About the presenter: Pamela Mertz works as a high school Career Specialist. She is an active member of the stuttering self-help community, including NSA and Friends. She is also active in Toastmasters, serving as her club's immediate Past-President. Pam is a blogger and writer, publishing a monthly newsletter called "Let's Talk About It," for the College of St Rose (Albany, NY) Fluency Council, and the electronic version of "Reaching Out" for Friends. She is a member of the Board of Directors for an agency that serves adults with disabilities.

You can post Questions/comments about the following paper to the author before October 22, 2009.

Things I Learned from Therapy

by Pamela Mertz
from New York, USA

I have spent the better part of my adult life fighting with myself to keep my stuttering hidden or covert. I was afraid of social punishment. I feared ridicule and isolation. I thought it was easier to keep stuttering a secret. What a shock when I realized how wrong that was! The emotional toll I paid to lug that secret around was expensive. Avoiding speaking situations created the very isolation I was trying to avoid. I turned a corner about 3 years ago, and have slowly worked towards being more open and allowing myself to stutter freely. It has been quite the journey, with many peaks and valleys.

I have been journaling and writing for the past several years and finally decided to formalize my work and let others read it. I wrote a brief piece for my blog (http://stutterrockstar.wordpress.com/) and newsletters shortly after discovering and entering therapy as an adult. I participated in school speech therapy when I was in third grade (about 9 years old). I do not recall it being particularly useful and it had no lasting impact on my stuttering, as I still stutter and quite differently than I did as a child.

The decision to enter therapy as an adult changed my life, in every sense. It was the first time I would acknowledge my denial. Not denial that I stutter. That I knew. However, I had been denying how much of an effect trying not to stutter had really had on my life. Making the decision to admit this and actually begin to talk about it created much initial anxiety for me. It meant that I was going to have to be authentic with my feelings, which had also been stuffed for many years along with the stuttering. Tackling both at the same time was daunting, requiring courage and re-assurance that I was doing the right thing.

This next sentence is an especially important note for SLP students. For the first three years of my involvement in therapy, I really had no idea what I wanted. Looking back, I was confused and searching for answers, but didn't know what questions to ask. Coming face to face with other people who stutter after having been covert for so long was both liberating and overwhelming. Sometimes, just being with other people, hearing them stutter and feeling supported was enough.

I have a very vivid memory of my second therapy support meeting. I was just there, like a sponge, taking it all in, absorbing. I was not participating yet. It was only the second time I had been around people who stutter, so many too, let alone just one other person. The format of this group was to go around the circle, say your name and share something. I passed the first week.

This time, I had thought I didn't want to be such a wimp and would try to share something about myself or just say that I stutter. However, as people went around the room, shared and stuttered, this huge powerful wave of emotion washed over me. My eyes welled up, I audibly gasped and my leg started to shake. I had been thinking of bolting when I could without being too obvious. I will never forget what happened next. The person sitting next to me glanced at me, and she put her hand on my knee. That's all. I felt so supported and accepted with just that small, important gesture. When my turn came, I was able to compose myself enough to say I wished to pass, which I did, and it was OK. That person sitting next to me gave me a hug at the end. We didn't say a word about what had happened. We didn't have to.

These are the insights I learned while participating in therapy as an adult. More importantly, this is what I have come to realize I need as a participant in therapy. This has been a valuable realization for me - that my needs are important.

I have participated in therapy as part of a college program that trains graduate level SLP students. All of the therapy I have received over the last three years has been delivered by graduate student clinicians, under the direct supervision of licensed speech and language pathologists (The College of St Rose, Council of Fluency, in Albany, NY)

This is what I have learned I need from therapy.

Therapy must be Person-Centered. I need a clinician that sees me as a person first, and not just a source of data collection for her class. When I first started adult fluency shaping therapy, I was quite intimidated and assumed that the clinician would drive the sessions and I would just follow her lead. I quickly realized that this was not going to work, that the therapy needed to be a partnership. The thing I hated the most was the frequency counting of my stuttered speech. I felt like a non-person when a clinician would sit across from me as I read, and she would put slash marks through the words I stuttered on. It bothered me that she was not paying attention to me, but just my stuttering. I spoke up about that soon enough. Now, the clinicians record my sessions and collect their data later by listening to the session.

