Use the following as a format guide in structuring individual therapy sessions. While this format is designed specifically for stuttering therapy, it is based on principles that apply to therapy for other disorders as well.

Set the tone for the session by getting started right away. Your interaction begins in the waiting room; get your 'chit chatting' done on the walk to the treatment room. As soon as you are seated in the therapy room, you might start off by reviewing homework assignments given at the last session. After that you may find the following protocol to be useful in designing your session.

Overview: Review the outline of what you want to do and accomplish in the session with the client. This will orient her/him to what will happen and her/his role in the session. Your organization and preparedness will be noted by the client.

Warm Up Activity: (5-10 minutes) A period of speech target practice in which the clinician provides intensive cueing and feedback. This gets the client "on track" right away, enabling him or her to demonstrate their proficiency level; it also sets a tone that "we're here to work"! Continue until the client achieves the expected level of proficiency.

Activity Two: Work Activity (5-10 minutes) During this speech activity, don't give any cueing or feedback; see how the client does on his or her own. You'll likely observe some things about the client's performance that you can convey after their performance. If the client does poorly, give them the necessary feedback to make the desired improvements.

Activity Three: Work Activity (15-20 minutes) This may be a speech or "feelings" activity. If its a speech activity, make the first part "too hard" for the client, so he or she struggles; then change something that will boost their success rate significantly.

If you choose a "feelings" activity, try to conclude on a positive note by pointing out a lesson learned or a new insight into their stuttering which resulted from the discussion.

Back Up Activity: (10 minutes) Despite your best planning, some activities just "don't work". Have another activity prepared; if you don't use it, you'll have it for another time.

Homework Assignment: Its vitally important that your client have something to work on each day to expedite his or her progress and carryover. Have a specific task for your client to do at least every day. Work out a specific time or situation in which the client will accomplish the assignment. Try to problem-solve with your client, including them in the process.

Wrap Up: At the very end, summarize what was accomplished in the session today, providing complements and constructive criticism. Talk about the next steps in therapy and what you hope to accomplish during the next session. This is an important part of your clinical teaching.

Other: If group therapy immediately follows your client's individual session, you may wish to spend some time preparing them to implement some of their targets in group. Talk to the group leader to find out what the activities will be in group that night. Give your client specific instructions of what to do during group. You may want to work out one or two hand signals to communicate instructions when your client is speaking during group. In this way you won't need to interrupt him or her and others in the group may not pick up on the signals.

Lesson Plans. A written lesson plan is submitted each week. We will review it during our weekly supervisory meetings. Only one lesson plan is necessary for each week.

Progress Notes. A progress note is written for each visit. It is important to describe the activities as well as the client's performance in the notes. Make progress notes clear and easy to follow by structuring the "objective" section of the progress note using the same format as your therapy session. If a client has individual and group therapy on the same day, one progress note can be used for both sessions.

© Rentschler, 2001