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Preface | |
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Acknowledgments | |
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Clinician Characteristics | |
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Introduction | |
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The Importance of the Clinician | |
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Clinician Attitudes About Stuttering and People Who Stutter | |
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Specialty Recognition in Fluency Disorders | |
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Educational Activities | |
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Guided Practice | |
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How Clinicians Interpret the Disorder | |
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Clinician Personality Attributes | |
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Clinician Intervention Skills | |
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Becoming Less Inhibited as a Clinician | |
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Avoiding Dogmatic Decisions | |
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Opening Your Treatment Focus | |
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Calibrating to the Client | |
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Using Silence | |
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Modeling Risk Taking | |
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Challenging the Client | |
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Humor and the Clinician | |
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A Historical Perspective | |
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What's So Funny? | |
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Humor in Psychotherapy | |
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Using Humor in Treatment | |
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The Conceptual Shift | |
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Distancing With Humor | |
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Mastery and Humor | |
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Conclusion | |
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Study Questions | |
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Recommended Readings | |
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Theories of Etiology | |
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Introduction | |
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Attempts to Define Stuttering and Related Terms | |
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Some Definitions of Stuttering | |
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Theories of Etiology--A Historical Perspective | |
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Stuttering From a Physiological Perspective | |
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Theories of Cerebral Dominance | |
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Evidence from Neuroimaging Techniques | |
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Temporal-Processing Abilities | |
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Genetic Influences | |
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Auditory Feedback | |
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The Covert Repair Hypothesis | |
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Stuttering as an Emotional or Psychological Problem | |
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Stuttering as Learned Behavior | |
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Multifactorial Models | |
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The Demands and Capacities Model | |
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The Multifactorial-Dynamic Model | |
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A Neurophysiological Model | |
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A Summary of Models | |
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Conclusion | |
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Study Questions | |
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Recommended Readings | |
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Characteristics of Stuttering Onset and Development | |
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Introduction | |
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Stereotypes of Stuttering and People Who Stutter | |
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Characteristics of Normal Fluency | |
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When Is It Stuttering? | |
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The Features on the Surface | |
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Distinguishing Normal and Abnormal Surface Features | |
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A Sequence of Development? | |
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Conditions Contributing to Onset | |
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Less Influential Factors | |
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Physical Development | |
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Illness | |
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Imitation | |
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Shock or Fright | |
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Emotional and Communicative Conflicts | |
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Socioeconomic Status of the Family | |
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Nationality | |
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More Influential Factors | |
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Sex | |
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Age | |
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Genetic Factors | |
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Twinning | |
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Brain Injury | |
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Speech and Language Development | |
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Motor Coordination | |
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Conclusion | |
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Study Questions | |
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Recommended Readings | |
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Assessing Adolescents and Adults | |
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Introduction | |
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The Variability of Fluency | |
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Surface and Intrinsic Features | |
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Two Basic Principles of Assessment | |
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Assessing Older Speakers | |
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Severity Versus Handicap | |
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The Nonrepresentative Sample of Clients | |
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Assessing Intrinsic Features | |
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Identifying Loss of Control | |
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Testing the Link Between Control and Fluency | |
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Assessing the Speaker's Decision-Making | |
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Mapping the Surface Features of Stuttering | |
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Frequency | |
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Duration and Tension | |
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Fragmentation | |
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Subtle Surface Features | |
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Avoidance | |
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Substitution | |
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Postponement | |
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The Client's Self-Assessment | |
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Determining the Client's Desire for Change | |
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Formal Measures of Severity | |
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Stuttering Severity Instrument (SSI-3) | |
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Modified Erickson Scale of Communication Attitudes (S-24) | |
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Perceptions of Stuttering Inventory (PSI) | |
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Locus of Control of Behavior (LCB) | |
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Self-Efficacy Scaling for Adult Stutterers | |
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The SEA-Scale: Self-Efficacy Scaling for Adolescents Who Stutter | |
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Crowe's Protocols: A Comprehensive Guide to Stuttering Assessment | |
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Assessing Atypical Fluency Problems | |
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Acquired Stuttering | |
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Neurogenic Stuttering | |
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Psychogenic Stuttering | |
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Distinguishing Between Acquired Neurogenic and Psychogenic Stuttering | |
