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From: Doug
Date: 10/13/03
Time: 11:38:32 AM
Remote Name: 147.129.18.202
Gunars, Thank you for your thoughtful response. It seems to me that an important key to long-term success in therapy is often missing in treatment programs. This is developing a very basic framework that helps both the client and clinician demystify stuttering. That is, treatment should include developing an understanding of how the physical struggle, emotions, negative imagery, self-talk, etc. that become a individual's stuttering are natural reactions and adjustments to sudden interruptions in forward speech behavior AND communication. Our minds and bodies respond in surprisingly similar ways to anticipation of threat, failure, fear, and so on. How we respond and adjust to these reactions vary in nature and degree with each person based on personality, perception of self-image, reactions to failure, and of course, the underlying characteristics of the basic speech problem. As such, a fundamental goal of therapy might be to develop a personal communication profile for each client that helps them understand their own communication difficulty in terms of their thoughts, arousal patterns, speaking behaviors, and adjustment/ coping strategies. Treatment might then focus on using this profile (which I found is constantly changing) to help the client develop more natural and facilitative ways of thinking, speaking, and adjusting. This is where I wonder whether if it is necessary to work specifically on stuttering in different ways or as you put it "playing games" with disfluencies. I understand your point, and it can have significant value for some clients. However, doesn't it make sense to help the client to learn to be in charge of what they can do to talk more naturally and effectively from the beginning? This can, and often does include changes in self-talk, perceptions of successful talking, etc. This includes talking fluidly in a way that allows for intermittant disruptions and understanding how to shape disruptions back to more fluid movement. Desensitization to anticipation and occurrence of stuttered speech becomes a natural part of learning to communicate more naturally and effectively (not necessarily fluently) under conditions of communication and performance demand/stress. As many of stated over the years, long-term success in stuttering treatment is shown in how one perceives themselves as natural and effective talkers more than the specific percent of fluent words spoken.
I wish you the best Doug