CONTENTS

This is a threaded discussion page for the International Stuttering Awareness Day Online Conference paper,
Relapse: A Misnomer?, by C. Woody Starkweather (Pennsylvania, USA). 


Relapse, Unfinished Business, Lapse and Displacement

From: Gunars K. Neiders, Ph.D.
Date: 10/1/98
Time: 7:49:19 PM
Remote Name: 199.238.253.11

Comments

Dr. Starkweather, 

Thank you for the well thought out paper on relapse. As you know I am more into cognitive behavioral
therapy approach than gestalt, although I consider experiental therapy as a valid tool in therapy. 

I quite agree with most of your conclusions. I only wanted to add a thought that besides "unfinished
business" at times there is a tremendous displacement of the "negative energy" (for lack of better term) that
takes place during therapy. One such instance would be when a neophyte fluency shaper clinician builds up
a perfectionistic attitude in the client. Then a small lapse, i.e. inconsequential disfluency, can start a snowball
effect. 

Do you agree that displacement as simple as that above or in some other perverted form is something that can
play a role in so called "relapses"? 

Re: Relapse, Unfinished Business, Lapse and Displacement

From: Woody Starkweather
Date: 10/22/98
Time: 1:12:49 PM
Remote Name: 155.247.228.166

Comments

Hi Gunars: 

I replied to this much earlier, but apparently messed up the details and it didn't get on. 

Yes, of course, and it happens often that fluency shapers use a very hard sell, telling the clients that this is
the ONLY way stuttering can be helped. Clients who give up on the technique often feel ashamed and as
though it was their fault that they aren't able to talk perfectly. In my view this is the most unethical kind of
treatment. Many clients are damaged by this practice. I see half a dozen like this each year. It is a practice
that ought to be stopped. Sometimes, they are so "brainwashed" by all the hype that they tell me how
wonderful it is that they aren't stuttering any more, and yet, even as they tell me this, their stuttering is as
severe as it was before they went for the miracle cure. clients year after 


Relapse

From: John Harrison
Date: 10/9/98
Time: 1:38:33 AM
Remote Name: 205.188.195.54

Comments

Woody -- nice article! It fits right in with my experience of stuttering. I've said this before, but for a guy
who never grew up with a stuttering problem, you certainly have developed a good handle on what it's all
about. 

But I wonder if this holistic perspective will ever get through to the people who suffer from tunnel vision.
They don't understand that constantly focusing on fluency enhancing techniques is like trying to keep a
beach ball under water. At some point it just takes too much effort, and people give up without looking for
alternatives such as (to continue the metaphor) finding a way to let the air out of the ball. What will it take to
have them step back and see the bigger picture? 

Regards, 

John H.


Re: Relapse

From: Woody Starkweather
Date: 10/22/98
Time: 1:15:20 PM
Remote Name: 155.247.228.166

Comments

Thanks John. 

I don't know what it will take. People have to stop being taken in by the false claims, I think. Suing is very
difficult because then suddenly they get very technical. 


Fluency shaping and clinicians who don't stutter

From: Andy Floyd╩╩ a624301f@edinboro.edu
Date: 10/9/98
Time: 5:38:45 PM
Remote Name: 208.166.66.116

Comments

Dr. Starkweather, 

First - excellent article! I enjoyed bumping into you at the last NSP convention when we had a little room
mix-up. My comments mostly address Mr. Harrison's last comments - but they apply to all of us. 

I stutter and I am a second year SLP grad student. It seems to me that taken as a percentage, a lot more
clinicians who stutter tend to use a more stuttering modification or combined approach and clinicians who
don't stutter use more of a fluency shaping approach. What I deduct from this and my personal experiences
as a grad student and as a PWS is that many clinicians who don't stutter are afraid or at the least very
uncomfortable with stuttering. 

Now, to look realistically at the future - even with the specialty recognition program (which is great and was
long in coming) the vast majority of PWS will be treated by clinicians who do not know much about
stuttering and who are afraid of it. How do we attempt to alleviate this problem? I could think of 3 things off
the top of my head that I'm sure others are already attempting to do - (1) For those grad programs that have a
Stuttering course, have your grad students do a pseudo-stuttering assignment of some sort. (2) Let's try our
best to try to get ASHA to reimplement the required stuttering course for all accredited programs. I know
this is easier said than done, but I think it is essential to success. (3) It has been documented that the vast
majority of SLP grad programs around the country do not have a clinical psych/counseling requirement. I
believe this should be changed and the training could aid not only stuttering clients, but bascially every client
that SLP's have. 

Any other suggestions?


Re: Fluency shaping and clinicians who don't stutter

From: Woody Starkweather
Date: 10/12/98
Time: 1:12:49 PM
Remote Name: 155.247.228.195

Comments

Thanks Andy for your comments. 

