This is a threaded discussion page for the International Stuttering Awareness Day Online Conference paper, What Is Wrong With John Wayne's Stuttering Therapy? by Hans-Georg Bosshardt (Germany). Humanistic Side of Treatment From: Ellen Bennett Date: 10/1/98 Time: 3:53:05 PM Remote Name: 129.108.2.198 Comments What a wonderful job of pointing out the need to looking at the humanistic side of treatment for people who stutter. JW's treatment style, though effective at that moment, can have a back-lash effect on the client. I encourage Speech Language Pathologists to consider the personal side of the client when developing treatment plans. SLP's should ask them selves "Would I be able to do this task?" or "How would I feel if I had to do this task?" Shocking the client into being fluent versus assisting the client to discover how to be fluent may have different long-term effects on the psyche of the client. Certainly is something to think about. Clinic room therapy From: Ed Feuer Date: 10/1/98 Time: 4:06:36 PM Remote Name: 207.161.63.109 Comments What John Wayne did is really not too different from the approach of those clinicians who get their stuttering clients relaxed in the clinic room where they control all the these clients relaxed in the clinic room where they control all the variables and there is only one focus. They give the stuttering client some ÒtechniquesÓ and voila Ñ they are temporarily "fluent" or there are less "moments of stuttering." "Now," says the clinician. "Just go out and use the techniques." Invariably the person who stutters falls flat on his/her face in the real world, and if he or she comes back to the clinician they are told: "Ah, you're just not working." Saddle up, pardners. Re: Clinic room therapy From: Date: 10/19/98 Time: 1:17:51 PM Remote Name: 209.18.244.27 Comments This is a good point. The "Try & Can" approach can easily infiltrate those who should know better.It was interesting that swearing was the venue for fluency. While this can be a fluency enhancer for some (did John Wayne know this?) the tense emotional conditions under which those words were spoken would tend (I'd think) to prevent fluent speech. I wonder how those two seemingly opposite reactions interplay So called "resistance" to therapy From: Gunars K. Neiders, Ph.D. Date: 10/2/98 Time: 5:34:42 PM Remote Name: 199.238.253.15 Comments Dr. Bosshardt, Thank you for making a good point. And, Ed, thank you for pointing out which therapists really have the John Wayne philosophy. Especially, those therapists that are unwilling to voluntarily stutter in the way the client does and yet ask him to go out and throw himself to the "dogs" without proper psychological preparation such as de-awulizing stuttering. Unfortunately a clients so-called "resistance" has been with us also in the field of psychology. There the "great" Freud invented the concept that some clients are resisting his good therapy. A more insidious type of JW therapy is the claim that a client is not overcoming his problem because he has some mysterious payoff over which he has some type of voluntary control. An example of this has been floating around on the stutt-x and stutt-l list servers, "I am just not ready to accept myself as a fluent speaker." Fragmented self From: Ed Feuer Date: 10/3/98 Time: 1:13:47 AM Remote Name: 207.161.119.14 Comments Further to what Gunars said about some SLPs saying their clients have the attitude: "I am just not ready to accept myself as a fluent speaker." This is a euphemism for the repugnant "secondary gains" idea. I think that problem is really that the clients donÕt want to accept themselves as persons who stutters. One of the major difficulties in treating stuttering is that very transience of stuttering Ñ a phenomenon that many SLPs don't really comprehend. We're walking around with a split Ñ a fragmented self. We don't stutter or stutter a lot less when there is little or no communicative stress (Situation A). We stutter more when there is communicative stress (Situation B). We want to view ourselves as A. But many significant people in our world see us only as B. Many fluent speakers, too, talk about a perception gap between how others see them and how they see themselves. For PWS, that gap is often far wider and real compared to the fluent speaker's "gap." And it probably has a lot to do with the resistance and sabotage about which SLPs complain. Problem is, far too much of current stuttering therapy is only token therapy and doesnÕt address the fragmented self issue, let alone deal with it. Ñ Ed Feuer Re: Psychodynamic functions of JW's approach From: Hans-Georg Date: 10/5/98 Time: 12:06:04 PM Remote Name: 134.147.208.1 Comments I like to comment shortly on Ed Feuer's and Gunnars Neiders the interesting remarks. They both focus on the psychodynamic role which interpretational schemes can have for the therapist himself. It is worth noting that before therapy no professional will buy JW's approach but I completely aggree with their suspicion that after nonsuccessful therapy for some therapists the situation is very different. One way to cope with the own disappointment at a failure is to blame the client instead of the own therapeutic skills. "Resistance" of the client is a similar interpretational scheme which can be used by the therapist to maintain a high self-evaluation in spite of a failure. I know of only one cure against this: continuous self-reflection and self-evaluation of the own therapeutical process and supervision. Thank you for having made these interesting points. Hans-Georg Re: Psychodynamic functions of JW's approach From: Gunars Date: 10/5/98 Time: 7:28:32 PM Remote Name: 199.238.253.11 Comments Another way for the therapists is to understand that they are fallible people with as yet incomplete understanding of the problem of stuttering. If the therapists truly adapt a view that they are entitled to make mistakes, as well as fail in the therapy process, without downing themselves as bad therapists or bad people, maybe they would not need to act defensively. Gunars Psychodynamic functions of JW's approach From: Hans-Georg Bosshardt Date: 10/6/98 Time: 1:02:03 AM Remote Name: 134.147.208.1 Comments Ed Feuer and Gunnars made very interesting comments focussing on the psychodynamic role which interpretational schemes can have for the therapist himself. It is worth noting that before therapy no professional will buy JW's approach but I completely aggree with their suspicion that after nonsuccessful therapy for