This is a threaded discussion page for the International Stuttering Awareness Day Online Conference panel, Paths Toward Recovery, by Kristin Chmela, Geoff Johnston, Walt Manning and Bob Quesal.. Have to's, shoulds, and musts From: Gunars K. Neiders, Ph.D. Date: 9/30/98 Time: 6:45:18 PM Remote Name: 22.214.171.124 Comments Your statement, "It has been about eliminating "shoulds", "musts" or "have to's", letting go of judging, and learning to talk and even laugh about stuttering." is similar to Rational Emotive Behavioral Therapy thesis. Did you yourself come up with this or were you exposed to cognitive behavioral psychology? Re: Have to's, shoulds, and musts From: Kristin Chmela Date: 10/13/98 Time: 9:32:19 PM Remote Name: 126.96.36.199 Comments Dr. Neiders: My name was not on this post but I think it is directed towards me. I actually have had counseling from a psychologist that practiced cognitive behavioral therapy. It was a very important piece of my recovery process (which of course is still continuing). I especially benefited from learning about cognitive distortions and changing the way that I perceived various situations related to my stuttering. Thanks. K. Chmela Bob: Attitudes and beliefs... From: Gunars K. Neiders, Ph.D. Date: 9/30/98 Time: 7:26:01 PM Remote Name: 188.8.131.52 Comments I agree partially with your statement that "New skills, beliefs, and attitudes take time to develop." But if we present to the client a set of attitudes, such as unconditional self acceptance, decatastrophizing ;-), and deawfullizing stuttering per se, wouldn't the process be shorter? Re: Bob: Attitudes and beliefs... From: Bob Quesal Date: 10/4/98 Time: 2:00:35 PM Remote Name: 184.108.40.206 Comments I guess I don't see how we "provide" a client with new attitudes. My take is we develop our attitudes based on our own experiences and history. If we try to introduce a new attitude, we're telling someone how to think. That's not how it should be done, IMHO. Re: Bob: Attitudes and beliefs... From: Gunars Date: 10/5/98 Time: 8:39:43 PM Remote Name: 220.127.116.11 Comments Bob, You are quite right! I misspoke! I only meant to say that removing some of the highly negatively charged attitudes about stuttering can be addressed by both experiential as well as cognitive behavioral therapies. Common Treatment Strategies From: Krista Affeldt-Bacon Date: 10/3/98 Time: 7:40:09 PM Remote Name: 18.104.22.168 Comments After reading the three different treatments that were completed, I was wondering how you felt about "common" treatments for all stutterers? I was under the impression after reading the three entries that you each had your various reasons for overcoming your dysfluencies and that possibly not everyone would be able to utilize that particular method of treatment. Re: Common Treatment Strategies From: Walt Manning Date: 10/5/98 Time: 10:53:30 AM Remote Name: 22.214.171.124 Comments Regarding a "common" treatment for all people who stutter. There are more or less comprehensive treatment strategies, I think, each with different associated techniques. The strategies and techniques all have value and I don't know that one is better than another. It's up to the clinician do decide what the client needs and when and why, choosing from among the strategies and techniques. Trying to find the ONE technique or especially, arguing that one is better than others is like comparing religions, political systems or coaching techniques. It depends on people, timing and experience. And maybe luck. support groups From: firstname.lastname@example.org Date: 10/4/98 Time: 7:40:53 PM Remote Name: 126.96.36.199 Comments Did any of you have an opportunity to be part of a support group when you were younger, say between 9-14? Would that have been helpful? If so, what discussion topics, problems or activities would have been most helpful? I am asking these questions because I'm about to begin a group therapy for kids, and Barry Guitar is going to simultaneously work with their parents. Any input is greatly appreciated!! Many thanks. Julie Re: support groups From: Walt Manning Date: 10/5/98 Time: 2:24:59 PM Remote Name: 188.8.131.52 Comments No, I had never had an opportunity to become a member of a support group....there wern't such things when I was young. There were barely any SLPs and most of them were afraid of somehow hurting the child who stuttered! Having taken part in some NSP programs with parents and children in the past few years, I wish I would have had such an opportunity. I believe it would have gone a long way toward helping me deal with the shame and would have helped my parents to deal with the guilt and enabled them to understand much more about the problem. The only advise they ever received (from a psychologist) was a suggestion that I stop swimming (something I loved) because it was a bilateral activity! A self help group From: Benny Ravid Date: 10/9/98 Time: 10:16:49 AM Remote Name: 184.108.40.206 Comments I'm not an SLP and my academic degree has nothing to do with speech therapy. I'm just a simple stutterer :-). I agree with the statement that "Client must become their own