This is a threaded discussion page for the International Stuttering Awareness Day Online Conference paper,
Stages of Coping: A Stutterer's Journey from Denial to Integration by Louise Heite
(Iceland). The presenter of this paper, has consented to have a personal email address posted here if you wish raise further questions and/or
comments. Lou Heite - 


From: Lou Heite
Date: 10/1/98
Time: 6:31:56 AM
Remote Name:


Welcome to the discussion area for "Stages of Coping." I really do hope that we can get a lively discussion
going here My main interest is to see how well the ideas that I have outlined in my article fit with other
people's experiences. 

A caution: If anyone uses this space to promote their own favorite brand of therapy, to soapbox, to make
personal attacks, or to post irrelevant material, I will not hesi- tate to ask Judy to delete the posting. Use the
kind of good manners you would expect to use in person (why do I feel that I need to say something so
obvious?!) and remem- ber that no matter how convinced we are of our own paths to recovery and coping,
other people's experiences are just as valid as our own! 

With that schoolmarmish caution out of the way, let's hear from you all! 

Lou Heite

Role of SLP

From: Judy Kuster
Date: 10/4/98
Time: 11:16:18 AM
Remote Name:


Thank you for your fascinating and insightful article. I'm wondering, how do a clinician and a client
determine what stage an individual may be, and is that important to determine in order to be effective with
that client in therapy? Is it important to facilitate progression through the stages and, in your opinion, can
a speech-language pathologist do that effectively? If so, any suggestions how?

Re: Role of SLP

From: LH
Date: 10/5/98
Time: 5:51:18 AM
Remote Name:


 Hi, Judy. Good questions! Before I try to answer them though, I have to remind you that I am not a
clinician, and any answers I might provide on subjects relating to clinical decision making are spun out of
clear air and cloud wisps. It's a little presumptuous for me to answer directly. I would rather prefer to hear
your own answers to your questions, and the answers of your colleagues. How would you apply these
ideas to the way you handle clients?    

You know also that what I have presented is not a procedure but a paradigm -- a large outline of an idea into
which many different specific expressions might fit. I certainly hope that nobody will be tempted to look at a
client and mutter to him- or herself, "Aha! A Stage Four! Well, that means ..." On the other hand, I hope
that this concept of staged progress might help the clinician recognize whether a person is really ready for,
and up to, the demands of a particular therapy procedure, or whether the client has perhaps passed beyond
the point where a given procedure is appropriate or even applicable.    

That said, I do think it should be fairly easy to determine grossly where someone is in the process of coping.
Assessing the readiness of a client for any procedure is part of the job, so I am told. This paradigm is not
really that different a way of thinking. You can usually spot the seekers, the angry people, the ones who are
so lost in a grief-like state that they may be a danger to themselves. And if you aren't sure, ask the client!
Some careful interviewing should reveal pretty quickly how the person feels about his or her speech and
how they feel about being a person who stutters -- which need not be the same thing at all. Also, if the
person's actions in therapy seem to belie their direct statements, that should be an important clue to how
realistically they view their problem at a deep level. It can also be a clue to the presence of other, interfering
problems that may need to be solved first before one can expect to make progress with speech therapy.    

Is it important to determine where a person is along this path in order to conduct therapy? Possibly not. But
having a progression in the back of your mind can certainly inform your goals and decisions, and for the
client it might help explain why you are asking him or her to do things that seem to be absurd. If you are
trying to climb over a very large and foggy mountain to get to the town on the other side, it helps to have a

Is it important to facilitate that progression, and can a slp do it? I am not competent to answer this, Judy.
Some day I will be, and I expect that the answer for me will be yes, and yes. But right now I shall have to
leave that answer to wiser and more experienced heads than mine -- like yours!    

I do think that for many the progression will happen more or less by itself, but not for all; and for still
others, not as quickly and smoothly as it might do. And while clients ultimately have to make their own
choices and find their own paths, it is sort of unconscionable to let someone misspend their energies without
at least calling their attention to alternate, easier routes. 

