(The comments in this essay were first presented at the 1996 American Speech-Language-Hearing Association Convention in Seattle, as part of a panel presentation entitled "Successful Treatment of Fluency Disorders: Examples of Long-Term Change." Other panelists were David Daly, Barry Guitar, Walt Manning, Bill Murphy, Lois Nelson, Peter Ramig, and Ken St. Louis. The moderator for the session was Steve Hood. After ASHA, the panel was invited to speak at the International Fluency Association World Congress on Fluency Disorders in San Francisco in August of 1997. That presentation was entitled "Various Paths to Long-Term Recovery From Stuttering." The members of the IFA panel included Kristin Chmela, David Daly, Thomas Krall, Walt Manning, Peter Ramig, and Ken St. Louis. Steve Hood again served as moderator.)
Let me begin with a little bit of personal history and my philosophy that has arisen from that history. I'll try to put my personal experiences into a more general context, since I am aware that I do not speak for all stutterers, and that the experiences of many people who stutter differ considerably. I do realize, however, that my personal experiences will always "color" my view of stuttering, at least to some extent.
If I were to summarize how I reached the point that I am at today, I would describe it in terms of knowledge, understanding, and acceptance. I think all three of those things go together, and I think those are the tools that a "successfully therapeutized" stutterer needs. When I think back over the past forty or so years, I can see how my knowledge about the disorder of stuttering has changed, and along with that how my understanding of my stuttering has changed. That has led to a change in my acceptance of my stuttering and myself as a stutterer. With those changes, I have become increasingly skillful in managing my speech, even though I remain disfluent to some extent. What is difficult for me to figure out is whether those changes could have come about any differently or if they could have come about any more quickly had my therapies been structured differently. I'll try to talk more about that later in this "musing".
Words like "knowledge," "understanding," and "acceptance" are like a lot of other words: they're used a lot, but can have a number of different meanings, to the point that we throw them around without being real sure of what we mean. For that reason, let me provide some dictionary definitions to clarify what the terms mean to me.Knowledge:
We can see that the terms overlap to an extent, particularly when the word "knowledge" is used in the definition of "understanding." The definitions I have emphasized have to do with the fact that much knowledge, understanding, and acceptance come about in an informal, rather than a formal way; they evolve over time. I will try to highlight events that led to changes in my knowledge, understanding, and/or acceptance of my stuttering.
If you'll indulge me for a while, I'd like to share with you some of my recollections about my stuttering and stuttering therapy that have stuck in my mind over the years. My earliest therapy was in the public schools in Yonkers, NY, during the early 1960s (to the best of my recollection). During those therapy sessions, about six or eight kids from my school who had speech problems would come together, sit around a table, and say things like "The red rabbit ran around the room." As far as I could tell, I didn't have any problem saying sentences such as these, and so I never could quite understand what the purpose of therapy was. I knew I stuttered, although I'm not quite sure when that fact had been established, but I didn't feel the need for therapy. I had therapy sporadically from first to sixth grade, but I really didn't learn anything that I can recall. In those days, I felt that I was able to be fluent when I needed to be, and my stuttering was really not a big deal to me. In the mid-sixties, I moved to Bloomington, Indiana, just before I began eighth grade. When I started school in Bloomington, I got a note saying that I was supposed to be enrolled in speech therapy. I went to visit with the assistant principal and told her that I had therapy in Yonkers, it really didn't help, and I didn't see the need for therapy at this time. The assistant principal assured me that the speech therapist was a good guy, and that he would help me. It turned out that she was right on one count--he was a very nice guy. We'd get together, talk about all sorts of things, but I don't ever recall talking about my speech. He did give me a book on speedwriting, which I still have. So, my early therapy experiences were not particularly beneficial, when viewed through the mirror of 20/20 hindsight. I didn't learn a whole lot, and I didn't understand what I was doing. At that point in my life, I was confident that I was just going to outgrow my stuttering, which is what my doctor had told my mother. Please understand that I'm not pointing fingers anywhere. I'm not blaming my mother, my doctor, or my SLPs for anything that occurred up to that point in my life. I'm willing to accept responsibility for my lack of motivation as a pre-teen.
