Journeying
Through Juggling
by Joseph Donaher
Stuggling and Juttering is a program that uses juggling as a
metaphor for stuttering at all levels of the therapeutic process.
It was developed at Temple University and is based on Woody Starkweather’s
Awareness, Acceptance and Change Model (Starkweather & Givens-Ackerman,1997).
The program combines the positive and rewarding aspects of juggling
with the challenging and frequently frustrating demands of speech
therapy for adolescents who stutter.
Juggling was initially used to build rapport with clients and
to act as a reinforcer. To establish rapport, the clinician would
juggle during the session and encourage the clients to take part
in the activity. It was quickly recognized that when the clients
were engaged with juggling, they felt increasingly free to interact
and share with the clinician. As a reinforcer, the adolescents
were rewarded for working hard during the session by being allowed
to practice juggling for five to ten minutes. These two goals
continue to be an essential part of the program. However, as the
program evolved, juggling became a more integral part of the therapeutic
journey.
Whenever this program is discussed, someone asks the question, "Why
juggling?" Truthfully, there is nothing inherently therapeutic
in juggling. It was used simply because the student-clinician
was a professional juggler. Prior to entering graduate school,
he had spent ten years performing in revue shows in Atlantic City
and at various locations around the country. Woody Starkweather
stressed that this clinician should allow his clients to truly
get to know him. The student-clinician felt that juggling would
be a great way to establish therapeutic relationships. In actuality,
juggling is not entirely without therapeutic merit. An accomplished
juggler demonstrates the qualities of concentration, balance,
rhythm, focuse and playfulness (Gelb & Buzan, 1994). Jugglers
attempt to make the complicated look natural. They become intimate
with small failures in the form of drops and strive to learn from
these minor setbacks. A juggler who never drops is a juggler who
never pushes his own limits and never takes risks. Jugglers also
become familiar with the process of learning. They are trained
to break things down and to analyze the component parts.
For example, when learning to juggle, you should always begin
with one ball. As your comfort level increases, you progress to
a second and then a third ball. As your learning curve advances,
you begin to experience increased confidence, self-worth and self-esteem.
Juggling also promotes increased concentration, attention, dexterity
and interpersonal communication skills. Juggling encourages patience
and relaxation through a meditation-like integration of mind,
body and spirit (Finnigan, 1992). Ironically, many of these variables
are frequently missing or underdeveloped in adolescents who stutter.
Gelb and Buzan present the idea of relaxed concentration in their
book, Lessons from the Art of Juggling (1994). They suggest that
when learning to juggle, one must be able to divide one’s
attention between various elements while focusing on the whole
picture. They feel that one must be relaxed and focused at the
same time. Each individual needs to discover when and where to
apply effort in order to make the task look effortless and natural.
Too often, individuals equate success with effort, according to
Gelb and Buzan. Unfortunately, if you are employing erroneous
patterns or techniques, increased effort will simply lead to frustration,
anxiety and failure. This has tremendous implications for adolescents
who stutter. If one’s speech is "stuck," the natural
thought is to "push it out."
This is exactly how secondary behaviors develop. The individual
adopts a behavior such as facial grimacing or head nods in an
attempt to escape the actual stuttering behavior. As these movements
become less effective maskers, the individual increases the effort
behind them. In this way, the secondaries grow larger and become
more socially stigmatizing.
The second commonly asked question is, "Why is this program
successful with adolescents?" First, consider that the majority
of research and intervention programs for stuttering concentrate
on either the adult population or on early intervention. With
adults who stutter, the SLP utilizes direct techniques to challenge
the individual to actively take responsibility for his or her
own progress. With young children, there are several established
programs that apply indirect therapy techniques to enhance the
child’s environment and promote fluency. Adolescence is a
time of limbo where the individuals are often too old for the
indirect techniques used with preschoolers but not yet ready to
fully take responsibility for their own journey. For this reason,
there are minimal programs developed specifically for this age
group and many SLPs dread working with this population.
Further complicating matters is the fact that this population
is frequently jaded toward speech therapy as a result of years
of ineffective or inappropriate speech therapy that implemented
no real change. It is nearly as common for adolescents who stutter
to report negative stories regarding their experiences with SLPs
as it is for them to report negative experiences with peers at
school. Some report being taught outrageous techniques while others
report spending countless hours practicing words and sentences
in groups with people who do not stutter. For whatever reasons,
adolescents rarely look at speech therapy as a positive experience.
On the contrary, juggling is universally viewed in a positive
light. It is usually displayed at festive engagements to create
an exciting atmosphere. Jugglers are viewed as entertaining, coordinated
and highly likeable individuals. Although everyone knows what
juggling is, relatively few people can actually juggle. An instructor
at Davidson College in North Carolina conducts a survey of incoming
freshman every year. He reports that on average less then 10%
of freshman can juggle three balls.
With this in mind, consider the question that is asked early
on in the Stuggling and Juttering program. "Which is more
difficult, effective communication or juggling?" Most adolescents
consider juggling to be much more difficult. Imagine their motivation
when they learn to juggle one, two and eventually three balls.
