This is a threaded discussion page for the International Stuttering Awareness Day Online Conference paper, What Is "Successful" Stuttering Therapy, by Robert Quesal. Welcome From: Bob Quesal Date: 9/29/98 Time: 3:07:51 PM Remote Name: 18.104.22.168 Comments I just want to say Hi to everyone who took the time to read my paper, and has come this far. There are may excellent papers in this ISAD conference, and I hope everyone gets a chance to read all of them. I'm honored to be a part of this. BQ Re: Welcome From: Bonnie L. Weiss Date: 10/3/98 Time: 8:06:57 PM Remote Name: 22.214.171.124 Comments Hi Bob-- What a GREAT paper. It was fun reading it and thinking that I actually met my e-mail buddy in person at Atlanta. We're gonna have to get back to chatting on line SOON! Bonnie Extended Lidcombe Behavioral Data Language From: Gunars K. Neiders, Ph.D. Date: 10/1/98 Time: 6:46:44 PM Remote Name: 126.96.36.199 Comments Dr. Quesal, Firstly, let me congratulate you on a humanistic view of stuttering therapy. I found your article exceedingly interesting. Meanwhile in the book Treatment Efficacy for Stuttering edited by Anne K. Cordes and Roger J. Ingham I found a paper Behavioral Data Language of Stuttering by Ann Packman, Ph.D., and Mark Onslow, Ph.D. which piqued my interest. The authors define stuttering as follows. Stuttering behavior [consists of] Repeated movements: 1) syllable repetition, 2)incomplete syllable repetition, 3)multisyllable unit repetition Fixed postures: 1) with audible airflow, 2)without audible airflow Superfluous behaviors: 1)verbal, 2)nonverbal As far as this model goes it is fine. However, we are trying to manage Stuttering Syndrome and not Stuttering per se. For example, avoidances and substitutions are totally ignored in their definition of "stuttering". Personally, I, Gunars, consider Ann Packman's and Mark Onslow's work on Lidcombe Behavioral Data Language of Stuttering as exceedingly worth while. To discard this effort would be unconscionable. Therefore, the reviewer Gunars Neiders proposes an alternate EXTENDED Lidcombe Data Language Model for STUTTERING SYNDROME! This model builds on the earlier one by adding other factors than just avoidances and substitutions. Below is the complete EXTENDED Lidcombe Data Language Model for STUTTERING SYNDROME. Enumeration signifies topics and subtopics. Further renumbering indicates further subtopics Stuttering syndrome [consists of] STUTTERING BEHAVIORS (per Lidcombe Behavioral Data Language) Repeated movements: 1) syllable repetition, 2) incomplete syllable repetition, 3) multisyllable unit repetition Fixed postures: 1) with audible airflow, 2) without audible airflow Superfluous behaviors: 1) verbal, 2) nonverbal The following is the Neiders extension. AVOIDANCES: 1)Substitutions, 2)Circumlocutions PSYCHOLOGICAL FACTORS: 1)Stuttering Shame, 2) Lack of self acceptance, 3) Guilt for not overcoming stuttering, 4) Phobias 4.1)Word 4.2)Sound 4.3)Speaking situation 4.3.1)Telephone 4.3.2Authority figure etc. 5)Hopelessness/helplessness 6)Demandingness 7)Catastrophizing 8)Low frustration tolerance 9)Perfectionism 10)Anxiety 10.1)Ego 10.2)Discomfort 11)Obsession SUBCONSCIOUS OR PRE-CONSCIOUS PATTERNS 1) Loss of control with associatedpanic/struggle 2)Some words more difficult than others 3)Mental scanning 4)Seeing speaking as difficult,prone to failure 5)Hearing "footsteps" of an oncoming block RISK AVERSION 1)Career related 2)Social situation related Obviously I have introduced many more vectors than even your short paper considers. Are they superfluos? I think not! I believe that the negative energy can be displaced from the actual stuttering behavior into other areas, say avoidances, fear or perfectionism. For the therapy to be successful it would have to have an outcome where all of the factors are reduced significantly or else the stuttering pattern would return. My question to you, Dr. Quesal: "Do you agree that a complete measure of success of stuttering therapy would have to include all of these factors so as to predict long term results?" Re: REFORMATTED: Extended Lidcombe Behavioral Data Language From: Bob Quesal Date: 10/4/98 Time: 2:04:03 PM Remote Name: 188.8.131.52 Comments Gunars said: My question to you, Dr. Quesal: "Do you agree that a complete measure of success of stuttering therapy would have to include all of these factors so as to predict long term results?" You don't need to include all factors in all cases. Everyone who stutters is different, and we need to treat everyone as an individual. I would agree that we need to consider all the factors, but some may be unimportant for specific individuals. Goals, the SID conference, etc. From: Anne Cordes Date: 10/8/98 Time: 11:41:06 AM Remote Name: 184.108.40.206 Comments I love some of these arguments, and they don't occur just for stuttering -- everything from HIV to diabetes to reading disorders struggles with the balance between "Why