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The
following ideas are the result of our experiences in
applying a solution focused point of view to work
with stuttering. For didactical reasons, we will
describe the work in schematic steps, but in actual
work, we always tailor the therapy to fit each
client.
The first step is to ask people: "How can I help
you?" This seems like an obvious question to ask, but
we have realized that the answers to this first
question can be very different, and that we can find
useful clues to the design of the rest of the
treatment here. Some clients will demand a
psychological intervention, while others prefer to
ask directly for speech therapy. We will try to fit
with their demands, and when clients ask for speech
therapy, we give them some articulation exercises
right from the beginning.
The second step is to let the conversation turn to
previous treatment experiences: "What have you done
before, with other therapists, that was useful for
you?" Many of our clients have several years of
unsuccessful therapy behind them, and they come to us
looking for a new chance. Knowledge about their
beliefs about what is useful or not are clues that
help us find the best way to help them help
themselves.
The third step is to address causes. We know that
this isn't a usual issue in solution focused brief
therapy, but for people with speech fluency problems
this seems to be a crucial question. Our impression
is that, if you don´t resolve this question from the
beginning, it usually reappears at a later moment.At
this point, we do a sort of deconstruction work. Many
people think that stuttering is a somatic problem
with no cure. We help them find different
explanations. "I wonder, how do you explain the times
when you speak fluently? It doesn't make sense for
me. These occasions don't fit with this being a
somatic problem?".
The fourth step is to focus on past exceptions, and
we invite the clients to examine the differences
between successes and failures by asking "How come
you speak better with some people?" and "What is
different on the days when your speech works
correctly?" We have found that certain words
frequently arise out of these conversations, and
'self-confidence' is our favorite among these. Many
people tell us -and we guide them to think that way-
that "Self-confidence is the key: when I trust
myself, I speak better". In these cases, to be more
self-confident with ones speech become the overall
goal of the therapy. This is more useful than having
"speaking better" as a goal, since that might put
people in a sort of paradox: "To speak better, I have
to control my speech more." But speaking is, as we
know, an automatic task, and if you try to control
it, things might worsen.
The fifth step is asking about goals. We prefer to
ask "What will be different in your life when you
reach this level of self-confidence in your speech?",
which is a more closed question than "When all the
problems you have are solved?" Apart from that, we do
classical "miracle question" talk. We also like to
encourage clients to continue to think about the
future at home after the session, and we usually ask
them to write about things that will happen in the
future.The following sessions are spent exploring
exceptions, i.e., any time they had spoken better or
any occasion they have gotten any advancement in
goals. For example, if they told us "I'm going to use
the phone more," we treat any phone call as an
exception even if they were stuttering throughout the
phone call. We like to see that as a strange loop:
for clients, goals are what will happen after their
speech has gotten more fluent, and we change this
into: "Reaching goals is what will help you to become
more fluent."Further sessions are dedicated to
building what we call "the box of resources" and "the
box of not useful things."
By analyzing exceptions, and sometimes failures, we
help people discover the secrets of fluent speech. We
also use scales, circular questions, metaphors, and
the whole set of traditional brief therapy
techniques. With people who are feeling guilty or
unable to cope with the problem, we even use
externalization. Sometimes this solution focused work
is enough to get a good improvement and treatment
stops. Other times we have to use specific speech
techniques with no relationship to solution focused
therapy, but that is another subject.
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