In the Year 2025
- by Ed Feuer
[note - the following was originally submitted to stutt-l by Ed Feuer.
Ed, a person who stutters, offered this unique perspective of what
therapy will be like in the year 2025 for people who stutter. His post
provoked a string of very interesting discussion, some of which has
been appended to Ed's submission. - JAK]
On Sun, 19 Feb 1995, Ed Feuer wrote:
Ever wonder what stuttering therapy for adults will be like in the
future? I do, too. So I got into my time machine, turned the dial to the
year 2025 and zipped around North America. I was amazed at the advances
in treatment.
First of all, I found professional jealousies have been overcome,
allowing more realistic concepts. There is now a coordinated
multidisciplinary approach in which speech therapists form only one
part of the treatment team. The speech therapists have recognized their
field does not hold all the answers because they lack the knowledge and
time to do all that is needed to help guide their individual stuttering
clients.
In 2025 there is a collaborative use of outside expertise. There is a
team approach but the the overall treatment model comes from speech
therapy. Treatment deals with the client as a whole person and helps
him or her overcome lifelong conditioned responses which Van Riper said
amount to a "brainwashing of incredible thoroughness". There is now much
greater understanding that the bruised psyches and emotional scar tissue
created by stuttering must be healed if working on the inappropriate
speech behaviors is to be successful.
The basic treatment model, handled by the speech therapist, is a
synthesis of the eclectic Van Riper stuttering modification and fluency-
shaping approaches and more, stressing unlearning (and understanding) of
old behaviors and then learning and relearning new ones. In 2025, there
is the understanding that treatment means not only the appropriate
movement of the speech apparatus. There is recognition that it is
necessary to deal with a life impediment, not only a speech impediment.
Most importantly, treatment has become oriented to the individual's own
unique strengths and weaknesses. With the assistance of the treatment
team, the person who stutters (PWS) works directly on improving self-
concept and reducing fears.
Depending on those individual needs -- and the speech therapist as major
facilitator plays a key part in determining what they are -- the PWS can
be referred to treatment team experts in such areas as desensitization
to fears, assertiveness training, anti-procrastination techniques,
interpersonal communnications, psychology and psychotherapy, acting and
drama, and anxiety and stress management. All members of the team are in
close liaison concerning the progress of the PWS, and treatment is an
ongoing process -- no two- or three-week quickie fixes here.
Advances in brain diagnostic imaging tools have provided important
insights into the physio-neurological roots of the core block. The
results of these findings have been incorporated into treatment. With
new technology and miniaturization, it is now possible to measure
communicative stress more accurately. The PWS can be connected to
monitoring devices that guage stress and physiological reactions both in
virtual reality simulator practice and in live situations outside the
clinic.
In regard to practice and maintenance, the PWS now has the assistance of
experts in the areas of human performance and sports psychology since it
has been recognized those fields are valuable in helping to create
consistency and motivation. As well, the PWS has the assistance of para-
therapist coaches or trainers who have been trained in the use of the
mechanistic fluency shaping techniques.
I must add that due to the efforts of such groups as the National
Stuttering Project and better education in general, the public in 2025
is much better informed about stuttering -- a situation which helps to
lower communicative stress and makes life in general easier for people
who stutter.
> * * * * *
To paraphrase John Lennon, you may say that I'm a dreamer, but I hope
I'm not the only one. Most of the above could be implemented a whole lot
earlier than 2025. Of course cost is a barrier, but not nearly as big a
problem as the Iron Curtains of professional jealousies. What I describe
is the ideal but meanwhile, progressive speech therapists could start
with small steps, reaching out to collaborate with experts from other
fields -- including members of other departments of their universities,
hospitals and other facilities -- to help adults who stutter. Maybe some
of these small steps have already been taken. Perhaps some prototype
coordinated multidisciplinary programs could be organized. Why do we
have to wait until 2025?
