COMPONENT 6. DESENSITIZATION THERAPY

Rationale: To desensitize the child to the fear and expectancy of the
stuttering moment. Appropriate desensitization procedures will also be
effective in reducing negative emotionality.

Research: 

Dell (1979) - advocated three ways of teaching a child to say a word:
the fluent way, they hard stuttering way, and the easy stuttered way.

Ham (1986) - defines desensitization in terms of client 
hypersensitivity's to normal nonfluencies, stuttering, people, 
situations, and/or specific words.  Therapy should incorporate 
activities which reduce one's fears and anticipatory behaviors. 

Peters (1991) - emphasizes desensitization to fluency disrupting 
stimuli, such as interruptions, competition to speak, or excitement
that may produce increased moments of stuttering.  Reducing negative
feelings and attitudes and eliminating avoidances need to be 
incorporated for some children who stutter.  

Van Riper (1973) - "Since the fears, avoidance and struggle which 
characterize advanced stuttering stem from it's unpleasantness, an
unpleasantness which tends to grow stronger, no therapy can
hope for success unless it seeks directly to reduce it."

Van Riper (1973) - "another essential and difficult thing to do is to
help the child to understand what he/she should do differently when
he/she fears or experiences stuttering."

Activities/Techniques:

 1. During therapy activities, model easy stuttering behaviors.  By
    reacting to your dysfluencies without struggle and tension or
    negative emotionality, the child learns a new way of reacting to
    his/her own dysfluent speech.

 2. While employing an increased length and complexity of utterance
    framework, encourage easy bouncing and stretching behaviors. 
    Teach the child he/she can stutter without struggle and tension.

 3. Structure therapy activities which provide the child with
    opportunities to "catch" the clinician bounding.  The clinician
    reacts to being caught in a positive manner, which facilitates
    increased acceptance of the stuttering, as well as providing an
    easy model of dysfluent speech.

 4. Activity number three may be expanded to include the clinician
    catching the child bounding, the child imitating the clinicianÕs
    bounce, or the child providing an "easier" way to say the 
    dysfluent word.  By incorporating activity number three prior to
    the above, the child reacts more positively to his "being caught."

The following is an example of the dialogue associated with these
activities:

Child:        "I heard you bounce."
Clinician:    "Good!  What word did I bounce on?"
Child:        "Marshmallow"
Clinician:    "Good!  Can you show me how it sounded?"
Child:        "M-m-marshmallow"
Clinician:    "Good!  Now show me an easy way to say that word."
Child:       "Marshmallow" (The child produced the word with a stretch
             on the first syllable).

 5. The clinician instructs the client to read or speak using easy
    pseudo-stuttering.  The client may be given general or specific
    instructions as to what words or place of the sentence to
    pseudostutter.  The client learns an easier, unforced form of
    stuttering while approaching his/her dysfluency.

 6. After the child experiences success with easy stuttering,
    encourage him/her to use easy bouncing and stretching on real
    stuttering.  Variation, such as slowing down, easing out of, or
    changing moments of real stuttering provides the child with
    feelings of increased control over their speech.  For example, 
    if the client is exhibiting silent laryngeal blocks with complete
    cessation of airflow, suggest (or model) that the child tries to
    "bounce out of the hard speech."  Or, if the child exhibits
    multiple-part word repetitions, slowing them down and stretching
    them out may be particularly successful.

7. For the older client, Ham (1986) recommends two approaches to
   desensitization: "1) desensitization to stuttering by repeated
   exposure to stuttering in a variety of modes and situations, and 
   2) desensitization to fears by exposure to a hierarchy of situations,
   ranked for their anxiety-causing, stuttering potentials" (pg.134).
   This exposure to a "stuttering bath" reduces spasm frequency,
   severity, and complexity while increasing tolerance and objectivity.