About the presenter: Elise Goodman, CCC/SLP and Board Recognized Fluency Specialist from Easton, MA, has been a speech/language pathologist for almost forty years. She received her Master's Degree from the University of Colorado, Boulder, where she had the opportunity to study with Dr. John C. Rosenbek, to whom she credits her passion for the field of communication disorders. Her professional experience includes teaching at Binghamton University and Bridgewater State College, working in acute care, stroke rehabilitation, schools, and with children and adults who stutter. Her other interests include musical theater, golf, and spending time with her family and new grandson.

You can post Questions/comments about the following paper to the author before October 22, 2012.


STUTTERING AND GOLF: lessons to learn from the game of golf to help manage stuttering

by Elise S. Goodman
from Massachusetts, USA

I became a fluency specialist in 1997. At the same time, I also took on the challenge of learning to play golf. The more I worked with adolescents and adults who stuttered, and the more time I devoted to practicing my golf swing and dealing with my complete lack of confidence, the more I realized the interesting similarities between a person who stutters and a person who plays golf. When I learned of Tiger Woods' childhood stuttering and the effort he devoted to improving his speech, as well as Ken Venturi's ( U.S. Open Golf Champion 1961) stuttering and how he compared the smooth movements of speech to the smooth movements of the golf stroke, it appeared there might be significant motor and cognitive similarities between golf and stuttering that could have potential therapeutic implications for people who stutter and the clinicians who treat them.

Current research suggests a multifactorial explanation for stuttering, which includes genetics, language, emotional/cognitive, and motor speech control ( Healy, 2004; Weber- Fox, 2010) and others. This paper will address the motor and cognitive parallels between stuttering and golf in an effort to assist the person who stutters (PWS) to understand that the fear, anxiety, shame, self-doubt, and embarrassment so often felt by the PWS, are not feelings unique to him. These feelings also prevail when, like the PWS, the motor performance expectations of golf become over-valued by the golfer, who then puts excessive pressure on himself to prove his worth, only to find that the self imposed pressure is what ultimately impairs his game and overall performance. Because golf is an individual sport which concerns itself with an individual performance, the analogy appears even more reasonable for consideration. For the clinician who treats people who stutter, the stuttering/golf analogy can be an added therapeutic tool to assist the PWS gain further insight into his communication challenges and help him to achieve "happy, effective communication."

MOTOR SIMILARITIES BETWEEN STUTTERING AND GOLF

It is generally accepted that tension, timing, rate of speaking, proprioceptive feedback and self monitoring are factors that significantly impact the motor aspects of fluent speech, and that it is necessary for treatment to specifically address these motor components of the disorder. While working with clients who stutter, I began to see a relationship between the physiological readiness needed to produce smooth, rhythmic, tension-reduced speech and those requirements necessary for a smooth, controlled, successful golf swing.

Tension

From a motor standpoint, a major factor contributing to the motor speech characteristics of stuttering is muscular tension. Directing clients to focus on easier initiation, light articulatory contacts and smooth movement from sound to sound is supported by much of the literature ( Gregory, 1991; Ramig & Dodge, 2005; Wall & Meyers,1995). Susan Dietrich's (1996) development of the "Tension Control Therapy" paradigm helps the PWS to decrease and control muscular tension during speech using a 1 to 10 muscle tension rating scale, encouraging the PWS to vary tension levels in the articulators in an effort to gain control over it.

Similarly, golf experts, like international golf coach Tracy Reed (2009) have written that. . . golf swing control requires "body muscle action, without creating tension, to produce an easy swing that produces maximum club head speed and accurate golf shots with the least effort" (web, para.10). Tiger Woods, in his book, How I Play Golf (2001) writes about muscle tension and grip. In fact, he describes his golf grip pressure as a 5, on a scale of 1 to 10, similar to Dietrich's 1 to 10 tension rating scale for PWS. Gallwey (1981) in his book, The Inner Game of Golf, adds that the primary physical cause of error in the golf swing is too much tightness in the muscles. The clinician and the golf instructor both need to work on helping the PWS, and the golfer, learn to reduce muscle tension to enhance motor control.

Timing and Rate

The factors of timing and rate of speech have also been observed to impact fluency. Bakker, 1997; Healy & Scott, 1995; Max and Caruso, 1998 have concluded that a slower speaking rate has a positive impact on fluency. Ramig & Dodge (2005) explain that " a reduced speaking rate helps enhance the spacing and timing of respiratory, phonatory, and articulatory movements necessary for the production of fluent speech"( p.123). When the client has the extra time, afforded by a slower rate, he is better able to engage his "tools" for more controlled speech. As with the PWS, timing and rate play an important role in golf .Golf instructors and sportscasters often talk about tempo and speed and how they significantly impact the golf swing. Woods (2001) writes. . . "When I am out of rhythm I can't find the on switch and every swing becomes problematic" (p. 251). Zack Johnson, also a golf professional, practices his golf swing using a metronome to practice rhythm and timing, similar to what Bakker (1997) does with his clients who stutter. Golf instruction focuses on a gentle grip of the golf club, a smooth and rhythmic take away, and a well timed down swing and finish, all done in an easy motion where timing and rate are crucial to success. Paul Wilson, ( 2012) golf professional, has written that, "Speed Kills Your Golf Swing." He reminds golfers that "the harder you swing, the tighter your wrists and arms through impact, and you won't make solid contact" ( Web.para. 6). Wilson adds that the golfer must convince himself that to hit the ball better, you have to swing slower. The person who stutters must also come to realize that to successfully engage his speaking "tools," he must reduce his speaking rate.

Self –monitoring and awareness

Key to reducing muscle tension and speed, is the ability for the PWS to self monitor and develop self awareness. . Van Riper (1973) concludes that self awareness and self monitoring are crucial in stuttering. Dodge & Ramig (2005) write that " improved self monitoring and self awareness help PWS to be more likely to stutter with less effort and t use fluency shaping and stuttering modification techniques" ( p.153 ). Dietrich's (1996) "Tension Control Therapy," works to help the PWS decrease the anxiety and tension that exacerbates stuttering, and the development of proprioceptive and kinesthetic feedback to reduce and control muscular tension during speech . The PWS needs to feel and adjust muscle tension and speed during speech production in order to gain added control.

Similarly, tension, timing and rate will significantly impact the motor performance of the golfer. Proprioceptive feedback and "feel" are needed to produce a tension free, smooth, well timed golf swing. Woods (2001) explains. . . "I try to feel everything moving in the golf swing. . . where I'm going wrong in the swing, and try to pinpoint it so I can fix it ( p. 12). . . My goal is to play my best golf all the time. There is only one way that is going to happen. . . practice and more practice. The best way to ingrain the correct movements and positions is through repetition" (p.107). This is the same repetition and muscle memory we strive for, through practice and repetition with our clients who stutter.

Knowledge of the Basics

Most important to the client's understanding of the aforementioned treatment concepts in stuttering therapy, is the knowledge of normal speech production. As adolescents and adults whose speech has for many years been characterized by disfluency, clients often do not have an understanding or proprioceptive "feel" for what they need to do during the process of speech production to achieve smooth, rhythmic, relaxed speech. . . ..sometimes even at the sound and word levels. Teaching and reinforcing normal speech production, along with the need to address tension, airflow, voicing, timing, and rate,( as we proceed to work on fluency enhancing and stuttering modification techniques), are important aspects of treatment ( Conture,1990; Manning, 1996; Zebrowski & Kell, 2002). Providing the client a model from which to develop better speech control is imperative in stuttering therapy.

Additionally, the golfer's knowledge of the "basics"of the golf swing is key to improving the outcome of his performance. The golfer must be clear on the set up, grip, stance, backswing, weight shift, downswing, and finish in order to succeed and make the shot. Jack Nicklaus ( 1974) writes, "The hard facts are that any method, new or old, will fail if, first, it is not founded on sound fundamentals and , second, if the golfer trying to master it will not force. . . himself into mastering those fundamentals". . . .(pp.15,16). When the golfer identifies the target motor skills, performs them in a slow and deliberate manner, and practices with multiple, intensive repetition, these new motor movements become more automatic.

My experience has been that the Stuttering-Golf Analogy is useful in helping PWS understand that stuttering is not a bizarre manifestation of their unique speech production behavior. The tension, rhythm, rate, poor proprioceptive feedback and general lack of smoothness and coordination are what golfers experience every day on the golf course while trying to perfect their golf swing.

THE COGNITIVE/PSYCHOLOGICAL SIMILARITIES BETWEEN STUTTERING AND GOLF

While the motor similarities between the physical act of controlled, more fluent speech and the successful golf swing seem closely related, it is in the cognitive/psychological arena that an even more intriguing connection appears to exist. It is these specific similarities that appear to have significant treatment implications, if only to assist the client and clinician to view stuttering through a unique lens and observe how the emotional reactions of PWS,(including the stress, anxiety, fear, avoidance, and self doubt) are similar to what many people experience on the golf course.

The fluency literature is filled with descriptions of stuttering that include anticipatory anxiety, fear, negative feelings about communication, avoidance, and a negative self concept. Van Riper ( 1982 ) writes that "stuttering occurs when the forward flow of speech is interrupted by a motorically disrupted sound, syllable or word, or by the speakers reactions to them" (Web. 2012). It is often the speaker's anticipation of difficulty that causes the struggle behavior and the dysfluency. Ham (1986) comments that therapy should provide activities that help decrease ones fears and anticipatory anxiety. Zebrowski (2002) works with her clients to focus on the identification and modification of the moment of stuttering, and to reduce or eliminate avoidance behaviors surrounding communication. Peter Ramig & Associates sum it up well in their advice to PWS:

It is what we do in our attempts not to stutter ( i.e.avoid, conceal,and/or release ourselves from stuttering ) that often results in an increase in severity and feelings of helplessness. . . . . A natural physical response to such emotional discomfort is muscular tension, which is a correlate of stress that often makes stuttering worse. When we feel stuck and at the same time embarrassed, we often react with increased muscular effort in our desire to escape the moment of stuttering and move on. It is these reactions, that we learn over time, that create more struggle and tension which often results in more stuttering. These are the behaviors we can learn to change if we are willing to identify what they are, how we use them in our attempts to escape or avoid stuttering, and how they interfere with the talking process. . . . . In doing so, you will become more fluent because you have learned to confront your stuttering without as much fear and trepidation, and thus with less confounding muscular effort that often fuels your blocks. . . . .. The less we try to hide and conceal out stuttering, the more we can learn to stutter with less effort. When this happens we become much more in control of out stuttering. In turn, we become more fluent .( web.2007).