can't the relevant professionals figure out how to make this GO AWAY?" and "How can I live a full and complete and happy life even though my body happens to have this?" I think at least some of the professionals working in cancer, HIV, reading disorders, stuttering, etc., ought to be concentrating on how to make the most basic features of the problem GO AWAY -- and for stuttering, the thing at the "core," the thing that if we could make it go away we wouldn't have to worry about social handicaps or occupational handicaps or emotional acceptance or any of the rest, has something to do with a physiological system that does not produce speech in as fluent a manner as most other physiological systems do. I think that the PROFESSION should have as one of its PROFESSIONAL goals figuring out how we can help people who would LIKE to learn to speak without stuttering to learn to speak without stuttering. I recognize that there are people who stutter who have other goals, but the fact that some people who WANT to learn to speak without stuttering have basically been forced to accept other goals is a failing of the profession, not a failing of any individual who stutters. My major problem with the Florida SID conference, and the reason we wrote the little piece for the SID newsletter (that was Ann Packman's original, by the way; we just listed our names alphabetically) is NOT that I disagree with the importance of measuring the social, emotional, human consequences of stuttering, and has nothing to do with the fact that some PWSs do not have "speak without stuttering" as a goal but have other things as goals. As a matter of fact, my major problem with the SID conference was that I DO think social, emotional, cognitive, human elements are important -- and, specifically, I think that they are so important that they deserve to be measured in ways that can be defended as producing reliable and valid data, the same way that I think that measuring the speech itself is important enough to deserve good measurement systems. The development of good measurement systems for the social, emotional, cognitive, etc., elements will never be achieved if we create our scales by letting someone dictate from the outside that they should be 7-point EAI scales and then by sitting around at a resort spending three days re-creating a half-baked version of some cross between the SSI and Silverman's old "what would you like to be able to say about your life that you can't currently say?" scale/profile. I truly think that people who stutter should expect more of the profession than that. Re: Goals, the SID conference, etc. From: Bob Quesal Date: 10/8/98 Time: 2:33:40 PM Remote Name: 220.127.116.11 Comments Gee, Anne, it's hard to know where to begin to reply to your post. At the risk of failing to see the forest for the trees, let me respond to just a couple of the things you said. First, you said "I think that the PROFESSION should have as one of its PROFESSIONAL goals figuring out how we can help people who would LIKE to learn to speak without stuttering to learn to speak without stuttering. I recognize that there are people who stutter who have other goals, but the fact that some people who WANT to learn to speak without stuttering have basically been forced to accept other goals is a failing of the profession, not a failing of any individual who stutters." What I read you saying is a couple of things. First, it appears that you think that stutterers who "have other goals [besides just fluent speech]" somehow choose to continue to stutter. That sounds like Don Mowrer. To suggest that I choose to stutter is about the greatest insult I can think of, because it implies either that I'm too lazy to do something about my speech or that there is some sort of secondary gain that I recieve because I stutter. To extend that argument to all people who have been unable to achieve "speech without stuttering" is, to put it mildly, a cheap shot. Second, by saying that professionals "force" people who want to learn to speak without stuttering to "accept other goals" is an insult to me as a speech-language pathologist. I believe that a lot of individuals who stutter are capable of fluent speech, and certainly that's the primary goal for me when I'm trying to help clients. Unfortunately, I have just seen too many folks who are NOT able to achieve fluent speech. I don't enter the therapy setting and say, "Well, you're a stutterer and you're doomed to stutter the rest of your life. Let's see if we can make you feel good about yourself in spite of that terrible affliction." At some point, however, that may become the reality. If I can help a client to "do the best he/she can" without holding out normal fluency as the ONLY reasonable goal, I feel I've done my client a service. I guess what gets me the most is that it's so easy to look at a stutterer and say, "Why can't you just talk fluently? Most people can do