One of the many possible goals of stuttering treatment is helping clients make "decisions about how to handle speech and social situations in everyday living." A process for achieving this goal is to, "Identify, with the client's help, attainable behavioral goals..." (Starkweather and Givens-Ackerman, 1997). A clinician may choose to identify a client's concerns using a routine questionnaire. The recent emphasis on evidence based practice has certainly increased my use of such questionnaires to quantify client input. But, my preference remains eliciting information in the context of relaxed conversation. I especially like this approach when treating children because they often respond to direct questioning with "I don't know." Conversation with children is more productive and fun.

Uncovering a client's personal preferences helps a clinician design meaningful treatment. Even when using a commercially available treatment program, "it is vital that clinicians modify its components to fit each specific child's needs" ((Shields and Kuster, 2003). One way I elicit information about a child, is to expand upon incidental comments they make while playing a variety of question/answer activities. Especially fruitful are games that involve playing cards. There is something about shuffling, sorting, flipping, selecting and otherwise manipulating cards that seems to be engaging. After employing one particular therapy program for adolescents that provides numerous questions about fluency, (Blood, 2003) I began making my own simple playing cards. Here is my clinical nugget: to help with initiating conversations about stuttering, take any questionnaire related to fluency and place each question on a separate index card. Use these cards to create a simple game. Note: this is a singular kind of game because stuttering can be a sensitive topic. The clinician's empathic listening skills are important to the success of this activity. Clinical judgment and client responses will guide the conversation and the development of clinical goals. One example of a questionnaire that the clinician can modify the wording of questions as appropriate to the needs of the client is available from Floyd, J., Zebrowski, P.M., Flamme, G.A. (2007) Stages of change and stuttering: A preliminary view. Journal of Fluency Disorders, 32, p. 113-117