When is self disclosure appropriate? – Loryn McGill, Stephanie Rodriguez, Amanda Bloemhof

About the Authors:

Loryn McGill, M.S., CCC-SLP is the owner of OC Fluency Center in Costa Mesa, CA providing therapy exclusively for people who stutter and at Chapman University she is an Adjunct Professor and teaches the graduate course in Fluency Disorders. At UC Riverside she is a member of a multidisciplinary team examining the benefits of collaboration and medical interventions for stuttering. She has conducted international research examining the benefits of early identification and its benefits. As West Coast Coordinator for Camp SAY she runs overnight and day camps for children who stutter and is actively involved with FRIENDS, The Stuttering Foundation, and the NSA.
Stephanie Rodriguez M.S., CF-SLP received her bachelor’s degree in Communication Disorders at California State University Fullerton. She received her Master’s Degree in Communication Sciences and Disorders from Chapman University. Stephanie has had the opportunity to work with St. Jude Hospital, Intervention Center for Early Childhood and Speech Language Development Center. Stephanie is currently completing her Clinical Fellowship year at El Monte City School District in California.
Amanda Bloemhof M.S., CF-SLP received her bachelor’s degree in Communications Sciences and Disorders from Biola University and her Master’s Degree in Communication Sciences and Disorders from Chapman University, where she became interested in fluency therapy. She is currently completing her clinical fellowship at Redwood Elementary and Richland Junior High School in Shafter, California. Amanda is enjoying putting all she has learned about stuttering therapy into practice in her school setting

In a study conducted by Iverarch, Rape, Wong, and Lowe (2017), 24% of a large sample of school-age children obtaining treatment for stuttering were identified as meeting the criteria for a diagnosis of social anxiety disorder, compared to only 4% of students who did not stutter.

Research states that negative peer attitudes can have damaging effects towards people who stutter (PWS) (Mallick, Kathard, Borhan, Pillay, & Thabane 2018). The research clearly shows that teasing leads to increased anxiety, depression, alienation, long-term negative consequences and in severe cases, suicidal thoughts and actions (Blood, 2012). Clinicians cannot eliminate teasing, but they can empower a child who stutters (CWS) with strategies for independently dealing with bullying. The goal of bullying strategies must be to respond, instead of react. Clinicians should find ways to respond to bullying that support self-esteem and confidence. Therefore, it is necessary for students who stutter to eliminate their social anxiety related to stuttering through the process of self disclosure. To date, a simple, age-appropriate self disclosure resource has not been formatted for clinicians to utilize as a therapy tool.

The focus of this paper is to first highlight therapy approaches and activities that prepare children for self disclosure. Secondly, this paper discusses reasons self disclosure benefits a PWS by neutralizing feelings towards the stutter. This paper will explain why self disclosure via the classroom presentation created is the final step within the hierarchy of stuttering therapy. Finally, this paper will provide speech-language pathologists (SLPs) an appropriate clinical checklist of how to incorporate the self disclosure presentation into their therapeutic goals.

 

Therapy Approaches To Facilitate Self Acceptance

  • Acceptance & Commitment Therapy

According to Beilby, Byrnes, and Yaruss (2012), communication effectiveness is diminished if gains in fluency are achieved through avoidance or use of speaking techniques that are burdensome and unnatural (Beilby et al., 2012). For this reason, acceptance and commitment therapy (ACT) is a key therapy technique when working with students who stutter. The framework of ACT is openness, confidence, acceptance and generalization. ACT challenges students to be surrounded by their unpleasant feelings, but not negatively react to them. This process ultimately leads students’ to desensitization of anxiety-provoking speaking situations. Through ACT, students will learn to accept uncomfortable situations and present a neutral response. Clinicians should construct a hierarchy of feared words, listeners, and situations to implement the stages of ACT. Clinicians will aid students in realizing the impact of their stutter either psychologically, emotionally, motorically, or socially.

  • Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT), a form of psychotherapy, is a key therapy approach in the treatment of fluency disorders in children. CBT’s greatest concern is demonstrating how one’s personal thinking affects their daily lives. For example, PWS may feel apprehensive about speaking, which are negative thoughts or predictions about the stuttering moment. In addition to personal negative reactions, evidence from Langevin et al., (2009) showed that a child who stutters may experience social exclusion and negative peer reactions, which leads to social anxiety (as cited in Kelman, & Wheeler, 2015, p.166). As a result, a PWS may manage their apprehensive feelings by deciding not to speak or choosing a safer word (Fry, 2009). CBT helps students develop awareness and enables them to challenge their negative thoughts by utilizing more adaptive coping responses, such as maximizing use of positive self-talk and establishing life-enhancing core beliefs (Kelman & Wheeler, 2015; Fry, 2009).

