Improving fluency outside of the clinical setting is an immense challenge for both the client and the treating therapist. I often hear adults talk about feelings of failure as a result of not being able to improve their fluency at a younger age in conversational speaking situations. As a result, many have given up on speech therapy and view their past experiences as negative. Feelings of blame and guilt develop and it is truly not their fault. Practice groups are important in hopes of preventing inner feelings of guilt and to improve confidence in speaking.

The importance of using fluency tools and effective communication strategies in functional communication situations cannot be stressed enough. Trying to decrease stuttering and be a part of the "fluent" world is an added stress, especially for a teenagers who are concerned with not appearing or sounding different from their peers. Teenagers often are concerned about not being accepted for what they wear and how they look. To sound different is often a challenge filled with fear and apprehension.

Practice groups can be used for teens who stutter to reinforce skills learned in the therapy room and serve as a bridge to using tools the outside world. It is something I consider a necessity in treatment. Before a teenager can be asked to truly use strategies in the outside world, they are asked to join a practice group with others who stutter.

The first step involves desensitization activities to reduce fear regarding the dreaded saying one's name, address and personal information in which word avoidances cannot be used. This might first involve saying the information while stuttering and maintaining eye contact. Immediately after they are encouraged to talk about how they felt during stuttering and what reactions they received. This is often difficult as it involves being honest with feelings of embarrassment. It is interesting to hear responses such as, "No one wants to listen to me", however when asked if that happened, they answer no. Changing perceptions of how one is viewed while communicating involves time as does decreasing stuttering. However, it is an important step to unpeel these layers of fear and guilt before effective strategies can be used.

The next step is to ask the teens to write a list of their top five most feared speaking situations. These can include things like, ordering in a restaurant, calling a friend on the phone, or raising their hand in class. The best scenario is a group of two or more teens who stutter so they don't feel alone in overcoming these difficult tasks. The least challenging task is addressed first to increase feelings of success. This also helps to promote fluency and confidence. It is first done in a role playing situation. As fluency increases, more challenges are presented to increase the likelihood of transfer to the outside world. Teens are invited to bring in family members and friends. Most tasks begin with a description of stuttering and tools used. If the fear is too great to utilize these tools around family members or close friends, then encouragement is offered to stutter easier and provide strategies to decrease tension while speaking. Although the goal is to decrease stuttering, it is also important to work on feelings of shame and guilt. We want to instill that we are working on improving communication without beating ourselves up for stuttering.

It is important for parents to be a part of these groups at some point to increase their understanding of stuttering. Stuttering is complex as it is only exacerbated by stress and demands placed by family and friends. However, with the appropriate support and education, teens can improve fluency, confidence and communication skills. It can't be stressed enough that if clients jump into the pool too early, they will literally drown in communication anguish. However, if they are encouraged to tread water slowly, they will be able to talk effectively with more fluency and improved communication skills.

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