Your abstract

From: Lieven Grommen
Date: 10/7/98
Time: 4:42:31 AM
Remote Name:


As a healthworker (General practionner) and PWS I was particulary impressed by your refreshing
approach to the evolution of coping with stuttering by comparing it to the mourning proces as described
by Kübbler-Ross. The model still works in all situations where real or supposed loss dominates. I think
positioning a PWS on that scale will help directing the therapy. The PWS himself will gain much insight
by the analogy. To me it was the most refreshing experience since I logged in on Stutt-L, and it finally
made me understand a lot of past emotions. When at the end of the route fully integration happens to
install, there will be often an important improvement of communication skills. Perhaps that perspective
must be given to the PWS in the earliest stages of the proces. I am very grateful. 

Re: Your abstract

From: LH
Date: 10/7/98
Time: 10:26:33 PM
Remote Name:


Thank you, Lieven. Kubler-Ross' ideas on the process of facing adversity are a very powerful paradigm.
This little think- piece is a first step to applying the idea to stuttering,and it can certainly bear a lot of
refinement and testing. I do think, though, that having some idea of where you are going will help make the
journey a little more bearable. 

Just wondering, in your work,do you encounter people with other kinds of chronic problems that might
have an analogous progression through different stages of coping? 

Lou H. 

Re: Your abstract

From: Lieven Grommen
Date: 10/9/98
Time: 2:54:58 AM
Remote Name:


In general medicine the most evident mourning proces is the one after the loss of a loved person. Other
conditions with the classical stages of grieving are cancer-diagnosis; chronic neurologic conditions like
multiple sclerosis etc.. In fact each chronic disease demands your description of an elaborate
mourning-labour. But very few people are able to pass till the final stage of integration; in my experience
there is much fixation, first in denial later in aversion or aggression.

Re: Your abstract

From: LH
Date: 10/9/98
Time: 11:13:55 AM
Remote Name:


Hello, Lieven. 

In the cases where people stick in these unhappy early stages, what do you and your colleagues usually do?
Do you usually send people to counselors, or are there methods that speech therapists might employ to help
people move on to a more productive place? 


Re: Your abstract

From: Lieven Grommen
Date: 10/10/98
Time: 11:46:55 AM
Remote Name:


Hello Louise, The keypoint imho. is the intelligence of the subject. ( Very inequal among humans). Second
point: coping requires time. A healthcare-worker has to be very patient and repect the own mental and
emotional rytm. Listening to him is very important. It can be the first time he is trying to verbalise his
emotions. When people get really stuck in a mourning phase I habitually refer to a psycho-therapist to help
accomplisch the proces. At this point the discussion about the kind of psychotherapy. Btw my wife just
comes in and says: there is a kind of loss that never hurts: the loss of weight...

when is a person "ready?"

From: Michael Sugarman
Date: 10/8/98
Time: 8:58:05 PM
Remote Name:


hello louise, thank you for your insight. Your description of how you and pws can process change is very
important for the stuttering community. I believe its very important for consumers to realize that they can not
just go to a therapist and expect change to happen to them. It is a process that one does for oneself. My
question to you has to do with, when in the process do you believe a person is willing or ready to work on
his or her stuttering and self?

Re: when is a person "ready?"

From: LH
Date: 10/9/98
Time: 10:59:43 AM
Remote Name:


Hi, Michael. You ask, “When in the process do you believe a person is willing or ready to work on his or
her stuttering and self?” 

That is an important question. I don’t really believe that working on the stuttering per se is going to be
effective until the person has passed the stages of denial and aversion (or anger for people who’d like to
stick closer to the classic mourning model.) I think that the reasoning here should be pretty transparent, as
one cannot work effectively on something that one won’t acknowledge, or won’t face. A lot of the
desensitization work that therapists do seems to be designed to move people through these stages to the point
that they can at least resign themselves to the need to do some hard work. How to do that is certainly best
left up to the individual and his or her therapist. The therapist’s job is to keep the person pointed in a good
direction, and perhaps sometimes to put them through the uncomfortable process of working through these
stages to a point that they are ready to take on the learning task that speech therapy really is. As Lieven said
in his latest comment, people tend to stick in denial and aversion or anger when confronted with a loss or
with other chronic conditions. There is no reason that stuttering should be different. 

