The task activity in therapy is a variable that can be used to increase or decrease the difficulty of the task for the client. The following information provides the clinician with a few insights into the use of a variety of speaking modes to promote the learning of new techniques and challenging emerging skills.

Reading. For most clients, reading is a less demanding oral communication task than speaking as the words, lexicon and ideas are already represented in the text to be read. However there are exceptions. Some clients experience reading difficulties that add to the disfluencies in the oral reading. In these instances, reading should be used sparingly or materials selected that are skill-appropriate. For others, written materials bring out their use of avoidance strategies, substituting other words for those which are perceived as likely to be stuttered upon.

Reading, however, is a good starting point for most clients. Some clients are able to read aloud with significantly less disfluency. For these clients, it is suggested that short articles be selected, followed by a discussion or summary of what has been read. One idea is to clip "Dear Abby", "Ask Ann Landers" or "Miss Manners" articles from the newspaper. Paste the letter on one side of an index card and the answer on the other side. Have the client read the letter aloud, then provide his or her own answer. Then read the columnist's response aloud. The blend of reading, speaking and reading again can be used to flow from a 'strength' to a 'challenge' and back to a 'strength' again.

For clients who have disfluencies reading, having a prepared text enables the clinician the advantage of knowing what the client is attempting to say, making it easier to provide instruction. Reading can be used to identify and analyze disfluencies and as an activity to implement speaking targets. Clinicians are encouraged to give clients feedback immediately as they read, stopping them when necessary. Clinicians should not wait until the client is finished reading a whole paragraph before instructing them in ways of improving their technique. Many clinicians have a tendency to advise clients on many types of 'errors' they make. It is better to focus on one or two speech targets at a time, rather than mix too many together.

Monologue. While some clients are very talkative, others are exceedingly quiet. Many adults who stutter have not had extensive positive experience talking and are very used to being verbally introverted. Adolescents too may prove to be reluctant to speak. For others, stuttering is more an annoyance or a frustration in getting across the many things the client wants to communicate. With these scenarios in mind, using a monologue task may or may not be appropriate.

For those reluctant to speak, the clinician should not ask questions which can be answered with "yes" or "no". A picture description task or giving directions to a local landmark may be more effective.

Clients reluctant to volunteer a sufficient number responses should be moved to reading tasks. Clients who are more verbose may require frequent interruption and direction. Some clients do not always discern that, in therapy, clinicians are more concerned with "how" things are said, than "what" is said. (In counseling sessions, however, just the opposite is true.) Inexperienced clinicians are often reluctant to interrupt a client before they complete what they are saying. However, a great deal of therapy time is "wasted" by allowing the client to stutter on word after word, not attempting to use any of their targets. Intrinsically, clients understand that it is the clinician's job to monitor his or her speech and provide feedback. As clinicians mature they learn to diplomatically stop the client, give instruction and resume the monologue. The objective of the task should be foremost in the clinician's mind in managing a client's behavior.... maximize the number of successes in each task. The length of monologue tasks is an important variable; begin short, expand the length of the monologue to correspond with the client's rate of success.

Conversation. The conversation mode is usually a more demanding task, as it allows little time to formulate and reply to the listener's verbal response. As such, managing a slower rate of communicating can be a vital component to the client's success. Also, emotional topics such as 'abortion' may evoke strong feelings that need to be expressed which compete with the client's ability to self-monitor and use speech targets. Nonetheless, such topics provide challenges as clients become more skillful.

Conversations enable the clinician to model targeted techniques while conversing with the client. Later, the clinician may use hurrying, disinterest, inattention, and interruptions to challenge their more advanced clients.

Conversation is also a mode to transition from the clinic to the outside. Engaging strangers in conversations, speaking with co-workers and conversing at social gatherings are activities that many people who stutter find stressful. As such, group therapy may pave the way toward transitioning to real-world experiences. These real-world encounters frequently represent a big step and as such, clients initially regress in their skill level.

Presentation. One of the most common stresses for virtually everyone is presentations. A presentation is most like an extended, prepared and rehearsed, and formal monologue. In my experience, a therapy assignment to make a presentation at the next treatment session, usually results in an excuse: "I forgot." or "I didn't have time." This is most often a translation of "I was too frightened to do it." More often the client needs to do a presentation at work or at school and is suddenly 'highly motivated' to work on their talk. Unfortunately, the big presentation is usually the next day or in a few days, leaving little time for any real constructive improvements. It is the clinician's discretion whether to try to work on it or not. Attempting to prepare the client for something way over his or her head most often has no impact and the client's feelings of "this doesn't work" are again reinforced. It may be more appropriate for the clinician to say, "This requires much more work than we can do in the few days left available. We can, however, begin today to prepare for the next talk you will need to give, but there is very little we can accomplish at this date. We need to learn from this experience and devote more time into preparing for future speaking occasions."

Spontaneous presentations are a very good activity for group therapy. As such, one of the goals is to become more relaxed while in the role of "the speaker". Presentations should be long enough to have the client experience the anxiety and feel it dissipate while standing before the group. Learning to be more comfortable in the speaker's role comes from multiple opportunities, in several different environments. Moving outside of the client's comfort zone promotes a feeling of fear, excitement and opportunity; the key ingredients of change and improvement.

Telephone. Most clients who stutter commonly fear the phone. Many express the concern that all the attention is focused on their speech because the listener can't see them. This attention increases the client's fear and tension, usually increasing their stuttering.

Another significant issue in using the phone is the time interval it takes the client to initiate speech. Listeners are very impatient when it appears no one is on the other end of the phone or the thought that it is a "crank call". Listeners wait just less than two seconds before hanging up...an experience the client has likely encountered countless times before. This time pressure is typically very difficult for people who stutter, usually precipitating stuttering blocks. With this pressure, the client seldom realizes how much they change their speaking pattern when attempting to use the telephone. Just the thought of making a call stirs emotions and consequently physical changes in the process of speaking.

Thus, phone calls often begin with desensitization tasks; stuttering voluntarily to the listener while asking the store hours. As the client less fearful and better able to initiate voice, continued practice results in smoother, softer initiation of speech. Attention needs to focus on the changes made in the normal, fluent speaking process when confronting phone calls. Often, breathing becomes shorter and more rapid. Typically, clients take a deep gasp immediately before trying to phonate, almost insuring they will block. As awareness is builds, the client begins to see the pattern that leads them into almost certain stuttering. With the clinician's guidance, they begin to implement their speech targets and eventually overcome their difficulty speaking on the phone. For most, it is a long and difficult struggle.

In General. Talking with your client enables you to begin to learn their feared situations, words and sounds. In the vast majority of cases, the client's pattern of speaking changes dramatically in these feared situations, most often without their awareness. The clinician should not always take the client's reassurances that particular situations to not present difficulty, as some clients attempt to mask their fears with their bravado. A few actual phone calls will reveal the client's actual abilities. Someone who doesn't find phoning difficult shouldn't mind making a few calls.

© Rentschler, 2001