Treatment plan based on OASES

GOALS ACTIVITIES OBSERVATION

Session I :
Case history will be taken
1. Understanding the nature of
problem by clinician
Client will be explained,
2. Understanding the nature of
 The way speech is
problem by client
produced
 Importance of
speaking while
breathing out
 Why do they get
dysfluencies and what
happens when they get
dysfluencies
 About vicious cycle
 No medication,
Exercises, practice,
determination

3. Client will be able to relax Relaxation exercises –

in general and his speech differential relaxation
musculature in particular program by Jacobson

Session II :

1. Improve breathing and Abdominal breathing

speech co-ordination

2. Easy onset of phonation

 GOALS ACTIVITIES OBSERVATION

Session III :

1. To reduce core behaviors in Using prolongation technique

reading along with the bell shaped
curve,
Ask the patient to keep his
finger on bell shaped curve
and practice prolongation ( at
word level ). If patient is able
to prolong words by using
curve, then gradually fade the
use of curve and ask the
patient to prolong words
without using bell shaped
curve. If he is comfortable at
word level , then move on to
two/three word phrases and
then on the sentence level ( in
reading )

Session IV :
 Ask the patient to read
1. reducing rate of speech aloud and pause after
every word. Ask the
patient to breathe and
start the new word
using the techniques
learned before

 Mirror practice
2. Reducing secondary
behaviors while reading
 GOALS ACTIVITIES OBSERVATION

Session V :

1. To get control over speech  Alternating fast and

while reading slow rate of speech
technique to be used in
reading ( once slow
rate of speech is
established in reading )

2. Reducing rate of speech and  Ask the patient to

core behaviors in monologue prepare a monologue
and speak in front of
clinician. Client will be
asked to use the
techniques learned
during reading ( i.e.
slow rate of speech and
pausing )
 Ask the patient to
practice at home, in
front of a mirror or any
family member with
whom he is
comfortable
 Ask him to record his
speech and listen to it

Note:
Explain to the patient that his speech might sound unnatural/ monotonous when he is using these
techniques and speaking. Explain him that it is just a part of the therapy program; he is not going
to speak in this manner forever.
 GOALS ACTIVITIES OBSERVATION

Session VI :

1. Continue with the

previous goals until a
basic level of fluency is
established

2.Counseling based on
the following points:

 Acceptance of his Explain him than every one

problem by himself has certain eligibilities and
certain lacunae

 Acknowledgement to
Pseudo stuttering
others of the fact of his
stuttering and
Systemic
desensitization

Session VII :

1. Reducing rate of speech If the client has established

and core behaviors in fluency during monologue,
conversation then he is asked to use all the
techniques in conversation
with the clinician

Clinician can record the

conversation and play it back
to the client
2. Counseling based on 1st step:
the following points: Explain him that, only you can
upset yourself about any event
 To reduce anxiety, – the events themselves, no
guilt, anger, matter how undesirable, can
frustration, etc by never upset you
identifying irrational
beliefs 2nd step:
Explain him that, no one can
ever disturb you until you
think so. Others can cause you
physical pain but you create
your own emotional suffering,
or self defeating behavioral
patterns, about what others say
or do

3rd step:
Once the client admits that he
distorts his own emotions and
actions, then explain him that
this happens because of his
demand on himself or his
demand on situations
For e.g.,
He might be thinking that:
he MUST do well in interview
or else he is worthless
OR
Life MUST be fair, easy and
hassle free, or else it is awful

4th step:
Explain to him that if he
makes his life “must-free”, his
emotions will heal
Even if he doesn’t do well this
time, there is always another
chance
 Session VIII :

1. Continue with the

previous goals

2. Counseling based on Client can be asked to re-

the following points: evaluate the bad event as
‘disappointing’,
To reduce anxiety, guilt, ‘uncomfortable’ or
anger, frustration, etc by ‘concerning’ rather than
identifying irrational ‘awful’ or ‘unbearable’.
beliefs Explain the client that even
the negative events almost
always have a positive side.

Session IX :

1. Post block correction

Ask the client to visualize the
2. Counseling based on unwanted event occurring,
the following points: then imagine going
forward in time a week, then a
 To reduce anxiety, month, then six
guilt, anger, months, then a year, two years,
frustration, etc by and so on, considering
identifying irrational how they will be feeling at
beliefs each of these
points in time. They will thus
be able to see that
life will go on, even though
they may need to make some
adjustments
 Session X :

1. In block correction

2. Counseling Reverse role-playing can be

used which is
designed to get the client
arguing against their
own dysfunctional belief. The
therapist role-plays
adopting the client’s belief and
vigorously argues
for it; while the client tries to
‘convince’ the
therapist that the belief is
dysfunctional. It is especially
useful when the client sees
that a belief is
irrational, but needs help to
consolidate that
understanding.
 GOAL ACTIVITIES OBSERVATION

Session XI :

1. Pre block correction

2.Counseling:
To reduce fear of failure Ask the client to deliberately
acting in ways he anticipates
disapproval (while, at the
same time, using
cognitive and emotive
techniques to feel only
concerned or disappointed).
For example, if he has fear
talking to his boss, ask him to
talk to his boss for at least 10
min.

Session XII :

Continue with previous goals