-- Ed Feuer
hzo971@freenet.mb.ca
(What follows is some of the discussion Feuer's post stimulated. It
is also available in the Stutt-l archives - JAK)
On Sun, 19 Feb 1995, Donald Mowrer at ATDNM@ASUVM.INRE.ASU.EDU wrote:
I have no argument against your vision. I read in our local
ASU student newspaper that a fellow in Elementary education just
received a 2.3 million dollar grant to produce an interactive CD ROM
for mathematics teachers to show them the very best teaching models
around the US. If this kind of money is available for math, why not
tap some it for a project like you suggest. For example, Einer Boberg
is supposed to be doing great things with his techniques in Canada.
Bruce Ryan traveled to England and Asia describing his successes.
Hugo Gregory at Northwestern and his wife have a practice that is most
successful. I had one of his "products" and must admit her speech is
great. Steve Hood has had great success too. Mark Onslow in Australia
has been publishing great results in his prevention program. People in
England are working with teenagers who stutter by concentrating on
family interaction problems and when these problems are solved,
fluency improves dramatically. Even though this is not 2025, there are
exciting things happening around the world that we all should be able
to see and the CD ROM way of communicating is an excellent manner to
see and hear what people are doing.
Don Mowrer
Arizona State University,
Dept. Speech & Hearing Science
Tempe, AZ 85287-0102
Bitnet Address: ATDNM@ASUACAD
Internet: ATDNM@ASUVM.INRE.ASU.EDU
On Sun, 19 Feb 1995, Ed Feuer replied
Dear Prof. Mowrer:
My point is that a coordinated multidisciplinary approach to
treating stuttering adults need not wait until 2025, nor must we wait
for revolutionary developments elsewhere. I have no doubt that at many
of our universities, including Arizona State, there are experts in
desensitization to fears, assertiveness training, anti-procrastination
techniques, interpersonal communications, psychology and
psychotherapy, acting and drama, and anxiety and stress management,
human performance and sports psychology. They are not beyond the seas
or in the next century, if speech therapists want to reach out --
something I believe can only help people who stutter. Even if they
start out only working with one of these people in other fields who
have something to offer ...
-- Ed Feuer
On Sun, 19 Feb 1995 Laval7767@AOL.COM wrote:
Ed,
You may be a dreamer, but no, you're "not the only one." Your multi-
disciplinary approach is something to strive for. There are a few
speech pathologists out there who do believe in treating the "whole
person," especially when working with the adult stutterer. In the
meantime, since I choose not to wait until 2025 (I'm too old and too
impatient), I feel that it's up to me to be my own "coordinator" in
terms of not only choosing the type of speech therapy that is right
for me, but also in "bringing in" whatever other disciplines or
training (psychotherapy, stress management, assertiveness training,
etc.) I feel will help me to achieve my speech and life goals. I'm
curious to hear from the academic world (college speech clinicians,
etc. ) as to the degree that stuttering therapy, nowadays includes
collaboration with other available disciplines.
>
Diane Laval
(Laval7767@aol.com)
Dear Diane,
Thanks for the kind words. I think the problem with trying to be our
own "coordinators" in terms of trying to tap this other expertise is
that the people in these other disciplines would more likely than not
try to "reinvent the wheel" in terms of imposing their own views about
stuttering and its cause. I think that to be successful the people
from these other disciplines would have to accept the speech therapy
model and offer what they can from their areas to help the treatment
work. (The professional jealousies I spoke of were not only in
reference to speech therapists.) If some of these other people are
willing to learn about the speech therapy model and work with speech
therapists in a team approach, then I think we'd have a situation that
would be most beneficial. Granted, as things are now, we pretty much
have to be our own coordinators.
-- Ed Feuer
On Tue, 21 Feb 1995, Woody Starkweather at V5002E@VM.TEMPLE.EDU wrote:
Hello Everyone,
I don't think it will be necessary at all to wait until 2025. The
therapy described in that posting is very close to what The Birch Tree
Foundation will be offering. First of all the interdisciplinary
aspect. The treatment will be offered by a two-person team,
consisting of a speech pathologist (me) and a PWS (Janet Ackerman).
