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From: Doug Cross (cross@ithaca.edu)
Date: 08 Oct 2004
Time: 08:27:42 -0500
Remote Name: 24.58.10.29
Dori, First, let me apologize if my reply appears on the surface to be overly simplistic. Also, Lynne Shield’s comments are thoughtful and very insightful. There is just so much one can accomplish in this type of forum. My answer to your question as to whether a good speech pathologist can incorporate the physical, psychological, and emotional components of stuttering into a treatment program is a definite YES. In fact, to focus solely on the mechanics of speech without incorporating the thoughts, emotions, and reactions patterns we experience naturally under conditions of performance stress (and communication is laden with performance stress) is to ignore the very essence of human behavior and reactions. This applies not only to stuttering, but also to the many behaviors and situations we face in our lifetimes. Perhaps I can draw from a non-speech example to explain. Let’s use the professional golfer who must perform an incredibly complex behavior under conditions of extreme performance demand. This is the same person who has confidently and calmly made the same three-foot putt thousands of times on during practice. Yet when faced when the same three-foot putt to win or loose a tournament everything changes. Perception of time changes, nerves become overly excited, and thoughts of fear and missing cloud the mind. The fear of missing the putt and the consequences that go along with it (or for speech getting stuck on a word in front of a class) actually interferes with the natural smooth mechanics of the putting stroke (or of the natural and smooth movements of speech). The very thoughts associated with performance failure and the consequences associated with failure trigger very natural emotional and physiological reactions that interfere with the ability to carry out the task naturally and smoothly. Sports psychologists are good examples of "therapists" who help individuals learn to maximize fluid movement under conditions of emotional and psychological stress. The stuttering response and stuttering therapy are similar. Some children have speech systems that at least at certain times during their lives are relatively "unstable" which can be caused by any number of factors. This instability in the speech-language processes results in the intermittent episodes of stuttering. These episodes occur more often under conditions of performance stress and perceived demand as well as numerous other issues. These factors are similar to those that undermine almost all fine motor skills, even in the most accomplished performer. Perceiving episodes of speech "failure" (episodes of stuttering or even the fear of stuttering) by the child leads to very natural, although unfortunate response patterns that further interfere and often intensify the problem. The more the child tries to talk without stuttering and thus avoid the real and/or imagined consequences the more involved the response pattern becomes. For some children when mistake-free or stutter-free speech becomes the child’s defining goal of talking "success" the psychological demand and stress can increase, further interfering with more natural communication patterns and confidence. While speech and language are certainly complex and unique behaviors the movements, thoughts, and emotional reactions are universal and experienced by all of us throughout our lifetimes. I see the fluency therapist as form of talking coach, a person who teaches, motivates, demonstrates, shapes, supports, and pushes. The end result should be a child (or adult) who can speech as effectively as possible given any limitations in their speech-language system combined with the situation demands. A good therapist should apply basic understanding of human behavior, movement, and reaction patterns to treatment. The therapist can help the child understand that episodes of stuttering might, and probably will occur once in a while but that they are capable of keeping their cool and talking in the most natural and easy way possible given the situation demands at the time. This does not always mean stutter-free speech. Specifically, the therapist can help the child understand how they talk, how talking mistakes (such as disfluencies and stuttering) occur, what to expect in certain conditions, what type of thoughts and adjustments make talking better or worse, and what they can do specifically to talk as easily and naturally as possible, especially under conditions of emotional and psychological stress. Lynne is correct. You are a consumer and should question the treatment philosophy, training, and goals of the therapists just as you would any other service provided. There are great clinicians out there! Doug Cross