From: Gunars K. Neiders, Psy.D.
Date: 16 Oct 2012
Time: 08:49:57 -0500
Remote Name: 98.247.240.81
Dear esteemed doctors, I most respectfully but emphatically believe that there is a better alternative definition of stuttering which was explained in my Psychology Doctor's dissertation now found on http://www.scribd.com/doc/26801137/G-Neiders-Dissertation-23009-2 after scrolling through the first blank page the definition can be found on pp. 108 - 113. In summary it is based on numerous sources as well as on direct observation that developmental stuttering does not exist when a person is in a totally relaxed state as when a person casually talks to himself or herself in absence of any observers or recording device. This I define as spontaneous fluency--where no thought is even given to how fluent or disfluent the speech is; the speaker is not even aware of these aspects of speech. I propose an operational definition of stuttering that includes six parts: 1) the directly or indirectly observable part which involves speech producing muscles; 2)the directly or indirectly observable part which involves muscles that serve no purpose in producing speech; 3) distortions of speech; 4) the avoidance mechanisms which for the most part cannot be readily recorded with audio or video equipment; 5) the emotions and cognitions that interfere with self-correction of speech and the enjoyment of life; and 6) the vocational and avocational choices that prevent a person from leading a truly self-actualizing and creative life. (...for sake of brevity I skip a lot of fascinating details of all of the above categories which can be found in the original...) The truly unique and pivotal part of my definition is the emphasis on the emotions and cognitions. The main emotion is what LeDoux (LeDoux, J. (2002)Synaptic self: How our brains become who we are New York:Viking) calls the (almost) unchangeable and nearly instantaneous short circuit fear response to certain categories of speech speech situations (the short circuit involving amygdala that has been conditioned during the childhood development of speech) and the cognitions that sustain this fear response. The cognitions which are explained in Robert Logan's second edition "The Three Dimensions of Stuttering: Neurology, Behaviour and Emotion" Wiley, 1999 are those in the "long circuit response" where the emotions can be overwritten by proper cognitive framework such as provided by REBT. The LeDoux fear response interferes with fine motor control and causes the other stuttering behaviors unless overriden by the saner cognitions. The fear can be reduced through massive desensitization which is very, very rarely seen in stuttering therapy except in the extreme cases of therapies. The self-enhancing cognition reconstruction is also equally rare in the prevailing models of stuttering therapy. Make no mistake that both behavioral and thinking patterns are very hard to break. It takes intense effort and results in frequent lapses that can easily lead to relapses. (Just try to open up all doors for a single day with your left hand.) Where we agree is that people with stutter make suboptimal life choices. I also think we agree that resolution or management of all the above facets of stuttering would lead to a fully actualized life. But my emphasis emotions (anxiety, guilt, fear, shame..) is way more intense as is my focus on cognitions. ... 109actualizing and creative life. The dissertator has adapted terminology to better describeeach of these categories. Embed Zoom of 359 Readcast . . .. 0inShare. 107 Write a Bird’s Eye View of Successful Therapy Both the therapist and the client could benefit from knowing how typical therapywould proceed and what would happen in typical circumstances. The sequencing of thesteps in therapy is provided by Dryden et al (2003). Sequencing and Organization of the Above Steps and Processes As can be seen there are many steps in the REBT approach to CPSS; some of thesteps clearly precede the others. Other steps will be done over a period of time. Thesequencing of the tasks in therapy is part of generating the therapy. Concluding Statements on Methodology for Building Treatment of CPSS The treatment for CPSS will focus on the holistic treatment of a person whostutters. It will include stuttering therapy, REBT, counseling, and reframing of the socialreality of the client. During the dissertation proposal no external clients will be used. The process will rely solely on theoretical deductive and inductive logic, and insightsgarnered from the dissertator’s own journey as a person who stutters. The first step, postdissertation, will be to conduct a pilot study with a few clients with the dissertator as thetherapist under the guidance ofrelevantly-qualified professionals.The second step will be writing a manual. The third step will be recruiting an SLPto apply the manual to one of his or her clients. The fourth step will be to set up a psychologist to conduct a case study on one of his or her clients who stutters. After that,the task will be to arrange clinical studies proving the effectiveness of the manual in thehands of both a SLP and a psychologist. The final step will be to present the results at professional conferences with pre-and post-measures. The hope is to get the StutteringFoundation of America interested so that the manual can be widely disseminated. 