368 Section III • Treatment of Stuttering

TABLE 16.1 Discussion Prompts for Identifying What and How Adolescents Can Make Changes That Are Personally Meaningful


Example Question to Ask

What they want to change

■ What would you like to see different about stuttering or how you live with it? I’m interested in what you want, not what you think your parents or teachers might want for you.

■ What are the pros or benefits of making this change? ■ What are the cons or drawbacks of making this change?

Why this change is important to them

■ What makes you think that this might be a good time to make this change?

How ready are they to make this change

■ The steps I plan to take in changing are… ■ The ways other people can help me are… ■ I will know that my plan is working if… ■ Some things that could interfere with my plan are… ■ What I will do if the plan isn’t working…

What steps they can take to make this change

change ) suggests that a person’s readiness to change hugely impacts their engagement in the change process and, ulti mately, how durable their change is over time. In this theory, as seen in Figure 16.1, there are five stages of change, rang ing from precontemplation (where the person is not at all ready to change) to maintenance (where they have stuck to a new behavior for at least 6 months). People tend to move through the stages dynamically or nonlinearly, meaning they can make progress, regress, and then progress again— multiple times over. As people re-cycle through the stages, they tend to move through the stages more quickly with each cycle and the change that results tends to be more durable. More information about the stages of change and its applica tion to adolescent stuttering therapy can be found in papers by Zebrowski et al. (2021) and Rodgers et al. (2021). Research has shown that it’s best to start a change journey with the tar get behavior that the client is most ready to change or finds most important to their well-being (Prochaska et al., 1994). Once they have started to make changes in that primary domain and start noticing signs of progress, they will likely feel more confident that they can address other domains that at first seemed too far out of reach. STUTTERING WITH GREATER EASE Most young people who stutter want talking to be easier. They may think that stuttering itself is what makes talking hard. But in reality, stuttering does not have to be hard nor does it have to make talking hard. Vivian Sisskin, a well-known stut tering specialist and pioneer of Avoidance Reduction Therapy for Stuttering (ARTS), distinguishes stuttering from struggle (Sisskin, 2023). Stuttering is not inherently struggled. Often, it is all the things that stutterers do to avoid stuttering that makes stuttering and talking struggled. For example, one

What would you be doing instead?” Perhaps they share that they would participate more in school, be more outgoing, or have better friendships. From these responses, you may say something like “It seems like participating in school is impor tant to you. Do you think it’s possible to participate more in school even if you still stutter?” This helps them focus on what’s important to them rather than on how fluent they are. It also plants seeds of acceptance where they start to consider that they can achieve what they want, with stuttering still a part of who they are. Additional SFBT-style prompts you can offer are: “What would more fluency/less stuttering mean to you? What difference would that make? How would you be different? How would your life be different?” These questions also open up possibilities that they can achieve their goals even if they still stutter (Rodgers et al., 2020). When confronted with the question about what they want to change, some adolescents may not know what they want or have difficulty expressing it. In this case, you can offer some evidence-based domains of change that Dr. Tricia Zebrowski and I have identified in our research (Rodgers et al., 2021; Zebrowski et al., 2021). Based on our interviews with adoles cents who stutter and stuttering specialists, we found three overarching behavior changes that are relevant to many teens who stutter: 1. Making speech changes to talk or stutter more easily 2. Developing more positive thoughts and feelings about stuttering 3. Reducing avoidance of sounds, words, situations The clinician can offer these three behavior changes and then ask them: “On a scale of 1-5, how important is each of these behaviors to you? Which one do you think you’re most ready to start with?” A prominent theory of behavior change known as the transtheoretical model (commonly known as the stages of

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