A therapy activity that can be used in conjunction with CBT is the Wise
 Brain
 Activity (Hinderscheit, Bodner, & Schools, n.d.)
. In this activity, clinicians teach students to use their “Wise Brain.” Clinicians must clarify if a student is only using one side of their brain (i.e., only the thinking side or only the feeling side), it can be a challenge to make appropriate changes in one’s thoughts or actions. Therefore, it is important to use “Wise Brains” and reflect on both thoughts and feelings.

  • Stuttering Modification

The stuttering modification approach aims to strengthen acceptance of one’s stuttering, as well as elicit motoric techniques to minimize tension related to stuttering moments. Stuttering modification treatment targets the speaker’s encounter with core behaviors and tension via desentization and assertiveness training. Along with targeting core behaviors and tension, counseling students is an integral aspect of stuttering modification. The purpose of counseling within stuttering modification is to help those who stutter understand their communication disorder, as well as identify ways to cope through education, problem solving and cognitive strategies. The clinician’s verbal responses during counseling moments can influence a student’s acquisition of skills needed for self disclosure ( Blood, Blood, Mccarthy, Tellis, & Gabel, 2001).

A therapy activity that stems from stuttering modification is the Worry Dial. To complete a Worry Dial, the child will brainstorm methods he or she can use to diminish worries such as, using positive self-talk or taking belly breaths. Gradually moving through a hierarchy allows students to expand the number of speaking situations they experience, minimize discomfort and acknowledge stuttering (Murphy et al., 2007).

  • Overcoming Avoidance

Avoidance Reduction Therapy (ART) states that a PWS desires to interact with others, but experiences an urge to hide their stuttering. According to the ART approach, these conflicting emotions cause maladaptive secondary behaviors that interfere with communication, such as eye blinking, leaning forward, using fillers, etc. PWS may feel they cannot partake in certain activities due to their speech. ART does not put an emphasis on fluency, but on improving a person’s ability to successfully communicate.

Clinicians can incorporate ART into their sessions by helping the child identify their stuttering patterns. Clinicians should challenge students to voluntarily stutter. It is key to begin these exposures in the safety of the therapy room and eventually branch out to different “real-life” situations (Leiman, 2014). A specific therapy activity to assist in overcoming avoidance is helping children learn to use pseudostuttering, also known as fake stuttering. As a student’s comfort with pseudostuttering increases, clinicians can set up situations, locations, and tasks where students can practice.

  • Desensitization

Desensitization therapy helps the student confront their stutter and any negative emotions. Desensitization will increase the student’s ability to tolerate stress and build their self-confidence (Fraser, 2010). Dell (2013) suggests clinicians should proceed at a slow pace to build trust with the child. Successful desensitization can be reached with direct, gradual, and successful confrontation of stuttering. According to the American Speech-Language Hearing Association ([ASHA], 1995), clinicians need to instruct students to practice fluent speech in a series of steps. The first step within the hierarchy is to identify when fluent speech is easiest to achieve. Then, the clinician would move toward situations where fluency is more difficult (ASHA, 1995).

General activities and techniques for desensitization can include clinician modeling of stuttering behaviors, clinician modeling of self-corrections, catching stuttering, purposeful stuttering, and contrasting hard and easy speech (Walton, 2018). Desensitization and self-awareness may be a precursor to self-acceptance and positive self-perception, which is the foundation for a student’s ability to self disclose and self advocate (Reitzes, 2005).

  • Self Disclosure

Self disclosure of stuttering is the final step of therapy and the overall purpose of this paper. Self disclosure means a child can discuss stuttering with no adverse feelings. Being open with stuttering helps reduce shame and fear, as well as remove the stigma about stuttering. A clinician should not force a student to self disclose before they are ready. The therapy approaches stated above should be successfully completed before the final step of self disclosure. Clinicians need to identify situations associated with negative feelings, and identify a hierarchy of feared speaking situations to begin the self disclosure process (ASHA, 1995). Self disclosure is tremendously important due to the toxicity of school culture for children who experience teasing, bullying, depression, reduced social and academic experiences and negative peer interactions. According to Blood et al. (2011), 44.4% of children who stuttered reported greater occurrences of bullying than students who did not stutter. It was also found that children who stutter have lower self-esteem and less optimistic life orientation than those who did not stutter (Blood et al., 2011). However, research states that peer attitudes can be addressed within the school context (Mallick et al., 2018).

