Self-Confrontation: A Personalized Therapy For Persons Who Stutter

Gerald(Jerry) F. Johnson, Ph.D., CCC SLP/A
Professor Emeritus, School of Communicative Disorders
University of Wisconsin-Stevens Point
Executive Director, AIMS
American Institute for the Management of Stuttering
474 Lake Bluff Lane
Grafton(Milwaukee), WI 53024-9754
414-377-5377; 414-377-2301

"What am I doing wrong?" Is a typical cry for help from many persons who stutter (PWS) both during and after therapy. In my opinion it is because the therapy was not self-directed by the PWS who should have been challenged to self-confront and problem solve. It Is also my opinion that many therapies are striving to be "white boxed-generic-cookbook" type therapies that try to fit the PWS to the therapy and not the other way around. The "what am I doing wrong" PWS is looking to the Speech & Language Pathologist (SLP) to TELL him/her what to do. This type of one way therapy is too weak to effect long term change in the PWS, Relapse is a common problem of most therapies which do not Provide for long term maintenance of the modification/fluency skills developed and learned in therapy. Cookbook type therapies do not have enough "sticking power" to help the PWS overcome the omnipresent negative stimuli he/she continues to find in his/her natural environment.

I would also argue against perfectionism in therapy for PWS Tolerance of imperfection, especially for imperfect speech, in everyday living is an important concept. Many PWS expect therapy for stuttering will make them into their preconceived "type of speaker" who does not falter or hesitate or avoid or-or-or. This unrealistic expectation gives rise to dissatisfaction with oneself and the therapy. Self-confrontation with realistic self-directed and identified goals on the part of the PWS helps the PWS establish tolerable progress in and out of therapy. It Is important to help the PWS understand the "Dynamics of Stuttering" in order to establish realistic goals and an objective self-analysis. My definition of the "Dynamics of Stuttering" is: "Stuttering, with its neurological, Physiological, chemical, and genetic underpinnings, along with its negatively enhanced development, environmental, sociological, psychological and behavioral components, and which manifests itself in negatively reinforced episodic stuttered speech and disordered language, becomes a powerful, self-reinforced behavior which ultimately becomes totally integrated Into a person's life." A thorough discussion of these concepts takes the mystique out of stuttering and also provides a base for discussing behavioral modification which is necessary to minimize each concept within the structure of the self-confrontation therapy.

For example, it is important to have the PWS understand the influence of the brain in stuttering and how these variables can be managed through understanding the BRAIN WARS and how to control the misfirings and conflicts that are inherent in the brains of PWS. Some 60 years ago it was postulated that the brain was confused in PWS and that it somehow misfired and became out of sync while the person was stuttering. Research continues to this day to map the brain's landscape and to discover more about these BRAIN WARS. In the near future a PWS will be analyzed by a neurologist who will do real time mapping of the brain of the PWS while at rest, doing various listening and motoric activities, while mouthing speech without voice, while whispering and gradually adding voice and volume, while singing, while reciting a well learned and familiar rhyme, joke, or saying, and while speaking under varying degrees of typical environmental stress. The outcome of these and other tests will determine which locale of the brain will be zapped to eliminate stuttering. Or, a pharmacological brain blocker will be administered to eliminate stuttering. However, their might be too much general in the brain during stuttering to overcome it in hard-core PWS by surgery and/or the use of pharmacological agents.

SLPs are neither brain surgeons or pharmacologists, but the SLP can guide the PWS through a self-confrontation, self-actualization type therapy either in conjunction with or isolated from other medical treatments. Reality still dictates that the PWS must learn to dictate to him/herself the direction of the therapy in order to "get better." As stated earlier, stuttering is an extremely complex disorder, but one that can be treated successfully through self-confrontation and the development of a personalized therapy program.

Without going into detail here (see Suggestions for Modifying Some Personal Attitudes of Persons Who Stutter), self-confrontation and analysis involves not only symptomatic stuttering analysis and modification but also analyzing and coping with the following personal characteristics: envy, imperfection, intimidation, obsession with stuttering, intensity, energy, satisfaction, accommodation, and the myth of stutter free speech for the hard-core PWS. In an article I wrote for the JFD ("Ten Commandments For Long-Term Maintenance Of Acceptable Self-Help Skills For Persons Who Are Hard-Core Stutterers", 12[1987], 9-18)(attached) I discussed the following concepts which fit nicely into this section of the mini-seminar:

Undertake an objective self-analysis, develop rational thinking, work for Philosophic change, achieve spontaneity, keep yourself healthy, do not fall victim to the guru complex, do not procrastinate, achieve independence, your choice-talk to yourself, and Monitor, Action, and Performance (MAP) your way to fluency.
Lastly, symptomatic stuttering analysis and modification are important to the PWS so that he/she can determine a self-direction for the modification of his/her stuttering. I call this section "Good Stuttering-Bad stuttering" (attached) and I offer ssuggestions for the management of stuttering, such as dealing with the continuum of the stuttering residual, identifying both "good and bad" stuttering, turning the anticipatory panic response (APR) into a therapy technique, tolerating good stuttering, positive self-talk and visualization, risk taking, adjusting the monitoring of symptom modification to fit the environmental condition, and options for modifying "bad stuttering."

added with permission, October 29, 1998