About the presenter: Ellen-Marie Silverman earned the Ph.D. in Speech Pathology from the University of Iowa. She believes successful therapy depends on a collaborative relationship of clinician and client where the power of the client is acknowledged and nurtured. A student of fluency, she authored Jason's Secret. The novel portrays a 10-year-old boy's first steps to constructively deal with his stuttering problem including his experience with speech therapy. She is a Fellow of the American-Speech-Language Hearing Association and a member of its Fluency Special Interest Group.

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

Why Seek Therapy

by Ellen-Marie Silverman
from Wisconsin, USA


Thank you for your interest in this paper.

I am pleased to participate in this Conference once again, this time to identify some assumptions we may hold, of which we may be only dimly aware, that, nonetheless, drive our decision to enroll in therapy, or not. These beliefs rather than leading us to experience greater satisfaction with our speech and with our lives can waylay those possibilities. But working within a 2,000-word limit means risking being somewhat sketchy. So please reflect on what you read here. Hopefully, partnering this way may net at least one meaningful takeaway.

But, first, I wish to thank Prof. Kuster for hosting this Conference, which helps us expand our personal and collective understanding of what having a stuttering problem can mean and what we can do to modify one.


It is a given: When we are sad, fearful, and angry, we are likely to be more reactionary than deliberate. So, in our 20's, 30's, and 40's, when we feel threatened by potential unemployment, resentful for being under-employed, unfulfilled in personal relationships, or uninspired by what we consider the everyday blah-ness of our life, we may reflexively sign on for a stint of speech therapy to shake ourselves out of the doldrums, so accustomed are we to believing or, perhaps, hoping, that, by changing the way we speak, we will live more as we wish. A man who worked as a commercial airline pilot recently contacted me. He feared present and future economic crises could trigger staff cutbacks where he worked and, if so, he might be singled out for dismissal if he continued to stutter making in-flight announcements. After years of successful employment and knowing how to respond to discrimination in the workplace, he now believed he needed to stop stuttering to secure his job. He may have been correct. But the fear was insufficient cause, of itself, to enroll in speech therapy, although, by motivating him to contact a speech pathologist to relate his concern, he did experience some relief.

A parallel version of this belief inspires some of us to work as speech pathologists. Many, and I among them, were delighted to learn we could earn a living helping others speak with greater ease and clarity. Yet, because those of us who have stuttering problems and those of us who are clinicians often approach this common belief with differing sets of expectations about our roles and responsibilities when working with one another, we can come to loggerheads. But that need not stop us. We can work our way through these impasses using unflinching self-reflection and negotiation (e.g., Silverman, 2009b; 2001).


Self-reflection jump-starts the possibility of desired change. This quiet process helps those of us who are clinicians know our true motivation for engaging with clients, which may not be what we readily think (e.g., Silverman, 2011b; 2009b; 2008), and it helps those of us with stuttering problems identify our true motivation for engaging with clinicians, which, also, may differ from what we think (e.g., Hahn, 2006). Motivations have deep roots (e.g., Berne, 1996) and, like the roots of living things, such as trees and shrubs, we usually need to dig beneath the surface to expose them. And so it may be with our true motivation for seeking therapy.

Motivation fashions behavior (e.g., Boorstein, 2012; Mipham, 2012). Our true intent for participating in therapy may be to change how we think and act or it may be to stay the same. So, if we intend to speak with greater ease and confidence more consistently, we will find ways to do that, which may mean choosing to actively participate in speech therapy as well as other personal growth activities to learn tools for change and ways to safely incorporate change into our lives. And, if our motivation is to continue as we are, we will do that, which may involve enrolling in speech therapy only to pay lip service to changing. We may do so deliberately or without conscious awareness. Let me explain.

A Conscious Intent Not to Change

Here are two examples:

We may enroll but not actively participate to diffuse mounting pressure from family or others to "do something" about our stuttering, which we neither want to do nor believe we can. We may arrive late, cancel sessions, or fail to follow through with assignments. And we continue the charade until the therapist discharges us for not assuming our responsibilities or until we quit because we are tired of wasting our time and money pretending to do something we do not want to do.

We tell family and others that we tried but could not change. We express our disappointment with the therapist who we say failed to incorporate our wishes regarding content, show compassion for our pain and suffering, demonstrate a workable knowledge of stuttering and stuttering problems, or meet our expectations in other ways (e.g., Silverman and Zimmer, 1982). Our rueful confessions usually stifle further suggestions that we change, at least for the present, providing us with the relief we sought by enrolling (e.g., Myss, 1998).

Minors in the United States sometimes behave similarly. Enrolled by parents and therapists despite their subtle or unmistakable protestations, which do not require x-ray vision to detect, they may resist active involvement to be discharged. They may believe classmates will ridicule them for needing help talking as did Jason, the 10-year-old lead character in Jason's Secret (Silverman, 2001), who believed going to therapy would mark him a "Freak." Some have other reasons, such as not wanting to miss a favorite class or perform specific therapy tasks. But, if they do not want to attend, they will not participate sufficiently to change as caregivers, professionals, and, even, they may wish.

A Subconscious Intent Not to Change

Reacting to the pervasive anger and sadness we may hold for failing to have overcome our stuttering problem despite attending therapy for years, we now may gravitate toward therapy primarily as avengers. Our goal: To expose the inability of therapy and therapists to help. Our tactic: To deny the therapist the opportunity to help by refusing to respond to directions and suggestions. Our payoff: To draw blood, not to change. Yet, we may be only dimly aware of our this. We even may be telling ourselves and others we are re-entering therapy to change.

