376 Section III • Treatment of Stuttering

It involves looking at thoughts rather than engaging or embodying them, because thoughts are simply something the brain does, they are not who we are. ACT practitioners help clients become unstuck from difficult inner experiences through various exercises and metaphors. A common one is using the carrier phrase “I’m having the thought that…” For example, if a teen who stutters tells you that they can’t intro duce themselves, you could offer a reframe like “You’re hav ing the thought that you can’t introduce yourself.” Or if a teen shares that when they’re stuttering, they worry that others will think they are weird, they could learn to defuse by saying “I’m having the thought that they’ll think I’m weird.” Then, they can practice saying thank you to their mind for being so helpful and working so hard to solve the problem (again, having a sense of humor can be helpful here). This creates some distance between the teen and their thoughts, and with enough practice, they start to realize that their thoughts are not facts and that they themselves are not their thoughts. Other defusion activities involve mindfulness visualizations where the teen can either imagine standing on the shore of a beach and placing their difficult thought/feeling on a wave and watching it roll back out to sea, or perhaps they imagine that they are a clear blue sky looking down at their thoughts that are clouds passing by below them. There are many, many more creative ways of guiding teens to develop their ability to accept and let go of difficult internal experiences. These ACT-inspired ones that I introduced here are all in service of strengthening their emotional intelligence so they feel equipped to handle difficult experiences as they arise. By helping adolescents identify and understand their range of cognitive and emotional reactions to stuttering, they learn to make space for challenges rather than get into a power struggle with them. These efforts will help them make peace with the inevitable ups and downs of their stuttering experiences. Creating Affirmations In helping adolescents approach everyday experiences with a more positive orientation, some may be open to focusing on an affirmation at the start of each day and/or in challeng ing situations. A rmations are positive statements about the adolescent’s characteristics or behaviors and are useful to reinforce change behaviors (Epton et al., 2015). Adoles cents may disengage if they sense the affirmation is overly cheerleader-like or disingenuous (eg, “I feel on top of the world” when they are actually feeling stressed or upset). It’s important that affirmations are honest and specific about target changes—for example, “I make space for stuttering,” “My stuttering does not define me,” “My stuttering makes me unique,” “I am an effective communicator,” “I have important ideas to share,” “I am becoming my best self,” “I am always learning more about who I am,” and “Let me be seen” to name a few. Affirmations can be developed with the adolescent in a therapy session and then written down for them to take with

them into their week. Make sure you have discussed a clear plan for how the affirmations will be used—for instance, writ ten in their planner and revisited at the start of each school day, said internally at the start of each class period or before certain interactions, etc. Finding Community One of the most powerful ways to combat the loneliness and isolation that often accompanies stuttering is to get involved in the stuttering community (Gerlach et al., 2019). In doing so, the teen feels, perhaps for the first time, that they are not alone—that they are not the only one in the world who stut ters, although it often feels like that. All adolescents who stut ter, regardless of their age, their background, or how they stutter, would benefit from meeting other people who stut ter, although the right timing will be unique to each of them. Some adolescents need time to understand their own stutter ing and their own experience before they are willing to meet other stutterers. As their clinician, know that this process takes time and you are encouraged not to pressure the teen to meet other stutterers if they indicate they don’t want to yet; doing so may backfire in unintended ways. There are several established stuttering communities that you can introduce the teen to. The two most common ones are FRIENDS (The National Association for Young People Who Stutter; and NSA (The National Stuttering Association; At the time of this writing, FRIENDS offers free monthly virtual support groups for teens. The NSA has some local chapters for families and some that are specifically for teens; both are supported by the Teen Advisory Council, which is an advi sory board comprised of teens who stutter. Both FRIENDS and NSA offer an in-person annual convention that both usually take place in July (thankfully on different weekends). If there is no local NSA chapter in your area and you are interested in starting one, reach out to the NSA office and they will help get you started. It’s relatively easy to get a new chapter off the ground logistically and as long as there are families of teens who stutter in your area who are interested in participating, you are encouraged to launch a chapter in your area. Metaphorically, you’ll receive big returns on your investment.

There are also numerous summer camps that have popped up all over the country for kids and teens who stutter. Camp SAY (NY), Camp Shout Out (MI), Camp Words Unspoken (MA), and Camp More (OR), to name a few. There are also some summer programs affiliated with university clin ics, like UISPEAKS (University of Iowa), Colorado Speaks (University of Colorado at Boulder), Camp Dream.Speak. Live (University of Texas at Austin), and CSTEP (Texas State University). If a university in your area has a speech clinic, you could reach out to them to inquire about sum mer programming for young people who stutter. If the clinic Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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