About the presenter: Peter Reitzes, MA, CCC-SLP, is an adult stutterer and an ASHA certified, speech-language pathologist working in an elementary school and in private practice in Brooklyn, New York. Mr. Reitzes is the author of 50 Great Activities for Children Who Stutter: Lessons, Insights, and Ideas for Therapy Success (PRO-ED) and is co-editor (with Gregory Snyder) of the Journal of Stuttering Therapy, Advocacy and Research (www.JournalOfStuttering.com). Mr. Reitzes may be contacted at www.StutterNY.com.

You can post Questions/comments about the following paper to the author before October 22, 2006.


Stuttering Well: The Clinician's Use of Positive Language

by Peter Reitzes
from New York, USA

Abstract
Many people who stutter experience negative feelings, emotions, and attitudes towards stuttering. One way to help prevent and counteract these negative feelings is by using positive and descriptive language to describe people who stutter and to describe the act of stuttering. This paper discusses positive and productive language options available to clinicians working with people who stutter.

Introduction
Negative attitudes and feelings toward stuttering are common among people who stutter (Andrews & Cutler, 1974; DeNil & Bruten, 1991; Guitar, 1998; Silverman, 2004). For example, one man explained, "Negative thinking, which was very common in my life, centered around my speaking. [I thought] I can't do this because I stutter. I'm so stupid because I stutter" (Floyd, 1999, p. 129)." Sugarman (2001) explained:

[Until I was 21] my stuttering represented my entire self-image. I was dominated by stuttering. It was difficult for me to express my wants and feelings. I stuttered and worried about what the listener would think of me as a person who stuttered. I struggled to push words out and felt helpless, anxious, afraid, ashamed, and guilty. (p. 78) One way to help counteract negative feelings associated with stuttering is by making a concerted effort to use positive and descriptive language to discuss and describe stuttering (Reitzes, 2006). Doing so may contribute to the normalization and acceptance of stuttering. For example, instead of characterizing a moment of stuttering as a "bad" stutter," it may be called a "good" stutter.

Starkweather and Givens-Ackerman (1997) noted, "Language can be a window through which the clinician can model an attitude toward the disorder that is nonavoidant and unafraid" (p. 8.) Manning (1996) wrote, "By changing the way we describe a problem, we can often change the problem itself" (p. 195). Shapiro (1999) explained, "How we talk with children, particularly children who stutter, is critically important to helping children establish or maintain positive feelings about communication and themselves" (p. 331).

It is up to the clinician to model all behaviors they wish clients to use (Breitenfeldt & Lorenz, 2000; Ramig & Bennett, 1995; Walton & Wallace, 1998). This includes talking openly and productively about stuttering and using unashamed and positive language to describe stuttering (Reitzes, 2006). Using positive language is more than simply "unshaming" stuttering (G. Snyder, personal communication, August 10, 2006). Snyder suggested that the use of positive language "exposes and confronts societal assumptions and misperceptions about stuttering and, in a sense, redefines the stuttered reality." In other words, stuttering and being a stutterer will often be viewed as something shameful and bad until another, more positive reality is provided.

This article will discuss some of the positive and productive language options available to clinicians working with people who stutter.

Stuttering Badly and Stuttering Well
It is common for a child or adult who stutters to come to speech therapy and announce, "I have been stuttering really badly today." One way to respond is by saying, "So, you have been stuttering well today; that must be very frustrating." By doing so, you have honored the client's feelings while having also provided an example of positive and productive language. If a client says, "That sure was a bad stutter," you may respond, "That sure was a 'good stutter'" (Donaher, 2003, p. 1). Many people who stutter are visibly taken aback by the positive reframing of their comments and may ask, "Do you really think stuttering is good?" When this occurs, you may respond, "Stuttering has to be good because you are good." By using such positive language, people who stutter will often smile with the understanding that you are not going to punish stuttering.

It is also important to stress the use of positive and descriptive language with teachers and family members. For example, if a teacher says, "Raul has been having a really bad stuttering day," you may respond, "So Raul has been stuttering a lot today." This rewording of the teacher's comment demonstrates that descriptive language, rather than judgmental or negative language, may be employed to describe stuttering.