Self Disclosure Through A Class Presentation

A PowerPoint presentation is the final step and most beneficial activity for the self disclosure process when peers in a school setting are the most feared population. The purpose of this final self disclosure milestone is to provide the student who stutters the power to live without anxiety, fear, and embarrassment. A classroom presentation allows the student the opportunity to tell people they stutter and that it is okay. As stated above, a classroom presentation is one of the final milestones for a student who stutters. A clinician’s attempt to reach this milestone before the student is ready, can be detrimental to the student’s therapeutic process. It is the responsibility of the student to independently determine their readiness for the final step of their self disclosing hierarchy. The crucial question is, “What deems a student ready for self disclosure in front of their entire classroom?” The answer is not the age of the student, how long they have been in therapy, or a coincidental “show and tell” scheduled in the classroom in the upcoming weeks. Due to the extremely sensitive decision a clinician must make, a resource checklist has been created to help assist clinicians in determining if their student is ultimately ready to take on the feat of self disclosing in front of their class.

Clinical Measures

In order to measure clinically whether someone is ready to disclose they are a PWS via a classroom presentation, standardized and non standardized assessments may be incorporated. The standardized measure most suitable to assess a child’s readiness for self disclosure is the Overall Assessment of the Speaker’s Experiences of Stuttering for School-Aged Children (OASES-S). In regards to informal measures, the clinician should send a caregiver and teacher questionnaire that discusses school-based activities and peer situations the child may avoid at home and in the classroom. The teacher checklists must focus on stuttering performance not the child’s academic performance. Although teacher and parent feedback is important, the ultimate reporter should be the child. The student checklist should highlight their feelings towards their stutter and ask questions related to their daily interactions. For example, the student’s willingness to talk in the classroom or on the telephone, and if he or she is relaxed during these interactions. The student questionnaire should ask if the child is able to stutter freely or if stuttering moments trigger feelings of failure. Finally, the clinician must ask the child if they have accepted being a PWS. The purpose of these clinical measures is to justify acceptance one’s stutter and readiness for self disclosure.

Conclusion

The emotional and cognitive effects of stuttering can cause fear, shame and embarrassment. In addition to negative thoughts and feelings related to stuttering, PWS may experience social rejection. According to (Blood et al., 2001), 59% of children who stutter reported being bullied. If a student who stutters learns to overcome avoidance, negative emotional reactions towards stuttering, and commits to self disclosure through ACT and CBT, he or she will be able to speak freely. A PowerPoint presentation can be used in smaller settings (e.g. in the therapy room with peers, friends, family) first to build up confidence and assist the child in reaching the final step of their fear hierarchy. Due to the critical nature of determining a student’s readiness for self disclosure through a classroom presentation, a readiness scale can aid clinicians in understanding the criteria that deems a student’s preparedness. In conclusion, if the proper hierarchy is followed according to a comprehensive view of stuttering, clinicians can help children reduce negative reactions to stuttering, overcome the adverse impact of the disorder, educate others, identify a supportive team of people and communicate effectively and successfully (Yaruss et al., 2012).

 

References

American Speech-Language Hearing Association. (1995). Guidelines for practice in stuttering treatment. doi:10.1044/policy.gl1995-00048

B Leiman. (2014, March 18). Avoidance reduction therapy: A success story. [web log comment]. Retrieved from https://blog.asha.org/2014/03/18/avoidance-reduction-therapy-a-success-story/

Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012). Acceptance and commitment therapy for adults who stutter: Psychosocial adjustment and speech fluency. Journal of Fluency Disorders, 37(4), 289-299. doi:10.1016/j.jfludis.2012.05.003

Blood, G. W. ( 2012). Bullying and SLPs: Enhancing our roles as advocates. Retrieved from https://www.stutteringhelp.org/content/bullying-and-slps-enhancing-our-roles-advocates

Blood, G. W., Blood, I. M., Mccarthy, J., Tellis, G., & Gabel, R. (2001). An analysis of verbal response patterns of Charles Van Riper during stuttering modification therapy. Journal of Fluency Disorders, 26(2), 129-147. doi:10.1016/s0094-730x(01)00096-1

Blood, G. W., Blood, I. M., Tramontana, G. M., Sylvia, A. J., Boyle, M. P., & Motzko, G. R. (2011). Self-reported experience of bullying of students who stutter: Relations with life satisfaction, life orientation, and self-esteem. Perceptual and Motor Skills, 113(2), 353-364. doi:10.2466/07.10.15.17.pms.113.5.353-364

Dell, C. W. (2013). Treating the school-age child who stutters: A guide for clinicians. Memphis, TN: Stuttering Foundation of America.