problem solver". But in my opinion , a PWS may become it's own problem solver, only if the strong emotions of guilt or shame which are connected to the stuttering are removed or at least are significantly reduced. Seems to me that a self help group provides a space, in which such emotions are being gradually reduced which changes the stuttering from being a shame or a guilt into a problem to cope with. Please comment. Re: A self help group From: Bob Quesal Date: 10/9/98 Time: 2:45:46 PM Remote Name: 220.127.116.11 Comments I agree that shame, guilt, etc. need to be dealt with. Self-help groups are but one option for help in this area, however. I think a good SLP can provide help with this, and there are other places, as well. I agree with your point that these factors should be addressed if one is to solve one's own problem(s). I hope this response answers the point you were making. Re: A self help group From: K Chmela Date: 10/13/98 Time: 10:22:16 PM Remote Name: 18.104.22.168 Comments I do believe that self help groups help many individuals deal with difficult emotions such as shame and guilt that may surround stuttering. I know that whenever I attend an NSP function I grow as an individual in terms of dealing with my own stuttering. For myself, some of my greatest growth has come from dealing with the issues related to shame, guilt, etc.. Re: A self help group therapy From: Les Anderson Date: 10/16/98 Time: 11:13:56 PM Remote Name: 22.214.171.124 Comments If I may interject here with a word of modest caution. Care and caution should be taken as to what form of therapy is gained from self-help group members. Most self-help group sessions are attended by lay people who stutter and share their personal feelings, aspirations and goals with each other. These are great emotional and encouragement factors in dealing with our stutter. Many times however, one or two of the group's members become self-appointed therapists and can inadvertently cause many problems with the advice given. I think a step of caution should be taken when accepting diagnostic advice from someone who is not properly trained. I agree most strongly that it is a very important step in our fluency process to join a self-help group but one should not dive in blindly. Our provincial Association in British Columbia encourages, that professional people be invited to attend and give seminars at group meetings from time to time. Les Anderson Kristins Story From: Julie - Denver, CO Date: 10/11/98 Time: 7:08:28 AM Remote Name: 126.96.36.199 Comments Kristin, I am curious if you still stutter at all. I can identify with most of what you say. I am 27 and didn't get proper speech therapy 'till 3 years ago at the University of South Florida. Before going into therapy, I had spent the last 3 years trying to deal with problems that had haunted me for years. With the combination of good speech therapy and continueing to work on deep seeded troubles, my stuttering has gone from severe to mild. Today,I do technical support over the phone and am a member of Toast Masters International (joined 2 months ago. Told them I had a stuttering problem in my first speech). Though, moving back in with my parent and getting yelled at and either I do what they say or live in the streets (finally getting my own place in December) has put me back a few steps, I truely believe by the year 2000 I will be completely over stutter. And as long as I continue to work on certain things for a bit longer, my stuttering should not return. I enjoyed reading your story and I'm sure others have as well. Best Wishes, Julie Re: Kristins Story From: Kristin Date: 10/13/98 Time: 10:20:41 PM Remote Name: 188.8.131.52 Comments Julie..I was not in a support group when I was younger (between the ages of 9-14). I think it would have made a tremendous difference in my life had I had one. I say that because of what I have seen happen to the children who are in our group. I usually carry between 12-18 school age children on my private caseload and last year we had a group that met once per month. The benefits for the children are many...we did not use our group as a "place" where they needed to "practice" their speech tools (although that is one great way to use a group). We used the group as a place where the childrne could meet others with the same problem and feel a sense of great support. Many of the kids chose to work on their tools which was great but we had no "expectations" for their fluency. Last year we decided as a group to write a newspaper to teach teachers about stuttering. The children developed twelve sections for the paper and at each meeting we would work on it. It was a wonderful experience for everyone. Many of the kids have continued to ask me when the group will be starting again. ( I will specify here that of course not all children would be ready for a group or would benefit from one) One thing I firmly believe is that if we are going to fomr special relationships with children we must have fun with them. We usually included pizza/pop/ice cream sundaes..whatever at the group. Whenever possible we included sports activities (easy