Giving Honest Feedback

It is difficult, but essential, to provide honest, objective feedback regarding your client's performance when he or she has not succeeded to the degree you or they might reasonably expect. Most clinicians feel they are being supportive by withholding or "sugar coating" objective analysis of a client's performance. But by not being objective, clinicians undermine their credibility by denying unsuccessful attempts in therapy. The design of therapy is not to be successful all the time. In fact, that is an indication that the treatment objective is far too easy for the client and that the clinician is failing to push the client hard enough. Effective clinicians help their clients evaluate and judge their own successes and failures. In the therapeutic relationship, the clinician needs to establish a clear objective and assess each attempt in an impartial way so as the client clearly understands what is expected.

Three approaches are offered to assist clinicians in communicating feedback objectively and tactfully to clients.

DIRECT APPROACHES: Clinician initiates, giving information specific to the event
1.	Direct, to the Point -- Work with the Client's Reaction Clinician: "You didn't use your targets!" Client: "I know, but I tried." Clinician: "When were you first aware you weren't using them?"
2.	Drop and Fix Clinician: "You were speaking too fast; let's try to slow your rate next time by only speaking when you have initiated eye contact."
3.	Plus Two, Minus One Clinician: "I say good airflow; I noticed good eye contact; but it seemed you hurried too much."
4.	Objective-Based Feedback (Separating the behavior from the person.) Clinician: "I noticed that the airflow didn't start early enough."
SEMI-DIRECT APPROACHES: Feedback is provided by relating it to the event; seeks to elicit the client's initiation of the topic
5.	Self-Assessment Clinician: "What did you notice happened that time as soon as you began talking?"
6.	Comparative Clinician: "How did that differ from your success at the meeting?"
7.	Re-Take Clinician: "If you could do that again, what would you do differently?"
8.	Instructive Re-Focus Client: "My targets didn't work!" Clinician: "It seemed in this situation we need to work more on preparing to use your targets earlier."
INDIRECT APPROACHES: Clinician shifts focus of feedback to another aspect of the event
9.	Refocus Client: "My targets didn't work!" Clinician: "It must be very frustrating being able to do it some times and not at other times."
10.	Indirect Client: "My targets didn't work!" Clinician: "I've seen things to have worked better for you in other situations."
PRAGMATICS OF PRESENTATION Attitude: The clinician expresses the following attributes through his or her attitude -- a solid belief system (the way he or she thinks about stuttering and fluency therapy), honesty, sensitivity, goal-oriented, respectful, sincerity, sense of importance and urgency, and directness. Word Choice: The clinician selects words which succinctly, directly (vs. vaguely), matter-of-factly, consistently and tactfully enumerates how a behavior varies from the expectation. Body Language: The clinician purposefully maintains eye contact with the client; his or her body posture is slightly relaxed so as not to be perceived as threatening or attacking; gestures and facial expressions are used to communicate sincerity, directness and objectivity.
A FEW LAST WORDS Artfully critiquing a client's performance is a skill that develops with time, practice and experience. Clients will respect your honesty, even when it directly identifies their flaws. Honesty builds trust in a therapeutic relationship. As a clinician, your first responsibility is to facilitate your client's improvement. It is nice to be liked by your client, but it is not imperative, and certainly secondary to your success as a therapist.