Fraser, M. (2010). Self-therapy for the stutterer. Memphis, TN: Stuttering Foundation of America.

Fry, J. (2009). Introduction to cognitive therapy. Retrieved from https://www.stutteringhelp.org/introduction-cognitive-therapy

Hinderscheit, L. R., Bodner, E.M., Schools, A. (n.d.). Stuttering treatment and the school-aged child: Emotional and attitudinal considerations [PowerPoint slides]. Retrieved from https://c.ymcdn.com/sites/msha.site-ym.com/resource/…/hinderscheithandouts.pdf

Iverach, L., Rapee, R. M., Wong, Q. J., & Lowe, R. (2017). Maintenance of social anxiety in stuttering: A cognitive-behavioral model. American Journal of Speech-Language Pathology, 26(2), 540-556. doi:10.1044/2016_ajslp-16-0033

Kelman, E., & Wheeler, S. (2015). Cognitive behaviour therapy with children who stutter. Procedia – Social and Behavioral Sciences,193, 165-174. doi:10.1016/j.sbspro.2015.03.256

Langevin, M., Packman, A., & Onslow, M. (2009). Peer responses to stuttering in the preschool setting. American Journal of Speech-Language Pathology, 18(3), 264-276. doi:10.1044/1058-0360(2009/07-0087

Mallick, R., Kathard, H., Borhan, A. S., Pillay, M., & Thabane, L. (2018). A cluster randomised trial of a classroom communication resource program to change peer attitudes towards children who stutter among grade 7 students. Trials, 19(1), 664.  doi:10.1186/s13063-018-3043-3

Murphy, W. P., Yaruss, J. S., & Quesal, R. W. (2007). Enhancing treatment for school-age children who stutter: Reducing negative reactions through desensitization and cognitive restructuring. Journal of Fluency Disorders, 32, 121-138. doi:10.1016/j.jfludis.2007.02.002

OASES-S (Ages 7-12) response forms – ENGLISH (n.d.). Retrived from https://www.stutteringtherapyresources.com/store/product/oases-s-printed

Reitzes, P. (2005, October 22). The Why and the How of Voluntary Stuttering. Retrieved May 10, 2019, from https://www.mnsu.edu/comdis/isad8/papers/reitzes8.html

Walton, P. A. (2018). Practical strategies for working with stuttering in the schools [PowerPoint slides]. Retrieved from http://www.metrospeechlanguagenetwork.org/

Yaruss, J. S., Coleman, C. E., & Quesal, R. W. (2012). Stuttering in school-age children: A comprehensive approach to treatment. Language, Speech, and Hearing Services in Schools, 43(4), 536-548. doi:10.1044/0161-1461(2012/11-0044)

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Comments

When is self disclosure appropriate? – Loryn McGill, Stephanie Rodriguez, Amanda Bloemhof — 31 Comments

  1. Thanks Loryn, Stephanie and Amanda! This is a great paper with some intriguing information. I loved your comment: ), communication effectiveness is diminished if gains in fluency are achieved through avoidance or use of speaking techniques that are burdensome and unnatural (Beilby et al., 2012)–This is huge in how we direct our therapy.

    I have a question about desensitization. I would propose that “densensitization” is not a part of ACT. With ACT, you help your clients understand those thoughts and emotions without passing judgement, to understand and accept them–not like them. I think that it is great to develop a hierarchy to help the child/teen/adult understand that situations matter AND I think that we are also helping them become more comfortable with being uncomfortable. I believe when we tell our clients: “if you subject yourself to this situation, you are going to being more comfortable with it…” we are setting them up for failure. What if they get to that “next level” complete the task and feel miserable the whole time. The message you send is: “aren’t you glad that is over!” I think a more realistic approach is to guide them to varying levels of difficulty while telling them to “prepare for the panic”–this is going to feel really uncomfortable, your heart may race, you may need to engage in some calming behaviors, which may or may not work, and you will do it anyway.” We need to send the message that this is hard and they did it anyway. As Jackie Robinson once said: No one is called a “good sport” when they win. No one is recognized for their strength unless they do something difficult.

