Chapter 16 • Treatment of Adolescents: Advanced Stuttering 373

When the success of therapy hinges on how much the young person stutters, they are more likely to conceal their stut tering because hiding it is the only way to not do it as often (Gerlach-Houck et al., 2023). And research has shown that the more one conceals their stuttering, the higher psycholog ical distress they experience (Gerlach et al., 2021). While young people cannot control when they stutter, they can make some choices about how they stutter and communicate. Through the process of codeveloping therapy goals and outcomes, which was described earlier, you can help adolescents and their parents consider “success” more holistically. For example, perhaps success means being more open about stuttering, communicating effectively by stut tering more easily and keeping eye contact, or being true to who they are. From there, you can help the teen iden tify and clarify their values around that vision of success. If “being true to who they are” resonates with them, help them explore their values surrounding communication, relation ships, and self-growth and then help them see that they can make decisions that align with those values. This is inspired by ACT, where a client’s values represent a “compass that guides people through the storms and confusing times of life and toward the things they care about” (Hayes & Ciar rochi, 2015). Values are most helpful when they are stated as actions. For example, some commonly valued activities that contribute to well-being include “connecting with others,” “giving to others and having a positive influence,” “embrac ing the moment,” “challenging myself and learning,” and “caring for myself.” Not all of these are equally relevant to all adolescents, so this list is not intended to be prescriptive. However, this list can provide a launching point for how val ues are usefully worded. The website https://www.therapist has several useful activities for facilitating discussions about values with adolescents. Over time, adolescents make value-driven deci sions and experience cohesion between who I am and what I do . This allows them to feel successful in being true to who they are, rather than hinging their success on how much they stuttered in a given situation.

and hopefully come to a point where you befriend it. You may choose to educate yourself about how safe air travel really is and how to handle stressful situations in flight. The same applies to stuttering; adolescents may experience a lot of anxiety and worry about stuttering and may not know a lot about it or believe commonly held misconceptions about it. It is helpful to spend time learning about stuttering: how many people in the world stutter, the fact that stuttering exists in every culture around the globe, what causes it, what con tributes to its variability, etc. There are plenty of websites that offer such information, just make sure that you vet the resources you find as there is plenty of misinformation floating around. Of course, learning about how the speech mechanism produces speech and stuttering (as described earlier in this chapter) also counts as learning about stuttering. It is also helpful to learn about other people’s experiences with stuttering, which can help normalize what the young person is going through. For adolescents who enjoy reading, you can do bibliotherapy where you both read a section of a book on your own and then at your next session discuss what resonated with the client (Gerlach & Subramanian, 2016). There are fictional books and memoirs about people who stutter. Paperboy is appropriate for middle-schoolers, while Out With It and Life on Delay are appropriate for older adolescents ( Life on Delay contains mature content so it would only be appropriate for those who are at least 18 years old). There are also several great documentaries and YouTube videos about stuttering that you can use for cin ematherapy (Azios et al., 2020). Feature-length documen taries like My Beautiful Stutter, The Way We Talk, and When I Stutter include adolescents who stutter. There are lots of shorter YouTube videos available as well, and I encourage you to find some that share healthy messages about stut tering rather than perpetuating misconceptions. Similar to bibliotherapy, you can have them watch a film on their own (or with their parents or a friend, if the teen is open to that) and then come to the next session ready to share what resonated with them. Adolescents who are savvy with social media can find numerous influencers who stutter on TikTok, Instagram, or other platforms who share their experiences with stuttering. Together, these avenues invite adolescents to learn about stuttering from others who stutter, which helps normalize their inner experiences.

Reframing “Success” and Celebrating Small Steps In addition to reframing “success” to be more holistic, we can also help young people notice small signs of progress. We all have had experience with wanting to change some thing quickly (eg, get fit, lose weight, feel better), and per haps feeling discouraged that change, in fact, takes a long time and a lot of dedication. It is a marathon, not a sprint , after all. One helpful thing that we can do to keep morale up and stay the course is noticing and celebrate small steps in the desired direction. For example, if one of your client’s goals is to be more open about stuttering, you wouldn’t with hold praise until they are open about stuttering all the time with everyone they meet. You would applaud small things they do that show they’re being more open. For example, perhaps they talked to one of their teachers about reason able classroom accommodations for oral participation, dis closed their stuttering to a new friend via text or SnapChat, Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. Because many young people who stutter and their parents seek speech therapy to become more fluent, they often gauge how successful therapy is by how fluent they become. Despite how rampant this perspective is, it can be harmful to young people’s well-being because they are being asked to control something that is quite uncontrollable and highly variable.

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