Stuttering Recovery: Personal and Empirical Perspectives

STUTTERING RECOVERY Personal and Empirical Perspectives

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STUTTERING RECOVERY Personal and Empirical Perspectives

Dale F. Williams, Ph.D., CCC-SLP

2006

LAWRENCE ERLBAUM ASSOCIATES, PUBLISHERS Mahwah, New Jersey London

This edition published in the Taylor & Francis e-Library, 2008. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” Copyright © 2006 by Lawrence Erlbaum Associates, Inc. All rights reserved. No part of this book may be reproduced in any form, by photostat, microform, retrieval system, or any other means, without prior written permission of the publisher. Lawrence Erlbaum Associates, Inc., Publishers 10 Industrial Avenue Mahwah, New Jersey 07430 www.erlbaum.com Library of Congress Cataloging-in-Publication Data Williams, Dale F. Stuttering recovery : personal and empirical perspectives / Dale F. Williams. p. cm. Includes bibliographical references and index. ISBN 0-8058-5734-6 (cloth : alk. paper) ISBN 0-8058-4771-5 (pbk. : alk. paper) 1. Stuttering. 2. Stuttering—Treatment. RC424.W495 2005 616.85’5406—dc22 ISBN 1-4106-1724-6 Master e-book ISBN

I. Title. 2005051041 CIP

To my wife Misty, for maintaining such patience during (and with) the writing process. It couldn’t have been that easy. To my children Brennan, Blaine, Cayley, and Caysey: If my life’s work elicits in you only indifference, hey, there’s a lot that’s OK with that. To Dale L., Christel, Sue, Pete, and Andy, because a funny family never hurts. And, finally, to the terrific storytellers in the stuttering support group that meets at Florida Atlantic University and to anyone else who is wrestling with this mysterious disorder, whether or not you choose to seek help.

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The journey is the reward. Chinese Proverb

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Contents

U

Acknowledgments

xi

Prologue: Start Here

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1

What Is Stuttering? What Is Recovery?

2

Eighth-Grade English Class

11

3

How to Read Research (and Non-Research)

16

4

An Empirical Investigation: Analyzing the Effectiveness of a Self-Help Application Method for Treating Stuttering

32

5

Recovery and Therapy

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6

The Depo

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7

Support Groups

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8

The Meeting

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9

The Stereotyping of People Who Stutter

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1

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CONTENTS

10

A Visit From St. Notker

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11

Listeners

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12

Stories of Listeners

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13

Friends, Family, and Significant Others

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14

The Family Dinner

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15

Self-Improvement Is Worth the Risk

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16

The Match of a Lifetime

137

17

Odds ’n Ends

144

18

The Bottom Line

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19

Questions for Discussion

165

20

Other Essays

176

References

185

Quotation Source List

197

Author Index

199

Subject Index

205

Acknowledgments

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In addition to those cited in the dedication, I would like to single out some individuals who read some or all of the chapter drafts, sometimes unknowingly, and offered everything from encouragement to specific editorial comments. These include Vikesh Anand, Tom Bachman, Klaas Bakker, Mike Brady, Gary Cohen, Susan Dietrich, Joe Donaher, Peter Dugan, Leslie Kirchoff Fauquet, Steve Hood, Judy Kuster, Jeff Lewis, Ken Logan, Fred Murray, Bob Quesal, Peter Ramig, Nan Bernstein-Ratner, Junior Tereva, Deena Wener, and all of the unnamed reviewers who tendered comments throughout the process (even the critical one—I’d ask what the deal is with you, if you hadn’t been right about so many things). Allow me to also acknowledge Kimberly R. Brinkmeyer, Cynthia Core, Ali Danesh, Rebecca Elman, Barb Fries, Luanne Hopkins, Nancy Lewison, Robert F. Kidd, Karen McCormack, Bill Murphy, Michael Schenker, Ron Taylor, John Tetnowski, and Scott Yaruss, all of whom helped me locate information I needed but couldn’t find myself. I guess my mom was right in her repeated comment regarding my good fortune in having an attached head. I wish to thank both Carlos Diaz and William Palmer for their contributions to this book. And Deb, thanks for the quote and know that you are greatly missed. I thank the other contributors as well, but promised I wouldn’t name them. At Lawrence Erlbaum Associates, several people deserve recognition: Bonita D’Amil, Derek Fiore, Victoria Forsythe, and Nadine Simms among them. I should also thank Mr. Erlbaum himself, given that he’s the one

