370 Section III • Treatment of Stuttering

deserves! A video of Dean Williams working with a teen is available on Lippincott Connect. It is titled, “Dean Williams helps a student stutter more easily.” Identifying Moments of Stuttering Once the adolescent has developed a clear understanding of speech anatomy and physiology, and has experimented with modifying tension on different target sounds and words, it’s time to help them identify when and how they actually stut ter. Many young clients (and adults who are new to therapy, too) will initially have difficulty with identifying stutters on the fly, so we need to scaffold initial skill acquisition to help them become good observers. I usually start away from the client (understanding other people’s stuttering) and then gradually work toward their own real stutters. Perhaps you could watch YouTube videos of people who stutter and work together to identify stutters in their speech by raising your finger when you see one. Then, pause the video and you and the client both try to imitate the stutter, followed by brief description of where in the speech mechanism it was pro duced and what type of stutter it was (repetition, prolonga tion, block). Once the client has showed that they are able to identify moments of stuttering in these recordings of others and can describe where and how they are produced, the next step could be you producing pseudostutters in conversation with the client, prompting them to raise a finger when they notice you pseudostutter, and then describing where and how you pseudostuttered. You do not need to make your pseu dostutters really hard and struggled. I once had a 13-year-old client tell me that she was uncomfortable when her previous clinician pseudostuttered because the clinician did it with a lot of physical struggle; the client thought, “is that what I look like when I stutter?” So, before you pseudostutter with a client, it is helpful to gauge their comfort with you pseudos tuttering and if they give you the go-ahead, know that you can make your point by pseudostuttering confidently and without a lot of struggle. After the client has demonstrated success with identifying your pseudostutters, it’s time to move to the client’s own stut ters. Some clients are willing to be videorecorded in the ses sion and then watching it back right away with the clinician and identifying their own stutters offline. However, watching recordings of oneself can be confrontational and uncomfort able, even for people who don’t stutter. So, if the client does not want to do this step, then by all means skip it and move to the last step where the client tries to identify their own stutters as close to in real-time as possible. Have them try to raise their finger when they notice themselves stuttering. The type of stimuli you use to elicit a conversational turn from the client in this activity depends on how frequently they stutter. For clients who stutter very often, you may get real stutters by eliciting shorter phrases. For clients who stutter less fre quently, you may need to elicit longer responses or increase the communicative stress by having them explain something

complex or take a stance about a controversial topic. Ensure that the topics and stimuli are relevant to their life—their interests, hobbies, school topics. Two notes about semantics here. First, in the spirit Dean Williams, it is useful to talk about stuttering as something the speaker does, not something that happens to them . If stut tering is something they do, they can do something differ ent about it; if stuttering is something that happens to them, then they likely feel at the mercy of stuttering, which robs them of making any choices about it. This type of active language is not intended to blame the client for the stut tering, but rather to instill a sense of autonomy. Second, if you are not a person who stutters and you are stuttering on purpose during an activity, it is more accurate to call what you’re doing pseudostuttering or voluntary stuttering rather than stuttering. This sends a subtle signal to your client that you respect their stuttering experience as something that is unique to them and the stuttering community. Often, well intentioned listeners and clinicians will attempt to console people who stutter or normalize stuttering by saying things like, “everyone stutters sometimes.” Everyone is disfluent sometimes, but not everyone stutters sometimes. Holding, Tolerating, Then Easing Out Once the adolescent has demonstrated knowledge of when, where, and how they stutter, they can start to figure out ways to reduce tension in moments of stuttering to ease out gen tly. At this stage, it’s helpful to stay in stutters for longer than usual so that they have time to turn their attention inwards and focus on how it feels in the moment. Most people who stutter will do whatever they can to get out of stutters as quickly as they can; stuttering can feel uncomfortable, stress ful, embarrassing, and so of course they want to get out of it as soon as they can. But a big part of desensitizing oneself to those negative thoughts and emotions amid a stutter is to stay in it for longer than they have to. This act of progressive desensitization increases their comfort with stuttering, which in turn will help them stutter more easily. To stay in a stutter, the person is guided to volitionally keep the tension in that spot to keep the stutter going. Many teens find it helpful to close their fist as a visual and physi cal way of “catching the stutter” and then keeping their fist closed as they keep the stutter going. This is what I mean by “ holding and tolerating .” Then, as they slowly unfurl their fingers and open their fist, they slowly reduce the tension in their articulators and ease into the next sound. As they ease into the next sound, the teen is guided to really elongate this moment and focus their attention on how the smooth transition to the next sound feels. It’s as if they are putting this moment under a microscope so they can study it and understand it. I have found that learning how to hold, tolerate, and ease out works best when teens begin with voluntary stutters. Once they have gotten a hang of how to do it with fake stutters, they

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