title: An exploration of the mechanisms of change following an integrated group intervention for stuttering, as perceived by school-aged children who stutter (CWS).
abstract: OBJECTIVE
  To explore the process of change and role of resilience following an integrated group intervention for children who stutter (CWS).
  
  
  METHODS
  Using an exploratory multiple case study design, this research sought to identify the most significant changes perceived by seven participants following therapy, the mechanisms of change, and the role of resilience in the process of change. Quantitative measurements of resilience were combined with qualitative analysis of semi-structured interviews.
  
  
  RESULTS
  Thematic analysis of qualitative data showed that cognitive and emotional change was a key driver for therapeutic change, enabled by the shared experience of the group and a positive therapeutic environment. These changes were generalised into clients' real-world experiences, facilitated by their support network. Quantitative data demonstrated a statistically reliable positive change in overall Resiliency scores for four participants and reduced impact of stuttering scores on OASES-S for all participants, maintained at 12 month follow-up.
  
  
  CONCLUSIONS
  This study demonstrates the importance of adopting an integrated approach in therapy for CWS, which incorporates Cognitive Behavioural Therapy (CBT) as a key component, to facilitate change and build resilience. These results are unique to this cohort of CWS and further investigation into the use of CBT and the process of change may be warranted.
  
  
  OBJECTIVE
  The reader will be able to (1) describe the integrated intervention used in this study (2) define the most significant change following therapy for the participants involved (3) summarise the key factors that facilitated change during the therapy process (as perceived by the participants).
authors.affiliation: Michael Palin Centre, UK. Electronic address: sarah.caughter@nhs.net.
authors.forename: Sarah
authors.initials: S
authors.lastname: Caughter
authors.affiliation: University College London, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Dunsmuir
mesh_terms: D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011615:Psychotherapy, Group; D013342:Stuttering / Q000523:psychology / Q000628:therapy*
keywords: children; client perception; process of change; resilience; stuttering