First Session Advice

Stuttering is an exceedingly difficult and often frustrating problem to treat as progress is usually slow, clients resist changing behaviors, and stuttering itself is so variable. Many clinicians are somewhat apprehensive about working with adults and adolescents who stutter; they often fear they will make the stuttering worse or are unsure of what to do. A few suggestions are offered to assist you in your first therapeutic encounters.

Focus on Speech Therapy First. The point has been made that stuttering therapy deals with both speech behaviors and the psychodynamic aspects that result from them. Start with the speech behaviors. Having a reliable speech technique is invaluable and the backbone of effective therapy. Clients are unlikely to share much of their feelings and emotions about stuttering with any new clinician; it takes time to get to know someone and trust them.

Have a Strong Rationale for What You Do. Know what you are doing, and why, in each component of your therapy session. The best therapy is usually "client-centered"; if you thoroughly understand your objective, making the adjustments and alterations based upon your client's individual needs will be much easier.

Keep Perspective. Remember above all you are working with a person, not just a problem. The problem has significance in the person's life and that's the important part.

	Be able to describe the client's stuttering behaviors Set a "down-to-business" (rather than "casual-social" conversation) tone for your session right from the start Learn what your client wants to accomplish in their therapy Be clear that the client is responsible for making the changes, that your are the guide or mentor right from the start, by the language that you use your orientation toward problem-solving Give daily homework assignments that require written verification
Don't:
	Focus on counting disfluencies Waste time - therapy time is valuable and expensive; most people spend more time watching television commercials each week than spend with you in therapy -- you need to make an impact in each session Concentrate on your own anxieties, it just heightens them; the therapy isn't about you anyway. If you are anxious, it just shows that you want to do a good job…. if you didn't care you wouldn't be anxious. Use more than your "share" of the speaking time; the client should do more of the talking than you do

The initial meeting with any client is usually the most difficult because the "unknowns" are much greater than the "knowns". First impressions are important, but it takes time for a therapeutic relationship to develop. Be organized, set your agenda, be direct and speak authoritatively, and enjoy the new clinical challenge.