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From: Ken St. Louis
Date: 16 Oct 2009
Time: 07:35:09 -0500
Remote Name: 157.182.15.121
Dear Bobbie, Good question...and one that we ask ourselves very frequently. Why is it that a person can be perfectly fluent in the clinic room one-on-one with the clinician but then walk out the door--or even open the door, stand up in the room, move to the other side of the table, etc.--and begin to stutter again? The answer is certainly different for every individual, but there is much that can be said to answer your question. First, the clinic room is a safe environment. The stutterer knows that stuttering will not be negatively judged or punished. Second, the clinician is usually helpful and encouraging. Third, the demands of the one-on-on clinical situation are greatly reduced from the normal daily communication environments. Fourth, training in speech targets, stuttering modification, or other "tools" occurred in that one-on-one clinical situation--not outside. Fifth, most people immediately carve out a "comfort zone" (See many of Alan Badmington's posts and articles) where they can be fluent (i.e., the clinic room) and, thereafter, changes in that comfort zone produce stress or anxiety. Sixth, stuttering is often highly situation-specific; past successes in the clinic room promote easier talking, and past failures outside promote harder talking. So it is wonderful if the stutterer can be/become very fluent in the clinic room as it can suggest what might be possible in other situations. Of course, that is just the first step. We call that first step establishment, instatement, etc. Any therapy worth its salt, however, will also have a transfer and maintenance component. Usually the transfer stage goes hand-in-hand with the establishment stage and, as your post mentions, involves going outside the clinic room to practice the skills learned there in different settings, with different people, and both of these together. In my view, therapy without transfer is like driver's training in a simulator with no real driving or instruction in white water rafting without the experience of rafting itself. Both are necessary. I won't say anything about maintenance, but these are activities designed to practice the skills over months and years so as to reduce (but not necessarily avoid altogether) the likelihood of a serious relapse. You also asked about the role of the female clinician and male stutterer. Personally, I have never seen that that made any difference at all unless there were other issues such as romantic inclinations, cultural taboos, etc. I hope this helps. Ken