PEER COUNSELING AND SELF HELP GROUP FACILITATION FOR PEOPLE WHO STUTTER

Developed by: Michael Sugarman M.S.W.
National Stuttering Project
5100 E. La Palma Ave. Suite #208
Anaheim Hills, CA 92807


Index

  • CHAPTER I: PEER COUNSELING SKILLS
  • CHAPTER II: SELF HELP GROUPS

    FOREWORD

    When Michael Sugarman asked us to write the foreword for his "Peer Counseling and Self Help Group Facilitation" manual, significantly it was at a Special Interest Division on Fluency conference entitled, "Bridging the Gap." As builders of this bridge between professionals and consumers, we are pleased to offer our enthusiastic endorsement of it.

    Self-help groups for people who stutter are thirty years old now, but rarely has such a comprehensive program been put forward for these groups to follow on a systematic basis. Allowing, as it does, for the person who stutters to come to terms with his/her stuttering, and to choose a direction he/she wants to go in dealing with the problem.

    Each of the two major sections; Chapter 1: Peer Counseling Skills and Chapter 2: Self Help Group, are broken down into clearly stated topics that are explored on a meeting-by-meeting basis in an atmosphere of honesty and openness. The peer counselor's job, a key component in any group setting, is especially well described.

    The peer counseling and self help group facilitation manual presented here is well thought through, starting with peer counseling skills. These skills set-up the structure allowing the techniques and principles used by the peer counselor to be effective in reaching the topic goals. The description of the peer counselor is especially important. "Know where you begin and end, and where the member begins and ends," is very helpful for a peer counselor. Respecting and really "hearing" the person who stutters is a significant part of the therapeutic process.

    An important value of a self help group for people who stutter is to help that person become more aware of the direction he/she wants to go in dealing with the stuttering. Awareness of the process increases the choices for the person who stutters. Through a self help group such as proposed, people who stutter can experience and get to know the various aspects of their stuttering. A sense of control can begin to be obtained over a given part of stuttering, rather than perceiving it as a powerful single force in control of them.

    The suggested topics, the sequence in which they are addressed, and appropriate setting of boundaries between a self help group and a professional have been achieved. This program can serve as an important bridge for people who stutter to move from where they are to where they want to go.

    Jeanna Riley, Ph.D. and Glyn Riley, Ph.D. California State University, Fuller ton The Center for Children who Stutter

    INTRODUCTION

    What is peer counseling?

    Peer counseling refers to people who stutter helping each other by listening, sharing common experiences. exploring options and giving support. Peer counseling is based on communication, empathy and understanding. People who stutter can provide peer counseling in a variety of settings including one to one or in a self help group.

    What happens in a self help group?

    When people who stutter meet together in a self help group, it is often helpful to have a peer counselor who can help the group in a variety of ways. Even though self help groups are not meant to be led by anyone, the peer counselor can assist in creating a safe and comfortable environment, giving all members an opportunity to share and helping individuals better communicate with and listen to each other. A peer counselor assists in setting group goals, develops an agenda and keeps the members on track. He or she can also be a resource for referrals to community services and support networks when the support group is unable to handle a difficult issue or an individual member needs more in depth therapy or professional assistance.

    How can I use this manual?

    This manual is intended to provide peer counselors involved in self help groups with valuable information to increase their competence in group dynamics and communication skills. It also provides practical information on how to facilitate a self help group, including ideas for agendas and group activities.

    How do self help groups and speech therapy work together?

    Self help groups are not meant to take the place of speech therapy. While professionals may be able to assist people who stutter in becoming more fluent or developing coping techniques for stuttering, self help groups can provide a safe place where people who stutter are able to share their feelings and know that they are not alone. Self help groups also allow individuals to develop self esteem by helping themselves and others at the same time.

    How can I find out more about self help groups?

    In addition to this manual, there are numerous books and article written about self help. Go to your local library or call the American Self Help Group Clearinghouse in your state.

    CHAPTER I: Peer Counseling Skills

    Introduction: Each self help group is different. A peer counselor uses each members unique issues and qualities to make every meeting different and interesting. The flavor of the group depends on the personality of the peer counselor as well as its members'. However, there are some basic concepts and experiences that are common to self help groups. These are shared below.