108CHAPTER IVA NEW ALL-INCLUSIVE DEFINITION OF CPSSIntroductionIn order to design a therapy for a condition it is necessary to provide an all-inclusive holistic definition of the phenomena. Currently, no such a definition exists. Thecurrent definitions, furthermore, use terms that are easily misunderstood.The following section of this chapter gives the dissertator’s original, all-encompassing description of CPSS with a clear definition of the terms in an unambiguousmanner. Then the next section gives reasons why the definition of chronic stutteringneeded to be expanded. The final section of this chapter is a discussion of why this newdefinition is superior to those that are currently available.Definition of CPSS Overview of Definition The dissertator proposes an operational definition of CPSS that includes six parts:1) the directly or indirectly observable part which involves speech producing muscles; 2)the directly or indirectly observable part which involves muscles that serve no purpose in producing speech; 3) distortions of speech; 4) the avoidance mechanisms which for themost part cannot be readily recorded with audio or video equipment; 5) the emotions andcognitions that interfere with self-correction of speech and the enjoyment of life; and 6)the vocational and avocational choices that prevent a person from leading a truly self- 109actualizing and creative life. The dissertator has adapted terminology to better describeeach of these categories. Visible and Audible Speech Producing Muscle Anomalies Repetitions As the common usage of the word indicates these consist of repetition of a wholeword, a syllable, or a sound. The repetitions are involuntary, voiced or unvoiced, andsometimes co-occur with struggle or other symptoms. Blocks Blocks are a stoppage of the forward movement of speech. Like repetitions, theyare involuntary, can be voiced or unvoiced, and sometimes co-occur with struggle or other symptoms. Voiced blocks are sometimes referred to in the literature as prolongations. Contrasted to Normal Speakers These Stuttering-Like Disfluencies (SLDs) occur not only in stuttered speech, butalso in normal speech in adults, teenagers, and especially in children who are learninghow to speak. The differences are usually in frequency, duration,emotionality andstruggle associated with them. Visible and Audible Non-Speech Producing Muscle Anomalies Stuttering is frequently accompanied by various superfluous or struggling behaviors that do not serve any superficially obvious, useful function in speech production. To the stutterer, secondary symptoms feel automatic, i.e. involuntary. Indeed,at the moment of stuttering they are involuntary. The automaticity and involuntarinesswill be discussed later. 110 Eye Blinks This is one of the most common secondary symptoms that accompany the act of speaking. Averting Eye Contact During a stutter the speaker averts his or her gaze from the person or persons heor she is talking to. He or she does not look the other person(s) in the eyes as other speakers in Western cultures customarily do. At the moment of stuttering this isinvoluntary. Snapping of Fingers This can be done by either or both hands. Swinging of Hands Again this can be done by either or both hands. Twitching or Tensing Various Facial Muscles These can resemble the facial tics or be more pronounced and widespread. Jerking of the Whole Head This can be quite severe. Tapping of a Foot The speaker may tap either of the feet. Swinging Back and Forth The speaker may rhythmically sway back and forth or perform more jerking,swaying motions. 111 Idiosyncratic Tensing, Twitching or Moving Other Muscles There are many other ways that muscles may be tensed, twitched or moved,muscles that in normal people are not involved in forming speech. Distortions of Speech There are a number of ways in which speech can be distorted that a trainedlistener can spot. Not all of these distortions are associated only with persons who stutter;some of them can also be perceived in persons who talk when they are under stress. Someof these may be involuntary; others may start out as a voluntary mechanism to avoidstuttering or even as part of stuttering therapy. Rate of Speech The stutterer usually has a slower rate of speaking. Tone A person who stutters frequently speaks in a shriller or higher pitch when talkingto other people than when he is by himself. Or on the other hand, he or she adapts a muchlower pitch of voice to relax the speech-producing muscles. Sing-Song Voice Some stutterers talk in a sing-song voice. This is usually the result of outmodedtherapy. Unnatural Prosody The stutterer frequently talks in a flat voice without inflections. This may be theresult of outdated therapy or an attempt at self-therapy. 