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ACKNOWLEDGMENTS

who OK’d all of this. Special thanks go out to Sponsoring Editor Cathleen Petree, who saw this project through from beginning to end, including answering all of my dopey questions with both patience and unrolled eyes. Finally, I thank all colleagues, students, clients, parents, support group participants, list serve posters, and everyone else who floated ideas out there for me to think about. This includes the guy in the local tennis league who shared numerous opinions about stuttering during changeovers. If I left anyone out, I’m truly sorry. Please remember the potential I apparently have for misplacing my own head and let me know that I forgot you. With any luck, there will be a next time and I’ll get to you then.

Prologue Start Here

U If I ruled the world, this book would not be necessary. That’s because recovery from stuttering would be far easier than it is today. Of this, I would make certain. How? Well, I haven’t worked out all the details yet, but I would begin by enacting the following laws. · Those who offer pedestrian advice such as “Slow down,” “Think before you speak,” and “Take your time” would be subjected to one full day with a really obnoxious person following them around and shouting out simplistic instructions (“Hey Joe! Having trouble with that budget report? Just write down what you want to say! Then print it!”). · Those who bully, tease, interrupt, or finish the sentences of people who stutter would be dressed in Cleveland Browns colors, flown to Pittsburgh, and dropped off at the nearest Steelers bar. The interpretation of this law would be broad enough to include those who mimic stuttering in private, waiters who audibly sigh to let stuttering individuals know they are taking too long, and people who grunt while listening, so breathless with anticipation are they to begin talking at the first inkling of a pause. · Therapists offering quick-fix solutions would be forced to enroll their own children in expensive private schools where teachers claim to impart all the necessary knowledge in two convenient 60-minute sessions, then spend the remainder of the kids’ educational years lambasting them for not implementing the knowledge properly. · Support group attendees who hijack meetings to push their personal cures would be sentenced to spend 48 hours in an elevator with a car salesman needing just one more deal to make quota.

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PROLOGUE

· Condescending listeners would be required to continue nodding their heads and smiling until such time as they are sold as bobbleheads. · Employers who don’t hire the stuttering applicant because he or she makes them uncomfortable would be immediately placed under the supervision of an Alaskan wolverine and forced to spend their workdays eating ferns and avoiding bite wounds. In cases where a wolverine is not available, an ’80s hair band will serve as an adequate replacement. · Those who question or blame the parents of stuttering children would serve lengthy sentences for unsolved crimes they clearly had nothing to do with. · Stuttering individuals who falsely claim to be “cured,” “fearless,” “covert,” or whatever the next flavor-of-the-month designation is would be forced to watch themselves on videotape until such time as they figure out what these terms do and do not mean, or until they willingly hire someone to spray paint the word DENIAL on their scalps, whichever comes first. · And finally, any pediatrician who cites an 80% spontaneous recovery rate as evidence that worried parents need not seek help for their disfluent child would be greeted with the following scenario at the end of the workday. “There are five cars remaining in the parking lot—yours and four others. “One of the five cars you see has been wired to explode on ignition. “You must either (a) take your chances and drive home or (b) turn around, go back inside, call every mother in town, and admit that maybe a 20% likelihood is not one to mess around with.”