    Shared Experiences: Successful self help group involves shared experiences between the peer counselor and the member. A PERSON WHO STUTTERS is the expert on his or her experiences. motivations and feelings. The peer counselor has similar experiences that may help to explore stuttering behavior and personal issues.

    Structure: Self Help groups should provide a safe and comfortable opportunity for all members to share ideas and feelings regarding stuttering. Members are encouraged to share their experiences. giving them a better chance to understand each others' feelings and concerns. In order to better facilitate participation. all members must be given an equal opportunity to speak without interruption. Consideration must also be given to the self help group's agenda and keeping on task.

    Group Size: The maximum number is more critical than the minimum number for member sharing. Five to seven is a good size; ten should be the upper limit. Ten members divided by an hour of group time works out to six minutes each--not much time for a member to talk about his or her life. However. even when a member is not sharing there is still much learning taking place. The peer counselor may decide to close the self help group meeting to "X" number of participants. Also. when a new member joins the self help group. the peer counselor must set aside time to inform him or her about the rules of the self help group. including confidentiality.

    Peer Counselor's Role: Self help group facilitation is the approach taken which calls upon the peer counselor to follow the members' lead as they address issues. Peer counselor can open. maintain and close discussions, and if necessary, remind members that all must have an equal opportunity to share feelings. Peer counselors can also help members explore feelings and behaviors brought up in self help group discussion more deeply.

    Context: Peer Counseling efficacy will be improved when peer counselors are able to bring forth and explore the context by which members address personal and stuttering behavior.

    Information alone does not lead to behavior change: Behavior change is a complex process. Providing information as the sole or main intervention is generally not sufficient to lead to changed behaviors.

    Neutral stance: It is appropriate for peer counselors to take a neutral stance when addressing ambiguous information from members and to maintain a non-judgmental manner when discussing speech therapy or personal behaviors.

    Options: Effective peer counseling offers options not directives.

    Feelings are Powerful: Feelings are a powerful part of everyone's experience. The peer counselor cannot take away a person's feelings or "THINK I CAN FIX" another's feelings.

    Limitations: It is important for peer counselors to recognize the limitations of their role and act accordingly.

    Within the structure of the self help group meeting some things are beyond the scope of the peer counselors experience. Peer counselors need to understand this and be confident he or she can refer the member to appropriate resources.

    COPING AS A PEER COUNSELOR AND SELF HELP GROUP FACILITATOR

    "Know where you begin and end, and where the member begins and ends".

    Take time to assess your own feelings -- think about how feelings affect your peer counseling and your role as a self help group facilitator. For example do they:

    Recognize signals of stress while in the self help group such as feeling uncomfortably involved with a member's problems, over-extending yourself beyond the peer role, feeling hopeless or conversely more powerful in a situation than is realistic or appropriate or taking on commitments for members that are beyond appropriate tasks.

    Recognize signals of stress beyond the self help group, such as obsessing about family or work or feelings of frustration or disappointment.

    Identify resources which support you such as consultation with peers or varying responsibilities in the self help group including sharing facilitation.

    TECHNIQUES TO USE AS A PEER COUNSELOR

    Listening and communication skills make up the major part of good peer counseling. Below are techniques to use which can improve your listening and communication skills and help you deal with problems which might arise in your self help group. The more you practice, the better you will get at peer counseling.

    Open-Ended Questions
    You will want to use open-ended questions to keep group conversation moving and probe deeper into topics and feelings raised by self help group members. A "closed" question can be answered with "yes" or "no" or a simple statement of fact. An open ended question requires other information to be answered.
    Example:
    Closed: "At what age did you first stutter?
    Open: "What was going on in your life when you first started stuttering?"

    Benefits of open-ended questions:

    Drawback of open-ended questions:

    Active Listening

    "Active listening techniques" include engaging and responding to the person who stutters based on something he or she has expressed, either in words, or in non-verbal actions or behavior.

    Not recommended:
    1. Repeating words should be used sparingly This is not actually an active listening technique. Repeating does not give a person who stutters a sense of being listened to.
    Person who stutters: "When I'm about to speak I get excited and stutter. It really upsets me."
    Peer Counselor: "This just really upsets you."

