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From: LH
Date: 10/22/01
Time: 12:16:50 PM
Remote Name: 209.193.20.6
Excellent questions. The idea that for some people stuttering may be associated with dissociation is new enough that nobody has yet experimented with different forms of treatment specifically designed to address that component. We don't know, for instance, whether the anxiety produced by stuttering causes the dissociation, or whether dissociation in conjunction with stuttering produces anxiety. It's rather cold comfort that the literature on dissociation in other disorders is also vague on that subject.
What we do know is that milder forms of dissociation, which I believe "la petite mort" represents, can be treated successfully through controlled exposure, self-awareness, and stress reduction. Some stuttering therapy programs and practices emphasize this kind of effort over the more basic behavioral techniques of traditional stuttering therapies.
As far as finding out whether or not a client experiences dissociation, and if so what kind, ASK THEM. I can't emphasize that strongly enough. Your clients are the best experts on their own stuttering. Some may argue that the client's self-report is not reliable, and indeed, you must be very careful not to ask leading questions. But the only way to get inside someone else's head is to trust that person to communicate with you as well as he or she can what his or her subjective experience is like. Make yor questions neutral and specific: "What do you see or hear when you are stuttering?" is preferable to "Do you ever feel dissociated from yourself while stuttering?" Stop a person in mid-stutter and ask them to inventory everything they see, feel, hear, experience at that moment. If a person does dissociate, it is very likely that they won't be able to report much, but as they learn to maintain awareness during the stuttering moment, their inventory of experiences should increase. If a person's description is impoverished, you can fall back on that old reliable, "Tell me more." Gently nag them into probing themselves for awareness with questions such as, "What did you see when you blinked your eyes just now?" Reassure your client that feeling detached from oneself while stuttering, or not being aware of what they are doing is not a sign of mental illness, and that a lot of people probably experience the same thing. Be careful not to make that a leading statement, though.
There is a psychological measure called the Dissociative Experiences Scale, which may be of use in corroborating the presence or absence of dissociation, but unless you are familiar with the scale, you are probably best off to trust your clients to tell you the truth as best they can.