Here too is where the “recovery” model kicks in, as for at least some of us no matter how accepting we are
and how hard we work, the stuttering won’t really go away. In drug and alcohol recovery, people are taught
that the job is never done, there are no cured addicts or alcoholics, only long-term recovering ones. One has
to make a daily choice as to whether one is going to give into compulsion or not. Stuttering is not nearly so
destructive as those two problems -- thank goodness! -- but still, one has to be prepared to refresh the
speaking techniques, or to allow oneself to stutter some, or to do whatever else one must to first, keep
equillibrium, and second, manage the speech. The really important thing is to know what you are doing and
not rush headlong into the “mustn’t stutter!” panic. You know you’re on the way when a bad speech day is
really no more an obstacle than a bad hair day. 


Stages of Coping

From: Lynne Shields
Date: 10/16/98
Time: 11:24:53 AM
Remote Name:


Louise, I was pleased to 'hear' from you via this conference. I read it early on in the conference and haven't
had time to respond until now.Your piece is quite good--I have usedit several times in class discussions here
lately. Thanks for putting it into words for us. I do have a question for you relating to the issue of
"recycling" of stages. You do mention briefly the notion that someone may backslide to an earlier stage. Do
you see this as a common event, from your perspective, in stuttering? I attended a short course given by
Dave Luterman last year at ASHA. He suggested that it is important to remember that people may need to go
through the grieving process more than once, particularly in the case of a disorder such as MS or
Parkinson's, where there is degeneration of function. The person and their family will need to grieve all over
again the losses as they occur. He saw too often the lack of consideration of this in treatment and in
counseling with families. 

It occurs to me that one might see this happening for someone who stutters, since the speech is
progressively worsening for the developmental period, for many. In addition, some people seem to
experience significant setbacks regarding fluency. 



Re: Stages of Coping

From: LH
Date: 10/16/98
Time: 3:07:21 PM
Remote Name:


Hi, Lynne! 

I do owe you a private letter! It will be a long one when it comes. A lot of water has passed under my bridge
since early last Spring. 

Thank you for your kind words. I am especially delighted that you have been able to use the article in your
class discussions. That is gratifying indeed. Making things like that possible is one of the very good effects
of this conference. Great! 

To the matter of “recycling” of stages, your observation is astute and important. I’m sure that you know that
the more recent iterations of the concept of staged grieving involve the idea that people don’t just do it once,
dust off their hands, and get on with things. Instead, most people more or less spiral through the grieving
process with gradually diminishing intensity for a very long time. And certainly in the case of progressively
degenerative diseases, the people who have them (and their families) often hardly have time to deal with one
loss before they are faced with a new one, and a new grieving cycle. 

I do say in the article that it seems that a chronic stutterer is faced with a constant, if low-level, reinforcement
of the sense of loss for several reasons. The cyclical nature of stuttering, and the impermanence of most
treatments, rather set the person up for this. Certainly too, some people’s speech does deteriorate over a
fairly lengthy time, although it seems to me from some not at all scientific sideline observation that most
people reach a nadir during or before their late teens, and then even without treatment the stuttering levels
off. Some lucky ones even begin to spontaneously regain some fluency. I ought to go look for some
longitudinal studies of people who stutter and see if this is a correct observation. (Perhaps you or another
reader can set me straight?) 

I am quite sure that a real setback in one’s speech could also set someone back in their progress towards
coping. I am also sure that that such a setback will be much more devastating to someone who is in the
earlier stages of coping than to someone in the later ones. In fact, one definition of successful coping with
almost any condition is he ability to deal with setbacks without losing equillibrium. 

I need to restate that for the nonce I am limiting this paradigm to adult chronic stutterers. I simply haven’t
observed enough children (and their parents) dealing with a long-term deterioration of their speech to do
more than speculate. How might understanding the coping process impact on a child whose stutter is both
developing and worsening? I know that you have worked with kids and parents a lot, and I’d like to have
your thoughts on this. 