In addition, both of us are getting ourselves trained in Gestalt
psychotherapy techniques, and of course, I had some psychology
training earlier (a lot earlier). In addition to the Gestalt psycho-
therapy techniques, our approach will combine Van Riperian techniques
with some of the elements of 12-step recovery programs, a pinch of
behavioral concepts, and a strong element of self-help. In fact, the
basic idea of this approach -- which for want of a better term we are
calling "Continuing Three-Step Treatment, or in light moments, "Waltz
Therapy" -- is a marriage of two powerful therapeutic agents -- speech
therapy of the Van Riper persuasion and self-help. It certainly is
designed to consider the whole person, and it certainly is designed to
be an ongoing process, rather than a quick fix.
Our first event will be a series of weekend workshops. These will be
in the "Scandinavian model", that is, a weekend followed by a five
week period back in one's everyday life to apply what has been
learned, then another weekend, then another five-week application
period, then another weekend. The idea is to start the journey. The
expectation is that it will go on for a long time afterwards. Since
each person is on his or her own particular journey, what the BTF will
offer will be completely individualized. It is fully expected that
some participants will be far along already, while others are just
starting. And each person's journey takes them along different paths.
There are as many different paths out of the swamp as there are to get
into it. The only element mentioned in the 2025 posting that will
not be included is the fluency-shaping. I have done it for years, and
I am not satisfied with the outcome. Even the most successful clients
have to be continuously vigilant, and the automatic production of
speech that is such a natural thing for nonstutterers, just never
seems to happen. So we left that out.
The BTF is, of course, more than a therapy program. WE have plans to
do many other things in support of people who stutter, but the weekend
workshops are our first endeavor. We thought we had the dates set,
and they were announced in Letting Go, but we are having a little
difficulty nailing down the site(s), so it is possible that we may
have to start up a little later than we planned. A brochure is being
developed and should be available in about a month.
I couldn't agree more that the time has come for a radical overhaul of
what speech clinicians offer to people who stutter.
Woody
On Thu, 23 Feb 1995, Ed Feuer wrote:
Dear Woody,
I have been heartened by the response to In The Year 2025 from
people who stutter, progressive speech therapists and speech path
students who believe there is indeed a need for a radical overhaul. I
appreciate what you are planning with the Birch Tree Foundation. You
are headed in a positive direction that can help change the attitudes
of your colleagues. But I am calling for something different. In
my modest proposal, I am saying that realistically, stuttering is
bigger than the speech therapists in terms of time and knowledge
required. I am all for what Van Riper was advocating in his book, The
Treatment of Stuttering, and his other works, but I believe only a
super-therapist like Van Riper in his prime could do it alone. Let us
re-read Van Riper and plug in outside experts into his treatment
ideas using a coordinated multidisciplinary approach -- with
people from such areas as desensitization to fears, assertiveness
training, anti-procrastination techniques, interpersonal
communications, psychology and psychotherapy, acting and drama,
anxiety and stress management, human performance and sports
psychology. I am not suggesting that we throw out the 60 or 70
years of accumulated research on stuttering. I am saying that the
emotional scar tissue and bruised psyches caused by stuttering are
standing in the way of what speech therapists are asking their clients
to do over the long term. Experts from other disciplines who can
be brought onside with the speech therapy model have something
valuable to offer. But speech therapists have to reach out. These
people are not beyond the seas or found only in the next century. They
are there ... today ... on your campus.
-- Ed Feuer
On Tue, 21 Feb 1995, Martin Schwartz at: schwrtz@IS.NYU.EDU wrote:
I am delighted to hear the description of Dr. Starkweather's approach.
I, too, agree with the notion that a multidimensional approach is
required for the treatment of stuttering. Since descriptions of
programs are allowed on Stutt-l, permit me to briefly describe the one
we have been following.