  2. Hi Rita,
    I agree with you. If we are speaking of desensitization in a true sense then yes, desensitization is NOT a part of ACT. However, by being able to sit with unpleasant feelings and show up and participate in ACT therapy is taking steps towards the ultimate goal of a less reactionary response to stuttering moments. I believe that by using ACT, a natural biproduct is that it desensitizes (even if just a little) a client because they are being taught to experience the challenging moment more objectively… a positive shift.

    I completely agree with what you said about setting a client up for failure if they cannot get to that next level and presenting therapy in a way of, “If you just do this then xyz will be the outcome”. I believe that by being open with your stuttering leads towards a more positive speaking experience and that everyone’s experience is different and their own.

    By using ACT and being able to identify feelings is working towards an overall broader goal of desensitization. Using ACT along with other cognitive therapy approaches will hopeful lead towards more confident communication, knowing that outcomes vary significantly based on personal experiences. Appreciate your feedback and insight,
    Loryn

  3. Hello Loryn, Stephanie, and Amanda,

    Thanks for your thought-provoking paper. I am certainly happy to see a paper on self-disclosure in this year’s conference. In my work setting, self-disclosure and its close relative, advertising, often seem to get overlooked as options for helping people who stutter. I am interested in your definition of self-disclosure as the ability to “discuss stuttering with no adverse feelings.” I have always viewed self-disclosure as publicizing the fact that one stutters by self-identifying as a person who stutters, e.g., “Hi, I’m Rob, and I am a person who stutters.” (This contrasts with advertising, which I view as using voluntary disfluencies to publicize one’s stutter.) Your paper seems to ask self-disclosure to do a lot of heavy lifting, to the extent that self-disclosure during a class presentation becomes the final step of therapy, expected “to provide the student who stutters the power to live without anxiety, fear, and embarrassment.” I wonder if self-disclosure during a class presentation can live up to its billing.

    What if we put all of our proverbial eggs in the basket of self-disclosure, and things do not go exactly as planned during the class presentation? It isn’t hard for me to imagine a school-age child who stutters getting to the end of the class presentation and simply being relieved that it is finally over. Because children who stutter need positive communicative experiences, I wonder about the possibility of setting them up for failure, rather than success, with a super high-stakes speaking situation. I wonder, too, about placing such importance on a single speaking activity as a therapeutic end game. What if we have gotten to the “final step” of therapy, but therapy is not finished? What if unwanted feelings and attitudes remain?

    That is the beauty of ACT – unwanted feelings and attitudes are allowed to stick around, to come and go, and we can make the choice to take committed action toward a valued outcome, anyway, and move in the direction of our life worth fighting for. So there is no need to get rid of unwanted inner experiences entirely.

    Also, while speaking situation hierarchies are important for guided practice, treatment is always differential – based on individual characteristics and needs – and dynamic, responding to the changing needs of people who stutter. A complex, variable, and persistent problem like stuttering is going to require ongoing problem solving and alterations to the treatment plan. Would you agree that based on individual needs, a class presentation may, or may not, wind up on a particular student’s hierarchy at any given time?

    Finally, I am wondering about pre-determining a final step in therapy and what exiting therapy would look like following the class presentation. I am thinking about the basic principle of Gradual Dismissal, Follow Through, & Maintenance, and I’m asking myself these guiding questions: • Was there a gradual dismissal from therapy? • Did we make a plan to check in? • Did we talk with the child and relevant others about relapse and a plan for maintenance? • Is there an opportunity for ongoing support? • Did we help the child and others know when it might be important to come back to treatment? • Does the child-others know that it is normal to possibly need more therapy as development occurs? I’d be interested to hear your thoughts. Best,

    Rob Dellinger

    • Hi Rob,
      Thank you for your thoughtful response and insight. In short, I agree with your concerns and points. This paper is a condensed version of it’s original and the thought behind it was everything you are saying. Using the other listed cognitive therapies to explore situations and thoughts if things don’t go the way you thought was part of the reason we created a non-standardized pre and post readiness scale ( not published in this paper) so the child could self determine if this is the path for them. Discussing and exploring , “what happens if/ when” is a critical part of the therapy process.