    Recommended:
    2. Paraphrasing Saying what the person who stutters has said, using different words.
    Person who Stutters: "When I'm about to speak I get excited and stutter. It really upsets me.
    Peer Counselor: "It's very distressing."

    3. Reflecting: Expanding on the topic, adding in an acknowledgment or exploration of feelings or unstated thoughts.
    Person who Stutters: "When I'm about to speak I get excited and stutter. It really upsets me.
    Peer Counselor: "Yes, I can see that and I wonder if you might be angry about it, too."

    4. Interest: Expressing genuine interest in the circumstances of a person who stutters and inviting further disclosure.
    Person who Stutters: "When I'm about to speak I get excited and stutter. It really upsets me."
    Peer Counselor: "Help me understand what it is like for you when you go through this experience. Can you give me a picture of what a typical stutter would be for you--how you feel when you start thinking about speaking, what happens once you're aware of these thoughts or "how do you feel upset?"

    5. Reframing: Offering an alternative way of looking at a situation, usually one that is more constructive and positive.
    Person who Stutters: "When I'm about to speak I get excited and stutter. It really upsets me.
    Peer Counselor: "Yes, you're miles ahead of someone who does not have those feelings and isn't willing to be aware of them. And being upset about your stuttering is a good sign because it means your instinct to take care of yourself is really kicking in."

    6. Interpretation: Making some inference that has not been clearly expressed by the person who stutters. This is a more advanced skill, best left to trained professional therapists. Additionally. while interpretation is an important technique in therapy, it has less applicability in the self help group. Even skillful peer counselors usually don't know enough to make successful interpretations. Simply, don't analyze the motivations of others.
    Person who Stutters: "When I'm about to speak I get excited and stutter. It really upsets me.
    Peer Counselor: Perhaps what is really upsetting you is the guilt and shame you feel about stuttering."

    7. Process: This skill involves listening. reframing. and expanding what the person who stutters said musing a question.
    Person who stutters: "When I'm about to speak I get excited and stutter. It really upsets me."
    Peer Counselor:"How come this upsets you?"
    Person who stutters: "I feel stupid?"
    Peer Counselor: "How come you feel stupid."
    Person who stutters: "I really don't know when to start speech therapy?"
    Peer Counselor: "You don't quite know how to begin....
    Person who stutters: "I don't know if this group is worth it?"
    Peer Counselor: "You feel?"
    Person who stutters: "I don't know who is good as a speech therapist?"
    Peer Counselor: "You're unsure of the kind of speech therapy you want?"

    8. Attending Behavior. This skill involves eye contact. posture and verbal and non-verbal cues.

    Eye contact may vary from person to person. So a peer counselor can't assume because a person doesn't look you in the eye. that she or he is hiding something.

    What posture should a peer counselor take? Whatever posture is comfortable for you. Be you.

    Are there verbal and non-verbal cues peer counselor can use? Try "us/huh" "hmmm." Also non- verbal cues are smiling. looking puzzled. nodding. or leaning forward in interest. Be you.

    9. Summation. This is a combination of one or more phrases and includes a reflection of feelings. A peer counselor ties together content and feelings and tries to put things in perspective and identifies important trends, conflicts and possible decisions. Peer counselors must be aware of the biggest danger: DISTORTION. Therefore, check periodically with your member for accuracy. Also, be prepared to focus on the positive aspects of the situation and don't feed into the negative aspects.

    Problem Solving

    If a problem arises between group members, here are a few hints for how a peer counselor could handle the situation.

    1. Identify feelings of members using the techniques outlined above. 2. Defuse the situation and encourage "airing out" of feelings

    A common problem in self help groups is that one group member is especially judgmental or monopolizes the self help group. A peer counselor may follow these suggestions:

    1. Talk with the person outside of group about your feelings and perception.
    2. Discuss options regarding how to maintain a supportive environment.
    3. Come to a joint resolution on how each person is an important support to another

    Awareness: Maintain your awareness of feelings. This alone may not be enough to keep difficulties from arising in the meeting.

    Observation: Acknowledge the feelings.

    Peer Consultation: Share experience with colleagues and express your frustration, as well as gathering information for dealing with such situations.

    Mentoring: Share experience with a more experienced colleague especially if there is a continuing issue with an ongoing member.