it, why can't you?" I wish we had simple answers. But as someone who has dealt with this for most of my life, I know there are no easy answers. I'll stand by the basic premise of my paper--there's more to "success" in therapy than fluency. As far as measuring unobservable things like attitudes, beliefs, feelings, etc. I agree that we need better ways to do it. It's a shame that you couldn't see *some* positives in the attempts at the Special Interest Division 4 Conference. Maybe 7-point scales aren't the best way to go, but we have to start somewhere. No one will be forced to adopt the SID4 measures, as far as I know. In the meantime, there will be lots of opportunities for folks who think they can do it better to do just that. (P.S. If the SID 4 newsletter piece was Ann Packman's article, why didn't she get senior author credit?) Re: Goals, the SID conference, etc. From: Anne Cordes Date: 10/8/98 Time: 4:19:15 PM Remote Name: 18.104.22.168 Comments Oh, my -- I apologize for anything that might have been interpreted as insulting, but somehow what I wrote seems to have communicated pretty much the opposite of what I meant. "You're so lazy; you're just choosing to stutter" is precisely the opposite of what I meant, and I don't believe it for a second, for you in particular (not that that is ANY of my business, and I did NOT mean to be going there) or for anybody else. I meant that I do think that "we" in a very large sense, we as a discipline and/or as a profession, have essentially forced some people who might like to be able to talk without stuttering into the position of having relatively few choices: they can work and work and work and work at trying to learn "treatments" that just aren't good enough, or they can decide not to work at those treatments and to accept that the treatments that we have to offer just are not good enough to be able to get them to the point of being able to talk without stuttering. Again -- not a failing of any individual person or individual "professional," but a failing on a large scale, because we as a discipline/profession just haven't developed all the right solutions yet. So defining "treatment success" includes, for me, recognizing that we, on a large scale, as a discipline, not as individuals who have done anything wrong or made any "choices," still have a lot of work to do in developing treatment alternatives (and in figuring out how to measure and document their goals and their effects). The newsletter piece was joint-authored by the time it was done; Ann didn't want to be first author for several reasons; and our names were listed alphabetically, as I said. (Sorry -- "I stole the piece from my friend" would have been a much more interesting answer, I know.) Re: Goals, the SID conference, etc. From: Bob Quesal Date: 10/8/98 Time: 5:03:34 PM Remote Name: 22.214.171.124 Comments I appreciate the clarification. It may be possible, however, that we're doing the best we can when it comes to *some* instances of stuttering. Not to say we can't do better, but I don't think things are quite as bleak as you painted them (or I *interpreted* you to paint them) in your original post. We need to keep working, I agree, but in the meantime, there are many ways to help people who stutter. Helping them deal with stuttering on a day-to-day basis may be one of the best things we can do. I'm working with a client right now who just gave a speech in a public speaking class. He talked about stuttering, and talked about his own stuttering. I asked him if he would have done that six months ago. Take the public speaking class?--doubtful. Talk about stuttering?--no way! ADMIT that he stuttered in front of a class?--NO WAY!! After his talk, two of his classmates came up to him and said, "Did you used to stutter? I never would have known it." Have I helped him by doing therapy with him? I hope so. Is he as fluent as he'd like to be? Not yet. But he's made a lot of strides in the past 6-8 months. I'd like to think he (and I) have had some "success." (P.S. I wasn't trying to accuse you of "stealing" Ann Packman's paper. It just seems pretty lucky when the first name in the alphabet gets first authorship. I think I'll change my name to Aardvark.) ;-)>> Re: Goals, the SID conference, etc. From: J. Scott Yaruss Date: 10/8/98 Time: 5:00:55 PM Remote Name: 126.96.36.199 Comments Hi Anne (and the rest of the on-line world ;-)... I thought I'd throw in my $.02, FWIW. The way I like to conceptualize some of what you and BQ are talking about is in terms of "the nature of the client's complaint." I know you've heard me talk and write about this before (it was at your conference and your book, after all, that I first got the opportunity to spout off about the issue...), but I'll be redundant since this is a public forum ;-) Baer's notion of addressing the client's complaint is a perfect one in my mind for separating out what you talked about as "how we can help