It does seem to me that the angriest and most aversive chronic stutterers are mostly young adults, who have
spent the greater part of their lives watching their speech deteriorate, and often their hopes and self-respect
along with it. It seems to me that if it is not possible to arrest the progress of the stuttering, it is incumbent
on theinvolved adults to try to lessen the impact of these cycles of disappointment and their attendant

That’s a big order, I know, but not impossible. I wish it were possible to put kids who are clearly at risk of
becoming chronic stutterers, or whose stuttering seems to have settled in for the long term, into one-on-one
contact with a fairly successful adult stutterer who can just be a friend and mentor. I’ve done that with a few
kids on my own, and I know that that is an incredibly powerful tool to help the child realize that no matter
how well or poorly they might be speaking on any given day, they will survive and even be able to make a
pretty good life. 

Lou H.

Bulimia and Stuttering

From: Chuck Goldman
Date: 10/17/98
Time: 4:56:24 PM
Remote Name:


I was mostly intrigued with the part of your learning journey that caused you to liken stuttering to abusive
and compulsive disorders. A close family member who suffers from Bulimia has often sought out my help,
perhaps, somewhat on a intuitional level. For her the symptoms that are in common include the chronicity of
the problem, the shame, the hiding involved, the relative "normalcy" of the primary symptom, the difficulty
in confronting the problem, and the belief at times that it can be hidden without enormous consequences.

Re: Bulimia and Stuttering

From: LH
Date: 10/18/98
Time: 9:53:30 AM
Remote Name:


Hello, Chuck. 

I think the resemblance between the social and personal consequences of stuttering and the consequences of
compulsive disorders is very important. I wish I knew enough about those conditions to really follow that
line of inquiry. I do know that some people have speculated about a genesis for some of those disorders,
particularly eating disorders, that is similar to the current stuttering theory that proposes an organic weakness
or instability that is triggered by stress. 

I wonder if some of the counseling techniques that specialists in those disorders use are adaptable to
working with stutters. Your experience certainly suggests that it can work the other way. Have you done
any reading or research in this? 

You know, it seems to me that we fumbletongues may not be as unique as we'd like to think we are! 

Lou H. 

Stages of Coping

From: Heidi Thorson
Date: 10/18/98
Time: 2:37:30 PM
Remote Name:


First, I would like to comment that I truely enjoyed your article on both a professional and personal level. I
am curious to know if there were any significant events or people that were especially helpful in getting from
one stage of coping to another(or if progression occured as a result time or from soul searching, etc.). 

Re: Stages of Coping

From: LH
Date: 10/18/98
Time: 4:10:10 PM
Remote Name:


Hello, Heidi. 

Oh, my, your question does make me think! 

To answer you quickly, yes there were both events and individuals who helped to move me, and
sometimes to propel me, into a new stage -- but not at every stage. I didn't want to get too deeply into
those details in the article because I think that those encounters depend very much on the individual's
own circumstances. I do describe a few of them in more detail in the supplementary and illustrative
material on the back pages of the installation (the links). 

Although I think that most people will negotiate the stages of coping pretty much in the same order, the
times in their lives when they do it, and the specific events that move them, are going to be highly
idiosyncratic. My real purpose in presenting this article is to try to outline a large process that people can
tailor to their own or their clients' lives without a lot of background noise from the details of mine. 

Early on in the process I had some encounters with stuttering and with stutterers that I just was not ready
for. The seventh-grade classmate whom I mention in the article is a good example. Some of those
encounters might have been very helpful if I had been less successful at avoiding the whole problem for
so long, but I was able to walk by them with enough of a show of at least superficial dignity that I only
recognize the lost opportunities in retrospect. I do wonder whether I would have come to terms with
stuttering much sooner if I had come from a more open and accepting family, but such speculation
belongs more to fiction than to analysis. 