After I had been in therapy in Bloomington for a year or two, I got a call one night from a woman who said that her husband was a doctoral student at Indiana University, and he was wondering if I'd be interested in taking part in a study. She explained a bit about the study, and asked what kind of books I was interested in, since part of the study involved reading aloud. We made arrangements for her husband to pick me up one afternoon, and he and I headed off to the psychology building at IU. I thought it was a bit curious that the wife had called, but didn't think a whole lot about it. When the doctoral student came to pick me up, however, he was the most severe stutterer I had ever met. Before that, I don't think I had met more than a few stutterers, if any, and none were particularly severe. The fellow whose study I took part in actually managed his stuttering quite well, but he was definitely using a "stutter more fluently" way of talking. I remember getting a sort of sinking feeling in my stomach when I heard him speak, and thinking "Oh my god." Remember, up to this point, I believed that one morning I was going to wake up a fluent speaker. This experience was the first time at which I started to think that perhaps I was not going to outgrow my stuttering, and may have been the first step on my road to acceptance of my stuttering, although that road has taken many twists and turns.
Before that incident, I really wasn't ready for speech therapy, probably due to my belief that I would someday "outgrow" my stuttering. After that incident, therapy wasn't available to me. By that, I mean that someone decided that I didn't need therapy in high school, so I went through those years without therapy, and managed my stuttering fairly well. I still didn't feel a need for therapy anyway. Then, during my senior year in high school, I was answering a question in my English class, and had a fairly severe (for me) repetition. The kids in my class started laughing, and I was kind of surprised. Then I thought, "If these kids who have known me for three or more years are laughing at me, what's going to happen when I go to college and have to meet new people?" I proceeded into a fairly quick downward spiral of avoidance. I can recall fairly vividly how I began to refer to people as "what's-his-name," and my language became much less precise--lots of empty speech, circumlocutions, etc. This all seemed to happen pretty quickly. I really didn't know what else to do, so avoiding was about my only alternative at that time. Viewed again through the mirror of 20/20 hindsight, I guess I was an avoider pretty much all of my life, but it was not something I felt the need to do a lot.
After that incident, however, I became a hell of an avoider. In college, I can recall walking all over the Indiana University campus because I wouldn't ask someone where a building was. I rarely talked to anyone in my college classes. I loved having lecture classes with 350 students in big auditorium, and I hated those small discussion sections. One story that I often tell is the day that I was waiting in line at Burger King. The line was fairly long, and the closer I got to the front, the more nervous I became. I wanted to order two Whoppers, but by the time I got to the window, I was such a wreck that I ordered two fish sandwiches. And every time something like that happened, I would chalk it up as a "failure." I didn't understand that by failing to enter into a situation, I had no idea what the outcome might be, but at that time, fear of failure was an important driving force in my life. After two relatively unproductive years at IU, I decided to drop out of college. During my year off, I worked at Otis Elevator Company as a fork lift driver, then (after finding out what it was like to actually have to work for a living) moved to Dallas to stay with a friend who was attending Southern Methodist U. I lived in Dallas for four months, doing basically nothing, but doing a lot of thinking. It was at that point that I accepted that I was letting my stuttering hold me back, and I decided to return to Bloomington, change my major to speech pathology, and get into therapy for my speech. I should point out that for a short time before I moved to Dallas and for a short time after I returned, I saw a counselor. I had decided to do that because at that time, based on the knowledge that I had, I felt that my stuttering was a psychological problem. The counseling was a good thing for me. I began to see myself differently, and more importantly I began to learn to put my speech and stuttering into a different perspective, or to keep with the theme of this "musing," I began to develop a different understanding. I think that made me more ready to get back into therapy.
When I enrolled in therapy at IU, the supervisor in the area of stuttering was Dr. Merle Stevens. She had studied at Iowa, and therefore my therapy had a definite Iowa/Wendell Johnson flavor to it. Dr. Stevens was the first person who pointed out to me that when I failed to enter into a situation, I hadn't "failed" as far as my speech was concerned, because I didn't know what the outcome would be. She'd ask questions like "how do you know you're going to stutter?" The best answer I could come up with is, "I just know." But I had to admit to myself that I didn't know. In therapy, by testing reality I found that when it came to my speech, I was pretty clueless. For example, if I thought about stuttering while rehearsing what I was going to say, I assumed that meant that I would stutter if I tried to say it out loud. Obviously, I didn't know about the difference between silent practice and talking aloud. By entering in to speaking situations, and having success, I came to realize that what I thought was going to happen and what actually did happen were often quite different. Up to that point in my life, I'd never been challenged about what I believed about my speech and stuttering, and therapy forced me to do some different thinking about things. I came to see that my knowledge and understanding about my stuttering were based largely on speculation rather than reality.