They have just joined the small fraternity of jugglers and have
experienced success in an activity that they once considered extremely
difficult.
The motivation gained from learning how to juggle transfers into
motivation regarding their speech. In the initial weeks of therapy,
they focus more on their progress with juggling. It is easy to
monitor progress in this area but often difficult for adolescents
to identify progress with their speech,
especially in the early stages.
One reason for this is the fact that many of the early goals
in therapy are intangible and unobservable. These include increasing
awareness, decreasing denial and dealing with the emotional issues
of fear and shame. Furthermore, for many individuals the initial
period of therapy is marked by an increase in stuttering behaviors.
This may be secondary to the reduction of avoidance behaviors
or a result of truly analyzing their own speech for the first
time. By allowing them to concentrate on their juggling successes
early on, the clinician fosters feelings of accomplishment and
shows the client that they can be victorious. In this way, the
individual gains control and avoids the feeling of helplessness
that frequently is felt by adolescents who stutter.
Regardless of individual experiences, most people would prefer
not to be in speech therapy. Adolescents, especially those that
have not experienced success in therapy, detest the idea of working
with a speech pathologist on issues including emotions, attitudes,
thoughts and behaviors. During adolescence teenagers have a tremendous
need to be considered "normal" and stuttering is not
considered "normal." This is why many families seek
professionals outside of their school system. They are attempting
to avoid the embarrassment and frustration that often accompanies
pull-out services in the schools.
Adolescents frequently will not admit that they are in therapy
and will manufacture elaborate stories to hide their secret from
their friends. This is the same emotional response that motivates
youngsters to hide their stuttering from others. A prime example
of this is a 13-year-old boy named Michael. He refused to work
with the school speech therapist because services were provided
in the trailer outside of his school. He felt that if he went
into the trailer, everyone would tease him for going on the "stupid
bus." He also refused to see a therapist outside of school
because he dreaded talking about his stuttering.
After his parents bribed him to start therapy at Temple University’s
Stuttering Clinic, he was enrolled in the Stuggling and Juttering
program. He then bonded with the therapist and thoroughly enjoyed
the challenge of learning how to juggle. Eventually the therapist
was permitted to address speech related issues because Michael
knew that was the only way to learn more juggling tricks. A few
weeks later, Michael’s mom reported that he was bugging her
to leave earlier so they would not be late for "juggling
class."
Juggling and stuttering therapy are also inter-related in the
underlying process involved in each activity. Both can be viewed
in terms of perpetual journeys. Just as there is no beginning
and end for juggling, there is no set beginning and end to therapy.
There will always be new tricks and new directions for jugglers
to explore, just as there will always be new emotions, ideas and
behaviors for the clinician and client to explore.
Each individual has begun his own journey prior to entering therapy.
The therapist must attempt to discover where the individual is
in his own journey and together they will move forward (Starkweather & Givens-Acker-
man,1997). The clinician must not tell the client when or where
the therapeutic journey begins. Imagine an expert juggler being
told that he must concentrate on a simple trick that was mastered
years ago or a novice juggler being told to concentrate on an
advanced trick. They would easily become frustrated and jaded
towards the process.
A major strength of the program is it allows the individuals
to practice skills or approaches in a variety of settings. The
topics that are addressed in therapy with the clinician are revisited
during the juggling sessions when only the clients are present.
During this time, the clinician meets with the families who have
been discussing their own topics in another room. The clients
are encouraged to discuss what they are working on with family
members at a later time. The clinician also stress the importance
of practicing juggling every day at home. This is an indirect
way of encouraging the student to think about stuttering outside
of therapy room.
By reintroducing the topics in a variety of controlled settings
with different people, the individual is more likely to develop
a strong understanding of the key issues. In this way, the program
is increasing the chances of carry-over into novel situations.
This program is not an attempt to teach all SLPs how to juggle
nor should it be viewed as a therapy cookbook. The aim is to challenge
SLPs to combine a bit of themselves into their therapy practices.
They need to view therapy as a joint effort between themselves
and their clients.
By incorporating their own interests and passions into the therapeutic
process, they will accomplish several things. First, they will
increase the interest level for both the client and themselves.
A client who is engaged and interested in therapy is more likely
to truly grow during the process. A clinician that is engaged
and interested in therapy is reducing the risk of burnout.
Second, they are strengthening the bond between themselves and
their clients by forming a more realistic relationship. It has
been suggested that the strength of this relationship is a much
better prognosticator of success then the specific strategies
or techniques utilized (Manning, 1996).
Third, by incorporating non-traditional techniques, they are
increasing their ability to reach individuals who have become
disenchanted with therapy. As a profession, SLPs have relied too
heavily on strict therapy protocols that treat all clients in
the same manner. Therapy does not have to be regimented, rigid
and painful. It does have to be challenging, insightful and rewarding.
Stuggling and Juttering should be considered a work in progress.
It is constantly evolving as new individuals get involved. Hopefully,
the main points and theories will encourage others to question
their intervention practice.
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