It was largely the mellowness of middle age that made me sensitive both to what I had learned over my
lifetime, and to what use I could make of that experience. Age is not the crucial factor though, so much as
a kind of generous honesty with oneself that begins to resemble wisdom. I know people half my age and
younger who cope with stuttering (and some with other disabilities) with enviable equanimity. I also
know a couple embittered older persons whose anger at their stuttering seems to ooze from every pore in
their bodies. 

The question of course is how to move a person (or oneself) through the negative stages into the more
positive ones. I don't know how to do that. I am only just beginning to explore this whole idea myself. I
wish very much that those who have been working with stutterers for years would chime in here with
their observations! 

I do know that it can't happen by formula. All of the world's failed religions stand in testimony to that. I
also know that having a wiser head around who knows where the path has to lead can help someone
negotiate those difficult early passages before he or she becomes hopelessly lost. Although I did not
benefit myself early on from anyone's proactive assistance, the generosity and kindness of a few people
made immense difference to me later when I was ready to accept it. 

So, Heidi, I don't know if I have really answered your question or not, but I hope this helps. 

Lou H. 

Re: Stages of Coping

From: Lynne Shields
Date: 10/19/98
Time: 11:33:41 AM
Remote Name:


Hi Lou, 

Thanks for your comments, which, as always, get me thinking. You asked how having an understanding of
the coping process might affect a child, in the developing stages of stuttering. That is a very good question.
First, I would suggest that there may be other stages or prestages, if you will, in the coping sequence for
children. There is the growing awareness of one's speech as being different and difficult, as something to be
concerned about. I imagine that helping a child cope with their speech and reactions to it might lessen or
change the process that follows the initial awareness, particularly in the case of a young child. If caught early
enough the hope is that one can prevent both the stuttering from developing further, as well as to help them
cope effectively with any negative emotion that occurs. 

My current mode of operation is to talk openly with children about the problems they are having with their
speech. I also advise parents to be open with their children, taking their cues from the child as to what the
child is feeling and what they want to talk about regarding their speech (or anything else, for that matter).
The hiding and covering up seem so detrimental. At the very least, I work under the assumption that to let
the child know that you are willing to talk, to make them aware that they can talk about their speech and their
feelings, will give them a way to bring up issues as they arise, and perhaps assist them as they learn to cope
with stuttering. 

I do not believe that it will prevent the process of coping, in cases where the stuttering continues to progress.
But, my hope is that the child will be better equipped to deal with stuttering and perhaps move through to the
more positive stages more rapidly. 

In your response to Heidi, you mentioned the use of a mentor, preferably a well-adapted adult who stutters.
This is the best of all models, if it is possible, as it can give the child or adolescent a real model of someone
who has worked through the stages, or is currently working through them, and who has done so

I cannot say with any certainty that my being open with a child will help, of course. Nor do I have a better
answer to your question regarding how to help a client move on to the later stages. I agree that there are no
formulas for this. I am learning to be more aware of what a client is saying or demonstrating concerning
their feelings, and to try to suggest other possible reactions or ways of coping. I am trying to make more
positive options available to them, knowing that they will only take them up, or devise their own, when they
are ready. I'm attempting to take the horse to water and hoping it'll catch on and get that drink! 

I'll be looking forward to hearing from you later on. I'm eager to know how you are managing school,
work, etc. Quite a handful, though I'm sure you are doing well at it. 



Re: Stages of Coping

From: LH
Date: 10/20/98
Time: 7:26:17 AM
Remote Name:


Hi again, Lynne. 

You wrote: 

"You asked how having an understanding of the coping process might affect a child, in the developing
stages of stuttering. That is a very good question. First, I would suggest that there may be other stages or
prestages, if you will, in the coping sequence for children." 

You describe these a little, but could you provide more detail? When does a child seem to become aware of
stuttering, and particularly, when in the process does the child seem to become aware that it is undesirable?
Do those awarenesses usually coincide? Is it necessary for a child to be aware of stuttering as such before
s/he becomes uncomfortable speaking, or can it happen the other way around? 