We start with a two-day workshop. On the first day we teach what I
call "Intent Therapy," i.e., a mental intent to REST on a passive
outflow of air coupled with the powerful mental intent to slow the
first word. We practice this technique within my cognitive
orientation that the trigger for stuttering is a stress-induced state
of increased inertia on the vocal folds and that "Intent Therapy" is a
powerful mechanical subtractor of vocal cord tension. We view all
supra-laryngeal events and all respiratory events as learned
anticipatory or extricatory struggle behaviors, i.e., as symptoms and
we do not address them. In other words, we do not treat stuttering.
We practice "Intent Therapy" through a hierarchy of linguistic
complexities. We also learn specific exercises designed to resist the
verbal speed demands of the "outside world."
On the second day we learn several powerful stress-reduction
techniques to lower what we call the Base Level Tension. It is
variations in the BLT which contribute to the good days and bad days
that PWS report. One of these techniques is quite new and clearly the
most powerful of the lot. It is called "Trained Neural Detachment"
(TND) and it works extremely well in eliminating stuttering in very
specific, high-stress speaking situations.
Patients try specific vitamins and minerals which have shown to lower
Basal Level Tensions in some individuals. They also test for
"Provocative Foods," food which have been shown to increase Base Level
Tensions.
The orientation is to attack the total tension on the vocal folds from
all of the potentially contributing sources.
To establish transfer and maintenance we make use of programmed
exercises, support groups, hotline numbers, weekly monitoring of
practice, and a device called the MotivAider. We try to shift the
"locus of control" for improvement from external to internal in our
patients, make use of hypnosis tapes specially prepared for our
program by a certified hypnotherapist, provide booster sessions, and
refresher courses.
MARTIN F. SCHWARTZ
Executive Director, National Center For Stuttering and Research
Professor Department of Surgery (Speech Pathology)
New York University Medical Center
On Wed, 22 Feb 1995, Carol at:
N710130%UNIVSCVM.BitNet@pucc.PRINCETON.EDU wrote:
Dr. Schwartz, please pardon me for being so direct, but it sounds as
if you have discovered - and are responding to - what many of us out
here discovered through our own failures as clinicians - and responded
to - that fluency shaping *alone* does not work, and secondly, does
not meet all the needs of a PWS.
Thanks for your participation.
Carol Clark Coston N710130@UNIVSCVM.CSD.SCAROLINA.EDU
USC Speech and Hearing Center voice: 803-777-2614
1601 St. Julian Place fax: 803-253-4143
Columbia, South Carolina 29204
On Thu, 23 Feb 1995 Luanne Hopkins LHOP4948@ACC.FAU.EDU wrote:
I am a graduate student in the communication disorders program at
Florida Atlantic University and am a new subscriber to the stutt lists
. The reading on all the lists these past couple of weeks has been
interesting and educational. My interest was especially captured by
the scenario discussed in the 2025 messages and the resulting messages
about the Birch Tree Foundation. I think the world described in the
year 2025 is a wonderful world to strive for and it's great to hear
that some strides are being taken toward developing programs which
take a multidisciplinary approach to the treatment of stuttering. In
fact, I think a multidisciplinary approach should be used in just
about every discipline that is directed toward helping people become
better/healthier people. It would be great if all speech therapists
could/would reach out to other disciplines for help, new ideas and new
ways to treat the person who stutters as a whole person and not as a
speech disorder. However, sometimes I can't help thinking about the
many obstacles that can get in the way of making the ideal world of
2025 available to ALL people who stutter.