Sometimes a teacher wants to inform the clinician that a student has been experiencing a relative decrease in overt stuttering. The teacher may say, "Raul has been having a really good stuttering day." When this occurs, restate the comment by saying, "Raul has not stuttered much today." Most teachers will understand that you are not correcting them, but are merely offering a less judgmental and more descriptive approach towards discussing a child's stuttering. If a teacher or client expresses disapproval of your language choice and asks, "How can you possibly describe stuttering as good?" you may respond, "I use positive language to describe stuttering because I do not find negative language to be helpful."

Fluency, Disfluency, Dysfluency, and Stuttering
Disfluency refers to normal, non-stuttered interruptions of speech and dysfluency refers to stuttered interruptions of speech (Starkweather, 1987; Manning, 2001). The term fluency means non-stuttered and forward moving speech in regards to both content and production (Starkweather, 1987). For various reasons one needs to be cautious when using these terms with people who stutter, family members and other professionals.

Many within the stuttering community have come to use the terms fluency and fluent as euphemisms for not stuttering (Reitzes, 2006). For example, a few years ago at a stuttering self-help meeting a person who stutters was addressing the audience. This gentleman was passionately discussing his life spent as stutterer, but he was not noticeably stuttering during his presentation. A mother in the audience turned to her son and said, "If you work hard, then one day you can be a fluent speaker too." What the child most certainly heard was, "If you work hard, then one day you will not stutter either." While many people who stutter understandably wish to stop stuttering, such a comment may set an unrealistic goal by putting a tremendous amount of pressure on the child to cease stuttering. Such pressure is often considered therapeutically unproductive. Such claims may (and often do) instill false hope, which may result in failure, shame, guilt, self-blame and self-loathing.

At self-help meetings and workshops it is common for some participants to speak about "gaining fluency" and "having a fluency problem" while carefully avoiding the term stuttering. In some situations, the term fluency may function as a politically correct replacement for the word stuttering. Unfortunately, using politically correct euphemisms such as fluency problem may have the unintended consequence of designating people who stutter and the act of stuttering as "ugly" and shameful.

In many situations, referring to oneself as having a fluency problem or a dysfluency problem is a form of denial which creates a safe distance between a person and his or her stuttering. Starkweather (1996) explained, "Many stutterers are hurt, shamed and frightened by their stuttering and they adopt defenses to minimize the pain. . .The problem is that denial, while it offers protection from pain, makes you lose touch with the problem (pars. 1-2)."

Some clinicians and some people who stutter argue that the most productive way to work on stuttering is by first admitting that you stutter. For some, using the term stuttering and talking about stuttering in an open, objective and direct manner is an important component of therapy, growth, and change (Reitzes, 2006).

One should also be careful using the term fluency when speaking with parents, teachers, and school staff members. Using the term fluency with parents may perpetuate denial. The same way that adults may use euphemisms to deny the existence of stuttering, parents may do so as well.

In the schools, it is common for the term fluency to be used in regards towards reading fluency (reading ability) and English language fluency (English language proficiency). By describing a child who stutters as having a fluency problem, the clinician risks confusing students, teachers, and parents by inadvertently linking stuttering with reading and language learning issues. It is not uncommon for professionals, such as teachers and principals, to assume that stuttering is caused by reading difficulties or by learning English as a second language. When a child who stutters is delayed in reading or is in the process of learning English, some professionals and some parents assume that the child's stuttering will "go away" once he or she begins reading at grade level or becomes proficient in English. One way to prevent the reinforcement of such inaccurate assumptions is by using the term fluency as little as possible. When you mean stuttering, say stuttering.

And of course, when working with young children you will want to use language and terminology that is appropriate for them. Many young children will have little or no concept of the term stuttering, but will better understand terms such as sticky speech, bumpy speech, and traffic talk. These are not euphemisms, but are simply examples of descriptive language to use with children.

