I get queries all the time from clinicians all the time asking me about me about why their school-age children who stutter aren’t motivated for therapy. I typically start by asking them about what their goals are for the child. The answer generally falls along the lines of “helping him learn to use easy starts (or some other technique) across various settings.” That is a reasonable goal, but I’d like to encourage clinicians to think of such a target as a process for achieving a goal rather than as a goal unto itself. For me, the real goals of therapy should have something to do with communication. What is the child having difficulty doing, with respect to communication, because of his stuttering. If we set the goal as helping the child communicate more easily, in whatever situations or tasks are important to him, then we tend to find that they are much more invested in therapy. So, rather than saying “child will use XYZ technique,” clinicians can work with kids to find out if they’re having trouble reading out loud or talking to friends at lunch or telling a joke or talking on the phone or solving problems at the board or giving their book reports. We then take those as the targets of therapy. Say to the child, “Today we will focus on making it easier for you to say what you want to say” and use the specific situations the child highlighted as your examples. Of course, the process for achieving that goal may involve using a technique (and, importantly, it may also involve helping the child learn to come to terms with and accept stuttering, desensitizing the child to stuttering, reducing tension and struggle in the child’s speech mechanism, helping others in the environment learn more about stuttering, etc…)… But, when the child sees that the purpose of therapy is to help him do the things he wants to do, he often becomes much more motivated. An analogy? The purpose of a diet is not to limit calories; it is to lose weight. Nobody would want to go on a diet whose sole goal were to limit calories…we want the product that comes from that process. In my opinion, many speech-language pathologists tend to get too focused on fluency and forget that there is a big picture out there – the child’s communication. If we keep our eyes on the real prize, then we (and the child) will better understand the reasons that we have to do various drills or other activities in order to help us get there.
So, how does this all relate to the OASES? Well, the OASES was specifically developed in order to help clinicians (and our clients – whether they be school-age children, teens, or adults) keep our focus on communication. The OASES is based on a model that puts daily functioning and quality of life at the forefront. Going through the OASES with my clients allows me to talk with them directly about what is affecting their lives, and then I use the results of the test to directly help me plan my treatment goals. We return to the OASES form often, talking about which aspects of communication are affected, and then we plan treatment activities aimed at minimizing the burden of stuttering that the test revealed. As we move through treatment, the OASES also helps me to document my treatment outcomes – what specific changes has the client experienced in terms of his/her perceptions about speaking, reactions to stuttering, ability to manage environmental or situational differences, functional communication skills, and, ultimately, quality of life. These are the things that matter to people (whether they stutter or not), so by addressing these topics, we find that our clients are far more motivated to actively participate in the therapy process.