Time and money (or the lack of both) take a toll on all professions
whose goals are to help others. From teachers to doctors to social
workers to SLP"s, it seems more often than not people are either
unable or unwilling to take the time or spend the money required to do
the job right. It takes time and effort to organize a
multidisciplinary team to treat a person holistically. To my mind, in
the year 2025 all professions which address themselves to the
betterment of others should take the time and money and effort it
requires to treat the whole person. Unfortunately, in this age of
HMO's, large bureaucratic clinics, SSI, Medicare, Medicaid and
budget cut backs, the world of 2025 sometimes seems unattainable. To
end on a positive note, however, it's nice to hear that the problem is
recognized and that some small steps are being taken in today's world.
>
Luanne Hopkins LHOP4948@ACC.FAU.EDU
Florida Atlantic University
On Thu, 23 Feb 1995, MR IRA ZIMMERMAN at: NGSC93A@PRODIGY.COM wrote:
One area that has not been considered by others in this subject is the
likelihood that there will be a medical treatment for stuttering.
There is significant work being done by the medical community in PET
Brain Scans studies and medication research. I'm mostly familiar with
the work at the University of California at Irvine Medical Center
which is studying the area of the brain that is not functioning
properly during stuttering. I can see this kind of medical research
resulting in a greater understanding of this thing we call stuttering
and it's inclusion in the treatment plan for stuttering in the year
2025.
Ira Zimmerman
NGSC93A@PRODIGY.COM
On 23 Feb 1995, Janet Givens Ackerman at:ackerman@ENIAC.SEAS.UPENN.EDU
wrote:
I couldn't agree with Ed Feuer more in his plea to have a truly multi-
disciplinary approach to the treatment of stuttering. I have been
calling for this, off and on, since I joined the list.
As many of you know from my postings (few and far between lately, I
realize) I often relate what I hear from the SLPs on the list to my
understanding of social psychology -- locus of control in particular.
My very first posting worked in attribution of responsibility (AR)
theory to a discussion of "who was responsible" when a client did not
improve with treatment. I have tried to introduce discussions (from a
social psych point of view) on the concepts of control and
perfectionism (not unrelated themselves) as they impact the lives of
PWS (and the stuttering themselves). I am very interested in applying
Identity Theory to a stuttering population and have broached that idea
on occasion. It is difficult to get a debate going -- I assume
because of the simple and understandable fact that this is not a list
of social psychologists. It is a list of PWS and of SLPs with a small
smattering of family and friends. Too often not only is our language
different, but our paradigms on how we look at life -- what we
consider to be salient -- is different. WE must all learn to listen
better to one another, IMHO.
I would LOVE to see Carol Pateman's political efficacy theories
translated into a research design that would include PWS. The world
is ripe for such interdisciplinary approaches. I am SO glad you
brought this subject up, Ed.
For those of you who don't know me, and since Woody's posting there
have been a few "who the hell is this janet ackerman person" -- my
education is in sociology (a master's in social psych, and four years
of doctoral work in political sociology), I also bring to the BTF four
years of work in Gestalt Therapy (the Be Here Now therapy, I often
call it) and many years in active 12-step recovery. My lifetime of
stuttering (I started when I was 6) was interspersed with many
different forms of ineffective speech therapy -- some which I
sincerely believe exacerbated my stuttering. I am today a "recovered"
stutterer. I still stutter, but now my reaction is more often, "oh
look, there goes another one."
Woody has referred to the BTF on other occasions as "a marriage of two
worlds." In many ways it truly is. He is the speech scientist,
clinician, and theoretician; I am the organization - person. While my
education (and my heart) is in sociology, my work experience is in
not-for-profit management and particularly fund raising -- over ten
years now. In this day and age, one needs expertise in both the
programmatic and the administrative.
I will be happy to respond to personal postings to me.
janet ackerman
On 2 March 1995, Terry Clark wrote:
My name is Terry Clark, and I'm a student at Florida Atlantic
University. I was particularly interested in comments that Ed Feuer
made regarding what to include in a Multi-Disciplinary Approach. I
agree that desensitization to fears has a place, but am concerned
about inclusion of assertiveness training, anti-procrastination
techniques, interpersonal communication, and psychotherapy. Along the
same lines, a couple people commented on the benefit of visualization
and relaxation techniques, both also coming out of the discipline of
psychology.
