Stuttering

Chapter 16 • Treatment of Adolescents: Advanced Stuttering 367

their mind—the little things that aren’t necessary like anec dotes, jokes, etc.—to minimize the cost: if I don’t talk, then I won’t stutter. If after a conversational turn with some tough stutters, you may offer some validation like, “I appreciate that you stuck with it. You have lots of great ideas and I want to hear them.” Together, these listening practices send the mes sage to the adolescent that you care about what they have to say and that you are not hyperfocused on how they say it. Ultimately, we want our adolescent clients to share whatever is on their mind and feel safe letting us in. As a clinician who stutters myself, I have found that stut tering openly and confidently can be one of the quickest and most powerful ways to establish a bond with teens who stut ters, many of whom have never met someone else who stut ters before. They may feel an instantaneous connection with you since there is an unspoken understanding that know what stuttering is like, and they may feel relieved to know an adult who stutters who survived adolescence. For all clinicians (those who do and those who don’t stut ter), you can show your client that it’s ok to stutter by con fidently putting stuttering in your own mouth. This is often called “ voluntary stuttering ” or “pseudostuttering.” First, ask the adolescent if it’s ok for you to try to voluntary stut ter like them, explaining that doing so will help you better understand how they stutter. Once the client has consented, have them teach you how they stutter and try to voluntary stutter in that way, learning their pattern by attending to where and how tension builds and how it can release. Even tually, you will model ways of stuttering more easily—easier bounces, easier blocks. As you try to help clients generalize a new communication skill outside the therapy room (whether it’s stuttering openly, maintaining eye contact while stutter ing, easing out of a stutter, or something else the client finds important), always offer to do it first and then offer to take turns while the skill is still new. This sends a clear message to the client that you’re not afraid of stuttering and that you are also willing to take the same risks that you are asking them to take. This inspires mutual trust and respect. Psychologist Kelly Wilson (2009) argued that clients are best served when they are valued as “a sunset to be appreciated rather than a problem to be solved” (p. 15). Clinicians can do a lot of good by focusing on the client’s strengths and values—those qualities that already reside within the client that motivate how they live their day-to-day and make choices. In line with positive psychology (Seligman, 2012), motivational interviewing (Miller & Rollnick, 2012), and solution-focused brief therapy (SFBT) (De Shazer et al., 2021), we can focus on “what’s right” with the client, rather than on their deficits or problems. Early in the therapeutic relationship, clinicians can ask their clients: “What do you think you’re good at?” and “What would your family and friends say you’re good at?” Another Focusing on “What’s Right” With the Client

way to tap into the client’s innate abilities is to prompt them: “I’d like you to think of another time in your life when you learned a new skill or made some sort of change. Perhaps you learned how to speak Spanish, or how to play basketball, or how to drive a car. What kind of skill have you learned? What happened? How did you manage to learn that new skill? What does that show you about yourself?” Clinicians may help clients recognize the incredible dedication and problem solving that already exists within them. This type of dialogue aligns with principles of motivational interviewing, where clients bring to conscious awareness their natural abilities that allow them to do hard things. To extend this conversation, you can also have the cli ent complete a “signature strengths” assessment to identify their top five character strengths (freely available at www. viacharacter.org). This facilitates the client’s self-knowledge and helps them focus on their positive attributes. Then, in conversations that unfold over your therapy sessions, you can help them identify times that they activated those character strengths. Week to week, as they share constructive shifts in their life, you can point out positive things about them that you’ve noticed (eg, “It seems like you care a lot about your friends,” “I can tell that you’re a hard worker,” “You figured out a way to take care of yourself.”). Sharing these observa tions often helps adolescents build their own ability to recog nize and appreciate these strengths within themselves. Goals and outcomes should be developed collaboratively between the clinician and adolescent. Involving young clients in the process sends the message that the clinician’s role is more facilitative than authoritarian, which bolsters the client’s autonomy, investment, and independence that are blossom ing at this time in their life. To do this, you pose open-ended questions to elicit what the adolescent wants to change. These open-ended questions can blend principles from SFBT and motivational interviewing to elicit the adolescent’s “best hopes” or “preferred future” (SFBT terms). Codeveloping Goals Guided by the Client’s Readiness to Change

In Table 16.1, when adolescents are asked what they want to be different, many of them will reply with something along the lines of “I want to be more fluent” or “I don’t want to stut ter as much.” This is an invitation to explore what meaning the client has attributed to fl uency on a deeper level. First, it’s important to validate their desire for talking to be easier through reflecting what they said and the underlying feeling. You can gently reframe the client’s language to help them start focusing on ease and communication over fluency. For exam ple, you may reply: “Stuttering can be really hard sometimes. It’s normal to want talking to be easier. I’m here to support you in exploring what easier talking sounds and feels like.” This sets the tone for the collaborative journey that lies ahead. Using the client’s language within SFBT-style questions can be useful to dive a bit deeper: “If you were more fluent (or if you weren’t stuttering as much), what would that look like? Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.