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From: Lynne Shields
Date: 17 Oct 2008
Time: 13:37:48 -0500
Remote Name: 68.143.177.2
Jen, John gave wonderful input on some ways to proceed with this young man. I would add that I think your idea about working together with this client to develop a ladder, or heirarchy, of situations is a great way to begin to address his feared situations. You might start by having him identify the situation/s that he thinks he would find the easiest for talking and the worst, and then begin to fill in between those two extremes. Then, you can ask him to locate a situation on the ladder that he wants to address. It might be making a class presentation, or maybe that feels too difficult just yet. Or, he might want to address presentations, because he needs to do those, as well as one other situation on the ladder. At any rate, once a situation has been selected, you can assist him in constructing a heirarchy for that specific situation. If oral presentations is the choice, then ask him to describe a scenario where he would feel the most comfortable giving a presentation. That might be presenting in an empty room, or to his best friend, in clinic with you, or even while talking to his pet cat. Whatever it is--he is choosing. The hardest might be in class in front of all of his classmates with the principal present. Once the extremes have been identified, fill in the slots between. Talk about what level he is willing to begin at, and what supports he needs at that level. If reading the presentation isn't the way to go, and it seems not for this client, what will make this easier for him to do? Note cards with just a few words about the main points, visuals to help him focus attention away from himself, etc. Will advertising his stuttering at the beginning of his talk reduce his anxiety about stuttering? Talk about what his expectations are in terms of what he would consider as a success. Is some stuttering O.K.? Why or why not? What about getting his main points across? Being able to insert some humor? Helping him to see all of the factors that are important in an oral presentation is probably an essential component of this process--a person can stutter quite a bit and still have a successful presentation. There's more to communication ability than just fluency. Once he has agreed upon the specific level of the presentation and has prepared and practiced, it is going to be important to have a de-briefing session afterward, to find out what he thinks went well, what he can modify next time--talking about it objectively can have a desensitizing impact and get him engaged in problem solving, as opposed to obsessing about how fluent he was or was not during the presentation. When he is comfortable with his accomplishment at the level he chose, then it's time to move up to a higher level for presentations--maybe he'll next choose giving his presentation in the clinic room with you, his best friend and his teacher, for example. You begin the same process at this new level. By engaging him in the process of developing the heirarchy, choosing the level at which to begin, problem solving the entire process and then reviewing afterward, you are giving this boy the opportunity to see himself as capable, as successful, and as a more powerful person when it comes to managing his stuttering. I hope these ideas are useful to you. Best wishes in working with this boy. Regards, Lynne