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The Best Stuttering Therapy Money Can Buy

From: Gunars K. Neiders neiders@halcyon.com
Date: 10/21/00
Time: 8:37:31 PM
Remote Name: 12.13.226.12

Comments

Dear Ubaldo,

The question you ask, "What is the best therapy money can buy?" may not have a simple answer. That is why the answers have been slow in coming. My answer has been arrived at after much thought. I have answered as completely as I could, trying to include the reasons for my hypothesis.

You can only go to the well once :- )

No matter how generous your employer is, I suggest that you go to him with a written out plan, so both of you can estimate the cost and the time involved.

Stuttering is a complex problem

Stuttering involves the Central Nervous System and the speech producing muscles. There is nothing wrong with the muscles themselves. However, it still is a mystery as to what exactly causes stuttering and how it is developed. I believe that stuttering is learned by children who have a predisposition to stutter. Once it is learned it tends to be aggravated by certain types of anticipatory anxieties and fears. Why do I believe this? Because most people who stutter report that when they are by themselves they either do not stutter or their stuttering is greatly reduced.

Stuttering therapy best be comprehensive

The best stuttering therapy best include both a counseling component, speech therapy component, and, in severe cases, some means to get through some tough situations while speech therapy is taking place.

What are the goals of stuttering therapy?

The goals of stuttering therapy are to help the client:

a) Gain unconditional self-acceptance and speaking confidence, whether he stutters or not.

b) Learn how to get more enjoyment out of life.

c) Become involved in the mainstream of society.

d) Pursue the occupational and recreational goals of his or her choosing.

e) Learn to communicate effectively and freely without struggling or forcing, without secondary symptoms of stuttering such as head jerks, etc., and without serious blocking (i.e. impounding of air). The speech best be forward moving even if small repetitions and elongations of sounds occur.

f) The speech best be normal sounding, not a monotone or as if directed by metronome.

g) There should be minimal anxiety while speaking in public or private situations.

h) Significant reduction of stuttering behaviors (although perfect fluency best not be a goal). The emphasis best be on flowingness, not on perfect fluency, since, the road to normal speech will be bumpy, to say the least. The ease of speaking in adults with chronic stuttering usually evolves and is not accomplished in one single step, nor one single two week period. There will be some lapses in fluency and maybe even a relapse or two.

i) The speech therapy best take into account how to handle lapses and relapses.

j) The goal of good therapy is also to develop a sense of humor to help one deal with the imperfections in the world, others, and self.

k) The counseling part of therapy best help an individual how to work through his feelings of inferiority, speech anxiety, word and sound fear, helplessness, hopelessness, guilt, shame, insecurity, timidity in taking risks, urgency while talking, self-downing, anger and blame.

l) The client, when he is done with therapy, best not use any avoidances and not hide his stuttering.

m) The stutterer best be able to call on some techniques of speaking if and when the going gets rough.

Maybe there are more goals, but this should do for a start. :--)

So what therapy can promise to achieve all of the above goals?

A combination of cognitive psychology with speech therapy can achieve these goals. My first choice is the combination of Rational Emotive Behavior Therapy (REBT), the original and the most popular cognitive psychology, and Stuttering Modification with elements of Fluency Modification or Fluency Shaping thrown in. I am also a staunch advocate of Joseph Sheehan's emphasis of Voluntary Stuttering, which can be best done in conjunction with REBT.

How can this be done?

The best way is to contact both a REBT therapist (a psychologist or a counselor) (see www.rebt.org for referrals) and contact a Speech and Language Professional (SLP) who specializes in Stuttering Modification techniques with emphasis on Voluntary Stuttering.

Both of these professionals would have to agree to work with each other. If you are fortunate and can find a SLP who is well versed in REBT techniques, this is also a good option. (Some of the SLPs who use REBT are mentioned in the article which I wrote a year ago

http://www.mankato.msus.edu/dept/comdis/isad2/papers/neiders.html ) .

Why do I need both?

Chronic stuttering is a tough problem. Changing attitudes and working through the self-defeating feelings on one hand and the speech techniques on the other hand, provides for symbiosis, the process where the combination adds up to more than the individual parts:

It is easier to change one's attitude about his/her speech, if he/she can see that he/she can reduce the tension and forcing by using various speech techniques.

And it certainly is easier to apply various speech techniques, if the anxiety about stuttering has been reduced through the change in self-talk.

So working at both in tandem is really ideal. Gains in one area, say the attitudes and emotions, naturally lead to gains in the ability to apply speech techniques. And vice versa.

Delayed Audio Feedback (DAF) Devices as Temporary Help

I believe that DAF should be used only to aid communication, and never, never, NEVER, to hide stuttering. The question arises, "Why use DAF at all?" The answer is quite simple, if one can't communicate and the job, daily living, or even therapy requires communication, it is better to stick something in your ear and wear something on your lapel, than let life slide past you. However, this is only a stop gap measure, since, I really believe that good psychological therapy and stuttering therapy in combination will improve your ability to communicate, where the DAF device will no longer be necessary.

But what about the people who say that DAF can be addictive and it really does not help

Some of these people are fanatics. They feel that everything has to be done according to some perfectionistic standard and that one should not, probably, even use eyeglasses to see better, because it may impede the "strengthening of the eyes". :--) To these people I reply that if the only way I could handle telephone conversations and communicate effectively in telephone conferences would be to wear a toilet seat, then I would not mind even wearing a toilet seat around my neck. :--) But I would certainly throw in some voluntary blocks, so that I, myself did not fall into the trap of starting to hide my stuttering. Remember, hiding my stuttering is the same as screaming in my ear: "Stuttering is awful. Stuttering makes me less worthwhile as a person." And if you have this type of self-talk, you will certainly build up self-downing emotions as well as extreme anxiety and shame. Remember, no self-defeating emotion can be sustained if not supported by irrational self-talk.

Again, since you can go to the well only once...

I think that I would present to my employer the following comprehensive plan:

1) Assure employer that you will stick with therapy until you can communicate effectively, but do not say that you will have 100% fluent speech. Some small lapses will occur, for a time at least. Nobody really minds a little stutter here or there. :--)

2) If you are a severe stutterer ask for a DAF to help with your phone calls now, but never use it to hide the fact that you stutter.

3) Tell your employer you will find an REBT psychotherapist to work on some of the problems that have arisen due to your stuttering. (As an estimate say that you might have to have about 24 weekly sessions of 45 minutes each. After that a few sessions scattered here and there to watch for relapses.)

4) Also find an SLP who practices Stuttering Modification. The length of this therapy cannot be easily quantified.

Some things to watch for

a) If either your psychological or speech therapist and you do not find each other a good fit, do not hesitate to find another one.

b) Remember the REBT and SLP practitioners can only show what you best do, the practice will be left up to you.

c) Never give up hope. Many, many persons have stopped their therapy before it has had time to work. Many of them do not carry out their homework assignments. The work outside of the therapy room is of utmost importance. A multitude of others have stuck it out, asked questions, tried many different things and succeeded. Remember you are in charge of your life.

Final words

I have no doubts that you will succeed if you practice, practice and practice. Good luck.

Gunars

If you have any other questions I can be contacted through stutt-x, neiders@halcyon.com or http://www.stuttering-therapy.com .


Last changed: September 12, 2005