Ethical Considerations in Stuttering Therapy: Balancing Autonomy and Beneficence

Blog by Tricia Hedinger, MS, CCC-SLP, BCS-SCF

When individuals first seek stuttering therapy, they often arrive with a simple and understandable goal: “I want to stop stuttering.” For many first-time clients, this statement reflects years of frustration, social pressure, and experiences in a world that often equates fluency with competence. However, this initial goal is rarely the full story. Part of the speech-language pathologist’s (SLP’s) ethical responsibility is to ask the right questions to help clients clarify what they truly hope will change in their lives if fluency increases. Is it greater confidence at work? More ease in social situations? Less fear of speaking up? Increased participation in school, relationships, or leadership roles?

Through thoughtful assessment and dialogue, clinicians can explore how clients believe improved fluency may positively impact their daily functioning and emotional well-being. This process opens the door to discussing multiple pathways for achieving those deeper goals—not only through fluency-focused techniques, but also through approaches that target communication participation, self-advocacy, emotional regulation, and acceptance. Ethical practice begins not with prescribing a single method, but with understanding the meaning behind the client’s goals.

At the heart of ethical stuttering therapy lies the ongoing balance between client autonomy and clinician beneficence. Autonomy supports the client’s right to make informed choices about their care, while beneficence obligates clinicians to recommend approaches that are grounded in current evidence-based practice (EBP) and likely to support long-term well-being. These principles are not opposites; when integrated thoughtfully, they can strengthen both treatment engagement and outcomes.

We must avoid placing the burden of decision-making on the patient yet remain attentive to their values and wishes. Individualized therapy is where this balance becomes most visible. Ethical, client-centered care does not mean simply following client preferences without guidance, nor does it mean rigidly applying a single preferred framework. Instead, it involves educating clients about current EBP in accessible, respectful ways and helping them understand how different approaches may align with their personal goals. When clients are informed about the range of therapeutic options available, their autonomy becomes more meaningful, and shared decision-making becomes truly collaborative.

Blended approaches are often particularly valuable in stuttering therapy. A client may seek increased fluency but be unfamiliar with strategies such as desensitization, cognitive restructuring, or stuttering modification. Introducing these approaches—while clearly explaining their purpose and evidence base—allows clients to consider tools they may not have initially imagined but that may strongly support their deeper goals of participation, confidence, and reduced speaking avoidance.

Ultimately, ethically grounded stuttering therapy is a flexible, collaborative process that centers on the individual. When SLPs thoughtfully blend client goals with evidence-based care, remain reflective in their practice, and resist relying solely on habitual or preferred approaches, they create space to honor both autonomy and beneficence in meaningful, responsive ways.

Beneficence is a fundamental ethical principle in healthcare and research, requiring professionals to act in the best interest of patients or participants to promote their well-being, prevent harm, and remove harmful conditions. It moves beyond merely avoiding harm (non-maleficence) to actively doing good through, for example, medical treatment, advocacy, or care.

Posted Feb. 17, 2026

CELEBRITY FOCUS

John Stossel

John Stossel is one of the most recognized and articulate reporters today. However, he once considered giving up his broadcasting career because of his stuttering.

“Fear of stuttering can easily become worse than the stuttering itself,” observed Stossel. “The idea that I’m on television and making speeches is still a shock to me sometimes.”

Bill Walton

From BillWalton.com

Thank you for your interest in my life long problem with my speech and communication skills. I was a very shy and reserved young man who could not speak at all without severely stuttering until I was 28 years old. Always a success in the classroom and on the basketball court, I took refuge in the things that I did well as a youngster. A straight A student, my athletic abilities covered the deficiencies that limited my overall growth and development. The game of basketball was my religion, the gym my church. It was a convenient way of avoiding my responsibilities of developing my human relation skills.

When I was 28, a chance encounter at a social event with Hall of Fame broadcaster Marty Glickman completely changed my life in so many ways that things have never been the same since, nor have they ever been better. That day, in a very brief, private conversation (one way, mind you, since I literally could not speak at the time) Marty explained, patiently and concisely, that talking, communicating was a skill not a gift or a birthright and that like any skill, whether it be sports, music, business or whatever, needed to be developed over a lifetime of hard work, discipline, organization and practice. Marty gave me some simple tips that day and then encouraged me to take those keys and apply them to methods of learning that I had received from the special teachers that I had come across in my life, particularly the 6 Hall of Fame basketball coaches that I had played for throughout my career. The beginning of my whole new life was as simple as that. No gimmicks, tricks or shortcuts. Just the realization that with some help, guidance and a lot of hard work that I too could do what seemed so easy, simple and natural to everyone else, yet seemed impossibly out of my reach and comprehension.

Frank Wolf

This Virginian congressman has served in the U.S. House of Representatives since 1981. The longtime supporter of the Stuttering Foundation drew national attention to childhood stuttering in 2006 when he submitted an article about Tiger Woods from the SFA newsletter to the Congressional Record. The congressman is featured in the Stuttering Foundation's Famous People Who Stutter brochure.

Darren Sproles

Darren Sproles, a former player for The Philadelphia Eagles, the New Orleans Saints and the San Diego Chargers, made history in 2007 when he became the first player in NFL history to return a kickoff and a punt for his first two NFL touchdowns in the same game. In 2021, he was selected to be inducted into the College Football Hall of Fame.

Bruce Willis

While the world knows Bruce Willis as an A-list actor, few know that he struggled with stuttering throughout his first 20 years.

Walter Bruce Willis was born in 1955 in West Germany to his German mother, Marlene, and his American GI father, David Willis. The family settled in David’s hometown of Penns Grove, New Jersey in 1957, and the couple has three other children.