    Referral: If your feelings are strong and interfering with ability to provide "good" peer counseling and after consultation the situation has not improved. Recommendation: Refer this member to another support group, seek professional assistance or ask members' from the self help group a consensus on the situation.

    What if a self help group facilitator runs out of things to say?

    Let the members lead, and you follow. Check in with members as to how they are feeling or what they want to do next. Remember you are the facilitator not a group leader and do not need to control the conversation. As a peer counselor, ask questions that may increase knowledge of your members' concerns. Go with the flow of the conversation and avoid changing subjects just to fit into the agenda if the conversation is productive. CHAPTER II: SELF HELP GROUPS

    CHAPTER II: SELF HELP GROUPS

    • Self Help Group Goals
    • Self Help Group Ground Rules
    • Self Help Group Agenda
    • Self Help Group Activities
    SELF HELP GROUP GOALS

    Suggestion: Self help support groups serve a variety of goals. Some of them are listed below. These can range from providing personal support and encouragement to providing advocacy, education and outreach to your local community. You can work with your group to set its own goals.

    Teach each other about the dynamics of stuttering

    Teach each other about how stuttering affects each one of us

    Help members feel better about themselves

    Validate members' experiences

    Help members identify, understand and express their feelings

    Build self confidence and self esteem

    Help members build a personal support system

    Help members learn how to have fun

    Teach stress management techniques

    Provide opportunities for members to help their peers

    Create a safe place to talk about feelings

    Help members identify what they need for themselves

    Help members realize that they aren't the only ones with this problem

    Strengthen coping skills

    Help members find ways to deal with their painful feelings

    Help members to trust others and if necessary explore obstacles which inhibit trusting

    Encourage intimacy and bonding within the support group Host workshops

    Community outreach regarding stuttering

    SELF HELP GROUP GROUND RULES

    Here are some basic ideas for ground rules for self help group meetings. You can hand these out at meetings, add to these or develop your own with the group.

    Cooperation: Cooperation is essential. Take care of yourself and others. Remember, these are learned skills.

    Group safety: Everyone's feelings of safety and comfort are top priorities in the group. "Negative" feelings such as boredom can serve a positive group function if expressed with concern.

    Expression of Feelings: To share feelings safely, make "I" statements: "I feel" or "I want..."

    Use of Time: When working on an issue or providing support, be brief and specific. Use the time as efficiently as possible.

    Identifying Needs: Learn to identify what you really want: nurturing, support, information, etc. Don't accept help that isn't exactly what you want.

    Confidentiality: It is essential that what occurs in the group remains in the group. In practice, there are many limitations to confidentiality, both individual and institutional. It is important that both the principle of confidentiality and the realistic limitations be acknowledged.

    Commitment to Change: Work in the self help group is often most effective when it includes a commitment to action to improve oneself. Ask: "What can be done to change the situation?" "How can we help each other?" Where can we go from here?"

    Celebration: Give priority self help group time to celebrate success.1

    SELF HELP GROUP AGENDA

    Meeting formats for self help groups range from loosely structured to more formally structured meetings. The following activities are common to many meetings and can be used as a guide for structuring your self help group.

    Announcements: Any information about community or national activities is shared with the self help group.

    Leftover feelings: Any feelings (appreciation, resentments, fears, etc.) or realizations from the previous meeting are expressed in order to clear away old feelings and enable everyone to be present.

    Formal Opening of Meeting: At the agreed upon time, the meeting should be called to order by the facilitator. A welcoming statement such as, "NSP is dedicated to empowering people who stutter to share through self help in a safe and comfortable environment" should be made.

    Check-in: Members express how they are feeling (excited, anxious, sad etc.) and whether they wish to use time in the meeting. It is essential that each member check-in with other group members.

    Activities/Discussion: At each meeting the peer counselor has two tasks:

    1. to facilitate a self help group activity or discussion and 2. to keep time to ensure all members who wish to speak have time to do so.

    Wrap-up: The self help group reserves five to ten minutes at the end for closing that includes appreciation and criticism.2

    Refreshments can be served at a break or after the meeting, providing time for informal conversation.