Unfortunately, I don’t run the world. Worse yet, I have seen scant evidence that those who do plan to implement the aforementioned laws. Until such time, then, recovery from stuttering will continue to be an uphill trek. Fortunately, however, there is help available. Research on recoveryrelated matters such as treatment and support groups is published so regularly that people in the field no longer even pretend to have read it all. Equally instructive are the experiences of those who have attempted to clear some of the barriers to recovery. If they are anything like me, they have stumbled on to an insight or two along the way. The book you are holding presents research, experiences, and even fiction (explanation to follow) pertaining to recovery from stuttering. To understand how it came about . . . well, I don’t recall exactly how it came about. I do remember: · Being handed a story written by a colleague, who told me that his

stuttering clients were thrilled at how they identified with the main character,

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· Giving the story to some of my clients and being asked why I never

did anything interesting like this before, · Being told by a colleague (a different one) that an essay I had written

had inadvertently helped a client better understand the long-term goals of his therapy, · Thinking about recovery and having copious discussions—in person, via e-mail, and over the phone—with speech-language pathologists, people who stutter, parents, spouses, and researchers. And, most importantly, I remember that, while thinking, discussing, and picking the brains of those smarter than me, there were several conclusions that emerged repeatedly. 1. Recovery from stuttering is a crucial concept for speech-language pathologists and their clients to grasp. 2. Recovery as a concept is about as easy to grasp as a goalpost slathered in Crisco (trust me on this one). 3. For a given individual who stutters, some elements of recovery are pertinent, whereas others are basically political debates—fun to talk about but functionally useless. 4. At least partly because of 2 and 3, recovery is often poorly understood, even by those who most need to understand it. 5. The implications of this misunderstanding are as widespread as birthday cake on a toddler’s face. 6. I need to stop writing similes. 7. Without a clear conception of recovery, therapy can progress toward a hazy place, one where objectives are vague and/or tasks inappropriate for a given client. 8. As treatment goals evolve differently for the speech-language pathologist, the client, and those in the client’s support system, bare-knuckle brawls (well, disagreements) can develop between individuals who should be working together toward the same ends. For example: a. Speech-language pathologists may view recovery in terms of meeting formally stated long-term therapeutic goals; b. Clients might consider themselves adequately recovered when they can say what they want to say without worrying about how they say it; c. Significant others might be concerned that their stuttering loved ones not let disordered speech stand in the way of reaching their full potential which, in most families I know, means leader of the free world or a job where you can get relatives free stuff.

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9. If speech-language pathologists could gain a clearer understanding of the entire stuttering experience, they could develop better goals for therapy. What’s learned in stuttering management textbooks—for example, improving attitudes, increasing speech naturalness, averting violence against boneheaded listeners—would be clearer. There would be a better sense of when to stop therapy for a disorder that cannot be cured, always a tricky endeavor. 10. Stuttering clients aren’t off the hook here either. They often come to therapy with unrealistic expectations. Although certainly understanding how encompassing stuttering can be, they may be guilty nevertheless of searching for a simple solution. As one member of the local support group phrased it, “They want the grail without lifting the pail.” I didn’t really understand it either, but I’ve chosen to interpret it as people who stutter get too wrapped up in the pursuit of a quick cure when they should instead be searching for answers to more realistic questions. By that, I mean questions such as: · How do I live with this disorder? · In terms of diminishing it, what’s the best I can hope for? · What’s my plan for getting there?

Such questions bespeak an attitude toward recovery in which it is seen not as a goal, but, rather, a process. The attitude is similar to that of the slothaholic (a word I made up to mean the opposite of workaholic) who forces himself to finish this paragraph before checking his e-mail for the 37th time today. In other words, the condition can be effectively managed, yet still be very much present. Similarly, many people who stutter are recovering, but few achieve full and complete recovery (i.e., are cured). So why would this be their goal? One idea resulting from these ramblings was to compose a book that could both provide accessible information and stimulate discussion on recovery from stuttering. Upon considering this idea, I concluded that writing a book would be a lot of work and that I would think about it later. I did, however, attempt to initiate recovery-related discussions in therapy sessions. The attempts were notable only in their ineffectiveness. Why this is, I am not certain, but I did feel that the issues needed to be explored in spite of my ineptitude. This feeling led me to search for reading samples that could be used in the same manner as my colleague’s story. Fortunately, I found some good discussion starters and, for many clients, this technique turned out to be a useful means of addressing aspects of stuttering—emotions, avoidance behaviors, difficulties talking to women (my clients have very specific priorities)—that they normally did not wish to discuss with me.

