Celebrations are an important part of life, and the value of incorporating that into therapy is one of the best lessons I've learned in my years of working as a speech therapist. It is easy to assume that when the therapist sees progress happening, the client and their family are also aware of it. That is not necessarily the case, and the lack of awareness of change in the positive direction may lead to discouragement on the part of the client and loss of motivation. Most of us are aware of how much more motivated we are to persevere in any endeavor when we are able to see the benefits and internalize our role in making positive changes (Bandura, A., 1977). Applying that to the therapy process can make a big difference in the client's perceptions about the process of change. Simply telling someone that they are doing well is unlikely to be of much value to the client. Taking the time to plan treatment to include client awareness and recognition of progress is just as important, if not more, than any specific fluency tool that might be implemented (see, for example, Bloom, C., & Cooperman, D. K., 1999; Chmela, K. A. & Reardon, N., 2005; Manning, W. H., 2010).

Following are a few aspects of treatment planning that may help to foster the ability of the client and their family to find and celebrate their "I did it" moments:

1. Engage the client in identifying their goals for therapy
2. Engage the client in outlining the small steps that will help them reach their goals
3. Begin at the beginning - with the easier steps in the hierarchy you have developed with the client
4. Once a step has been achieved, ask them to explain what role they played in achieving that step
5. Ask them to talk about how they feel as a result of meeting the challenge
6. Celebrate the achievement of that step overtly

As an example, I worked with a young man who experienced a great deal of fear about talking on the telephone; he worried that he would stutter, and tended to avoid making calls as a result. He agreed that talking on the phone was something he would really like to address in therapy. Now that he had identified the goal of making phone calls, we worked out a hierarchy on paper relating to making calls. This was set up a series of steps, from easier to harder, to be followed (and modified as needed) in treatment. In doing this, we broke a difficult task down into smaller, do-able components, giving the client many opportunities to recognize and celebrate progression toward the goal.

The client was first willing to simply listen to me make phone calls and stutter on purpose. We did this activity as a part of every therapy session for several weeks. He initially noted that he felt very uncomfortable listening to me stutter on the phone; eventually he began to comment that he was no longer breaking out in a sweat or experiencing emotional discomfort when I made a call. I asked the client to tell me more about how he came to recognize his change of view. He reported, "I noticed that you don't get upset when you stutter even when you get a negative response from the listener, and I decided that I can see myself making calls". I pointed out that he had made the decision to change how he looked at phone calls, and asked if he saw this as a positive change. He agreed that it was an achievement, and that it felt good, that he was ready to move on to a slightly more challenging step. We 'checked off' that achievement on our hierarchy list, to preserve a visual acknowledgement of the success, and moved on to talk about the next step to take; whether to move to the next step he had originally placed next on the hierarchy, or to add a new step that might be more comfortable and approachable for him.

For family members of the client are involved in treatment, it is helpful to implement similar steps with them. For example, if a parent is working on making positive comments about their child's use of good eye contact, be sure that you help them develop do-able steps to achieve this, and acknowledge and celebrate their successes in implementing changes. Helping them recognize that they accomplished a goal and noticing how this impacted their child is vital in empowering parents as agents of change.

If you are wondering what might constitute a 'celebration', it can be as small (but still significant) as checking off an item on a list, as for my client working on phone skills, or more tangible, such as earning some sort of small but meaningful treat. I refer to this as 'giving yourself a goodie' with my clients, and I ask them to decide what will help them remember their accomplishment. For some of my younger clients, they work out a deal with their parents, earning an extra 30 minutes of TV or computer time when they achieve something important to them. For others, it is earning a reading break, buying a celebratory cup of espresso, or calling a close friend to tell them about their success. So, while it might initially be something tangible, eventually, most clients begin to internalize the sense of understanding that they are the author of change for themselves; simply acknowledging this, saying "I did it", becomes the celebration.

References:

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215.

Bloom, C., & Cooperman, D. K. (1999). Synergistic stuttering therapy: A holistic approach. Boston: Butterworth-Heinemann.

Chmela, K. A., & Reardon, N. (2005). The school-age child who stutters: Working effectively with attitudes and emotions...A workbook. Memphis: The Stuttering Foundation.

Manning, W. H. (2010). Clinical decision making in fluency disorders, 3rd Ed. Clifton Park, NY: Delmar, Cengage Learning.

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