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From: Gunars Neiders
Date: 10/15/03
Time: 12:32:49 PM
Remote Name: 12.211.116.92
Dear Professors,
In writing my term paper on stuttering I was required to redefine stuttering in my own terms without using the accepted usage in the field of stuttering therapy so as to avoid inadvertently taking on any prejudices and assumptions with me from the diverse therapies such as Fluency Shaping, Stuttering Modification, Wendell Johnson’s General Semantics based approach, Martin Schwartz’s “Stuttering Solved” approach, Stanley Goldberg’s Behavior Cognitive Stuttering Therapy, etc.
Starting with the most basic assumption of natural speaker versus stuttering speaker, I categorized the natural way of speaking, cognitive processing, emoting, hearing, having proprioceptive and tactile feeling, seeing, and behaving versus disrupted speaking, cognitive processing, emoting, hearing, having proprioceptive and tactile feeling, seeing, and behaving.
Defining the differences using only the criteria what a natural (fluent) speaker does as compared to a person who has a history of being self-labeled or other labeled as a stutterer, it soon became obvious that even after successful stuttering therapy there are many disruptions that remain although these provide for a better communication, are often less offensive to the listener, and less aggravating to the speaker.
For example, when the client has successfully completed his or her therapy instead of blocking or having involuntary repetitions, he or she may well use easy onsets or pullouts. Regardless of whether the easy onsets or pullouts were in response to the real or imagined footsteps of an on-coming block or whether they were introduced prophylactically, they ARE disruptions to the natural speech and prosody and should be counted as instances of disfluency. I further posit that it does not matter whether these easy onsets or pullouts are voluntary (the result of controlled speech) or involuntary (the result of the brain having learned to perform this task automatically) they are nevertheless instances of disruption or disfluency.
The naďve or partisan reader might well ask, “What is the purpose of pursuing this type of definition of disfluency. Surely, the listener would rather hear an easy onset or a pullout instead of the original highly disruptive, struggled and forced block! And how about the speaker, he certainly would rather have an easy onset or a pullout instead of the original highly disruptive, struggled and forced block!” If those were the only two choices I would tend to agree with this argument. However, we only need to look back a half a century and rediscover Wendell Johnson’s “Iowa bounce”, or as it is called in modern times “voluntary pseudo-repetition”, to see that we have at least a third choice. Are there any advantages to this third choice? The answer is a resounding YES! A re-repetition, just like laughter (“ha-ha”) is a natural release of tension which is the building block of stuttering. I also posit that our nervous system (see Logan, R. (1999) The Three Dimensions of Stuttering: Neurology, Behaviour, and Emotion (2nd ed.) London: Whurr Publishers) may recognize the “Iowa bounce” as the erstwhile instance of stuttering. If that is so, use of this technique may truly rewire the brain. Logan on page 94 also states that, rational emotive behavior therapy visualization and psychodramas can be generated to prepare the client for rational productive pre-and post-reactions. ‘Failure’ can be discussed as well as success. We want to change both behaviour and emotion in order to effect a neurological change. Both emotion and behaviour affect beliefs and it is the belief system of the client that is contributing so heavily to reinforcement of the inappropriate neurological component that forms the basis or stuttering.”
So where does it leave us with respect to easy onsets, pullouts, and Iowa bounces? If we are going to count speech disruptions (i.e. stuttering frequencies) All of the above have to be counted. What is the advantage of therapy then? At first the minimization of the severity of struggle, the length of disruption, and the disturbance to the natural prosody of speech can be judged and valued. Eventually, the frequency may find a natural occurrence rate if Eugene Cooper is right and some people are truly chronic stutterers. If Logan and I am right then the frequency may also be drastically reduced, though not eliminated.
My questions to you, professors are: 1) Disrupted Speech. Should not the outcome be based on the frequency, severity, and unnaturalness of disrupted speech: including blocks (with or without sounds); involuntary and voluntary repetitions (Iowa bounces); elongations in speech; easy onsets; pullouts; pre-formed speech/pre-pullouts; talking while taking on the role as an orator or actor; use of low vibrant voice a la James Earl Jones; breathy voice a la Marilyn Monroe; continuous phonation, light articulary contacts; sing song voice; elongation of vowels; going floppy (a la Martin Schwartz); passing “invisible, inaudible breath over the vocal folds” (a la Martin Schwartz) etc?
2) Disrupting Actions. Should not the therapy be also judged on the number and severity of avoidance behaviors? Aren’t the continued therapeutic assignments also a disruption that has to be taken into account by letting the client judge how obnoxious they are to him or her (of course, after the right counseling is performed)? And are not the avoidance of life’s challenges both vocationally and avocationally to be considered?
3) Disrupting Emotions. Should not the disturbing emotions of shame, guilt, anxiety, self-downing, and conditional self-esteem (based on how fluent one is) be taken into consideration when evaluating a therapy?
4) Disrupting audio-input (feedback). Should we not also consider the need for audio feedback, Non-Altered Feedback (NAF), Delayed Audio Feedback (DAF), Frequency Adjusted Feedback (FAF), or just plain noise in the ear, as produced by SpeechEasy device and Edinburgh Masker be considered when evaluating the outcome of stuttering therapy?
5) Quality of life attained. And, finally, should not the quality of life attained be also factored into the treatment outcome? How does the individual stack up in his or her achievements with respect to somebody of an equal Socio-Economic Status? At first glance this may not seem to be in the purview of stuttering therapy but as Yaruss and Manning maintain counseling is an integral part of the therapy of a person who stutters. In conclusion, don’t you agree with the special section in Journal of Fluency Disorders on Evidence-based Treatment of Stuttering, as long as all of the dimensions of disruption in life caused by stuttering are addressed?
Respectfully,
Gunars