It’s funny how things come in threes. In the past few weeks, I’ve been invited three times to give presentations on “acceptance-based therapy” for stuttering. This is a general term that doesn’t refer to a specific method, but seems to exist as a concept, based on these requests. 

Where is this coming from, exactly?

There is a rapid cultural shift occurring in the field of speech therapy, and I wouldn’t be surprised if this applies to other disciplines within health care. We have more people with disabilities entering the field — or perhaps the same number as always, but they are now able to be more open about their disability, and use their experience as a source of authority. It’s more common for graduate students to begin their studies familiar with concepts like trauma and the social model of disability. Identity-affirming care, as a general practice, was once a radical concept and today is increasingly seen as foundational.

Within my specialty of stuttering, advocates and professionals have been beating the drum of “stuttering acceptance” for longer than I’ve been alive. Literally. It has taken decades of tireless, maddening efforts to convince speech therapists — and those they serve — that it’s okay to stutter. The message has gotten out there, slowly, in a patchwork manner. 

The work, however, is nowhere near complete. Beliefs like, “You can be fluent if you just work hard enough,” and “Practice your strategies more,” are entrenched in both the clinical and general societal milieu. This is fixable. Fix it. 

Considering this historic inertia, it’s exciting and refreshing to have so many clinicians who work in generalist settings seeking out “acceptance-based approaches” to speech therapy for stuttering — and other experiences as well, I hope! Finally! There is an appetite for change, and those that need to learn are taking the initiative to educate themselves and explore new concepts. This is fantastic.

The catch is: I have very, very mixed feelings about describing any approach as “acceptance-based”. Within the stuttering and disability communities at large, “acceptance” is a very, very loaded term. It is complex, layered, and elicits very strong reactions. 

Years ago, I wrote and presented about the importance of acceptance, doing my best to add my voice and efforts to so many others. If these new requests are an indication that the work was successful, maybe we are entering a new phase. I am likely over-projecting here, as this is a very new trend and the old one has persisted for centuries. 

An “acceptance” bandwagon would not be the worst thing in the world, but bandwagons can move so fast that it can be difficult for people to hang on, or to drive thoughtfully. Pushing “acceptance” in therapy can be very invalidating and counterproductive to health long-term change.

So let’s revisit this word that means so many things: acceptance.

Complexity 1: Defeat vs victory

“It’s important to accept your [disability/struggle/pain/thing that is causing difficulty in your life].”

What does that sentence mean to you?

People typically seek out professional help when they are struggling and want change. They are unhappy with where they are, and believe that a more fulfilled life is possible if they change something about their current situation. Some people have very specific visions about the positive change they want to see. Others don’t know exactly what that might look like, but they have a sense that it is the opposite of what they’re experiencing right now.

If you have been struggling and are just starting to take active steps towards changing your struggle, being told to accept it can unleash a host of reactions. The word “acceptance”, at this moment, sounds a lot like “give up”. 

Accept where you are. It’s not going to change. You need to get used to this and learn to make the best of things. Adjust your attitude.

This is a very natural, common, normal way to interpret the word “accept”. This normal interpretation is why I personally avoid using the word “acceptance” when working with clients. Coming from a therapist, it may be received as an instruction to give up. And the person is not ready to give up. Quite the opposite! They are ready to work, grow, and change.

Confusingly, “acceptance” can simultaneously be interpreted as a positive goal. Many people who are in a proverbial “good place” in their journey say that “acceptance” was a key part of the process. 

I had to learn to accept myself. Once I accepted my [disability], I was able to start making real changes. I still have hard days, but I can accept the good with the bad and it doesn’t weigh me down or hold me back.

Most people who enter therapy for some kind of chronic challenge are aware of both versions of this word. This creates a paradoxical relationship with the idea of “acceptance”, especially early on in the therapy journey. There is a sense that acceptance is important, vitally so. But the idea has such passive, negative connotations. “How can I possibly accept this painful existence that I’m currently living? But if I don’t accept it, I won’t be able to change? This makes no sense!”