      I think for many children the class presentation can be empowering and freeing and for others, the worst thing that could happen. I believe that the decision to do this is highly personal and the paper was a response to the class presentation being a ‘ blanket’ goal for so many children on IEP’s. In my experience, critical steps were being missed and a child was put in one of their most ( if not the most) terrifying situation without working up to it. A overview of the different cognitive therapies was to guide clinicians in what they can use to facilitate discussions about stuttering and address fears.

      A guide for anything is not an answer for all. I have many clients who have done presentations and many who have not. I do not believe it is appropriate or has the benefit for all children who stutter. For those who do have a goal, it was a mutual decision and something they felt would ultimately make communicating in the classroom more comfortable. The classroom presentation is not the end of the journey, merely a step in a longer adventure. Appreciate you taking the time to read the paper and write such a thoughtful response,
      Loryn

  4. Loryn, Stephanie, Amanda,

    Thank you for this thought-provoking look at the therapeutic process that culminates with a mutually agreed upon moment where the CWS does a self-disclosure presentation. I find myself wanting to know more!

    You mention that “self-disclosure means a child can discuss stuttering with no adverse feelings….” Can you elaborate or give advice regarding how to help them achieve this or how to know when this is achieved? I am in the initial stages of my journey learning about ACT and how it relates to fluency treatment, so any advice would be appreciated.

    Thank you,
    Erma Hanson

    • Hi Erma,
      Thank you for your question. I think it is important to validate that it is ok to have all the feelings one is having without necessarily changing them, but to identifying them and not ignore the experience. Shifting a focus from ‘ I can’t tell anyone that I stutter,’ to, ” I have having thoughts about not telling anyone I stutter.” is taking steps in working through the stages of ACT. What I enjoy about doing ACT with my clients is that you are giving the client validation for their feelings and the opportunity to still feel , hopefully long term in a more objective way.

      In the fourth step of ACT, one can be aware of one’s own experiences without attachment to them or an investment in which particular experiences occur. As a result, acceptance may be fostered.

      It is important to note that other cognitive therapies that were mentioned can also be helpful in the therapeutic process.
      Loryn

      • Loryn,

        I appreciate your reply and advice. I am working on “XYZ” to “I have thoughts …about xyz”. It sounds simple, until you have strong emotions, sometimes destructive, associated with it. For me, practicing while the emotional/cognitive price is low gives me more potential for success when the price is higher. (Emotion is stronger, maybe associated with self-stigma)

        Thank you!
        Erma

  5. Loryn, Stephanie, and Amanda,

    Thank you so much for putting together a clinician-friendly resource for working with children who stutter. This paper is a resource I have saved for potential future application.

    I do have a couple of questions. Do you guys have a case study for application of this process? Additionally, I am curious on your thoughts for how to accurately assess if a child is ready for this self-disclosure piece. I worry that a scale wouldn’t be sufficient evidence that the child is or is not ready. Would you recommend making it a collaborative decision by having a meeting with the teacher(s), parent(s), and school counselor rather than just a questionnaire for them to fill out independently?

    Looking forward to hearing your insight and advice!
    Mackenzie McBride

    • Hi Mackenzie,
      Thank you for your feedback! This paper is a much shorter version of it’s original form and is accompanied by non standardized pre and post readiness scales ( not published here) which we developed to help assist clinicians in determining readiness with the child’s feedback. We have often seen in the schools that there is a goal of the class presentation as a form of self disclosure when it is not at all appropriate for the child for a variety of reasons.
      The decision to do a presentation is ultimately up to the child with we as clinicians as guides, not the decision makers. The ultimate goal of any disclosure is a child feeling free to speak, regardless of if they may stutter.
      Loryn

  6. Loryn, Stephanie, and Amanda,

    Thank you for all of this information! It really made me think about a lot of aspects of stuttering that I hadn’t necessarily encountered before.

    I have worked with both a young child who stutters as well as an adult who stutters. The child was fairly unaffected by his stutter but the adult avoided many social situations because of his stutter. I think that this approach to provide a disclosure statement would have been beneficial for my adult client who stuttered. However, after reading this article, I am not sure that he would have been prepared to give a self-disclosure statement to his coworkers or friends. Even though he is now an adult, should we still go through the therapy approaches in hopes of reaching the point where he can give a self-disclosure statement? Would you take a different approach to this situation?

