Full Goal

Given pre-taught instruction in cancellation (stopping after a stuttered moment, pausing, and re-producing the word with reduced tension) and pull-out (modifying tension and rate during an active stuttered moment to release it), across structured tasks (single-word reading, sentence reading) progressing to conversational speech, client will apply cancellation and/or pull-out to identified stuttering moments of their choosing, with reduced physical tension and struggle with self-rated successful application on ≥60% of self-identified stuttering moments across 3 consecutive sessions, with at least one session including a conversational task; success is client-rated, not fluency-rated, as measured by client self-report log, optional joint review of audio recording, and clinician observation of tension/struggle behaviors (not stuttering frequency).

Neurodiversity-Affirming Framing

Cancellation and pull-out are stuttering-modification techniques from Van Riper, sometimes confused with fluency-shaping (which aims to eliminate stuttering). Stuttering modification accepts that the client will stutter and works on changing how stuttering happens — reducing physical tension, struggle, and avoidance — not on reducing stuttering frequency. This goal is written in that tradition:

• The target is the moment, not the frequency. Success is operationalized on stuttering moments the client identifies and chooses to modify. There is no fluency-percentage target.
• The client identifies moments to modify. Not every stuttered word benefits from intervention. Clients may modify moments that feel struggle-heavy and leave easy moments unmodified. The choice is the client’s.
• Reduced tension, not eliminated stuttering. A successful pull-out releases a moment with less physical effort. The word may still be stuttered. That is the intended outcome.
• Avoidance reduction is a separate goal. Modification techniques work on overt stuttering moments. They do not address word and situation avoidance, which is often a larger contributor to the lived experience of stuttering. Pair this goal with avoidance-reduction or self-disclosure goals.
• Not all clients want this. Stuttering modification assumes the client wants to change something about stuttering moments. Some clients prefer to focus on disclosure, acceptance, or unconditional pride in their stutter without modifying moments at all. Goal selection should reflect what the client actually wants.

Individualization Guidance

Before using this goal, verify:

• Client is part of the goal-setting conversation. Stuttering modification works through client agency. A goal imposed without buy-in produces compliance, not generalization.
• OASES at baseline. The Overall Assessment of the Speaker’s Experience of Stuttering captures impact across four subscales (general information, reactions, communication in daily situations, quality of life). Use it to ground the goal in the client’s reported experience rather than just observed stuttering.
• Pre-teaching is foundational. Cancellation and pull-out are taught explicitly in earlier sessions before being applied in conversation. The goal assumes the client knows what each technique is and what successful application feels like.
• Identify, don’t impose. The clinician does not point out every stuttered moment and say “try a pull-out.” The client identifies moments. Clinician role is supportive observation and joint review.
• Generalization context. Structured reading is the easiest condition; conversation is the hardest. The goal requires at least one conversational session because that is the functional generalization environment. If the client is not yet conversational with the technique, that’s a precursor goal at the structured level.
• Audio recording is optional. Some clients find joint review of audio recordings helpful for identifying their own moments. Others find it stressful or counterproductive. Offer it as an option, not a requirement.
• Pair with self-disclosure and acceptance work. Modification techniques in isolation can subtly reinforce the idea that stuttering moments need fixing. Pair with self-disclosure, acceptance, and identity-affirming work so the framing remains client-centered.

Clinical Notes

The ≥60% threshold on self-identified moments is lower than traditional 80% accuracy criteria because the unit of measurement is different. Each stuttered moment is a high-stakes event; expecting modification on every moment is unrealistic and counterproductive. 60% across self-selected moments is meaningful evidence of skill use.

The “self-rated successful application” criterion centers the client. A pull-out that the clinician judges “well-executed” but the client experiences as forced or unnatural is not successful for goal purposes. Conversely, a modification the client experiences as helpful counts even if it does not match a textbook description.

Stuttering frequency is explicitly not a measure for this goal. The goal targets moment quality (tension, struggle, the client’s experience), not moment count. Including a fluency percentage would convert this into a fluency-shaping goal — a different intervention with different rationale.

For school-age clients, IEP teams may expect “decreased stuttering” goals. Be explicit at the meeting that this goal targets moment modification, that the evidence base supports this approach, and that stuttering frequency reduction is not an outcome of stuttering modification. Cite Van Riper, Manning & DiLollo, or Guitar to anchor the rationale.

This goal is one tool. Pair with self-disclosure (already in this bank), avoidance-reduction, acceptance work, and mindfulness depending on what the client wants. A complete fluency program for a school-age or adult client rarely consists of modification alone.

Related Goals

• Voluntary Self-Disclosure and Self-Advocacy — Neurodiversity-Affirming — companion identity-and-agency goal
• Anticipatory Anxiety Reduction in Stuttering — affective-component goal