people who would LIKE to learn to speak without stuttering to learn to speak without stuttering" vs. "people who stutter who have other goals." This is simliar to saying, the people who have as their primary complaint the fact that they stutter vs. people who have as their primary complaint (or perhaps even a secondary complaint) the fact that they can't talk on the phone, get the job they want or the girl they want, or whatever. I differentiate this in my model in terms of people whose complaint is the IMPAIRMENT vs. people whose complaint is also the DISABILITY or HANDICAP of stuttering (discussed in more detail in my on-line ISAD paper and in the chapter in your book). I think that some treatments SHOULD focus primarily on the impairment so that the people who have the impairment as their primary complaint can get the treatment they want/need. Other treatments, meanwhile, should focus on the impairment, disability, and handicap as appropriate so the clients who have that stuff as their complaint ("I'm tired of what the stuttering has done to my life") can get the treatment they want and need. Since every person who stutters is unique, then every treatment should be unique, IMHO. Likewise, the goal of treatment should vary with the client's goal. If the client primarily or only wants to be fluent, then treatment should focus on that. If the client wants to be fluent but also focus on how stutters has affected his life, then the treatment should focus on those things. The clinician should follow the client's lead in determining the goal of treatment. So, I think there's room -- and, indeed, a need -- for both approaches (as well as others). The problem then becomes -- and I think this is part of where your post originated from -- how we document whether the treatments are indeed effective. For impairment-based treatments, this is relatively straightforward (though there are of course pitfalls) -- if the goal is fluency, then we measure the fluency. For treatments focused on other levels, though, we need to SUPPLEMENT impairment-based measures with measures of other aspects of the disorder. That's where my effort described in the ISAD paper came from and what we're trying to accomplish. Bob Quesal is an important part of that effort and my collaborator in developing the instruments, so it's only fitting that the discussion arises in response to his article ;-) Hope this doesn't muddy the waters too much, but that's how I think about these things. Since you asked ;-) S Re: Goals, the SID conference, etc. From: Bob Quesal Date: 10/8/98 Time: 5:05:37 PM Remote Name: 188.8.131.52 Comments Thanks, Scott. I couldn't have said it any better. Focus of treatment From: Andy Floyd╩╩╩╩ firstname.lastname@example.org Date: 10/10/98 Time: 11:17:33 PM Remote Name: 184.108.40.206 Comments Dr. Quesal, First, it was a real pleasure meeting you at the last NSP convention. I had heard so many good things about you from Dr. Hood and Dr. Ramig. There sometimes seems to be more beliefs out there about how to treat PWS than there are PWS. I heard from someone that she finds out what her stuttering clients believe caused their stuttering and then focuses her treatment in that direction. Therefore if the client believed that his stuttering was completely a learned behavior, the clinician would focus the treatment on unlearning the behavior and would incorporate operant and classical conditioning. The clinician does not attempt to educate the client in the current thinking about stuttering if the client already has an idea in their head that contradicts what we in the field think and know about stuttering. To tie this in somewhat to Dr. Yaruss' comments, I would think that most clients will come into therapy hoping to stop stuttering. I see it as my professional obligation to educate the client as to the current thinking about that possibility among other things. If the client does not want any part of desensitization or talking about feelings and emotions surrounding stuttering and only wants to focus on the physiological movements of speech (fluency shaping therapy), is it my responsibility to try to counsel that client into opening up about their stuttering, refer them to a fluency shaping SLP or throw my beliefs out the window and treat that person with only fluency shaping techniques? Re: Focus of treatment From: Bob Quesal Date: 10/11/98 Time: 11:57:47 AM Remote Name: 220.127.116.11 Comments Like I said in my article, I try not to enter the therapy process with the preconceived notion that any particular client is going to need work on attitudes, beliefs, etc. So if a client came to me and wanted just to be fluent, we'd focus just on fluency skills. However, attitudinal statments come up all the time in the therapy process. When they come up, I think we need to deal with them. Over the years, I've referred a number of clients to other professionals (e.g., Hollins) when I (and they) felt that the type of therapy that I was able to provide was not meeting their needs. I *like* to think that I operate out of a flexible framework for stuttering therapy that can be adapted to individual client needs. But as I've said elsewhere, I realize that I can't help everybody, and not everybody wants the kind of help I want to provide. That's the reality. I hope this addresses the issue you raised. (I really enjoyed getting a chance to get to know you better at NSP, too.) Therapy for children From: Molly Tami Date: 10/12/98 Time: 7:59:14 AM Remote Name: 18.104.22.168 Comments I found your article very interesting and from my perspective, right on! I am the parent of an 8 year old boy who has been in therapy for several years. His stuttering has varied greatly from time to time, and he is now enjoying great periods of fluency, though not "normal" fluency at all times. My goals and expectations for his therapy have greatly been altered over time, and the approach you present is one that I think works for most parents of children who stutter. My son and I attended a month long intensive course at ISTAR in August, and this was very much the basis of their approach. Also- your comments on how people and some SLPs, think that all people who stutter can be fluent is very accurate. Only from working through this process for a long time, have I come to realize and accept that self-monitoring one's speech is not something easily accomplished and is extremely difficult for some people who stutter. Keep up your good and valuable work! Re: Therapy for children From: Bob Quesal Date: 10/12/98 Time: 8:58:53 AM Remote Name: 22.214.171.124 Comments Thanks for the very nice comments, Molly. Perspectives of those who have "been through it" often are different from those who "watch it." I'm pleased that your son is doing well. Successful Therapy From: Sarah Henderson Date: 10/13/98 Time: 7:22:47 PM Remote Name: 126.96.36.199 Comments I enjoyed reading your article. I am in agreement with many of the "goals" of therapy for us people who will never be "fluent" speakers. Re: Successful Therapy From: Bob Quesal Date: 10/14/98 Time: 8:48:51 AM Remote Name: 188.8.131.52 Comments Thanks very much, Sarah. Stuttering Therapy From: Bernie Weiner Date: 10/13/98 Time: 10:11:27 PM Remote Name: 184.108.40.206 Comments I enjoyed reading your article and can really relate to some of the issues regarding goals for stuttering therapy. Like many pws, most therapy which I have had over the course of my life has been directed towards acheiving perfect fluency. Naturally, this has just set me up for some real nasty falls and plenty of frustration. I am interested to know if as a therapist and stutterer, you know when someone has reached their limits as far as obtaining fluency. Is there a point in the therapy process where you can no longer get a client to progress any further? Re: Stuttering Therapy From: Bob Quesal Date: 10/14/98 Time: 9:01:24 AM Remote Name: 220.127.116.11 Comments This is a difficult question to answer. In my experience, nearly every client reaches a point of "maximum fluency" and that may not be the level they desired when they first entered therapy. The determination of that point, however, is not a sudden event. With clients whose speech still is not "stutter free," we work on skills to reduce the severity of the "remaining" stuttering. In many cases, these skills are the ones that the client feels are important. I don't think any clinician can tell a stuttering client that they will never stutter again once they leave therapy. In fact, what motivates and frightens a lot of stutterers is the fear that "the Big One"--that lethal stutter--is still out there, even after "successful" therapy. If a client has skills to work through disfluencies, to make them less effortful, that's a very important skill, in my opinion. So, even when a client has reached maximum fluency, a considerable amount of time is spent in exploring, understanding, and modifying the remaining disfluency. I hope this answers your question. Newsletter From: Speak Easy Inc. Date: 10/14/98 Time: 7:34:28 AM Remote Name: 18.104.22.168 Comments 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: Bob Quesal Date: 10/14/98 Time: 9:03:01 AM Remote Name: 22.214.171.124 Comments I'd be honored if you reprinted the article. Guidelines for Success From: Chuck Goldman Date: 10/17/98 Time: 5:35:04 PM Remote Name: 126.96.36.199 Comments Success will always be a subjective measure but just because that is true, it does not mean that your preferred outcomes checklists are unimportant. Besides objective measures being necessary for our increasingly objective-driven society it aids us all in directing our energies from client and clinician perspectives. Re: Guidelines for Success From: Bob Quesal Date: 10/19/98 Time: 8:08:07 AM Remote Name: 188.8.131.52 Comments Good point, Chuck. I agree wholeheartedly. BQ Re: Guidelines for Success From: Les Anderson Date: 10/19/98 Time: 11:14:27 PM Remote Name: 184.108.40.206 Comments Robert, I have read every paper that has been submitted to this online conference and the comments, suggestions and concerns that have followed. In this entire conference I have yet to read any address to the fear that a stutterer has towards his/her own stutter. I agree will all that accepting ourselves as being stutterers is vital in the therapy process. So is accepting our stutter, our relationship to it and situations and so on. There is much discussion about avoidances and the fear of certain situations and scenarios that lead to stuttering. I truly feel that we as stutterers do not "FEAR" telephones, sales people, bus drivers or the situations that these environments place us in. I believe it would be more to the truth that we fear the humiliation, shame and rejection that comes as a result of being placed or connected with these scenarios. If one were afraid of dogs, one wouldn't approach one voluntarily or buy one, if one was afraid of busy places such as stores and sales people one would not enter that establishment or situation. If one was afraid of telephones one sure would not have one in their homes. We fear the consequences of using or placing ourselves in these scenarios. I have never looked at my telephone in fear or have been fearful of any sales person or establishment. I have though dreaded the results of using my telephone. I have hesitated or would not talk to a sales person because of my fear of my stutter coming out and humiliating me again. We have this avoidance thing pounded into us but are rarely asked the reason for the avoidance and what we are actually afraid of. It is generally assumed that we fear the situation because it will make us stutter. In reality, it is usually the other way around. We fear the stutter for what is does to ourselves AFTER we have placed ourselves in the situation. I think that once a stutterer has come face to face with his/her real fear then he/she can start dealing with the rest of the therapy process and can realize substantial success on a level that he/she will accept. I hope this makes sense to you. Les Anderson Re: Guidelines for Success From: Bob Quesal Date: 10/20/98 Time: 9:23:39 AM Remote Name: 220.127.116.11 Comments You make an excellent point, Les. I guess it's implied that the fear is not of objects, situations, listeners, etc., but the fear of failure and the humiliation that could follow. In my personal experience, I used to avoid quite a bit because of the fear you are talking about. Once I had "failed" in a situation, I decided that I would always fail in that situation, and would try not to put myself in that situation again. I came to realize that what I thought was going to happen was often (in my case usually) quite different from what I expected to happen. I didn't stutter as badly as thought I would, and listeners were generally more tolerant that I would have expected. I know, however, that for many people who stutter, talking is hard and probably always will be hard. Part of the therapy process, for many individuals, is exactly what you are saying--come face to face with the fear and move on from there. What I tried to suggest in my essay is that one thing that can help to reduce that fear is the realization that we can change the way we talk. We can speak with less effort (maybe not in a totally effortless way). We can do things we previously thought we couldn't do (even something as simple as ordering a pizza on the telephone). Fear of failure is an important force--I think this is what you are addressing. There are many ways to work to reduce fear. You suggest a direct approach. I use a more indirect approach. Either one would have its pros and cons, based on the needs of a particular individual. I hope this response addresses what you were getting at. I appreciate your comments. BQ Re: Guidelines for Success From: Trent Belaney,╩ Halifax, NS Date: 10/20/98 Time: 5:15:41 PM Remote Name: 18.104.22.168 Comments Robert, For the first time ever I have read something that tells the truth about stutterers and avoidances. The comments from Les Anderson hit the nail so squarly on the head that it shook me. I to, and many stutterers like myself have little fear of the objects that we are told that we are avoiding because of our fears of them. If I had a fear of these objects and or places, why do I not fear them when I have just been through a fluency shaping refresher. I have always had an intense fear of talking on the telephone and it sure was not because I was afraid of the telephone. Les's comments just made me realize what I was actually afraid of. "TALKING" No normal person wants to be humiliated and be thought of as retarded, and I have been faced with both many times. Great insight Les and Robert you answered his comments very well. A question for Les, are you