Research supports that PWS need to address the anxiety and avoidance behaviors they exhibit in a varied of communication situations. Manning (1996) concludes that "decreased avoidance translates directly into decreased handicap"( p.230). Kroll, Grotell, Ayuyao,& Venkris (2009) recommend that stuttering modification techniques should include avoidance and anxiety reduction, attitude change, and self acceptance. More recent exploration of Cognitive Behavior Therapy (2010), for people who stutter, examines the relationship between thoughts, feelings, physiological reactions, and resulting behaviors experienced by the PWS and how to guide the client to a new understanding of himself and his stuttering behaviors.

CHANGING BELIEFS AND REDUCING COMMUNICATION STRESS

In the book, Golf Is A Game Of Confidence (1996), Robert Rotella and Robert Cullen write that "confident athletes let their nervous systems perform the skills they have rehearsed/mastered without interference from the conscious mind. The more confident the golfer is the better chance he has that he ball will go where he wants it to. The best athletes combine confidence and physical competence ( pp.10,11). Simply stated, the less we think about the skill and rely instead on what we have practiced, the more likely we are to be successful. The self imposed performance pressure for the golfer, also exists for the PWS because of the high value he places on fluency. This is why in therapy, we need to give the client, and he needs to give himself, permission to stutter. Like the golfer, when performance pressure is lessened, motor performance can improve.

Zebrowski (ASHA 2003) discusses the importance of mental training in stuttering therapy. She emphasize the effectiveness of mental practice that prepares the mind and body to perform, by creating visual, kinesthetic and emotional images to help the PWS build confidence and trust in their abilities.

Tim Gallwey, in his book The Inner Game of Golf (1981) writes, "If you want to change something, first heighten your awareness of the way it is." (p.68). His approach to teaching golf is to help the student learn from experience and increase his own self trust. He notes that "when faced with the unknown or the uncertain, a common thing for human beings to do is to enter a state of doubt, and tighten instinctively to protect themselves. . . ..and doubt is the fundamental cause of error in sports"(p.41). This concept of "self doubt" appears to permeate the communication attitude of so many of our clients who stutter. The key (according to Gallwey) is being able to recognize it and separate oneself from it. In speaking , it is the same "uncertainty of mind" (p.46) and self doubt that impacts a PWS almost every time he wishes to communicate. And it is that learned cycle of behavior that perpetuates his stuttering and needs to be broken.

What is the lesson here for the PWS and the golfer? The golfer needs to work to ignore the doubt and work toward self trust. So does the PWS. Through systematic desensitization activities, the use of visual imagery, positive self talks, role playing, etc., it is possible for the PWS to significantly diminish the self doubt surrounding specific speaking tasks and foster comfortability and increased control of his speech. The goal for the PWS is NOT to try to prove oneself, but rather to accept oneself and move on. Gallwey adds that . . . . "Once I learned to be free of my own expectations, I could begin letting go of the unneeded expectations of others"( p.165). He was able to change the rules of his inner game, alter his thinking, and reduce his own self imposed pressure. This resulted in an improved golf game.

Similarly, PWS may not be able to alter our cultures' value of fluent speech, but they can alter their own expectations and the self pressure they place on their own fluency. Like the golfer, the PWS can freely choose to reinvent the rules of his" inner game of communication" and work toward changing his own beliefs about stuttering. He can allow his stuttering to define him or he can chose to define himself as a multidimensional person, who happens to stutter. Coming to the realization that it is not the blocks or repetitions or prolongations that sustain stuttering, but rather the value the PWS places on them in defining who he/she is as a communicator, and an individual, is invaluable for the PWS.

CONCLUSION

The "Stuttering- Golf Analogy " appears to be a useful way to help people who stutter gain insight into the motor and cognitive aspects of their stuttering behaviors. It has served this clinician as a useful therapeutic aid in treatment. By comparing the motor aspects of speech and stuttering to the motor aspects of golf, clients seem better able to connect with the tension, rhythm, rate, and proprioceptive feel of their stuttering blocks. Helping the PWS internalize that the fear, anxiety, and self doubt he may feel when communicating are also feelings shared by the golfer, who overvalues the outcome of his golf shot and allows his performance, like the PWS, to impact his self confidence, appears to make stuttering a more understandable and less insurmountable challenge for the PWS. By altering the value they both place on high performance, self expectation and the expectation of others, the game of golf, and more importantly the act of communication, can be improved, enjoyed, and celebrated.

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Zebrowski, P. M. ASHA Convention presentation (2003)


You can post Questions/comments about the above paper to the author before October 22, 2012.


SUBMITTED: March 1, 2012
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