    SELF HELP GROUP ACTIVITIES

    It often helps if the peer counselor has an activity or discussion topic planned for each meeting. Ideas can come from members or can be taken from the suggestions below. Some of these ideas can be completed in one meeting and others may need to be completed over a series of meetings. If you have other good ideas which have worked in your support group, please send them to:

    Michael Sugarman 7626 Valentine St. Oakland, Ca. 94605.

    1.

    Topic: Introductions

    Goal: Establish group rapport

    Activity: Getting to know each other

    Pair members in the group--preferably with someone they don't know very well and instruct members to ask each other the following questions:

    Name, when or where you were born? What one word describes you best? How do you feel about your stuttering? What do you like about your stuttering or What does your stuttering show you? What bugs you about your stuttering? Ask members if they want to share what they have learned about the other person.

    2.

    Topic: Stuttering History

    Goal: Validate personal experience

    Activity: Discuss my social history

    Pass out a piece of paper and markers and give members an entire meeting to draw a chronological history of their lives --from when they were born to the present. This is a time line. Beginning with birth, describe some of your memories relating to your stuttering behavior, describing each situation noting on the time line when it occurred. Members share their time line in the group.

    3.

    Topic: Personal Awareness

    Goal: Increase personal awareness

    Activity: Discuss my feelings

    A. Begin the meeting by asking members to name as many feelings as they can--such as: A time I felt angry was; A time I felt happy was; A time I felt scared was; A time I felt guilty was; and A time I felt was, etc. and members share.

    B. Discuss how you feel when people focus on your stuttering.

    C. Discuss a response that a person made about your stuttering and how you responded to him or her.

    D. Homework assignment: Keep a journal for one week that focuses on how you perceive your stuttering in various situations. For example you might use a chart with the following headings: Day/Time; Situation/Setting; Activity; Reactions of other (5); My thoughts and feelings; and consequences. Have members share their experiences.

    E. Discuss three situations where your stuttering stopped you from expressing what you wanted.

    4.

    Topic: Stuttering Information

    Goal: Discuss stuttering therapy

    Activity: Group discussion about your experiences in speech therapy

    A. Members share their experiences from speech therapy.

    B. Members share their understanding on the causes of stuttering. Use available resources in your community such as the library, another person who stutters, a speech-language pathologist, or your partner.

    5.

    Topic: Defensiveness

    Goal: Identify how you protect yourself from being hurt

    Activity: My other side

    A. Members share one defense mechanism easy to talk about. Then discuss one defense mechanism difficult to talk about.

    B. Ask members to discuss something they have never before disclosed about their stuttering.

    C. Discuss how your stuttering affected your expectations in personal relationships, marriage. education and employment opportunities

    6.

    Topic: Self Esteem

    Goal: Increase self esteem

    Activity: Discuss me

    A. Ask members to discuss their feelings about the following topics: What is my attitude toward and perception of myself? Of me in this group? What is my attitude toward my stuttering? What do I think of myself as a stutterer?

    B. Ask members to share their thoughts on self esteem with other members.

    C. Using experiences from your life, discuss examples of being passive, being assertive, being powerless and feeling powerful.

    D. Ask members to discuss qualities about themselves that increase their self esteem. Members share their qualities.

    E. Pass Out a piece of paper and pencil and ask members to create a song or a poem for the group on "My self-esteem". After each member reads a song or a poem, the members share the experience.

    F. Ask members to discuss personal rights and their importance.Use. large newspaper size blank paper. Ask members to create a list of personal rights. Members share their experience.

    G. Group members discuss the concept of physical and emotional needs. Ask members to discuss what physical needs he or she may have including, such as food, shelter and clothing. Then discuss what human needs he or she may have in order to be emotionally healthy. These needs can include being loved, giving love, feeling appreciated, and being safe. Ask members to discuss: My own needs-- Met and Unmet.

    H. Ask members to discuss: "shame and self talk." Self talk is the dialogue which goes on in your mind in any given situation.

    I. Discuss three personal goals you wish to accomplish and when.

    J. At your support group meeting discuss the following handout (copy this page):

    "Rules for Being Human: Philosophical Consideration

    You will receive a body You may like it or hate it, but it will be yours for the entire period this time around.