    Thank you in advance for your information!
    Lyndsay Schmitt

    • Hi Lindsay,
      Thank you for you question. I would start with trusted people at work and then work outwards after the home environment has been disclosed to ( family, close friends) . The workplace, like school is a place that someone spends a lot of time and within their day are many tasks and people that can be used to design goals so that the work place is a more comfortable place for communication. My clients disclose on phone calls, clients meeting, presentations, anytime they will be speaking and want to feel more comfortable. Disclosing for the first time can be very stressful and should be done with trusted people who can support the client moving forward in their self advocacy.

  7. Hi Loryn, Stephanie, and Amanda,

    Thank you so much for creating such an insightful resource that clinicians can reference when working with students who stutter.

    I have previously worked on constructing a solid disclosure statement with a person who stutters, but I have never thought about how effective a disclosure statement presentation would be for a school-age child. This is a fantastic approach to take with a student who wants to address his/her entire class at once. However, I feel like this is a big step for a student to take, so I absolutely love that there is a checklist that we as clinicians can use to determine whether or not our student is ready for this next step.

    A question I have for you all is what exactly should be included in the student’s presentation? From experience, what has been the most effective presentation layout you have utilized with your student who stutters?

    • The Stuttering Foundation will be posting the powerpoint soon as a resource for school aged children, keep a look out. Thank you!

  8. Hi Loryn, Stephanie, and Amanda,

    Thank you so much for these helpful therapy approaches! Self-acceptance can be extremely difficult for PWS. As clinicians it’s our job to help these clients feel more confident by eliminating negative feelings about themselves.

    One of the approaches you discussed is cognitive behavioral therapy. I’m currently taking a counseling course, and we recently covered CBT and the positive effect it has on clients with communication disorders. I love how you suggest self-talk and establishment of core beliefs to challenge negative thoughts. I was wondering if you could elaborate more on the Wise Brain Activity. Can you give me an example of when a child is using the thinking or feeling side versus the whole brain?

    Thanks so much! I am a huge fan of this article, and I plan to implement these therapy techniques with future clients.

    Taylor Parker

    • It is designed by Dr. Lisa Scott at a CBT activity and differentiates emotional thinking from rational thinking. My thinking side knows xyz but my feeling side knows xyz and what does my wise brain know? It is a great activity for kids and also to use as a discussion with adults and teens to experience perspective on their stuttering. Thank you for your feedback!

  9. Hi Loryn, Stephanie, and Amanda,

    Thank you for synthesizing these therapeutic techniques, as well as their application for people who stutter. I imagine each of these steps would be very personalized depending on what a particular individual values most in communication. Do you foresee therapy proceeding in a linear fashion starting with ACT and ending with self-disclosure? Or is it more like a cake, where you begin with the first layer (ACT), and then the next (CBT), and so on, where each layer builds on the other? I imagine it would depend on the client. One person might need to begin with ACT and skip to generalization activities before they are able to process their thoughts related to stuttering. For other clients, they might be really attuned to their thoughts and feelings, and need more time processing prior to jumping into realworld application of techniques.

    Thank you for sharing!
    Taylor

    • Hi Taylor,
      I believe in meeting clients where they are at so therapy is custom, often not linear with steps forward, backwards and sideways. Being in tune to our clients needs and realizing that some interventions work for some and may not be appropriate for others is the clinical decisions we get to make. Knowing options for intervention helps to make us effective clinicians. Thank you for reading, Loryn

  10. Hello Loryn, Stephanie, and Amanda,

    Thank you for sharing such an informative article. I was pleased to read your work as it relates more to social and emotional aspects of treatment approaches. I am currently enrolled in a graduate fluency disorders course and am learning more of the foundational pieces to understanding theories and therapeutic approaches. Reading your article has helped to fortify some of the concepts I have learned so far as well as provide a break down of the variety of approaches that are new to me!

    I have learned how much of therapy actually consists of socio-emotional aspects especially in school-aged children. I was wondering about the carry-over of these approaches to older students and even adults. Especially for those that may not have reached their goal of self-disclosure in the past but experience the same type of anxieties and fears in different social situations (job interviews, conference meetings/calls, and even relationships). Would you suggest any modifications be made to either the checklist or form of self-disclosure for these individuals? I would greatly appreciate your insight and look forward to hearing your suggestions.

    Thanks again,
    Lara Sugatan

    • Hi Lara,
      Thank you for reading the paper. My adults that I work with advocate for themselves in the workplace whether it by before an interview, presentation or meeting with business partners. As with children, you start small and work bigger with familiar people and expanding outwards and the same goes for teens and adults. For teens it may be disclosure on a sports team or to a new group of friends. Everyones value in disclosure is personal and the paper was a platform to address criteria for one specific type of disclosure that we commonly see as part of school goals.

