Chapter 16 • Treatment of Adolescents: Advanced Stuttering 379

stuttering helps adolescents do the thing they are so often afraid of doing: stuttering. Voluntary stuttering is done sup portively with the intention of (1) exposing the teen to the physical and emotional experience of being in a moment of stuttering and (2) stepping into the space of stuttering-as identity. If I voluntary stutter when I don’t have to, I am claim ing my right to stutter and accepting the identity of someone who stutters. I’m not hiding that part of myself. Together, vol untary stuttering often helps reduce the client’s reactivity to, and fear of, stuttering, thereby allowing them to better self regulate in moments of real stuttering and feel equipped to go ahead and “let it rip”. As their fear of stuttering goes down, so does the compulsion to avoid sounds, words, and situations. I will say that adolescents will greet the prospect of volun tary stuttering with varying levels of openness or willingness. It’s important that your rationale for voluntary stuttering is cogently delivered so they understand why this would be helpful for them. And even with the most articulate, clearly stated pitch, some teens still won’t be on board. That’s ok. That tells you about where they are in their stuttering journey and there is no need to push them too hard. Remember, the more you push, the more they’ll resist. ■ Adolescence is a period of great risk and opportunity rooted in neurobiological changes of puberty; clinicians are encouraged to work with adolescents’ increasing desire for independence and social connection. ■ A crucial ingredient in an effective therapeutic experi ence is to create a safe stuttering space . ■ Therapy goals should be developed collaboratively with the client through solution-focused discussions about what changes are important and achievable to them. Behavior changes can be both overt (observable to oth ers) and covert (changes to thoughts and feelings). ■ Learning to stutter in an easier way involves learning about the speech mechanism to understand how stut tering works, then practicing holding, tolerating, and easing out of moments of stuttering. Clinicians who model desired behaviors (including voluntary stutters) show their clients that they are willing to do new, scary things too which facilitates mutual respect and can be motivating for the client. ■ Cognitive-behavioral therapy and ACT are useful ways to help adolescents develop healthier thoughts and feelings about stuttering. ■ To help clients reduce situational avoidance, you can help clients identify their values so they can make value-driven decisions bolstered by their strengths, affirmations, and rolling self-imposed stop signs when they are ready. SUMMARY


1. How can clinicians create a safe stuttering space? 2. What is unique about adolescents, which makes it different than working with chil dren and adults? 3. What are some common behavior changes that adolescents who stutter and clinicians believe are important? 4. How can you guide an adolescent client through the process of desensitization and learning to ease out of moments of stut tering? 5. How are CBT and ACT similar? How are they different? 6. What are some ways to help adolescents who stutter reduce avoidance? SUGGESTED PROJECTS 1. Visit, create a free account, and complete the Signature Strengths for Adults assessment, which should take around 10 to 15 minutes. Click “Skip and get your free results.” List your top five strengths, describe each of them. 2. Write a script for how you would teach an adolescent about speech anatomy and physiology, and how you would guide them through experiencing easiness and tension in different areas of the speech mechanism. 3. Think of a time in your life when you wanted to change some thing about yourself (eg, lose weight, stop drinking soda, floss your teeth daily, manage your anxiety). Reflect on how ready you think you were to make that change at that time, and gener ate a list of pros and cons of the target behavior. This exercise is intended to help you reflect on how hard it is to change parts of yourself, and it may help you empathize with how difficult the change journey is for adolescents who stutter. 4. Think of a challenge that you’d like to achieve. Make a situational hierarchy for yourself to help you work systematically toward meeting that challenge. 5. Listen to a guided meditation, perhaps one by Tara Brach that’s freely available on her website and as a podcast. Then, find a guided meditation that would be appropriate for adolescents— one that either (1) helps them tune into their body or (2) inte grates visualization to help them experience letting go of difficult experiences. 6. Fill in a comfort-stretch-stress zone diagram for yourself. 7. Research stuttering support groups or camps that would be available to adolescents in your area—either local or national opportunities.

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