fo rme to do being that my husband is co-owner of an indoor sports complex. One of the neatest things we did was go indoor rock climbing. That was an activity that had alot to do with working on stuttering!!! Most children love physical activity and it's a great way to utilize "team building" and relate it back to speech. Good luck! PS. Teh younger kids usually benefit greatly from having the older kids there as role models. I have clients that have been out of therapy for years and they still call to come back to the group. Kristen Chmela- Recovery From: Lee Caggiano Date: 10/13/98 Time: 7:31:49 AM Remote Name: 184.108.40.206 Comments Your story of personal recovery was absolutley inspiring. Kristen thank you for sharing your journey with us. As a mother of a teen who stutters and as a clinician with the awesome gift of being allowed to share this journey with others your story brings a great feeling of peace to me. I am thankful for yet another opportunity to learn from you. Lee Re: Kristen Chmela- Recovery From: K Chmela Date: 10/13/98 Time: 10:21:37 PM Remote Name: 220.127.116.11 Comments Thank you, Lee. One of the greatest things is to realize that the "journey" becomes the most special gift of all. Newsletter From: Speak Easy, Inc. Date: 10/14/98 Time: 12:50:24 PM Remote Name: 18.104.22.168 Comments Kristin, Your paper is very interesting and would also be of interest to those stutterers not participating in this online conference. As Canada's organization for people who stutter, may we publish a copy of your paper in a future issue of our monthly magazine, "Speaking Out"? Re: Newsletter From: K. Chmela Date: 10/22/98 Time: 9:23:50 PM Remote Name: 22.214.171.124 Comments You asked it you could publish the paper in your newletter. Absolutely. I am honored. Thank you. Recovery From: Jean O'Conor Date: 10/16/98 Time: 8:14:29 AM Remote Name: 126.96.36.199 Comments What do you think the struggle to "accept" stuttering experienced by many adults who stutter tells us about how to treat young children? Is the prevention of fear and negative feelings enough or do they still have to go through years of therapy to manage the disfluencly? Is it even possible to prevent the negative feelings or does one always have to confront them at some time in one's life? Re: Recovery From: Bob Quesal Date: 10/17/98 Time: 5:37:01 PM Remote Name: 188.8.131.52 Comments Jean asks an extremely good question. I wish I had an extremly good answer. I don't think that "prevention" of negative feelings and fear would be possible in a child who had any more than a mild stuttering problem. Some people who stutter are not affected by it much at all. Others are deeply bothered by it. And the depth of despair is not directly linked to the severity of the stuttering in many cases. So on the surface it would seem that if we could lessen the fear and negative feelings, that might be an important step. It still seems to me, though, that you need to have some sense of "control" over your speech. A person unable to control their stuttering, or modify it, is not very likely to be able to avoid the negative feelings and fear. The other issue about acceptance, that I talk about in my paper, is that in many cases it does just come with maturity. We change our perception of how important things are as we are exposed to more and more things in our lives. What was a big deal at age 16 may not be a big deal at age 36, or 56. I don't know if I could have been "taught" or "encouraged" to accept my stuttering when I was younger. It'd be interesting to travel back in time and see if different therapy when I was young would have led to changes in the way my life has progressed. I know that Kristin Chmela and Bill Murphy (as well as others) do a lot to help reduce the shame that children feel about their stuttering. I think it's an important component to therapy. I'm not sure how well it works by itself, however. A very long, convoluted answer to a very good question. BQ Newsletter..Speak Easy From: K. Chmela Date: 10/16/98 Time: 10:51:42 AM Remote Name: 184.108.40.206 Comments You asked it you could publish the paper in your newsletter. Absolutely. I am honored. Thank you. Walter Manning: My Story of Achieving Fluency... From: Heidi Thorson Date: 10/18/98 Time: 2:51:56 PM Remote Name: 220.127.116.11 Comments Thank you for sharing your story. I enjoyed very much. My question to is the following: When you changed some of your attitudes about your speech and yourself did find that it also changed the attitudes/reactions of listeners or did it have little or no effect among listeners. Sometimes I think attitudes can have a ripple effect and I am curious to know if you experienced that. Re: Walter Manning: My Story of Achieving Fluency... From: Walt Manning Date: 10/19/98 Time: 10:08:47 AM Remote Name: 18.104.22.168 Comments Heidi- I'm not sure just what my listeners may have thought. I know that the more I accepted myself as a person who stuttered and the more I was "open" about it, the easier it was for others to accept and discuss my speech. There is some research indicating that if a person with a disability