I like your emphasis on openness, particularly as I know from my own experience that covering up is
certainly not helpful. Do you ever see kids who simply refuse to talk about stuttering? How about parents? I
suppose that parents who take their kids to a speech clinic are a relatively cooperative subset of a larger
group that necessarily includes parents who are themselves in some kind of denial or aversion, and who
can't make themselves take an appropriate action. As a teacher, I have more than once encountered parents
whose reaction to a child's fairly obvious learning problem is to say, "Whaddaya mean, MY kid has a
problem! You're just a lousy teacher!" You can find "stage mothers" in every walk of life. 

But even among the parents you see, it could be that a parent is far more aversive than the child, and
willingly or not, lets it show. Believe me, that is a hard thing for a kid (even a grown-up one) to deal with.
How can you help a child understand that the parent's reaction is wrongheaded and even hurtful without
treading into territory that can be very dangerous for anyone in a helping profession? 

"I cannot say with any certainty that my being open with a child will help, of course... I am trying to make
more positive options available... I'm attempting to take the horse to water and hoping it'll catch on and get
that drink!" 

Which of course is all that anyone can do, really. 

Lou H. 

Re: Stages of Coping

From: Lynne Shields
Date: 10/20/98
Time: 1:52:39 PM
Remote Name:



You wrote: "You describe these a little, but could you provide more detail? When does a child seem to
become aware of stuttering, and particularly, when in the process does the child seem to become aware that
it is undesirable? Do those awarenesses usually coincide? Is it necessary for a child to be aware of stuttering
as such before s/he becomes uncomfortable speaking, or can it happen the other way around?" 

Good questions, all of them, and I'm not sure if I'm the one to answer them. In the children I've worked
with--mind you, this is probably in the neighborhood of 10 children who were in the early stages of
developing stuttering, a very small sample--I have only been able to guess at awareness based on the
external behaviors I have seen. I assume that a child has at least some level of awareness when s/he show
any signs of struggle, forcing words, muscle tension, and the like, or if they show any avoidance behaviors
such as averting their eyes when they speak, or wincing or frowning when they are disfluent. 

As to whether the recognition of difference in speaking and a determination of undesirability coincide, that I
can't say. I suspect that it will vary from case-to-case. To give you an example of the difficulty in
determining this, one of my sister's has three sons. When the youngest was just three years old, she called
me, alarmed about Phillip's speech, which had become so disfluent. She was concerned because his
disfluencies were much more frequent compared to her other two boys at that age, and she was seeing
struggle behavior developing not long after she noticed the repeated words beginning to occur. He forced
words out, he averted his eyes, he gave a heavy sigh at times when trying to talk, or even told her that it was
'just too hard to say it' at times. He also began to show those signs of continued development--more
part-word repetitions and beginning blocking. Now he obviously was quite aware of his speech difficulty.
Did he decide that it was undesirable on his own? Or as a result of my sister's looks of concern when he
struggled? I am not sure I can say. My sister said she tried not to react to it, or say anything to him about his
speech, but, could she really keep the worried look out of her eyes? Or, did she only begin to react once
Phillip had become so aware and began struggling to speak? I'm not sure whether we will ever know the
answer to those questions. Phillip never developed further in stuttering. I don't know whether he was truly
developing stuttering or whether he was just over-reacting to normal disfluencies. After this went on for
some time, I gave my sister some suggestions regarding modifying her speech and and also suggested she
talk with Phillip about his struggles when he indicated frustration. She had long-distance phone therapy, as
it happened, after one in-person visit from me. Over the next 3 months, the disfluencies subsided, and he is
a normally fluent child now, at the age of five. 

I think that the awareness, while different for each person, may often develop slowly, and that the feeling of
it being a negative thing, can come from both the child's perceiving that speaking is no longer as easy as it
used to be, and the reactions that s/he sees in others as they also become aware of the child's difficulties. I
do think that when family members react very negatively, it is likely that the child will perceive their speech
in a more negative way, too. So, I think you are correct when you suggest that parents may have more
averse reactions than the child does, and this certainly can cause more problems for the child, particularly
when the parent cannot be open with their child about it. 

