The clinician should have a end goal in mind to direct their counseling efforts and work toward; a model to be created in the mind of the patient. There are several approaches or tools available to assist in the counseling process.

An initial step is to learn what the client currently thinks and believes about their stuttering. This is somewhat of a "moving target" in that the client is learning and discovering their attitudes about stuttering even while the clinic is gathering the information. But the process of discussing stuttering can be as important as the information which results -- its therapeutic just to be able to talk about it!

Once the baseline information is gathered, the clinician plans strategies to modify the way the client thinks about their stuttering. At first, the willingness to entertain different thoughts about stuttering is an important step. This flexibility demonstrates a lowering of the client's guard; recall that the emotions of stuttering serve to diminish creative and flexible thinking....this is a initial effort toward making change.

TOOLS AND STRATEGIES

Logic. A logical argument is usually ineffective in fighting against emotions. For example, for the patient who's speaking rate is too quick, the clinician might explain that by slowing overall speaking rate, stuttering will be diminished. By stuttering less, the actual time it takes to read a sentence aloud will be reduced. While this makes sense, it will be ineffective in convincing the client to consistently slow his or her rate for more than a minute or two. Rate is governed by emotions, not logic.

Other Feedback Modalities. Getting a "fresh look" at a persistent problem can afford an opportunity to re-evaluate beliefs. For example, patients commonly complain that using certain fluency techniques make their speech sound too slow. Having the patient listen to a recording of their speech may change their perceptions. Some patients, after listening to a recording of their speech, are surprised that it doesn't sound as slow as it feels. Afterwards, they are much more willing to use their targets.

Having a client look at their mouth in a handheld mirror may provide feedback which the client was not aware of. For many, it is rather startling to see that the visual manifestations of stuttering are much more apparent to others than the client believed. This can be a very unsettling discovery, but is often very motivating.

Challenging Beliefs. Some clients have constructed unrealistic beliefs about their stuttering predicament. Challenging these beliefs is one way of dispelling and changing them. For example, many clients are unwilling to talk about their stuttering with others, fearing that their listener will ridicule them. Encouraging the client to test this hypothesis out in a relatively safe environment is one way of facilitating change.

Reframing and Alternate Explanations. Its easy to get locked in on one way to interpret a situation. Clients often loose the ability to see other perspectives on issues. Helping them develop other explanations or reframing situations and events may enable patients to become more flexible thinkers, and change their beliefs. For example,

Confrontations. Sometimes by "looking fear in the face" (confrontation) the client discovers that it is not half as bad as it was built up to be. Being petrified with fear that one might stutter places the client in an "immovable" position. But stuttering on purpose or having a "stuttering contest" (see who can stutter the longest or loudest) can teach the client that fear need not be a part of stuttering.

© Rentschler, 2001