Chapter 16 • Treatment of Adolescents: Advanced Stuttering 375

nonjudgmental present moment awareness. The book 5-Min ute Mindfulness Meditations for Teens by Nicole Libin might be a good addition to your clinical bookshelf if you’d like to guide your adolescent clients in short guided meditations. There are also prerecorded ones available online; I particu larly like the ones by Tara Brach, although they tend to be closer to 15 to 20 minutes each. Another relevant domain is acceptance—letting private experiences just be there without trying to do anything like get rid of them, avoid them, or replace them. The attempt to suppress or control difficult thoughts and feelings can actu ally amplify them and make them harder to cope with. For younger teens, you can do a glitter bottle activity where you get a bottle, fill it with a combination of clear glue and water, have the client add some scoops of glitter or metallic confetti, and then seal the lid. Have the client shake the bottle so the glitter is swirling all around in the water. You tell the client that the goal is to get the glitter to go back to the bottom of the bottle. They realize that they can’t do anything to make the glitter go down, they have to just wait for the glitter to set tle. If they try to turn the bottle, the glitter will go the oppo site direction and will take longer to settle. Our thoughts and feelings are like the glitter in the bottle; often, the most help ful thing we can do is wait for the thought or feeling to settle on its own without trying to control it in any way. An additional experiential activity that works for foster ing acceptance is using a Chinese finger trap. Have the client put their index fingers into each end of the finger trap. If they try to pull their fingers out using brute strength, they will get even more stuck. This is often what happens in the physi cal moment of stuttering, and it happens with our thoughts and feelings too. The way to get out of the trap is to relax into it and actually bring their fingers together, which at first seems counterintuitive. This activity is so relevant to stut tering—both in demonstrating the benefit of easing out of physical tension rather than pushing harder, and the value of accepting thoughts and feelings—that it may be worth while to purchase a bag of these inexpensive finger traps so you have them handy whenever the right teachable moment arises with your clients. The last idea I’ll share for fostering acceptance is to help the teen learn to say hello to their thought and feelings. This works best if they are able to infuse some humor into it. For example, “Hello fear about stuttering, you’re looking fabulous today!” or “Hey worries about what others think of me, it’s so nice to see you again!” This type of dialogue can help teens welcome and soften thoughts and feelings that they may have historically wanted to avoid or may have felt consumed by. It is also a process of “name it to tame it,” a phrase dubbed by psychologist Dr. Dan Siegel who suggests that labeling a feeling can help ground us when we’re feeling emotionally overwhelmed or disconnected (Siegel, 2010). The final domain I’ll describe here is defusion —stepping back and getting some separation from one’s thoughts.

conclusions they can draw. By exploring alternatives, the teen may realize that there are more helpful ways of thinking about something that allow them to be resilient and to keep moving forward. An alternative would be cognitive defusion , which is an ACT approach that is summarized in the next section.

Accepting and Letting Go of Difficult Thoughts and Emotions

While the basis of CBT is to help people control diffi cult thoughts and emotions, ACT offers a somewhat more humanistic approach that recognizes that pain is an inevita ble part of building a meaningful life. With ACT, people learn to let difficult thoughts and emotions just be , without avoid ance or control, by staying in the present moment, noticing what’s happening without trying to change their thoughts or feelings, and moving in the direction of what matters to them (Black, 2022). True ACT is an embodied experience, where experiential activities and metaphors help clients gain a vis ceral understanding of the skills. There are six principles of ACT that help teens develop this sort of cognitive flexibility: present moment (stay here), self as context (notice yourself), acceptance (let it be), defusion (let it go), values (choose what matters), and committed action (do what matters). It is out side the scope of this chapter to dive into each one of these principles in detail, but let’s cover a few that are specifically dedicated to accepting and letting go of difficult thoughts and feelings about stuttering. If you are interested in developing your ACT knowledge, I highly recommend the book ACT for Adolescents: Treating Teens and Adolescents in Individual and Group Therapy by Turrell and Bell (2016). First, they can learn to stay in the present moment and become aware of those present moment experiences. This is commonly known as mindfulness . This may be particularly important for teens who stutter because it’s often difficult for them to pay attention objectively to the momentary physi cal experience of stuttering, and/or they find themselves not fully present when talking to others because they are think ing about stuttering. For example, have you ever had the experience where someone is talking to you, and you realize that even though you’ve been standing right in front of them, looking into their eyes while they are talking, you were actu ally thinking about something else, so afterward you don’t remember what they said? This often happens to teens who stutter, especially if they are ruminating about some stutter ing that just happened or anxiously planning what they’re going to say next or how they’ll say it. Mindfulness activities to increase their present moment awareness can be helpful to build this skill. You can guide them in eating a sour gummy worm mindfully (a teen-friendly alternative to the common “raisin exercise” for which you can find scripts online), 5-5-5 exercise where they are prompted to notice five things they see, hear, and feel at any moment, or short guided mind fulness meditations to help them build their capacity for

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