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Cluttering | |
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Spasmodic Dysphonia as a Fluency Disorder? | |
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Conclusion | |
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Study Questions | |
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Recommended Readings | |
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Assessing Fluency Disorders in Children | |
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Preliminaries to Assessment With Children | |
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Determining Whether or Not the Child Is Stuttering | |
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Eliciting Fluency Breaks | |
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The Nature of Fluency Breaks | |
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Indicators of Awareness | |
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Determining a Child's Level of Anxiety About Speaking | |
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Parent Participation in Assessment | |
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Examples of Assessment Measures | |
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The Component Model: One Comprehensive Diagnostic Approach | |
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Determining the Likelihood of Chronicity | |
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Fluency Breaks That Signal Chronicity | |
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Making the Decision to Intervene | |
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(Stream I children who have all five recovery factors) | |
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(Stream I children who have four of five recovery factors) | |
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(Stream II and III children with a score of seven recovery factors) | |
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(Stream II and III children with a score of six or fewer recovery factors) | |
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(Stream IV children with a score of four or fewer recovery factors) | |
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Using At-Risk Registers | |
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Conclusion | |
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Study Questions | |
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Recommended Readings | |
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Facilitating the Change Process | |
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Introduction | |
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The Nature of Change | |
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The Likelihood of Success | |
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Matching Treatment to Client Stages of Change | |
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Precontemplation | |
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Contemplation | |
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Preparation | |
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Action | |
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Maintenance | |
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Processes of Change | |
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Difficulties in Initiating and Maintaining Change | |
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Leading From Behind | |
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The Goals of Treatment | |
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Levels of Fluency | |
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Achieving Spontaneous Fluency | |
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The Importance of Modeling | |
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Variables in Choosing a Treatment | |
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The Timing and Duration of Treatment | |
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The Complexity of Treatment | |
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The Cost of Treatment | |
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The Treatment Setting | |
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Conclusion | |
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Study Questions | |
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Recommended Readings | |
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Counseling Strategies and Techniques | |
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Introduction | |
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Egan's Three-Stage Skilled-Helper Model | |
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How to "Do Counseling" | |
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The Necessity of Counseling | |
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Counseling in Psychology | |
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Counseling in Communication Disorders | |
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Emotions Encountered During Treatment | |
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Counseling Strategies | |
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Behavioral Counseling | |
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Humanistic Counseling | |
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Existential Counseling | |
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Cognitive Counseling | |
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Examples of Counseling Techniques | |
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Nonverbal Behaviors of the Clinician and the Client | |
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Verbal Behaviors | |
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The Content Response | |
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The Counterquestion Response | |
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The Affect Response | |
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The Reframing Response | |
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The Sharing Response | |
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The Affirmation Response | |
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Active-Listening Techniques | |
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Expressing Empathy | |
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Probing the Client | |
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Challenging the Client | |
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Using Humor | |
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Client Responsibilities | |
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Metalinguistic Indicators: Changing How the Client Describes the Problem | |
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Choosing a Future | |
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Clinician Characteristics | |
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Conclusion | |
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Study Questions | |
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Recommended Readings | |
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Treatment for Adolescents and Adults | |
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Introduction | |
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The Special Case of Adolescents | |
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Choosing a Treatment Strategy | |
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Some Specifics of Fluency-Modification Strategies | |
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Some Specifics of Stuttering-Modification Strategies | |
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Identification | |
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Desensitization | |
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Variation | |
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Modification | |
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Stabilization | |
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Cognitive Restructuring | |
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Experimental Treatment | |
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Group Treatment | |
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Determining Group Membership | |
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Advantages of Group Treatment | |
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Potential Problems With Group Activities | |
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The Effective Group Leader | |
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Establishing Group Norms | |
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Structuring Group Activities | |
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Relaxation-Imagery Exercises | |
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Role-Playing | |
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Public Speaking | |
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Demonstration of Client Skills and Progress | |
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Treatment of Atypical Fluency Cases | |
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Acquired Neurogenic Stuttering | |
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Acquired Psychogenic Stuttering | |