PROLOGUE

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This initial success put me on the lookout for good readings. And although I found much of value, sometimes I did not find exactly what I was looking for. I became quite annoyed until someone pointed out to me that materials are not published solely for my benefit. Even so, my annoyance continued to simmer when I noticed that even the most effective essays had a significant drawback: They took real work to find. With a sigh, I realized it was time to take the book idea off the shelf. Given my beliefs that usable material on recovery had already been written but that more was needed, my goal in writing this was twofold: (1) provide additional information on recovery-related issues and (2) make my essays look better by aligning them with good ones. Regarding the latter point, I included a chapter (Chap. 20) that references and summarizes other writings appropriate to this topic. The result (this book) is an attempt to address issues of recovery independently while at the same time realizing how overlapping they can be. Or, stated in a way that actually makes sense, each chapter focuses mostly on one issue, but there are some places where I try to provide a more global viewpoint. The book is written for people who stutter, their significant others, and speech-language pathologists. My hope is that it will be read, reflected on, and discussed within and between all three groups (and, when it’s not, that it be kept on the shelf between Van Riper and Bloodstein as if it belongs there). The chapters alternate between informational papers and stories, as both can, in their own ways, illuminate the different aspects of recovery. Before you begin, just some serious notes on the less serious chapters (the stories). Most are based on firsthand accounts of people who stutter; some (e.g., Chap. 4) are clearly not. The exceptions will (hopefully) be obvious to the reader. The firsthand accounts are either personal stories or those collected from others who stutter. For purposes of confidentiality, it was necessary to rid the latter stories of identifying information. Rather than leave gaping blanks in the written accounts, I chose to fill these voids with new details (read: stuff I made up) to keep flow of the story going. In all cases, however, the final draft was approved by the individual who related the account, on the bases that (1) the spirit of the story was not violated and (2) I agreed to stop calling at 3 a.m. to request this approval.

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Chapter

1

What Is Stuttering? What Is Recovery?

U

He still lives, that boy, afraid his words will break like ice between his teeth. Reading round-robin waiting for his turn to speak, he tried to squeeze the trigger of his mouth and nothing fired. That boy still lives far from the warmth of words his older self now knows. —William Palmer The Boy Inside

It is a disorder of unknown cause or cure, but endless speculation and confusion. Perhaps because of these reasons, stuttering has always been difficult to define. Yet this is where we must begin. After all, in order to examine recovery related to a particular disorder, one must be clear about what that disorder is. Or, as one local support group participant put it, “You can’t talk about recovering if you don’t know what you’re recovering from.”

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As might be expected with such an elusive disorder, there is no uniform definition of stuttering. Exactly which symptoms should be considered characteristic of the disorder are open to debate (Brutten & Shoemaker, 1967; Perkins, 1990; Van Riper, 1982). Still, while there are many definitions, nearly all include the overt behaviors of prolonged and repeated speech units. For the average listener, these speech breakdowns are what characterize the disorder. For the speech-language pathologist, they are the basis of stuttering; it cannot be diagnosed without them. For people who stutter, however, the disorder is far more than disfluency. It is also anxiety, worry, guilt, shame, self-consciousness, and a host of other auxiliary features. It is energy spent trying to hide disfluencies, be it via bodily movements, the rephrasing of utterances, substituting words, or any number of other behaviors that individuals have employed for this purpose. In other words, people who stutter deal with not only their speech, but also with secondary behaviors, emotions, attitudes, and fears about speaking. In a now famous analogy (at least within my circles), Sheehan (1997) characterized stuttering as an iceberg. That is, the visible portion is actually quite small relative to the entire disorder. Looking at it from a different perspective, read the following descriptions and determine which person has the bigger problem. Person A presents one-second prolongations and/or repetitions in 10% of speech when talking to friends. Person B is afraid to make friends because of the shame associated with speaking. In other words, what is the real disorder? Is it disfluency or is it the anxiety, embarrassment, and other components that lead one to withdraw? Yaruss (1998) defined stuttering in terms of impairment (the speech disruptions), disability (inability to perform specific communicative tasks), and handicap (failure to fulfill everyday needs, be they occupational, economic, or social). This design indicates how the disorder can extend far beyond disfluencies. In fact, one could argue that the impairment is of concern to the individual only because of the resulting disability and handicap. Of course, the manifestation (not to mention the amount) of impairment, disability, and handicap varies from person to person. Stuttering is, if nothing else, a highly individualized disorder. Still, there is commonality in its development that may help to explain its complexity.

