Speech Pathology — Advice Letter to an Adult who Stammers on Starting Therapy
A speech-language pathologist writes an advice letter to a 28-year-old man who stammers, following his initial assessment, explaining the therapy approach, the self-management strategies introduced, and what to practise before the next session. This is a beginner case focused on warm, clear, patient-centred communication.
Letter type
Advice
Write to
Patient
Target length
170–190 words
The case notes
Patient: Mr Ethan Blake, 28 years old; trainee teacher; has stammered since childhood; referred by GP after increased severity following job stress
Assessment findings: SSI-4 (Stuttering Severity Instrument): moderate severity; predominantly repetitions and prolongations; secondary behaviours: head nodding and eye avoidance on anticipation; avoidance: avoids telephone calls, raises hand to speak in meetings but withdraws; self-assessment: 'my stammer controls me more than I control it'
Therapy approach discussed: Acceptance and Commitment Therapy (ACT) approach alongside fluency strategies — addressed the avoidance cycle; therapy is about living fully despite the stammer, not eliminating it; supported willingness to stammer openly
Strategies introduced today: (1) Voluntary stammering — intentionally stammer on a sound to reduce anticipatory anxiety and demonstrate control; (2) Pausing before speaking — reduces time pressure and secondary behaviours; (3) Smooth starts — begin words with a gentle vocal onset, not abrupt push
Practice for next session: Practise voluntary stammering in one low-risk situation per day (e.g. ordering coffee, speaking to a colleague); record observations in the therapy diary
Next session: In 2 weeks; will review the diary; introduce the CALMS approach to telephone calls
Task: Write an advice letter to Mr Blake explaining the therapy approach and the strategies to practise before his next session.
Writing task
Write an advice letter to Mr Blake explaining the therapy approach and the strategies to practise before his next session.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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The therapy approach: ACT-aligned — about living fully alongside the stammer, not eliminating it, and reducing avoidance
Setting the therapeutic frame is the most important thing the patient takes from the first session. A patient who expects elimination of stammering and instead receives acceptance-based therapy will be confused and may disengage. The letter reinforces the frame.
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The three strategies with brief descriptions: voluntary stammering (to reduce anticipatory anxiety), pausing before speaking, smooth starts
The patient needs these in writing — the session content is new and often partially retained under the anxiety of the first appointment. The advice letter serves as a take-home reference.
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The specific practice task: voluntary stammering in one low-risk situation per day and recording observations in the therapy diary
A specific, do-able task converts the session into an action. 'Practise stammering' is too vague; 'stammer deliberately when ordering a coffee or speaking to a colleague once a day and note how it felt' is the instruction the patient can follow.
Leave out
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The SSI-4 severity score and the clinical assessment findings
The assessment is in the clinical record. The advice letter focuses on what the patient does next. One line of positive framing — 'your therapy starts from a good understanding of how your stammer affects you' — is appropriate; the score is not.
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A description of the CALMS approach
This is next session's content. Introducing it now overloads the patient. 'In your next session, we will introduce strategies for telephone calls' is the correct forward reference — one sentence.
Criterion in focus · Genre & Style
A stammering advice letter must be warm, respectful, and empowering — never clinical or distancing. The patient has shared something vulnerable about how his stammer affects his professional and personal life. The tone acknowledges this: 'You described feeling that your stammer controls you more than you control it — our therapy focuses on shifting that experience.' The letter is not a clinical summary; it is a continuation of the therapeutic relationship in writing.
Now write the letter — and find out what is blocking your Grade B
Write a 170–190 words advice letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.