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From: J Scott Yaruss, Univ of Pittsburgh
Date: 02 Oct 2011
Time: 17:51:39 -0500
Remote Name: 72.194.64.133
Hi Ari! So nice to see you in this format! You've raised a superb question... I think it's fair to say that many (though definitely not enough) clinicians do include work on changing the moment of stuttering in their comprehensive therapy approaches. Certainly not the fluency-shaping therapies - but anything based on the work of Van Riper, Williams, Breitenfeld, and others, would include work on using desensitization as a means of changing the moment of stuttering. When I do my trainings, one of the analogies I use is that of a coconut: a coconut is comprised of a tough outer husk and a the inner meat and milk that everybody wants. The inner part is likened to the fluency... the outer husk is the tension and struggle that characterizes the moment of stuttering. If you try to just get straight to the meat and milk, you'll have trouble getting there because it's encased in the tough outer husk, but if you take the time to strip away the husk, you'll have an easier time getting to the insides. Likewise, if you take the time to strip away (through desensitization, awareness, understanding, acceptance) the tension, the struggle, the avoidance, and all the rest of the reactions to the moment of stuttering, then you'll have a much easier time of getting to the increases in fluency. As a clinician (or a speaker), you can't do just one or the other - you need to do both (to varying degrees). Moreover, you need to do both in the right order and in the right amounts for each individual speaker. Then, if my audience is with me on the analogy that far, I'll add in the kicker... if you think carefully about the husk of the coconut and view it in another light...not just as a nuisance that must be stripped away but as a useful part of the coconut, then all of a sudden, you have two useful things to work with... shells (for building your houses, bowls, utensils, clothing, etc.) and food (for sustenance). Likewise, if you view the moment of stuttering as not just something to run from or something to be avoided, but rather as an expression of the underlying block, then you can see other ways of using the moment of stuttering as a way of improving communication... Stuttering more easily, pseudostuttering / voluntary stuttering helps to prevent the tension from building, and that, in turn, makes it easier to improve fluency (even if through the use of fluency enhancing techniques). Perhaps a bit complicated, but it highlights the exact point I think you're trying to make -- you get improvements in fluency when you work on the stuttering and accept the stuttering and allow the stuttering rather than denying the stuttering, and optimal outcomes follow from working on the entire disorder from all perspectives... Looking forward to the dialogue! Take care, Scott