Mild, Moderate, and Severe Stuttering
Using the terms mild, moderate, and severe do not adequately describe or explain how a person is stuttering, how stuttering affects one's life, or how a person feels about stuttering. For example, a person who stutters frequently may be diagnosed as having a severe stuttering problem, but does not feel that stuttering severely affects his life. On the other hand, a person who is heard to stutter very little may be described as having a mild stuttering problem while in actuality, the person feels that stuttering severely affects his life. For example, one woman explained how infrequent moments of observable stuttering had a severe impact on her life. She wrote:

Outwardly, my speech is pretty smooth, and I work very hard to substitute words I can say for words I can't easily say. . . I end up feeling like I'm missing out on many opportunities. I feel that I fail by not saying things to people. (Summerlin, 2001, pp. 31-32) Instead of using low-meaning and vague terms such as mild, moderate, and severe, it is suggested that clinicians use descriptive language to describe stuttering. For example, instead of writing, "Sarah stutters severely," the clinician may write: Sarah demonstrates frequent blockages and prolongations of speech, characterized by secondary behaviors that include head tilting, eye blinking, and using fillers such as "um" and "you know." Sarah's communication flow is often slowed or halted by her variable ability to move forward through moments of stuttering. For another example, instead of writing, "Kevin has a mild stutter," you may write: Kevin reports that he often chooses not to speak rather than risk stuttering. Kevin demonstrates and reports using avoidance behaviors including word substitutions, postponements, and feigning illness such as pretending to be sick when it is his turn to give an oral presentation in school. Kevin's use of avoidance behaviors typically results in few noticeable or audible moments of stuttering. Kevin's reluctance to speak, his use of word substitutions, and his fear of stuttering adversely affect his academic performance. Stutterer and Person Who Stutters
Within the stuttering community the terms stutterer and person who stutters (PWS) are discussed and debated. St. Louis (1999) conducted an in-depth study on this topic. He explained, "The large amount of data I gathered and reported clearly shows that there is no pejorative or stigmatizing connotation of the term 'stutterer' versus 'person who stutters' for all but a very small fraction of the population" (St. Louis, 2001, p. 26).

Shapiro (1999) reflected the voices of many opponents of the term stutterer when he wrote, "Referring to a person as a stutterer establishes that the disorder captures the essence of the person" (p. 15). As many people who stutter have noted, they wish to be viewed as much more than disordered speakers. They want to be known as people first. Some feel that using "people who stutter" instead of "stutterer" focuses attention on the person, not the speech action.

Starkweather & Givens-Ackerman (1997) have offered strong support for the term stutterer. They explained that the term person who stutters and its acronym PWS are considered by some as "a kind euphemism a softening of the harsh reality of the disorder and, as such, a form of avoidance that does not serve the person well" (p. 8). Some proponents of the term stutterer support its use because they feel it is not possible to fully face a problem until one fully admits to having a problem. Some feel that using the term stutterer in a neutral or positive manner assumes that there is nothing inherently negative with the term stuttering or the act of stuttering.

It is important to use and choose language that best supports the client and the client's family. For example, if a parent refers to their child as a stutterer, it may be unwise for the clinician to use the term person who stutters. By doing so, the clinician may unintentionally imply to a parent that the use of the term stutterer has harmed the child.

Instead of using stutterer or person who stutters, some prefer to use the term person living with stuttering. While at first blush this term may seem pretentious or unnecessarily politically correct, it is not without merit. For example, in the documentary film titled Spit It Out (Skurnik & Shames, 2005), an adult stutterer is featured who is shown coping with a host of personal issues that include substance abuse, emotional abuse, and stuttering. This film provides a vivid example of a person living with stuttering. Within the text titled Living with Stuttering (St. Louis, 2001), more than 20 people describe their personal experiences living and growing with stuttering. These rich accounts portray individuals who are truly living with stuttering.

Conclusion
People who stutter, family members, and professionals have many productive and descriptive language options at their disposal to discuss stuttering. It is often up to the clinician to take the lead by using and demonstrating positive and descriptive language options. It is hoped that the use of positive language to describe stuttering will help create and provide a "stuttered reality" that is unashamed, productive, and proud.

Acknowledgments: I would like to thank Cindy Drolet, David Reitzes, and Greg Snyder for editing assistance.

References

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You can post Questions/comments about the above paper to the author before October 22, 2006.


August 21, 2006
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