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Cluttering | |
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Conclusion | |
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Study Questions | |
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Recommended Readings | |
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Treatment for Preschool and School-Age Children | |
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Introduction | |
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Basic Considerations When Treating Young Children | |
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Indirect and Direct Strategies | |
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The Role of the Parents | |
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Stages of Parent Involvement | |
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Educational Counseling | |
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Facilitating Communicative Interaction | |
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Parents as Observers and Participants | |
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Treatment Strategies and Techniques | |
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Using the Demands and Capacities Model | |
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Enhancing the Child's Ability to Produce Fluent Speech | |
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Helping the Child to Respond to Stuttering | |
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Cognitive and Affective Considerations | |
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Stuttering Coexisting with Other Communication Disorders | |
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Two Effects of Coexisting Problems | |
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Transfer and Termination Issues | |
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The Possibility of Relapse With Children | |
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Suggestions for the Classroom Teacher | |
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The Problem of Teasing | |
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Examples of Fluency Programs | |
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The Successful Stuttering Management Program (SSMP) | |
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Personalized Fluency Control Therapy (PFC) | |
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Extended Length of Utterance (ELU) | |
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CAFET for Kids | |
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Speak More Fluently, Stutter More Fluently | |
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Easy Does It | |
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The Fluency Development System for Young Children (TFDS) | |
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The Stuttering Intervention Program (SIP) | |
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The Fluency Rules Program (FRP) | |
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Gradual Increase in Length and Complexity of Utterance (GILCU) | |
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Systematic Fluency Training for Young Children | |
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Conclusion | |
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Study Questions | |
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Recommended Readings | |
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Indicators of Progress During Treatment | |
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Introduction | |
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Defining Progress | |
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The Variability of Change | |
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Chronic Perseverative Stuttering | |
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Paper-and-Pencil Measures | |
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The Locus of Control of Behavior (LCB) | |
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Self-Efficacy Scaling | |
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The Modified Erickson Scale of Communication Attitudes (S-24) | |
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Asking the Client | |
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The Multidimensional Nature of Therapeutic Change | |
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Variables Influencing Progress | |
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The Treatment Strategy | |
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The Nature of the Fluency Disorder | |
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The Age of the Client | |
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The Intensity of Treatment | |
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Indicators of Progress | |
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Increasing the Client's Self-Monitoring Ability | |
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Increasing the Client's Ability to Produce "Open Speech" | |
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Decreasing the Frequency and Duration of Motoric Fluency Breaks | |
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Increasing the Frequency of Formulative Fluency Breaks | |
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Increasing the Naturalness of Fluent Speech | |
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Development of a Naturalness Rating Scale | |
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The Effect of Feedback | |
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Acoustic Features of Speech Naturalness | |
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The Effect of Speaking Task | |
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Audio and Video Samples | |
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Metalinguistic Changes | |
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Increasing Open Decision-Making | |
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Decreased Avoidance | |
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Increased (Speech) Assertiveness | |
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Increased Risk-Taking | |
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Improved Self-Concept, Improved Self-Esteem, and Role Changes | |
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Increased Distancing and Objectivity Through Humor | |
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Criteria for the Termination of Formal Treatment | |
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Conclusion | |
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Study Questions | |
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Recommended Readings | |
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Determining Progress Following Treatment | |
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Introduction | |
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Our Limited View of Change | |
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Maintenance and Transfer | |
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The Nature of Relapse | |
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The Possibility of Relapse | |
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Defining Relapse | |
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Possible Causes of Relapse | |
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Neurophysiological Loading | |
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Continued Effort Is Required | |
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Client Adjustment to a New Role | |
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Listener Adjustment to a New Speaker | |
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Speaking in a Nonhabitual Manner | |
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Failure to Follow Maintenance Procedures | |
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The Cyclical Nature of Fluency | |
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Overt and Covert Measures of Long-Term Change | |
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Predicting Success Following Treatment | |
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The Importance of Support Groups | |
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Reports of Long-Term Success | |
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Transfer and Maintenance Activities | |
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Conclusion | |
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Study Questions | |
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Recommended Readings | |
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Epilogue | |
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References | |
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Appendices | |
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Annotative Listing of Assessment Procedures | |
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Resources and Support Groups in Fluency Disorders | |
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Useful Booklets and Videotapes for Parents, Teachers, and Spouses | |
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Guidelines for Practice in Stuttering Treatment | |
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Subject Index | |