    You will learn lessons. You are enrolled in a full time informal school called life. Each day in this school you will have the opportunity to learn lessons. You may like the lessons or think them irrelevant and stupid

    There are no mistakes, only lessons. Growth is a process of trial and error and experimentation. The "failed" experiments are as much a part of the process as the experiment that ultimately "works".

    A lesson is repeated until learned. A lesson will be presented to you in various forms until you have learned it. When you have learned it, you can then go on to the next lesson.

    Learning lessons does not end There is no part of life that does not contain its lessons. If you are alive, there are lessons to be learned.

    "There" is no better than "here". When your "there" has become a "here" you will simply obtain another "there" that will again look better than "here".

    What you make of your life is up to you. You have all the tools and resources you need What you make of them is up to you. The choice is yours.

    Your answers lie inside you. The answers to life 's questions lie ins ide you. All you have to do is look, listen and trust

    You will forget all this. 3

     

    7.

    Topic. Family Relations

    Goal: Increase understanding of family dynamics

    Activity: My family relations

    A. Pass out a large piece of paper and color markers and ask members to draw expressive faces of each member of their family; partner, children, mother father and siblings. And then next to each face write down your feelings. Members share what they drew and wrote with the group.

    B. Pass out a piece of paper and pencil and ask members to write a letter to parents and/or partner describing how they are affected by stuttering and what they need. These letters are not sent. However, the letters are destroyed in a ritualistic fashion. If members want to share their feelings--they can.

    8.

    Topic: Coping

    Goal: Develop coping skills about your stuttering

    Activity: How to take care of me

    A. Ask members to discuss as specifically as possible how their stuttering bothers them? Then discuss what strengths they may have developed as a result of stuttering.

  • B. Ask members to role play situations when they did not say meant in order to avoid stuttering. Has anyone been in this type of situation before? Was it difficult or easy to handle? Try to learn to say what you mean. The peer counselor may ask members who agreed to role play to leave the circle to develop a skit for the group. Theatrical props can be used. After the role play members discuss how they can learn to say what they mean.

    C. Discuss how your stuttering affects your decisions and whether stuttering interferes with your final decision. For example, talk about jobs, relationships. and social activities.

    D. Pass out a piece of paper and pencil and develop a self questionnaire that focuses on: How does stuttering affect me? Share your questions with others in the support group.

    9.

    Topic: Stress

    Goal: Teach stress management

    Activity: Stress reduction exercises

    A. Discuss how stress affects your personal and career life and what activities you do to relieve your stress. Do you consider taking an aerobic exercise class, hiking, challenge yourself in hobbies, social activities or solitary activities? These are just a few. Have each member, who wants to, commit to do something for him/herself to relieve stress during the upcoming week and tell the group what it is.

    B. This is for those peer counselors who want to try something that's different for a group activity. Use your community resources and request the following professionals to assist your group:

    10.

    Topic: Letting Go

    Goal: Separation

    Activity: Letting go of the stutterer

    A. Members share their experiences of relapse.

    B. On a large piece of paper make two columns. Label one "person who stutters" and the other "stutter." List and discuss whether the two are the same or different.

    C. Discuss the following statement on letting go.

    Members share how "letting go" applies to them.

    11.

    Topic: Support System

    Goal: Increase members support system

    Activity: You are not alone

    A. Pass out a piece of paper and pencil and make a list of your support system. "Who do I talk to if I have a problem?" "Relapse?" Share your list with the group. Discuss ways members can increase their support network.

    12.

    Topic: Speaking Circles

    Goal: Opportunity to practice speaking in public

    Activity: See Reference section "Speaking Circles Make Debut at Los Angeles Chapter," Letting Go (March/April 1996)


    1. Adapted from handout "Self Help Group Ground Rules", Support Group Training Project, Oakland, Ca.
    2. Adapted from "Peer Support Group Structure" Support Group Training Project. Oakland, Ca.
    3. Adapted from Handout "Discuss Rules for Being Human at Care for the HIV Care giver Workshop, 4/26/96. East Oakland Recovery Project. Oakland, Ca.
    4. Handout from flyer "Care for the HIV Caregiver Workshop 4/26/96. East Oakland Recovery Project
    5. Adapted from flyer "Letting Go", Kairos, San Francisco, Ca.


    added with permission of Michael Sugarman
    September 25, 1998