There are different aspects of stuttering therapy that contribute to success. We know that we need to address the affective aspects of stuttering (the "A" of therapy). We address the behavioral (the "B" of therapy). And we consider the cognitive ( the "C" of therapy). I also believe we need to focus energy on "E" - empowerment. By empowerment I mean that "a person believes they have the power to change or control some aspect of their life". Clients who stutter and are empowered are clients who believe they have choices over the way that they speak. This belief is an integral part of change.

This "clinical nugget" will share ways I have found successful in empowering my clients in their journeys for change. This changes across age groups so I will address each separately.

Empowering the Preschool Age Child

Even the youngest child can benefit from empowerment. At this age, there are many fun things we can do to encourage empowerment. First, talking about hard speech or stuck-talk, is critical. This opens the door for us to brainstorm different things we can do to our hard speech, such as put it in jail, lock it in a box, throw it into a trash can, or send it to the basement in the elevator! I have found it effective to buy some of the cardboard pencil boxes kids use for school and have them draw or write on it. They create their own hard speech box where they can put their hard talk.

For younger children who benefit from using some easy bouncy speech to reduce struggle and tension and minimize negativity, we often talk about their hard talk crying in the corner because they are in charge of their talk. Telling children that they are "being the boss of their talk" also encourages empowerment and sends powerful messages to the child. Using terms like "speech ranger", speech ninja", or "speech super hero" can also create a sense of empowerment for the younger child, and keep therapy fun. Use of these terms can be enhanced in therapy by the use of pictures and stickers.

Finally, having the child catch you having hard or bumpy talk is an effective means of empowerment. Taking it a step further, and having the child be the "therapist" and teach the clinician how to speak more easily is a fun activity for the child. The children I work with come to therapy knowing "they are going to beat my easy speech". I often say to them, "You can't do more easy speech then I can!" or "You can't say that easier than I can!" Once they do, I respond, "Oh, how did you do that? You can't beat my easy talk, I am the teacher!"

Empowering the School-Age Child

I believe that the center of empowerment of school age children revolves around giving them choices in therapy and embracing the goals they have for talking. Knowing that they are in therapy to change the things they want to change helps them "own "it, which is an important first step in empowerment. One of my favorite things I have my school age kids do is write on the front of their folders, "I am SO over you hard speech". Every time they come to therapy this is the first thing they see and it opens the door for us to talk about ways they have "been in charge" of their speech during the week.

Talking to school age kids about their experiences with stuttering and helping them understand what they are doing when they stutter, helps them see that much of what is happening when they are stuttering "they are doing." When a child can understand that stuttering is not something that just happens to you, but rather something you are doing, they begin to see that they have choices for talking.

Teasing cannot be overlooked in this age group and giving children ways to cope with teasing can aid their sense of empowerment over stuttering. My favorite thing to give school age children is a stack of my business cards, so every time someone makes fun of them by pretending to stutter, I tell them to grab a business card, give it to the child and say, "I didn't know you stutter too! Here is my speech teacher's card, give it to your mom." Or the child could say "you are doing it all wrong".

Lastly, I think school-age children need to be able to tell their parents what they will and what they will not be willing to do with respect to their speech, especially with respect to practicing and using speech tools. Embracing their goals gives the child a sense of power and control.

Empowering the Teenager and Adult

Empowering older clients is anchored in their belief system regarding recovery and we must find ways to help them see that change is possible. I frequently show my older clients the DVD "Transcending Stuttering" because of the powerful sense of change that comes from it. Having them meet other people who stutter who have experienced success with therapy can be powerful as well, having the opportunity to discuss the therapy process, what worked and what didn't can be very motivating for a client who has had previous therapy that my not have worked well for them.

My experience with older clients has taught me that I need to be constantly aware of how they are thinking about their therapy. In this age group, I see clients who want change quickly, are very quick to self-criticize, and maximize failures while minimizing successes. I believe that it is critical to their development of a sense of empowerment that they are counseled in the process of change (every session if needed!), encouraged to be kind to themselves, and help them to celebrate the small successes in their therapy as they are the building blocks to change.

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