some therapists the situation is very different. One way to cope with the own disappointment at a failure is to blame the client instead of the own therapeutic skills. "Resistance" of the client is a similar interpretational scheme which can be used by the therapist to maintain a high self-evaluation in spite of a failure. I know of only one cure against this: continuous self-reflection and self-evaluation of the own therapeutical process and supervision. Thank you for having made these interesting points. Hans-Georg JW therapy From: Chuck Goldman Date: 10/9/98 Time: 5:02:36 PM Remote Name: 152.163.205.59 Comments The JW stuttering philosophy is akin to the old notion that stuttering is in the stutterer's control. Although most leading research acknowledges that stuttering is not in control of the stutterer ( In fact voluntary loss of control is at the heart of the Perkins definition), the JW therapy approaches persist to some degree and with some reason. Stutterers must simply believe that they can control fluency to some degree in order for any therapy program to be successful. Re: JW therapy From: Hans-Georg Bosshardt Date: 10/16/98 Time: 2:13:31 AM Remote Name: 134.147.208.1 Comments Dear Dr. Goldman: I aggree with you that the belief in the effectiveness of therapy and in the own ability to speak fluently is essential for therapy. But it is essential for therapy motivation and for the maintenance of this motivation in spite of relapses. Therapy with adults who stutter can be - and often is - a time consuming enterprise for which clients and therapists need to be highly motivated and must be able to maintain their motivation over some time. However therapy effect studies clearly show that there are therapies available which do not only influence the beliefs but which in addition have solid effects on speech fluency. In my article I wanted to stress that the inability for fluent speech has to be taken serious and I wanted to make clear how harmful the consequences of JW's behavior most probably will be. But I wanted also to stress that every "cannot" depends on the present demands and abilities. Both components are no "natural constants" but can be changed and therefore today's "cannot" must not necessarily be next year's "cannot". Personal motivation and belief in success are of course the essential forces which drive such a change. Thank you very much for your comment and for providing the opportunity to explain this in greater detail. Hans-Georg Bosshardt Loss of voluntary control, direct and indirect From: Gunars K. Neiders, Ph.D. Date: 10/19/98 Time: 6:31:32 PM Remote Name: 12.13.226.11 Comments In constructing Rational Emotive Behavior Therapy for stuttering, I am wrestling with the concept of voluntary control. Voluntary control is a slippery concept that can not be readily understood (at least not by me :-) ). To make things more confounding is that even the non-stuttering normal dysfluencies encountered by a normal speaker from time to time are NOT under voluntary control. When building up a client's confidence in the success of the therapy I posit we let the client know that two types of indirect voluntary control are available to all of us. Even though strictly speaking this control is voluntary it is displaced along the time axis. The after fact control was clearly demonstrated by Van Riper and his pullouts. The pre- pullout was a try at voluntary control started after the client anticipated a stuttering incident, but before he started to talk. The easy onset also at times are used by the clients to voluntary control stuttering by acting before the onset of the block. The second type of indirect voluntary control is the statistical control via desensitization and de-awfulizing stuttering using cognitive psychology methods such as REBT. These are not perfect controls. The pullouts and pre- pullouts, when done correctly would, even though starting with imperfect control, be extended until the feeling of control is established. My question then is: Could not a therapist convey to the client that voluntary control is not a Boolean variable (i.e. having the values of only yes and no) but a concept from "fuzzy logic" where control is both a function of time and probability that can be enhanced with work done a priori? Re: JW therapy From: Hans-Georg Bosshardt Date: 10/16/98 Time: 2:13:43 AM Remote Name: 134.147.208.1 Comments Dear Dr. Goldman: I aggree with you that the belief in the effectiveness of therapy and in the own ability to speak fluently is essential for therapy. But it is essential for therapy motivation and for the maintenance of this motivation in spite of relapses. Therapy with adults who stutter can be - and often is - a time consuming enterprise for which clients and therapists need to be highly motivated and must be able to maintain their motivation over some time. However therapy effect studies clearly show that there are therapies available which do not only influence the beliefs but which in addition have solid effects on speech fluency. In my article I wanted to stress that the inability for fluent speech has to be taken serious and I wanted to make clear how harmful the consequences of JW's behavior most probably will be. But I wanted also to stress that every "cannot" depends on the present demands and abilities. Both components are no "natural constants" but can be changed and therefore today's "cannot" must not necessarily be next year's "cannot". Personal motivation and belief in success are of course the essential forces which drive such a change. Thank you very much for your comment and for providing the opportunity to explain this in greater detail. Hans-Georg Bosshardt Window Analogy From: Valerie Johnston Date: 10/14/98 Time: 8:57:10 PM Remote Name: 209.30.10.182 Comments I thought your analogy of the fragility of glass in a window as compared to the disablities behind disfluent speech was a good one. It is a comparison that I plan to use with the parents of children who stutter that I work with to explain how the environmental factors interact with the personal factors. Thank you for the insight. Valerie Johnston Re: Window Analogy From: Hans-Georg Bosshardt Date: 10/23/98 Time: 10:06:51 AM Remote Name: 134.29.30.79 Comments Dear Valerie Johnston: I am really delighted that this image is helpful for your work. It was originally invented by philosophers to make their highly abstract "dispositional concepts" more concrete. Thank you very much for your comment. Hans-Georg Bosshardt