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.