Group therapy can serve several purposes in the treatment of stuttering. Most obvious, it is a place to practice using speech targets that, for most people who stutter, provides greater challenges than individual therapy, but less than the world outside the clinic -- sort of a halfway station to assist clients in transferring their skills. Secondly, it is a place for "building bonds" between people who stutter. Many clients have had very little exposure to others who stutter; and when they have, it is usually very uncomfortable. Group affords the opportunity to "compare notes", to learn in what ways their stuttering is similar and in what ways their stuttering differs from others. This experience is usually very "centering"; it enables the client to see their difficulties from a new perspective. Finally, group therapy offers acceptance and socialization. It is a place to feel less inhibited about stuttering; a place to openly discuss what is otherwise a part of life that is concealed from the rest of the world. Some clients, due to their stuttering and sometimes other factors, have not attained a comfort level in social situations. As such, group therapy also offers an environment to cultivate social skills interacting with others.
A Format for Group Therapy
A suggested format and brief rationale for group therapy sessions follows. Clinicians should change or modify it to suit the needs of their fluency program and their clients. Most sessions offer a chance to practice speech targets and a time to share is provided in a group session.
Welcome. The clinician (group leader) begins the session by offering a topic on which each participant will give a brief extemporaneous speech. For example, "What is your biggest pet peeve?" The group leader then stands, introduces himself or herself to the group and gives their extemporaneous speech. Other participants then take turns standing, introducing themselves, and giving their brief speech. Rationale. Most people who stutter have difficulty introducing themselves; group is an excellent place to practice. Standing up draws more attention to the speaker, adding to the challenge. There are several different modes of speaking; we want to provide practice in as many of them as possible. Thus, an opportunity for extemporaneous speaking is a desirable component of the therapy session. |
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Check-In. The group leader requests a brief review of each client's speech since the last meeting, asking clients to share their difficulties and successes with the group. Next, he or she then asks which speech targets each client will be practicing during the session. Rationale. It is important that clients be cognizant of the expectations for the group's work. With the support of everyone in group, the likelihood of their success is increased. |
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Activity One. The group leader introduces the topic of the first activity, instructs participants how to respond, and initiates the activity. Often the "sharing" activity comes first as it sometimes extends beyond the anticipated time. (Sample group "sharing" activities are offered in a separate section.) Monitoring the client's use of speech targets is often of secondary importance in "sharing" activities. It is often difficult enough to put feelings into words; having the added burden of needing to use speech targets may therefore be at cross-purposes with this activity. At the conclusion of the activity, the group leader summarizes the discussion and highlights important points that surfaced in the activity. Rationale. Sharing activities are an important component of the treatment of stuttering. The ability to speak about the feelings and emotions that accompany stuttering is a very valuable part of therapy. Speaking openly about the problem usually serves to reduce the overall tension created by attempting to conceal stuttering behaviors. |
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Activity Two. The group leader introduces the second activity, instructs participants how to respond, and initiates the activity. This activity is usually a "speech practice" activity; it is most often "light" in nature to contrast with the "sharing" activity that preceded it. A "fun" or "party" atmosphere, whereby clients interact with one another in a jovial way, provides a positive, affirming place in which to practice and promote openness about stuttering. (Sample speech activities are offered in a separate section.) The group leader often provides feedback to each participant immediately after their contribution, and may offer them another brief opportunity to try their technique another time, suggesting a means of improving performance. Feedback from other clients is actively solicited to enhance the involvement of other group members, learn to support one another, and improve the 'critical thinking' skills of listeners. At the conclusion of the activity the group leader summarizes the activity and highlights points he or she feels to be important for all to hear. Rationale. Providing a challenging opportunity to practice speech targets in a primary purpose of group therapy. Learning to cope with disfluencies in a lighter, healthier manner is an important goal as well. Developing other people to support a client's efforts, whether they are others who stutter, family members or co-workers, is very beneficial. Learning to self-evaluate performance objectively leads to better fluency management abilities and more productive coping skills. |
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| Wrap Up. At the conclusion of the session, the group leader critiques each client's performance individually based upon the goals expressed at the beginning of the group. The leader should blend positive feedback with suggestions for improvement in the future, providing both affirmation and constructive criticisms. Again, significant points that surfaced during the session are interpreted for the group. | ||
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Group therapy is multi-dimensional and often rather free flowing. Becoming an effective group leader takes time and practice. Group therapy is an important treatment format that can be very useful for clients and fun for clients and clinicians.
© Rentschler, 2002