It seems to me that two different psychological issues are
being lumped into one broad "psychology" catch-all. The first deals
directly with speaking situations and/or words that a stutterer
confronts. Desensitization, visualization, and relaxation are all
ways of coping with natural fears and anxiety which have resulted from
stuttering in certain situations and/or on certain words. I agree
that these techniques should be employed in a Multi-Dimensional
Approach.
The second, separate issue is in the realm of personality
disorders/psychoses. To include assertiveness training, anti-
procrastination techniques, interpersonal communication, and
psychotherapy within a Multi-Disciplinary Approach is to imply that
there are some disorders of personality peculiar to the stuttering
population. Is it true that this is the case for the stuttering
population more than it would be for the general populace? In class,
we discussed this idea as being folk theory, and related it to
Johnson's 1967 article, "Speech Handicapped School Children", which
labels it as folk theory. Does anyone have a basis for including
these treatments in a Multi-Disciplinary Approach for stutterers?
On 4 March, 1995, Ed Feuer answered:
First of all, nowhere in my posting did I imply that there are
some disorders of personality peculiar to the stuttering population.
What I did say is that in 2025 there would be "much greater
understanding that the bruised psyches and emotional scar tissue
*created* by stuttering must be healed if working on the
inappropriate speech behaviors is to be successful."
Let me suggest a way to help make that understanding come about
earlier than 2025 so that you and your classmates will be more than
just part of the unsuccessful crowd of tongue jockeys concerning
stuttering.
What I am about to recommend is worth at least one whole graduate
course. Take your classmates and your prof and go out and do a couple
of months of pseudo-stuttering in all kinds of speaking situations
and on the telephone. Not just a token hour or two but a few months.
Keep a journal in which you can record the reactions of the
listeners and your own feelings about each of these experiences.
Then you'll start to understand what stuttering really is about. I
can predict that your prof (providing he or she isn't a PWS) will be
too arrogant to want to gain such understanding and empathy -- but
that of course is part of the problem.
Stuttering is bigger than the speech therapists. That is why we need
a multidisciplinary approach. Not just a multi-dimensional approach
with one person who lacks the knowledge and time trying to do it
all, but a coordinated multidisciplinary approach that includes
practitioners from other fields as part of a treatment team. The
status quo is the "folk theory".
-- Ed Feuer
On March 3, 1995, John Harrison at johnnyh@holonet.net responded:
I'm one who fully subscribes to a multi-disciplinary approach, and
speak from good authority. For 25 years or so I dealt with a
stuttering problem, and for the last 25 or so I have been totally
recovered. Being a good observer along this "road", I discovered that
stuttering is anything but a unitary problem. There are many
different factors involved, such as self-assertion and interpersonal
communication issues involved. However, it is incorrect to assume
that just because there are other factors involved, that these are
indications of personality disorder.
What I discovered is that chronic stuttering is a **system** in which
a number of factors come together in a particular way to create a
dynamic, self-supporting system. You do not need pathology to make
this happen. You simply need a series of life circumstances that
brings these factors together at the right time in the right
combination to create a living system. It is in the same
classification as a performance fear, but with some other interesting
ramifications.
If you would like to read a more complete discussion of this system
approach, you can access the new gopher site on stuttering at Mankato
State University. I have a number of essays on file, including one
that talks about "A New Paradigm for Stuttering." A number of people
have read this paper to date and it has created some interesting
discussion. I would love to pursue this further with others who would
like to discuss and explore these ideas on the net. I'll also be
happy to send you a 23 page printed version that has a lot prettier
text and drawings if you send me $3 to cover copying and postage.
The gopher site on stuttering can be reached at:
gopher.mnsu.edu following the path /academic colleges and
depts/communication disorders/stuttering
John C. Harrison
Program Director
National Stuttering Project
johnnyh@holonet.net