I am afraid that I don't think ASHA is going to put back the requirements the way they were without some
very powerful force. I huge suit from a person who stutters or from a parent charging malfeasance or some-
thing is what it is going to take. I would be happy to testify. I think ASHA has done a terrible thing and has
abandoned its own code of ethics. But, unfortunately, ASHA is not moved by my opinions, which they
have heard. 

Your second suggestion is also an excellent one. You are way too young to remember that there was a time
when courses in counseling psych or in abnormal psych. were part of most curricula in Speech and Hearing.
Probably there are still some curricula that have these courses. But I don't think it is likely that we will see
these courses added to the graduate curriculum. A curriculum is one of the least movable objects in the
universe. Currently, the curriculum for speech pathology students is stuffed to the gills with courses that
seem, in the opinion of most faculty members, to be absolutely necessary. Nor is it likely that SLP training
will be expanded to three years, although it is inching in that direction. 

I think our only hope is through specialty recognition. The Board has now been elected, and the specialty
recog- nition program is going forward. I am pretty sure the first applicants will be heard from within a year.
One excellent way to become specialized is to demonstrate that one has expanded one's education in the
counseling or psychotherapeutic direction. Several forms of psychotherapy seem particularly well suited to
treating the baggage that accompanies stuttering, and I am sure that many applicants for specialization will
find them and expand their clinical skill by getting trained in these techniques. So, I don't think it will be too
long before there will be more well-trained clinicians. Once that happens, it will put pressure on the training
programs, and then we may see them change too. ASHA members too may soon see that the people with
specialty recognition are getting all the clients, and that may lead to some further regulation on ASHA's part.
So, I am hopeful for the future, via the specialty recognition route. 

Woody 


Experiental therapy resource

From: Andy Floyd
Date: 10/9/98
Time: 9:16:27 PM
Remote Name: 208.166.66.210

Comments

Dr. Starkweather, 

Could you give the name and possibly the publisher of the one book (if you had to pick one) that explains
the experiental therapy that you use that works on "relapse?" 


Re: Experiental therapy resource

From: Woody Starkweather
Date: 10/12/98
Time: 1:17:29 PM
Remote Name: 155.247.228.195

Comments

Andy: 

I am working on a book now that will lay it out in enough detail for a clinician to understand what it is, but I
think it is not so easy to learn from a book. There are, however, Gestalt Institutes in most major cities where
you can get the training over a three year period. 

The best book on Gestalt therapy is Erving and Miriam Polsters' book called Gestalt Therapy Integrated. It
is available from the Cleveland Gestalt Institute. 

Woody


Relapse

From: Sarah Henderson
Date: 10/13/98
Time: 6:57:50 PM
Remote Name: 152.163.197.63

Comments

Woody, 

I enjoyed reading your article. I have stuttered since I was a child, and currently, I would say I have a
mild-moderate stutter. 

I have had relapses, occasionally, very severe. Most of the time these are due to situations in which I am
very ambivalent or frustrated. I can see the point you make that I have not totally dealt with how to handle
situations like these. However, as I get older the relapses don't seem as long. 

It was refreshing to read an article from someone who does not blame the person who stutters for the
relapse.


Re: Relapse

From: Woody Starkweather
Date: 10/22/98
Time: 1:16:44 PM
Remote Name: 155.247.228.166

Comments

Thanks Sarah. I appreciate your comments. 

Newsletter

From: Speak Easy Inc.
Date: 10/14/98
Time: 8:05:07 AM
Remote Name: 198.164.4.111

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: Woody Starkweather
Date: 10/22/98
Time: 1:18:02 PM
Remote Name: 155.247.228.166

Comments

Yes of course you can publish it. I replied to this earlier, but I must have failed to follow the directions, and
my answer was lost. 

Woody Starkweather

psychotherapy for stuttering treatment

From: Les Anderson
Date: 10/16/98
Time: 1:28:50 PM
Remote Name: 209.167.123.229

Comments

Mr. Starkweather 

The importance of psychotherapy has been mentioned over and over again in many of the papers and
comments and question areas of this conference. It seems that over the past two or three years, there has
been a very strong movement to deal with the emotional baggage that many stutterers carry around with them
before, during or after intensive programs. I am one of those who agree very strongly that what we carry
around from the past has a great deal to do with how we deal with realizing fluency. My question is,
psychotherapy is generally a long term program that must be taken one step at a time so how does a clinical
program gear its self to combining fluency skill usage and psychotherapy over a three week period? Dr
Boberg, Deborah Kully, of ISTAR, and I have discussed this many times and the same stumbling block
always appears. The time factor. It his difficult enough to learn to use fluency skills successfully over a three
week period. Could it be said that a stuttering treatment program might be better suited for those who stutter
if it were a two tier process? And, which process comes first: fluency skill usage or psychotherapy? I realize
this is a loaded question but one that many will be asking. 