Human psychology, Eastern (e.g., Kornfield, 2009; Hahn, 2006; Reynolds, 1980; 1976) and Western (e.g., Berne, 1996; Steiner, 1994; Whitney, 1985), offers insight into this stark, subconscious tendency to hurt others to lessen our own pain. Successfully doing so requires a willing partner. Eric Berne (1996), founder of Transactional Analysis, describes this unwholesome partnership in The Rescue Triangle, a psychological game played to evade personal change (e.g., Myss, 1998). The game begins with the players relating amicably, at least superficially, and ends in a seemingly surprising twist with inevitable blood-letting. In a 2001 ISAD Conference paper, "Consumer Alert: Gender and Stuttering Research," I summarized the roles, activities, and payoffs for the players. Here is a recap:

The Rescue Triangle. This is an interpersonal game for two with three interchangeable roles, Victim, Rescuer, and Persecutor. To start, one player assumes the role of Rescuer, the other, Victim. The Rescuer (therapist) believes his or her task is to manage others' lives and only feels okay when doing so. The Victim (client) seeks help but does not want to be told what to do or how to be. A complementary pair, neither is consciously aware of their own or the other's basic motivation.

Their interactions become increasingly strained as Victim refuses to engage with either the therapist or the process and as Rescuer, fearful of not helping, focuses increasing anger on Victim until, in a stunning turn-around prompted by disappointment, fear, anger, or superiority, one switches roles to become Persecutor.

Victim as Persecutor attempts to induce feelings of shame and/or failure in Rescuer by implying Rescuer is too unknowledgeable or unskilled to help him or her, while Rescuer turned Persecutor attempts to inflame feelings of anger and hurt in Victim by implying that he or she can not change. If the surprised Rescuer succumbs to feelings of anger and hurt for being played this way, he or she becomes Victim; if the astonished Victim experiences anger and hurt for feeling dumped by someone considered inferior, he or she becomes a more entrenched Victim.

The game ends with the original Victim feeling more powerful or more hopeless and with the original Rescuer doubting his or her self-worth for failing to help a client and, possibly, believing adults with stuttering problems can not be helped. In each scenario, players feel satisfaction from verifying their initial, subconscious beliefs about themselves and the other. And that sense of being right perpetuates their status quo, which brings temporary relief from anxiety but not change.

Playing The Rescue Triangle can calcify our stuttering problem or force our development as clinicians into rigor mortis (Silverman, 2009b). But we can learn something helpful from anything or anyone at anytime. And what we can learn from playing The Rescue Triangle is that trying to subjugate others, even for the loftiest notion, encourages rebellion, insurrection, mayhem, and, ultimately, stagnation. What do we do instead? We take charge. . . of ourselves.


Some of us may have realized when we were young that we needed to care for ourselves and that that was our primary job in life. We somehow knew we needed to make wise choices and to thoughtfully and skillfully act on them. But, when we were young, we frequently were stifled when we tried. We may have been cared for by people who preferred subordination to our emerging independence and may have tagged us as rebellious and needing a short leash or worse if we acted according to our wishes.

Obedience, rather than collaboration, also may have been our experience in therapy. We, as was Jason, the 10 year-old lead character in Jason's Secret (Silverman, 2001), may have been enrolled in speech therapy despite expressing we did not wish to attend. And therapists may have structured the entire experience, from scheduling meeting times and dates to selection of goals and activities, without consulting us. But therapy then does not have to be therapy now.

We need to consider carefully whether and how decisions we made about speech therapy as children and teens may be affecting how we think about speech therapy now. So we use the quintessential tool of self-reflection to clarify what we think and need. Then we identify those who may congenially meet our desire to work as partners and assess honestly our willingness to participate. We are learning that no matter what method we may choose to be as we wish, we will not change unless we change (e.g., Dyer, 2012: Kongtrül, 2006; Silverman, 2009a). Not even 1,000 speech pathologists can make us change if that is not our wish (e.g., Dyer, 2012). Children no more with voices often unheeded we now choose moment-to-moment what we will and will not do for ourselves. We consider all possibilities, including non-therapy practices, such as mindfulness (e.g., Silverman, 2012; 2011a; Salzberg, 2011) to speak and live as we wish.


Time to go.

Expert in human consciousness and New York Times best selling author Caroline Myss advises that the best way to experience a happy tomorrow is by leaving a sad past far behind (Myss, 1998). Childhood is over. We are no longer teens. Clinging to memories, to feelings about them, and patterns of behavior we adopted then will stymie our wish to change.

We learn to live more skillfully and happily. We do not repress: We recognize. We resolve. We integrate (e.g., Silverman, 2010; von Franz, 1964). We ask ourselves, "Where do I want to go?" (Boorstein, 2012). Then we climb aboard the Me-Train and move away and beyond, with or without therapy.


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Silverman, E.-M., and Zimmer, C. (1982). Demographic characteristics and treatment experiences of women who stutter. J. Fluency Dis., 7, 273-285.

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Paper Presented at the 15th Annual International Stuttering Awareness Day (ISAD) Online Conference 2012 by Ellen-Marie Silverman

[Copyright Notice: The following is a copyright protected document, Copyright 2012 by Ellen-Marie Silverman. Neither excerpts nor the entire paper may be published in hard copy, copied to another website, or otherwise reproduced in other media without advance permission from Ellen-Marie Silverman (TSSS920499@aol.com). Permission is granted to read or print out a single copy for personal use. --- Ellen-Marie Silverman, Milwaukee, Wisconsin, August 31, 2012.]

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

SUBMITTED: April 24, 2012
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