is able to accept their problem and be up front about it, listeners are more likely to take this approach also. If the person who stutters opens the door for discussion we find that most people want to talk about it since stuttering is, in fact, a very interesting syndrome. I guess it's true that the more OK you feel about yourself & the brighter you shine (whether you happen to stutter or not) the more likely it is that you will attract (rather than repel) others. Geoff Johnston- smooth speech From: R. Flicek Date: 10/19/98 Time: 4:48:27 PM Remote Name: 22.214.171.124 Comments Mr. Johnston, you mentioned "smooth speech" as being the most effective fluency technique for you. As I am unfamiliar with this, could you tell me more about it? Thank you. Re: Geoff Johnston- smooth speech From: Geoff Johnston Date: 10/21/98 Time: 5:03:29 AM Remote Name: 126.96.36.199 Comments Smooth Speech is the primary fluency shaping technique used in Australia. The main elements of Smooth Speech are: 1. Easy Onsets / Beginnings Breath into the beginnings of words so that your speech sounds somewhat like a sigh. Must be a totally passive airflow! Say first word very slowly! 2. Soft Contacts All consonant sounds should be made with your lips, tongue, teeth and palate (roof of mouth) resting very lightly together. 3. Aspiration of Vowels All vowels at the beginning of phrases (ie when you begin speaking or after you have paused to take a breath) should have an "h" sound before them. Vowels produces in the middle or end of phrases should be joined to the sounds which precede them. 4. Blending of Syllables through: o Continuous Airflow - breathing should be from the diaphragm and ribs, and not short and shallow. When speaking, you need to use a lot of easy, continuous airflow; and o Continuous movement of your speech muscles - your tongue and lips should be moving all the time while you are speaking. Sentences should be produced with smooth, continuous blending of each syllable into the next. 5. Reduce speech rate to under 200 syllables per minute Slow speech gives our speech mechanisms time to do what is necessary for fluent speech. Main emphasis should be on slow speech with linkage of words in phrases. Remember: Stuttering is something I DO as I talk, NOT something that magically "happens to me". I will remain a stutterer as long as I continue to pretend not to be one. Ready for treatment From: Kristi Bongaarts Date: 10/20/98 Time: 11:42:29 AM Remote Name: 188.8.131.52 Comments Dr. Manning, you mentioned that a client needs to be ready for treatment and want to alter their response to a situation. I agree with that but I work with some adolescents and I find that they are not ready to work toward change. What do you suggest I do to help them? Should they be dismissed from services until they are ready for help or do I keep having them come to speech even though they don't want to and are not making any progress? Re: Ready for treatment From: Walt Manning Date: 10/20/98 Time: 3:24:29 PM Remote Name: 184.108.40.206 Comments Kristi- Teenagers are usually not ready for treatment, as I probably mentioned in an earlier post. Other things take priority...like, "What am I going to do Friday night!" I don't think we can force them, although sometimes we can lay some groundwork for future change. At least they can find out that there are competent clinicians out there who really do understand what's going on with stuttering and are excited about helping. The internet is a great source of information for adolescents as well as the information provided by the Stuttering Foundation of America in the form of video and booklets. National Stuttering Project videos, printed materials, workshops, and web page are wonderful ways for a teenager to find out that he is not alone and that there is much to learn, and maybe change, about his situation. So, your are right, it is often very difficult to get teenagers to commit to the treatment process and all we can do is give them the opportunity. ISAD From: Anita S. Blom Date: 10/22/98 Time: 6:46:47 AM Remote Name: 220.127.116.11 Comments Wow, what a day. We didn't have time to have a big seminar, but contacted over 300 tv and radio stations and newspapers: the phone hasn't stopped!!! It was on the first news bulletin this morning and will be on almost every local station during the day. We really have a tool here. Wipe me up when this day is over....... Thanks and happy ISAD!!! Anita S. Blom Common treatment strategies From: Dick Curlee Date: 8/22/99 Time: 4:31:38 PM Remote Name: 18.104.22.168 Comments The effectiveness of specific treatment strategies and procedures reflect the skill with which they are used as well as the appropriateness of their use for specific clients. I suspect this could be demonstrated empirically if 10 similarly qualified clinicians were each assigned a group of 30 randomly selected persons who stutter and if each clinician employed the same strategies and procedures with each person in his/her group. I am confident that not only would there be a range of outcomes in each group, but the groups' average outcomes would also differ.