Acceptance. I need a clinician who makes it clear that stuttering is OK, and is as comfortable letting me stutter, and listening to me stutter as she is with teaching fluency shaping or stuttering modification techniques. For the first couple of years, I worked hard to shed my covert skin and found that I wanted to just stutter freely. I wasn't ready to let fluency targets in. But I wanted to be in the therapeutic environment, as I needed the support as I walked this journey. That needs to be OK for as long as needed. During this acceptance period, which is still on-going, I explored a lot of feelings that I had not even been able to identify, let alone accept. The clinician needs to recognize that this may need to come first, before any fluency therapy.

Goals Need To Be Personally Meaningful. When I first began therapy, I thought I was expected to set goals that would match the student's checklist. I knew it was important that the student got the "clock hours" needed for practicum completion. But it was more important for me that our goals were mutually developed and had relevance to my life at the moment. I let the clinician know that I wanted to practice things like workplace presentations, Toastmaster speeches or interpersonal communication scenarios. Relevance to my life allowed me to feel more ownership of the process. I think it's OK for both adult client and clinician to sit together in the front seat as we drive forward. It's up to me to let the clinician know if I feel the gears have slipped or we're going backwards. She won't know I am troubled about something if I don't speak up.

Do As I Do, Not As I Say I Do. My clinician will not ask me to do anything she herself is not comfortable doing. For example, when we worked on voluntary stuttering, the best clinician did it with me, even when she felt weird doing it, so she got a good sense of how it feels to really stutter. I will admit, when I first heard of voluntary stuttering, I thought it was ridiculous, but it has turned out to be the best tool for me.

Being a perfectionist, purposeful stuttering gives me the feeling of being in control that I really want with my stuttering, my life. The best experience I had with a student clinician was actually this past spring, when there were more clinicians than adults who stutter. So, I was assigned to work with two clinicians. I was wary at first, but it turned out very positive, because we all worked on voluntary stuttering. And both student clinicians shared with me that it was difficult. One said she felt disrespectful of me - felt it bordered too close on making fun of someone who stutters. So, she chose to practice stuttering differently than I do. The other student also reported feeling discomfort. It took energy and focus to stutter. When we went out in the community to stutter on purpose, we got to share one of the negative reactions we got from a movie clerk. I think that drove home what it is really like to stutter.

Go With the Flow. My clinician and I recognize that life is a work in progress. Sometimes a goal may change, or something may come up that becomes more of a priority. That is OK. I should be getting exactly what I need out of therapy. And as a client, I should feel totally comfortable saying that. I am in charge, not the clinician. There have been times when I have not felt like talking about stuttering at all. I remember the first time that happened, I felt a little guilty, but quickly lost that! What we talk about in the therapy room should always be the client's choice.

Don't Be Afraid. I need to work with a clinician who is comfortable with stuttering and is not afraid of it. That is crucial - you can get a sense of how the therapeutic relationship will go based on the clinician's comfort level. SLP students may never have worked with someone who stutters, and may indeed be intimidated by stuttering. In my case, there is/was so many emotional aspects that need/ed attention, and it never has been or will be just about the actual stuttering heard or seen. That can be intimidating. I always ask the clinician if I am the first stuttering client she has worked with. Most say yes! Then we talk about it. Sometimes, I have sensed a little unease on the clinician's part at my directness, but it has always worked. Putting it right out there in the open puts us both at ease, and opens the door wide for everything else that will follow.

Know When To Push. I need my clinician to help me look for opportunities that will push me outside of my comfort zone. I look for innovative ways to engage in the therapy process and the best clinician goes along with it. For example, I have recorded presentations I have done at work and we have reviewed them together to come up with ideas as to what I might want to work on next time. My clinicians have also listened to pod casts I have done and looked at my You Tube videos. Those are examples of affirming my need to keep challenging myself.

Right Relationship - Right Reasons. This is perhaps the most powerful insight I have learned. In order for a relationship to work, not just a therapeutic one, it has to be right. This is simple, but has the most potential for impact. Both people have to be vested in honesty. The clinician and client have to be open and value the power of the relationship. Being honest brings life to the relationship, and that is where meaning and value come from. If for some reason the client does not feel it is a "right relationship" the client should feel comfortable enough to say that and let someone know that a change is needed. The clinician should not take it personally. Right relationship is the heart of person-centered planning, where people have the right to make choices and plot the course for their own life.

Stuttering therapy can be a life changing event for both parties. It indeed has been for me. I am confident that I have also taught some clinicians far more than they may have bargained for. Stuttering is not just about stuttering. It is about a person's life. Recognizing and valuing that may be one of the best lessons not learned in a classroom.

You can post Questions/comments about the above paper to the author before October 22, 2009.

SUBMITTED: July 6, 2009
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