112 Talking as if Simultaneously Chewing This way oftalking is usually a result of a therapy that really was not well thoughtout or a result of the individual finding a way to hide his or her stuttering. Idiosyncratic Speaking Manner The dissertator believes that there are other ways in which the naturalness of voice has been either voluntarily or involuntarily altered. Not infrequently, a person whostutters will adopt an accent to, at least temporarily, hide his or her stuttering. Avoidance Behaviors while Speaking Avoidance of Sounds Many stutterers have more difficulties with certain sounds at a given time.Throughout the lifetime different sounds are designated in the stutterer’s head as“difficult” (i.e. sounds that he or she will probably stutter on). The stutterer willfrequently avoid these sounds by substituting words or by the use of circumlocution. Avoidance of Words Sometimes the fear is associated with a word and not a sound. In this instance, thestutterer scans ahead and avoids words he or she has had difficulty saying in the past. Justas with sounds, the avoidance of a word can be accomplished by substituting words,circumlocution of words, or by inserting phrases that have nothing to do with expressingthe original thought or answering a question. Use of Starter Phrases, Words, Sounds or Pauses Starter phrases, words, or sounds are used as a means to avoid going directly tothe feared sound or word. Sometimes, the “phobic period” can be “waited out” by of 359 Readcast . . .. 0inShare. 107 Write a Bird’s Eye View of Successful Therapy Both the therapist and the client could benefit from knowing how typical therapywould proceed and what would happen in typical circumstances. The sequencing of thesteps in therapy is provided by Dryden et al (2003). Sequencing and Organization of the Above Steps and Processes As can be seen there are many steps in the REBT approach to CPSS; some of thesteps clearly precede the others. Other steps will be done over a period of time. Thesequencing of the tasks in therapy is part of generating the therapy. Concluding Statements on Methodology for Building Treatment of CPSS The treatment for CPSS will focus on the holistic treatment of a person whostutters. It will include stuttering therapy, REBT, counseling, and reframing of the socialreality of the client. During the dissertation proposal no external clients will be used. The process will rely solely on theoretical deductive and inductive logic, and insightsgarnered from the dissertator’s own journey as a person who stutters. The first step, postdissertation, will be to conduct a pilot study with a few clients with the dissertator as thetherapist under the guidance ofrelevantly-qualified professionals.The second step will be writing a manual. The third step will be recruiting an SLPto apply the manual to one of his or her clients. The fourth step will be to set up a psychologist to conduct a case study on one of his or her clients who stutters. After that,the task will be to arrange clinical studies proving the effectiveness of the manual in thehands of both a SLP and a psychologist. The final step will be to present the results at professional conferences with pre-and post-measures. The hope is to get the StutteringFoundation of America interested so that the manual can be widely disseminated. 108CHAPTER IVA NEW ALL-INCLUSIVE DEFINITION OF CPSSIntroductionIn order to design a therapy for a condition it is necessary to provide an all-inclusive holistic definition of the phenomena. Currently, no such a definition exists. Thecurrent definitions, furthermore, use terms that are easily misunderstood.The following section of this chapter gives the dissertator’s original, all-encompassing description of CPSS with a clear definition of the terms in an unambiguousmanner. Then the next section gives reasons why the definition of chronic stutteringneeded to be expanded. The final section of this chapter is a discussion of why this newdefinition is superior to those that are currently available.Definition of CPSS Overview of Definition The dissertator proposes an operational definition of CPSS that includes six parts:1) the directly or indirectly observable part which involves speech producing muscles; 2)the directly or indirectly observable part which involves muscles that serve no purpose in producing speech; 3) distortions of speech; 4) the avoidance mechanisms which for themost part cannot be readily recorded with audio or video equipment; 5) the emotions andcognitions that interfere with self-correction of speech and the enjoyment of life; and 6)the vocational and avocational choices that