Stuttering

378 Section III • Treatment of Stuttering

Expanding Comfort Zone

S

S

S

Z

S

Z

E

O

E

O

R

N

R

N

T

T

E

S

E

S

H

C

Stuttering openly at basketball practice

T

Z

E

O

R

N

T

E

S

Presenting in class

stuttering openly at basketball practice

C

H

T

E

Z

R

O

giving a class presentation

Talking to best friend

T

N

S

E

Holding/tolerating stuttering with mom

talking to best friend

Talking to mom

Disclosing that I stutter

Ordering at a restaurant

COMFORT ZONE

COMFORT ZONE

Auditioning for theater

Answering the phone

Increasing Confidence

Disclosing that I stutter

answering the phone

talking to Mom

Ordering at a restaurant

Holding/tolerating stuttering with mom

participating in a debate

Participating in a debate

auditioning for theater

Interviewing for a job

Figure 16.3 Comfort, stretch, and stress zones fluctuate depending on one’s confidence.

As they tell you about situations they encounter and avoid in subsequent sessions, you can ground the discussion in this visual of the three-tiered comfort zone. You are encouraged to validate how hard some things feel now and be intentional about your language to facilitate growth mindset. You’re not quite ready to do that yet, and that’s ok. I know it feels out of reach right now, but it won’t always be. What’s a small thing you could do to step into your stretch zone, or safely roll this stop sign? It’s important to recognize that pushing adolescents (all clients, really) into their stress zone, even if you think they’re capable of doing it or that it would be good for them, is counter-produc tive. Our goal is to help adolescents tune into their body and make decisions that facilitate self-growth, in their desired direc tion, when they decide the time is right for them. This is a life skill that will help them learn how to direct their own behaviors and changes, with a focus on stepping into their stretch zone if it moves them toward a value-driven direction. The situational hierarchy discussed previously in the section on “Using Hierarchies to Level Up” can also be situated in this comfort-stretch-stress zone context. Identify which steps on the hierarchy constitute each of the three zones. Then, you and the client can cocreate weekly opportunities that are guided by the hierarchy or the zones. Make sure that you are in consen sus about what constitutes a “success,” focusing on doing the hard thing regardless of how much they stuttered. Perhaps suc cess means that they ordered exactly what they wanted instead of ordering what was easy to say, or that they asked a follow up question when they normally woudn’t have, or that they answered the phone instead of letting it go to voicemail. Clients can record their observations about those opportunities in a journal or on a note on their phone and bring them back to the

therapy session to discuss with you. If they are hung up on how much they stuttered, try to redirect their focus on the fact that they felt afraid and did it anyways, and that’s what matters most. (Notice the use of “and” not “but”—“you felt afraid and still did it”; this contrasts with “you felt afraid but still did it,” which dis counts the feeling of fear.) If they are hung up on how other people reacted or behaved, try to help them separate their own self-worth from other people’s evaluations of them (whether perceived or actual). Offer lots of verbal praise for trying to take advantage of opportunities even if it didn’t go exactly according to their plan, and perhaps help the teen identify something they can do for themself as a reward. Over time, these efforts com pound to expand one’s comfort and stretch zones. Voluntary Stuttering The methods for using voluntary stuttering in the therapy setting were discussed previously in the section on “Identify ing Moments of Stuttering.” Voluntary stuttering is also some times called pseudostuttering, fake stuttering, or stuttering on purpose (although I like to say stuttering with purpose). In a nutshell, you and the client both practice voluntary stutter ing in situations of increasing difficulty, starting in simple, structured therapy activities and working up to opportunities outside the therapy room (eg, ordering at a coffee shop, ask ing a store clerk a question in person and on the phone, with a family member). Use the client’s individualized linguistic and situational hierarchy to guide this process. Voluntary stuttering is a form of exposure therapy, which is a common psychotherapeutic method for addressing fears and avoidances. In the context of stuttering therapy, voluntary

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