a SLP? Trent" where are you? From: Les Anderson Date: 10/20/98 Time: 9:20:07 PM Remote Name: 22.214.171.124 Comments Thank you for the comment. No, I am not a SLP. If you will look at your post you will see some numbers up top. You are using the same server that I am using. You say you are in Halifax but this server IP address is in Northern BC. Where exactlty are you? Re: Guidelines for Success From: Bob Quesal Date: 10/21/98 Time: 12:26:32 PM Remote Name: 126.96.36.199 Comments People who stutter have a lot of valuable insights to share, that's what makes this conference so interesting and important. The "reality" of stuttering is what we experience, not what someone tells us. In many cases, we learn more from others who stutter than we do from professionals. In other cases, the professionals have important insights to share. The critical word here is "share." No one's right, no one's wrong. We just approach things differently, based largely on our experiences. Re: Guidelines for Success & sharing From: Les Anderson Date: 10/21/98 Time: 4:28:13 PM Remote Name: 188.8.131.52 Comments Robert You made a most excellent point in your comment about sharing. Sharing emotional troubles, thoughts and ideas is something that very few stutterers are, or have been able to do. As you know, when any stutterer becomes emotionally upset and tries to verbally convey that emotion with someone else, there is usually a break down in the fluency process. This inturn usually leads to a great deal of frustration and when a stutterer becomes frustrated because he/she cannot verbally expend their emotions, their dysfluency becomes just that much greater. For some reason few non-stutterers, even career SLPs who work with stutterers, grasp this. The usual response from a nonstutterer or a nonstuttering SLP is, "slow down and take a breath and start out slowly". It is rarely the speech rate or the breathing that is causing the problem. It is the emotional frustration of more and more garbage being trapped inside with no means of escape. Nonstutterers can "imagine" what is like to stutter, nonstutterers can, "understand" what we are going through and most can "feel" the frustration that the stutterer is going through. There is one area that they will never have: "to KNOW" what a stutterer is going through. We all can imagine what it must feel like to almost drown. How many of us "know" what it feels like to almost drown. Most stutterers have desperately wanted to share their feelings but the those who have nontreated impediments, still cannot get over that immovable stonewall. Sharing emotions is beautiful and sure goes a long way in the road to the story of success. Les Anderson Re: Guidelines for Success & sharing From: Bob Quesal Date: 10/22/98 Time: 9:40:07 AM Remote Name: 184.108.40.206 Comments Right on, Les. One other thing I'd add, however, is that we as stutterers don't always know what *other* stutterers are experiencing, either. I think we're closer to "knowing" than nonstutterers may be, but everyone is different, and everyone's experience is different. I really appreciate your contributions to this discussion. Happy ISAD! BQ "fluent" speakers From: Jeff Shames Date: 10/19/98 Time: 8:26:34 AM Remote Name: 220.127.116.11 Comments Bob, it was a great pleasure to meet you at the NSP Convention in Atlanta this summer. And your article is very good. I, too, find myself frequently using quotation marks when discussing this topic. I know a person who stutters who is forever talking about striving to talk like a "normal" speaker. I am not sure what this means. There are some stutterers I know who are better communicators than "normal" speakers, even with occasional dysfluncies. I also picked up on the "rapid reduction in dysfluencies" phrase. The general public wants stuttering therapy techniques that work quickly. Yet this "rapid reduction" is by no means the most efficacious type of therapy. We all know of therapists who claim over a 90% "cure" rate, without defining what this means. And it increases the stutterer's negative feelings of self when the inevitable relapse occurs. It is so much more useful to look at the larger issues, as you have, and not just the issue of "fluency". Re: "fluent" speakers From: Bob Quesal Date: 10/19/98 Time: 12:52:00 PM Remote Name: 18.104.22.168 Comments Jeff, I appreciate your comments. I agree with all the points you make, as well. Thanks. BQ Thank you all From: Bob Quesal Date: 10/22/98 Time: 3:49:00 PM Remote Name: 22.214.171.124 Comments It's getting to be late in the day, and soon I'll be heading home, and the ISAD Internet Conference will draw to a close. Before I leave, I just wanted to thank everyone who took the time to read my ISAD paper. I really appreciate all the insightful comments. I've learned a lot from all of the papers, and have learned a lot from you. I don't know what I used to do before the internet. Thanks again! Bob Q.