Les Anderson 


Re: psychotherapy for stuttering treatment

From: Woody Starkweather
Date: 10/22/98
Time: 1:24:33 PM
Remote Name: 155.247.228.166

Comments

Hi: 

It is difficult to do anything meaningful in a three week period, and the research shows clearly that the more
intensive the program is the more likely that there will be a relapse. The real skills that one needs, not just to
speak fluently -- that's pretty easy -- but to go on speaking fluently and easily, to go on taking care of
yourself, growing, dealing with unfinished business, learning how to kill fear permanently, learning how to
deal with anger and frustration, and most important, learning how to recover from toxic shame, it takes time.
I wouldn't try to incorporate it into an intensive program. 

I do realize the practical value of doing intensive work, but what is done during the intensive work should
not be work on speech at all, it should be work on self, work that will give the person the emotional skills to
deal with all the issues that are going to come up. Better speech follows if the emotional issues are dealt with
effectively. The problem in the past has been that the psychotherapists knew little or nothing about
stuttering. What I am trying to do is develop psychotherapeutic techniques that are specifically for stutterers,
tuned to their particular needs and issues, yet flexible enough to be useful for many different individuals. 


Relapse

From: Chuck Goldman
Date: 10/18/98
Time: 10:44:23 AM
Remote Name: 152.163.206.194

Comments

Firstly I'd like to say thanks for the 1997 book "Stuttering". I've used it successfully with graduate students
this past summer. I too have gone to the "dental" school of stuttering therapy with regard to relapse. I've
found that in addition to this model I offer the client a specific way of dealing with the lack of naturalness a
fluency-shaping element in therapy may afford. My client and I usually acknowledge that use of an artificial
fluency shaping device no matter how well learned, may never be natural. In accepting this we realize that as
much as we try to utilze such a technique we may often "forget". Rather than fighting this apparent truth we
acknowledge our lapse back to old speech patterns but we also acknowledge that because of our
non-avoidance and desensitization therapy some of our old pattern may indeed be more fluent than originally
encountered. In this way the fluency shaping techniques have served to generalize fluency even in utilizing
older speech patterns. Undoubtedly however this generalized fluency cannot last so the real challenge to
relapse is to self monitor your speech so well that when a disfluency or potential anxiety occurs you can
"shift" into the more exaggerated use of the successful fluencing enhancing technique. One would then have
to maintain this technique in its supercharged form until the feeling of control returns. It may then again be
assumed that use of old paterns may again emerge only to be monitored again in much the same way as
described. In such a paradigm true integration of stuttering modification and fluency shaping is achieved.


Re: Relapse

From: Woody Starkweather
Date: 10/22/98
Time: 1:28:32 PM
Remote Name: 155.247.228.166

Comments

Hi Chuck: 

Thank you for your kind words about our book. 

I have to disagree with you however. We need less monitoring, not more. It is already too difficult for
stutterers to monitor their production of behavioral targets. We need a treatment that changes the way they
think and feel about speech and about fluency and disfluency. When these attitudes are changed, or when the
person is given the understanding and skills to change those attitudes, their behavior changes automatically,
without the need for intensive monitoring. Some small reflection on events that may have just occurred is
necessary however. 


Relapse And Cycles of Stuttering

From: Bernie Weiner
Date: 10/18/98
Time: 9:42:11 PM
Remote Name: 205.188.192.54

Comments

It was really refreshing to read a paper that does not place blame on either the stutterer or the therapist. In my
case, like many stutterers, relapse is not a very good term. I tend to have cycles where my stuttering is much
more severe. Is this really a relapse, or something that would occur even if I am using every tecqnique at my
disposal. Now , I just tend to let it happen and keep plugging away. I have tried to document when my
stuttering is more severe, but it really doesn't seem to follow much of a pattern. Once again, thanks for a
refreshing view on therapy for the stutterer.


Re: Relapse And Cycles of Stuttering

From: Woody Starkweather
Date: 10/22/98
Time: 1:35:00 PM
Remote Name: 155.247.228.166

Comments

Cycles of severity are, in my opinion, unrelated to what is usually called relapse. Cycles of severity seem to
be related to the stutterer's anticipation of difficulty and the confirmation or deconfirmation that his
expectancy receives when he produces the stuttering. If the deconfirmation is negative, that is, he feels that
he did worse than expected, it introduces an increased tendency to stutter in the future, given the same
circumstances. This then causes further negative deconfirmations, until the person is talking as badly as he
ever has. At that point, he can only have positive deconfirmations, that is, he will tend to stutter better than
he expects to because he expects the worst. These positive deconfirmations introduce a tendency for the
stuttering to be better, which increases the likelihood \of more positive deconfirmations and speech gets
better and better until the person reaches a point where he is talking as well as he ever has. Then of course,
he can only have negative deconfirmations, and the cycle starts over again. 

I have no way of knowing if this is actually what happens, of course, but interviews with many stutterers
who have cycles of severity convince me that it is a process somewhat like this.