I have had some children as well as parents who have difficulty admitting the full extent of their fears and
concerns. There is a 13-year-old in our clinic at the moment, and he at first claimed that his stuttering did not
really bother him. He is fairly fluent now, due to modifying his speech using a slow, easy mode. After a
few sessions, he began to offer, on questioning, that he does not like to answer questions in class, and that
he is bothered by his speech when he has the occasional block. The student clinician and I are planning on
talking with him today about avoiding speaking--I suspect that he is fluent in part because he is still avoiding
words and situations (even though he initially denied that this occurs). I don't think that these were
addressed in his previous therapy. 

I use parent counseling time to address issues that may concern them, even if they do not recognize or admit
it to themselves. Talking more in the general sense and working up to the personal situation seems to work
fairly well in getting to the sensitive issues. 

But, as you suggest, there are cases where the child does have to deal with a less-than-positive reaction on
the part of a parent/teacher/etc., and the best I can do in that situation is to talk with the child in terms of
ways to respond to those who cannot deal with the stuttering. To help them learn to discern when a problem
is theirs or another's may help to relieve some of the guilt and self-blame that surely occurs. Perhaps you
have some thoughts on whether or not you think this may have been helpful in your own case, or for others
with whom you have had contact. 

Well, it's time to get to clinic. Your article has provided much food for thought. Thanks, again, for taking
the time to write it. 



Re: Stages of Coping

From: LH
Date: 10/22/98
Time: 6:54:58 AM
Remote Name:


Hello again, Lynne. 

I am going to have to keep this short as I have two midterms today. Back in the harness, I fear! 

>I have only been able to guess at awareness based on the external >behaviors I have seen... 

Is it common, or even effective to ask the child at those times what s/he thinks of what is happening? 

>Did he decide that it was undesirable on his own? Or as a result of my >sister's looks of concern when he
struggled? I am not sure I can say. 

Oh, the subtlety! Your sister is fortunate that she had you to help her! 

>I have had some children as well as parents who have difficulty >admitting the full extent of their fears and

Lynne, have you any suggestions for Kathleen, whose letter is just below this thread? 

>To help them learn to discern when a problem is theirs or another's >may help to relieve some of the guilt
and self-blame that surely >occurs. Perhaps you have some thoughts on whether or not you think >this may
have been helpful in your own case, or for others with >whom you have had contact. 

I think that is an important issue, and I know that some guidance in that direction would have been very
good for me - and not just in the case of stuttering. That is still a very difficult concept for a child to grasp,
though. Heck, adults have enough trouble with it! 

Which suggests that this is an issue that deserves more thought. I don't have answers, certainly. 

Lou H. 

Total denial

From: Kathleen Roetzel
Date: 10/21/98
Time: 8:21:34 PM
Remote Name:


I have found your article and the comments of the readers to be very interesting and insightful. I have
worked with a fifth grade student in a public school setting who was in total denial. Because this child was
emotionally fragile, I was concerned about being agressive in confronting him about his speech. His
stuttering was very severe, and he had been stuttering for less then a year according to reports by his teacher
and parents. Do you have any suggestions about the best way to approach a child and help him get beyond

Re: Total denial

Date: 10/22/98
Time: 6:39:15 AM
Remote Name:


Dear Kathleen: 

Wow, you have a big job on your hands. You use the past tense a lot, are you still working with this child? 

There is no way to separate the problem of stuttering from other factors of the child's life, and it would be
pretty foolhardy for me to offer any specific suggestions at this remove. You need to answer some questions
for yourself, though. Does the child really understand what is happening to him? If not, what might be
preventing that? Also, if the child's stuttering is both sudden and severe, I would wonder what else is going
on in his life. 

Whatever seems to be the cause, I'd bet that you have a very frightened little boy on your hands. There are
times when "doing something" can be counterproductive. Sometimes the best thing to do is simply to be

As a classroom teacher I have twice had students whose stuttering, one very severe and one mild to
moderate, was a source of great emotional turmoil to them. They were not so much in denial as scared to
death of this thing that they did not understand and could not control. In both cases, I at first simply made
myself available to them, in school or out. I let them know directly and by demonstration that I understood
very well what they were going through. I made some allowances, at first without saying anything but as
they became bolder and more confident with me, I began to explain in private to them why I was doing the
things I was doing. I also found plenty of excuses to praise - something I really try to do with all my kids -
and tried to sensitize the other teachers to the problems that stuttering can cause. It wasn't fast, but in time I
gained both children's confidence enough that we could talk about stuttering and even laugh about it together
a little. 

