Chapter 16 • Treatment of Adolescents: Advanced Stuttering 377

doesn’t have a summer program yet (or even a local support group that meets throughout the year), you could broach the idea of collaborating to start one. Most adolescents who stutter will admit that the stutter ing experience is filled with daily mental gymnastics. Aside from the looming sense of worry about impending stutter ing and rumination about how past interactions went, many teens find themselves in interactions where they are actively scanning ahead to figure out ways to not stutter—constantly updating current plans depending on how the moment and context unfold. This avoidance happens at the level of certain sounds the teen thinks is challenging to say, words they have historically had difficulty saying, or situations they don’t want to stutter in. These mental gymnastics of avoiding trigger ing sounds, words, and situations is what often contributes to mental load and fatigue, rather than the stuttering itself, and it is cognitively and emotionally exhausting. Thus, one of our responsibilities is helping adolescents become more aware of how their own mental gymnastics works and figuring out ways they can reduce that mental load so they can commu nicate more freely. Stuttering is often an isolating experience. Not only do ado lescents sometimes feel like the only person in their world who stutters, but because of their increasing desire for inde pendence, they may feel like stuttering is something they have to, or want to, deal with on their own. While in some ways this may feel safe and comfortable because they are not sharing their vulnerability with others, it can come to feel like a very heavy burden to carry solo. For many adolescents, choosing at least one safe person to open up to about stut tering (other than you, the clinician) can be life changing. This can be a family member, a close friend, or other trusted confidante. The intention behind this task is multifold. First, connecting with a trusted listener about our hurt and vulner abilities can be cathartic if we are met with empathy. Heal ing and authenticity happen in empathetic space. Second, it can help the adolescent build their skills and confidence in self-advocacy. Perhaps they choose to tell their parents what is helpful or unhelpful about how their parents attempt to support them, or they want to vent to a friend about recent interpersonal challenges that they want to address. Talking this out with someone the teen trusts can open opportunities to live more authentically and proactively. While it’s helpful (albeit scary) to talk to someone new about stuttering, disclosing one’s stuttering to new listeners Expanding Comfort Zone Everyone has situations that are within and outside their comfort zone, and those zones look different for each per son. Situations within our comfort zone invite us to act right away, as we feel safe and equipped to meet the demands of the situation with the skills we have now. Not all situations out side our comfort zone are equally difficult. Some situations may perhaps feel doable now, although it requires courage, while other situations feel wholly out the realm of possibility because they are too stressful. A little bit of stress can be help ful and facilitate growth, while a lot of stress is a signal that the body (including the mind) is not equipped to handle the demands of the situation and needs safety. This can be visu alized as a three-tiered ring with comfort zone at the core, surrounded by the stretch zone, and enclosed by the stress zone. As seen in Figure 16.3, as one’s capacity for self-regula tion and agency increase in the face of challenge, their stress zone shrinks, which allows increased comfort and adapt ability with a wider range of behaviors and situations. I have found it incredibly helpful to discuss this graphic with teens and guide them to share situations that are in their comfort, stretch, and stress zones for them right now. This introduces the importance of understanding one’s body. Another useful metaphor is borrowed from Vivian Sisskin’s work with ARTS, wherein adolescents identify self-imposed “stop signs” in their everyday life—things like words they don’t want to say, situations they don’t want to experience, events they don’t want to attend, emotions they don’t want to feel (Sisskin & Goldstein, 2022). With compassionate guidance, teens iden tify stop signs they can safely roll on through and what that might look like. Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. Talking Openly About Stuttering and Increasing Disclosure offers great rewards. Self-disclosure is the act of overtly tell ing or showing that one is a person who stutters. Many people assume that self-disclosure is verbal, but there are other creative ways to share one’s stuttering identity such as through putting a stuttering sticker on their water bottle or laptop, wearing a stuttering T-shirt or hat, posting about it on social media, sharing a creative artifact they created like a slam poem or painting about stuttering. There is a growing body of literature on stuttering self-disclosure, some of which has revealed that nonapologetic disclosures are perceived most favorably by listeners (Byrd et al., 2017). I imagine that nonapologetic disclosures also benefit speakers because not apologizing for something out of one’s control can increase their sense of self-worth. For adolescents for whom talking about stuttering and/ or self-disclosing is challenging, it could be helpful to dis cuss, script out, and/or role play a variety of disclosures. In my experience, for young people who stutter, the trick is to figure out a way to disclose naturally at a time that doesn’t draw attention to themselves. If the teen has a good sense of humor, help them tap into that; using humor can ease an otherwise tense or nervous moment for them. REDUCING AVOIDANCE OF SOUNDS, WORDS, AND SITUATIONS

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