prevent a person from leading a truly self- 109actualizing and creative life. The dissertator has adapted terminology to better describeeach of these categories. Visible and Audible Speech Producing Muscle Anomalies Repetitions As the common usage of the word indicates these consist of repetition of a wholeword, a syllable, or a sound. The repetitions are involuntary, voiced or unvoiced, andsometimes co-occur with struggle or other symptoms. Blocks Blocks are a stoppage of the forward movement of speech. Like repetitions, theyare involuntary, can be voiced or unvoiced, and sometimes co-occur with struggle or other symptoms. Voiced blocks are sometimes referred to in the literature as prolongations. Contrasted to Normal Speakers These Stuttering-Like Disfluencies (SLDs) occur not only in stuttered speech, butalso in normal speech in adults, teenagers, and especially in children who are learninghow to speak. The differences are usually in frequency, duration,emotionality andstruggle associated with them. Visible and Audible Non-Speech Producing Muscle Anomalies Stuttering is frequently accompanied by various superfluous or struggling behaviors that do not serve any superficially obvious, useful function in speech production. To the stutterer, secondary symptoms feel automatic, i.e. involuntary. Indeed,at the moment of stuttering they are involuntary. The automaticity and involuntarinesswill be discussed later. 110 Eye Blinks This is one of the most common secondary symptoms that accompany the act of speaking. Averting Eye Contact During a stutter the speaker averts his or her gaze from the person or persons heor she is talking to. He or she does not look the other person(s) in the eyes as other speakers in Western cultures customarily do. At the moment of stuttering this isinvoluntary. Snapping of Fingers This can be done by either or both hands. Swinging of Hands Again this can be done by either or both hands. Twitching or Tensing Various Facial Muscles These can resemble the facial tics or be more pronounced and widespread. Jerking of the Whole Head This can be quite severe. Tapping of a Foot The speaker may tap either of the feet. Swinging Back and Forth The speaker may rhythmically sway back and forth or perform more jerking,swaying motions. 111 Idiosyncratic Tensing, Twitching or Moving Other Muscles There are many other ways that muscles may be tensed, twitched or moved,muscles that in normal people are not involved in forming speech. Distortions of Speech There are a number of ways in which speech can be distorted that a trainedlistener can spot. Not all of these distortions are associated only with persons who stutter;some of them can also be perceived in persons who talk when they are under stress. Someof these may be involuntary; others may start out as a voluntary mechanism to avoidstuttering or even as part of stuttering therapy. Rate of Speech The stutterer usually has a slower rate of speaking. Tone A person who stutters frequently speaks in a shriller or higher pitch when talkingto other people than when he is by himself. Or on the other hand, he or she adapts a muchlower pitch of voice to relax the speech-producing muscles. Sing-Song Voice Some stutterers talk in a sing-song voice. This is usually the result of outmodedtherapy. Unnatural Prosody The stutterer frequently talks in a flat voice without inflections. This may be theresult of outdated therapy or an attempt at self-therapy. 112 Talking as if Simultaneously Chewing This way oftalking is usually a result of a therapy that really was not well thoughtout or a result of the individual finding a way to hide his or her stuttering. Idiosyncratic Speaking Manner The dissertator believes that there are other ways in which the naturalness of voice has been either voluntarily or involuntarily altered. Not infrequently, a person whostutters will adopt an accent to, at least temporarily, hide his or her stuttering. Avoidance Behaviors while Speaking Avoidance of Sounds Many stutterers have more difficulties with certain sounds at a given time.Throughout the lifetime different sounds are designated in the stutterer’s head as“difficult” (i.e. sounds that he or she will probably stutter on). The stutterer willfrequently avoid these sounds by substituting words or by the use of circumlocution. Avoidance of Words Sometimes the fear is associated with a word and not a sound. In this instance, thestutterer scans ahead and avoids words he or she has had difficulty saying in the past. Justas with sounds, the avoidance of a word can be accomplished by substituting words,circumlocution of words, or by inserting phrases that have nothing to do with expressingthe original thought or answering a question. Use of Starter Phrases, Words, Sounds or Pauses Starter phrases, words, or sounds are used as a means to avoid going directly tothe feared sound or word. Sometimes, the “phobic period” can be “waited out” by