  11. Thank you for the insights you shared on self-disclosure. I am a graduate student currently taking a fluency disorders course, and I found your paper to be helpful, especially the accessible breakdown of the various therapy approaches listed. I am participating in a supervised clinical placement in a public school where I work with an 11-year-old. His 3-year reevaluation is approaching, and my supervisor and I developed a goal for him to address bullying through self-advocacy. A class presentation may or may not be appropriate for him, and not necessarily at this time. I find myself wondering if there are other avenues or contexts of self-disclosure that might be of benefit to this child to respond to bullying as he approaches middle school, and if you have some suggestions of age-appropriate ways to phrase disclosure statements. I enjoyed reading your paper. Thanks!

    • I like to do the worry ladder to have the child design their own goals for the situations they want to be more comfortable in. A classroom presentation is defiantly not for all children and advocacy can be achieved many ways. Thank you for advocating for your client!

  12. Thank you for the great insights on self-disclosure in the school and classroom setting. This will be a very helpful tool as I enter the speech-language pathology profession. I hope to work in the school system and have found limited resources for fluency that make positive life-long impacts. I was wondering if there was a recommended age group for classroom presentation and self-disclosure or other, age appropriate ways for self-disclosure?

    • A powerpoint will be available soon through the Stuttering Foundation. Thank you for reading!

  13. Dear Loryn, Stephanie and Amanda,
    I really enjoyed reading your paper. I do believe that disclosure is a powerful way of enabling the PWS with an internal locus of control. While I agree with Dr. Dellinger’s comment that therapy would, ultimately, need to be individualized, the hierarchy and activities you talk about can certainly serve as a good guide.
    I had a very specific query about one of the activities you mention for anxiety reduction. I was wondering if “belly breathing” bring along the danger of turning into a secondary behaviour? I’ve seen that happen to some children who had been inadequately trained in the use of the Airflow technique. Any similar experiences that you have had with belly breathing?

    • Hi. I do not believe we mention this technique in the paper. In general, I do not support such actives as they often turn into secondary behaviors. Thank you for your feedback.

  14. This was such an informative read! I am currently enrolled in a graduate fluency course, and we’ve touched basis on the cognitive and emotional aspects PWS experience. I strongly believe that clinicians should counsel CWS on how to face and accept stuttering, and on how to be a educator to their peers. I believe that these are great therapeutic approaches to help CWS overcome the fear of speaking without feeling ashamed, embarrassed, or less intelligent. Self-disclosure is not only an important step it is also a breakthrough step in full self-acceptance. Thank you for sharing this research.

  15. Hello,
    This article was very informative and will be super helpful as I start my career in the field. How old would you say a child would have to be to understand that they speak differently than their peers. After their realization, how old, or how many years of therapy, do you think a child would have to go through to accept their stutter and reach self-disclosure.
    Thank you!

  16. Loryn, Stephanie, and Amanda,

    Thank you so much for sharing your knowledge and providing such a great outlook on self disclosure. I really enjoyed reading about the ACT. Acceptance and commitment are both extremely important in everyone’s life, they truly light the fire in feeling confident and loved. That being said, I’m so glad you took the time to address those topics and to show us the role that acceptance and commitment play in the lives of someone who stutters. Something I really took away from your paper is when you said “ACT challenges students to be surrounded by their unpleasant feelings, but not negatively react to them”. I think this is an amazing goal to strive for and could really help so many people. How long does it usually take students to stop the negative reactions? I imagine that at first, for most students, it is their instinct to have a negative perspective about their unpleasant feelings. So when do most of them change this perspective and begin to adjust to what ACT teaches them?

    Again, thank you so much for sharing!

  17. As I read this article, I was reminded of an encounter at an ecumenical conference I attending as an undergraduate student. The table I was assigned to sit were with a lot of catholic priests and nuns. The priest that I was sitting next to was a PWS. After exchanging some greetings, the priest immediately let me know that he stutters. I, in intern, told him I was an undergraduate student majoring in speech-language pathology. Instantly, I saw the tension in face left, as he felt relieved to speak freely without any reservations. Acceptance is a huge component in interacting with PWS. He stuttered throughout our conversation, However; his stuttering seemed to dissipate as the conversation continued. ACT seems to be the therapy technique that would be most successful for PWS because it addresses situations that may be more problematic and how to approach those more problematic encounters and remain confident while communicating.