Complexity 2: Experience Sorting

Another complication when discussing “acceptance” is that, on its own, “acceptance” doesn’t communicate a whole lot. The word exists as part of a phrase: “Accept my _____.” That blank can completely change how the word “accept” resonates. 

Communication traits are quite amazing. A single communication pattern — disfluency, vocal quality, accent, word choice — can impact nearly every aspect of your existence, socially, romantically, professionally, spiritually. 

The impact is what drives people to seek change. 

In a client’s first session, we ask how their communication patterns are affecting their life overall. In the vast majority of cases, people will share that they aren’t able to make friends, or aren’t able to progress in their career, or haven’t been able to find a romantic partner because of their communication difficulties. Or maybe they can do these things, but only to a limited extent, living only a shadow version of the life they actually want to have.

People are aware of the direct connection between their communication difference and the broader life impact. By seeking out speech therapy, they are trying to address the source of the problem. If your speech or voice is holding you back, then changing how you speak should logically create access to all the opportunities you’ve been missing out on.

The relationship between source (the communication pattern) and impact (the secondary life impacts) presents a challenge when considering “acceptance”. If you have a speaking disability and you’re aware that this has prevented you from connecting with people on dates,  does “accepting” your disability require you acquiesce to a lifetime of being single?

Of course, experienced therapists and those who are in that magical “good place” will tell you: of course not. The relationship between how we communicate and what we experience is, in fact, extremely flexible and varied. This can be very difficult to understand when you’re still living in a place of struggle, but learning to separate all these experiences out is a critical part of the change process. This is why counseling is such a big part of communication therapy.

What goes in the _____ of acceptance makes all the difference in the world. We can learn to accept ourselves, to accept differences, to accept certain manifestations of struggle and pain, to accept the realities of life. We do not have to accept — nor should anyone accept — relegation to a life of less-than experiences and isolated existence.

Complexity 3: State vs. process

Many of the people who come to us at speech IRL are active, motivated people, individuals who believe change is possible so long as you work hard and stay committed. One fall, I did a back-of-the-napkin calculation and discovered that nearly half of the clients I was seeing at that time were signed up to run the Chicago marathon. Speech therapy is hard work, but these folks are no stranger to hard work!

If you’re the kind of person who runs marathons or is otherwise oriented to active self-improvement, “acceptance” may imply a passivity that just does not resonate with how you live your life. Conceptualizing acceptance as a state of being, whether as a starting point or a goal, feels like boxing yourself in.

Acceptance can also be conceptualized as a process, something that requires active practice for one’s entire life. Michael J. Fox, who has been living with Parkinson’s disease for 30 years, famously described his view of acceptance: “Acceptance doesn't mean resignation; it means understanding that something is what it is and that there's got to be a way through it.

While it’s common for people to speak of acceptance in the past tense (“I’ve accepted my stutter”), my experience is that those same people usually have a more nuanced and active relationship with “acceptance”, if you invite them to open up. Some days are easier than others. Some experiences are more tolerable to accept than others. A person may feel that they are generally able to deal with life with an acceptance-based attitude, perhaps except for one particular type of experience that they continue to wrestle with. 

So, what is “acceptance-based therapy”?

Acceptance-based therapy is, to me, just therapy. 

Therapy, personal growth, self-improvement… These are all messy, scary, emotional, challenging endeavors. People often begin a change process hoping for a certain outcome. The actual outcome is rarely what we envisioned, and that’s usually a very good thing. 

Change is paradoxical. It’s a push-pull, knowing when to strive forward, when to self-care and rest, learning to identify the difference between a surmountable challenge and a dangerous threat, understanding when to trust yourself and when to ask others for help. Acceptance is involved in all of these choices, whether you are resting or striving, stretching yourself by soloing or inviting the support of other people. Acceptance is a constant discussion of what we’re doing, why we’re doing it, how we feel about it, and the impact it’s having on us and those around us. 

So if that’s the latest trend for speech therapy, I think we’re in for a pretty good ride.