Avoidance Reduction Therapy for Stuttering: Case Spotlights Through an ARTS Lens

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Purpose: There is an increased interest among stutterers and clinicians in therapy approaches that focus on improved quality of life rather than increased fluency of speech. This interest is fueled by shifts in thinking about when and if stuttering is a problem, how society views differences, and what can and should be changed. Questions emerge: What are the desired outcomes and associated therapeutic goals? What are the basic principles of the therapy? What does therapy look like in practice? What assessments are congruent with stutter-affirming values? How can progress be measured? This clinical focus article includes the perspectives of six practicing clinicians shining light on a therapy case within the framework of Avoidance Reduction Therapy for Stuttering (ARTS). They demonstrate the alignment of therapy principles, outcomes, activities, and the measurement of change. Method: The cases highlight an aspect of the stuttering therapy journey across the lifespan, applying the ARTS framework with attention to (a) relevant background, (b) theoretical underpinnings, (c) the therapy process, and (d) key insights. The creativity, problem-solving, and counseling skills inherent in working within an ARTS framework are highlighted. The cases presented in this clinical focus article are fictionalized/composite examples created for illustrative purposes. They do not describe actual individuals, and therefore, informed consent was not required. Results: Cases reveal that, within a stutter-affirming therapy framework, (a) outcomes are less often measured by the frequency of stuttered moments (fluency) and more often by the stutterer's reported comfort and confidence in daily communication (impact); (b) goals shift from reducing stuttering-related behaviors and attitudes to reflecting the individual's priorities for speaking ease, self-representation, and socioemotional well-being; and (c) key ingredients for client change include clearly articulated rationales for therapy targets/goals, client-developed assignments, individualized counseling, and support from the stuttering community. Conclusions: Collectively, these cases underscore the importance of aligning therapeutic outcomes with the values and priorities of the stutterer. In doing so, they reframe therapeutic success beyond fluency to emphasize identity, participation, and well-being as meaningful indicators of progress. Further development of assessment measures and research grounded in stutter-affirming practice is needed to support and strengthen this framework for practice. Supplemental Material: https://doi.org/10.23641/asha.31448824

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