Can you get this child to express how he feels about stuttering, or for that matter about anything else that
might be in the way of his facing the stuttering, through some other medium than speech? Acting out, role
playing, art, story writing, music, are all ways for him to communicate with you about what he is really
feeling. If you can show that you accept him and his feelings just as they are, you can probably wear down
his resistance to whatever therapy you want him to try. Until you deal with the demons, the therapy will be
just a waste of time. 

As he begins to trust you, you will be able to ease him into a deeper understanding of what is going on, and
what he can do to take control. However, you won't get anywhere until he is good and ready. That can be
frustrating, particularly if you have some kind of authority looking over your shoulder expecting results. 

When he is ready - and you'll know when that happens - you can introduce him to resources such as the
childrens' section of the Stuttering Homepage, or perhaps one of the child-oriented self-help groups that are
discussed elsewhere on this website if there are any in your area. Knowing that others share this problem,
and knowing how they cope, will help ease the loneliness and embarrassment. 

I wish you both the best of success. I also wish that I could be more specifically helpful, but as with just
about everything else concerning this slippery disorder, there really are no fast answers. 


Denial & Stages

From: Lynne Shields
Date: 10/22/98
Time: 10:41:12 AM
Remote Name:



Your response to Kathleen provided some quite useful guidelines for working with a child who is at a very
vulnerable stage. You asked in response to me whether it was useful/common to ask a child what is
happening to them when you see a reaction to a stuttered word. There is a videotape from SFA (Stuttering
Foundation of America, for those not familiar) entitled "Therapy in Action: The School-Age Child Who
Stutters". It is quite inexpensive, and therefore, very accessible! It has some nice footage of clinicians
talking with younger children about their speech. Asking them, for example, 'what happened when you had
that bumpy word'. If you have begun to establish a relationship with a child, I don't think they will find that
terribly threatening. If they do, you get a response something like, 'I don't know' or 'Nothing'. Then you
know they aren't yet ready to talk about it. 

I do recommend that videotape for clinicians who are working with school-aged stutterers. It can be a good
resource for them, and also may be a tool to use in therapy with a child, especially if they are the only person
who stutters that they know. I can see showing them the portions where children are shown stuttering and
talking openly about it. 

We are running out of time to pursue this discussion in this forum. I've learned quite a bit from the articles
I've had time to read. 

Good luck with your midterms, Lou. 



Re: Denial & Stages

From: LH
Date: 10/22/98
Time: 4:52:59 PM
Remote Name:



Thank you for your comments, both the suggestion of how to tell if the child is ready to talk, and the
suggestion of using videos to help open a child up. I'd forgotten about that resource. NSP has some too.
There are other videos for people who are outside of the United States. CAPS has at least one, and so do a
number of European stuttering associations. 

Lou H. 

Re: Total denial

From: Kathleen Roetzel
Date: 10/27/98
Time: 1:14:04 PM
Remote Name:


I know that it is past the date for this confrence, but I wanted to take the opportunity to thank you for your
helpful response, even though it might be a while before you check this again. I no longer work with this
child because he is in middle school, but I do know the clinician who does. I will pass this information
along to the his current clinician and also the school psychologist. Thank you again, Kathleen

Thank you all!

From: Lou Heite
Date: 10/22/98
Time: 4:57:01 PM
Remote Name:


I want to take this nearly-last opportunity to thank everyone who has responded to my essay on the ISAD
page. Your comments are all intelligent and thoughtful, and you can be assured that I will be thinking about
what you have said in these postings as I look for ways to refine and polish this idea. 

I also want to publicly thank Judy Kuster and Michael Sugarman for giving me the opportunity to participate
in this first ISAD conference. Good work, people. You can sleep proud this weekend! 

Lou H.