Ok, be honest. Does the thought of treating stuttering cause you to run screaming from the room like you just watched the latest episode of Stranger Things? (Was that just me? It got scary, y’all!) If so, take a deep breath and know you’re not alone. Our friends from the research world are here to help with some fresh therapy ideas and a planning tool that will definitely reduce the fear factor.

First up, Tichenor et al. remind us that when we plan for stuttering treatment, we need to consider speakers’ experiences in and around the moment of stuttering. As we work to embrace anti-ableist practices across the field of speech-language pathology, centering our treatment around what the speaker experiences rather than what the listener hears is critical. Through a review of previous research, the authors report that most people who stutter experience moments of disfluency as a feeling of being stuck or a loss of control. They share a number of therapeutic approaches that can be used to directly treat those feelings during moments of disfluency:

• Mindfulness - Help your client pause in the moment of stuttering to reflect deeply on the behaviors, thoughts, and feelings that occur during disfluency and then begin to change those reactions. (See here for more on using mindfulness in stuttering therapy.)
• Desensitization - Encourage clients to speak in previously avoided situations and practice voluntary stuttering. This can help gradually reduce negative personal reactions to the moment of disfluency.
• Cognitive therapy - Approaches such as Cognitive-Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) are effective at reducing negative reactions to stuttering. See the article for a summary of CBT and ACT as they apply to stuttering therapy.

Of course, these approaches are best incorporated into a well-rounded treatment plan that addresses affective, behavioral, and cognitive aspects (ABCs) of stuttering. If this sounds overwhelming, don’t fret! Gore and Luckman Margulis have created a therapy planning tool based on those well-researched ABCs called the 3Es (Education, Ease, and Empowerment) model. Ready for some more letters? By targeting the 3Es in therapy, you can help your client achieve outcomes across the 3Cs: competence, confidence, and change. The image below ties it all together:

Grab a downloadable version of this image here. 

It’s important to note that the 3Es model is not a single therapy approach or technique. Rather, it helps to guard against a one-size-fits-all approach to stuttering intervention by helping SLPs create a “menu” of goals and activities tailored to each individual client. For example, “Education” activities might include listening to the StutterTalk podcast, or your client might address “Empowerment” by writing a letter to a bully. Of course, an essential first step in the process is completing a thorough stuttering evaluation that addresses stuttering behaviors as well as the social-emotional impact of stuttering—check out this brief review for a place to start. Once you’ve gathered your data, then you can start writing goals for each of the 3Es based on what your client needs. Depending on their age and ability, you may even involve them in the goal-setting process - a great opportunity for empowerment! 

What’s that? You’d like a resource to help with goals? Good news, we have options. If you can access this full paper, check out Tables 2 and 3, which list activities and measurable goals for each of the Es. Can’t get your hands on the paper? (Did you try our tips?) You’re still in luck. The authors have an open-access blog with an overview of the 3Es model and three posts on goals, as well as links to materials for purchase.

I don’t know about you, but I feel educated, empowered, and ready to plan with ease. Goodbye, stuttering scaries!

Gore, K., & Luckman Margulis, C. (2022). 3Es: An all-inclusive stuttering therapy tool. Perspectives of the ASHA Special Interest Groups. https://doi.org/10.1044/2022_persp-20-00300 [available to ASHA SIG members]

Tichenor, S. E., Herring, C., & Yaruss, J. S. (2022). Understanding the speaker’s experience of stuttering can improve stuttering therapy. Topics in Language Disorders. https://doi.org/10.1097/tld.0000000000000272