the client and their family.

• We do this by listening, validating, affirming and moving locus of control from outward to inward.

Questions?

• Thank you!


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Recommendedwebsitesandresourcesrelatedtopositivepsychology

http://www.authentichappinesshttp://www.authentichappiness.sas.upenn.eduBrief strengths test:https://www.authentichappiness.sas.upenn.edu/questionnaires/brief-strengths-testHappy, The Movie- http://www.thehappymovie.com/The Virtues Project- http://www.virtuesproject.com/Virtues Reflection Cards -https://virtuesshop.com/index.php?option=com_virtuemart&page=shop.product_details&flypage=flypage.tpl&product_id=45&Itemid=53Project Implicit https://implicit.harvard.edu/implicit/takeatest.html

ResourcesonbullyingbyScottYarus• http://apraxia‐kids.org/webinars/view/48/Helping_Children_with_Communication_Disorders_Minimize_Bullying

• https://www.youtube.com/watch?v=GywCzVfe7xA

• https://www.youtube.com/watch?v=x12YeYOu4nU&feature=youtu.be

• https://www.youtube.com/watch?v=pbaIbKEE_Jo&feature=youtu.be


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ReferencesandSuggestedReading

• Brammer, L. M. and MacDonald, G. (2003). The helping relationship: process and skills (8th ed.). Boston, MA: Allyn & Bacon.

• Dali Lama and Cutler, H. C. (1998). The Art of Happiness. Riverhead Books, Penguin Putnam Inc., New York, NY

• Holland, A. & Nelson, R. (2014). Counseling in Communication Disorders A Wellness Perspective 2nd edition. San Diego, CA, Plural Publishing Inc.

• Kotbra, A. (2015). Selective Mutism An Assessment and Intervention Guide for Therapists, Educators & Parents, Eau Claire, WI, PESI Publishing & Media.

• Kotbra, A. (2015). When Anxiety Gets in the Way: How to Understand and Work Effectively with Anxious Children. Webinar on Speech Pathology.com http://www.speechpathology.com/slp‐ceus/course/when‐anxiety‐gets‐in‐way‐7046

• Kroth, Roger (1975). Communicating with parents of exceptional children: Improving parent‐teacher relationships. Denver: Love Publishing.

ReferencesandSuggestedReadings

• Luterman, David (2008). Counseling persons with communication disorders and their families (5th ed.). Austin, TX: Pro‐Ed.

• Lutterman, D. (2008). Sharpening Counseling Skills DVD from The Stuttering Foundation

• PAVE Partnerships for Action. Voices for Empowerment. http://wapave.org/

• Peck, S. (1978). The Road Less Travelled. Touchstone Simon and Schuster

• Remen, R. N. (2007). Kitchen Table Wisdom Stories that Heal. Riverhead Trade

• Seligman, M. E. P. Authentic Happiness http://www.authentichappiness.sas.upenn.edu/Default.aspx

• Shames, G. H. (2000). Counseling the Communicatively Disabled and their Families: A Manual for Clinicians. Boston, MA: Allyn and Bacon.

• Spillers, C. (2008). An existential framework for understanding the counseling needs of clients. American Journal of Speech Language Pathology. Vol. 17, 191‐197

• Tanner, Dennis (2003). The Psychology of Neurogenic Communication Disorders A Primer for Health Care Professionals. Boston, MA: Allyn and Bacon

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