I was in therapy at IU for 2-1/2 years. I've often kidded that I didn't need therapy for that long a period of time, but IU needed a stuttering client for that long. In many ways, being in therapy for a long time was beneficial to me, because I was exposed to a number of different clinicians and different therapy techniques and ideas. Interestingly, I didn't really learn a whole lot about doing therapy while at IU, because I attended the program during the heyday of the operant therapies, and so what I learned in my classes was, in many ways, different from what I was exposed to as a client. Most of what I "knew" about stuttering was the result of my personal experiences rather than any broader view of stuttering and stuttering research. Because of that, I don't think I was a particularly good fluency clinician when I graduated from IU.
Luckily for everyone who stutters, I only worked as an SLP for two years after completing my Master's degree, and during that time only worked with a handful of stutterers. Then I was accepted into the Ph.D. program at the University of Iowa, where I was lucky enough to study with Dean Williams. There's no question that my knowledge of stuttering grew considerably during my years in Iowa City. I served as Dr. Williams's teaching assistant in his stuttering class during my first semester at Iowa, and later was able to supervise stuttering therapy in the Wendell Johnson Speech & Hearing Clinic for one year. By doing those things, I began to learn a lot more about stuttering and stuttering therapy. In fact, as a supervisor, I had an opportunity to "practice what I preached": when I made suggestions to a client, I had to be sure that I could do what I was asking that client to do. I became more willing to try different things when I spoke, and became a better student of my own speech. Williams's notion of "staying in the present," exploring what I did when I stuttered, made me much more knowledgeable about my own speech and stuttering. Another Williams notion, effective speech rather than fluent speech made a lot of sense to me. (Since I usually strive for mediocrity in everything I do, why not have a similar attitude about my speech?) In addition, by studying the then-current and classic research in stuttering, I began to broaden my views of the disorder beyond my personal experiences, and to appreciate the truly multi-faceted nature of stuttering. One of the first things that Dr. Williams told me when I began to supervise was that I should not project my experiences onto the clients with whom I worked. He emphasized the danger of thinking that I was like all stutterers, and I've tried hard over the years to keep this in mind. To my way of thinking, it's a critical caveat for anyone working with stutterers. It's also something critical for stutterers to think about when they are trying to "help" other stutterers. With the knowledge I gained at Iowa, I was able to better accept what I could and could not do as a speaker.
As a doctoral student, there were lots of opportunities to speak: in seminars, to the students and faculty at proseminar, to various faculty, to other students, meeting new people, etc. And I really can't recall any instances where my speech held me back. I suppose there were some opportunities that I may have passed up, but I can't recall them. What that indicates to me is that by that time in my life I no longer obsessed about my speech--I focused on my successes rather than my failures.
Since I graduated from Iowa, I have worked at three universities. I have taught hundreds of students. I have presented at local, state, and national meetings. I have met a lot of people. I still stutter. And I think that last statement is the clearest illustration of my acceptance of stuttering. I accept that I stutter; it's part of me; I'll do it occasionally, often when I prefer that I not; I can manage my speech pretty well--it's rare to have one of those "out of control" experiences; I don't blame my stuttering for any of my shortcomings. When I think about it, I realize that I've accepted a lot of things in my life. For example:
When I work with clients, or supervise my students working with stutterers, my goal for the clients is for them to be the best speaker they are capable of becoming--not necessarily a "normally fluent" speaker, but a better communicator than they are when they enter therapy. I try to help them to reach that point by giving them knowledge about speech and stuttering, helping them to understand what they are and are not capable of doing at a particular point in time, and, I hope, helping them to accept themselves as they are and to accept the changes that come about with changes in their speech. Do I succeed? Sometimes yes, sometimes no. But I accept that I can't help everybody, nor does everybody want the kind of help that I try to provide.
My words of wisdom to SLPs would be these: make sure you know what you are doing in therapy, and why you are doing it. Make sure your client knows what and why, as well. Help your client to learn about speech and stuttering, so that stuttering becomes something that can be talked about in concrete terms, rather than some sort of an "it." Help your client to understand what he or she can and can't do, and understand that not every question about stuttering can be answered or explained easily. Help your client to accept himself or herself as he or she is; put stuttering in the proper context.
To stutterers, my message is similar: do the best you can. Don't strive for immediate success, but work toward getting better. New skills, beliefs, and attitudes take time to develop. You get out of therapy what you put into it--if your therapist is not doing what you expect or want, tell them that. Believe it or not, SLPs are not mind readers.
Finally, SLPs and stutterers have to work together. SLPs shouldn't be afraid of stutterers, and stutterers shouldn't hate SLPs. Unfortunately, I see all too much of that out there. We need to realize that we're all on the same side. I wish I had a solution, and who knows, I may offer one elsewhere on this website.