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DEVELOPMENT OF STUTTERING Stuttering usually begins during the preschool years (Shapiro, 1999). As the onset is typically gradual, it takes time for parental concern to develop. However, because early stuttering is episodic (Gregory, 2003a), whatever worries parents develop may soon dissipate. When the problem becomes too big to ignore, parents often ask the pediatrician for advice. A common response from pediatricians is that 1) stuttering is normal and, 2) if ignored, it will go away on its own. Although the first point is false and the second controversial (see section entitled Stuttering: What it is not in this chapter), for the present discussion it is important to note that parents have been advised to ignore their child’s struggles with speech. For a time, the child stutters without concern, taking little notice of parental reactions (or lack thereof). At around the age of 7 years, however, awareness increases as stuttering children begin to show anxiety about their speech difference (DeNil & Brutten, 1987). By then, parents are still, for the most part, disregarding it, save for the occasional advice to “slow down” or “think about what you want to say,” usually delivered out of frustration. Between these extremes are frowns and fleeting looks of disappointment that parents may be unable to uniformly hide. Whether their discontent is aimed at the child or at themselves is immaterial. What is important is that the reactions serve to increase the speech-related anxiety. The child realizes just how wrong it is to stutter. Because of the child’s shame, the parents’ guilt, and the pediatrician’s original advice, stuttering is not discussed within the household. With increased age, the child often becomes progressively more pleased with the family’s unspoken pact, as he or she prefers not to think or talk about this despised condition. Of course, by that time, the stuttering is quite apparent, so the situation takes on an almost ridiculous tone as people ignore an obvious part of their daily experience. It is the emperor’s new clothes in reverse: Everyone knows it is there, but no one acknowledges it. Because the topic is off-limits at home, the child cannot ask his or her disappointed parents for help. Unfortunately, this time of increased awareness of stuttering and its consequences coincides with the ages during which teasing typically begins (Noll & Carter, 2004), a problem that only increases with age (Dickinson, 1999). Thus, it is unlikely that the child will confide in peers about what has become an embarrassing condition. Given no alternatives, it becomes the child’s problem to solve, alone. Initial solutions typically involve eluding the stutter. Children learn early that actions such as hitting the table and blinking the eyes help propel words that get stuck. Behaviors designed to avoid stuttering emerge as

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well. Answering with “I don’t know” is a common avoidance. So is evading speech altogether. These secondary behaviors are so universal that they are considered part of the stuttering experience (Conture & Kelly, 1991). As the term secondary implies, the behaviors follow a primary source (that is, the disfluencies). Obviously, without the prolongations and repetitions, there would be no need to evade or hide them. Still, this term should not be used as evidence that these behaviors are somehow a lesser part of the disorder of stuttering. They are not secondary in the sense that a limp is secondary to a broken leg (i.e., mend the leg and the limp goes away with it). Rather, many of the emotional aspects are secondary more as a child’s self-doubt is secondary to teasing by peers. The source perpetuates the symptom and vice versa. Unfortunately, the effectiveness of secondary behaviors is only temporary. This leads to two problems. The first is that the behaviors are often maintained after their effectiveness has diminished. In the long run, then, secondary behaviors can become strange and seemingly purposeless maneuvers that serve to further complicate the stuttering problem. For example, a child struggling with a word may simultaneously bang a fist on the table, blink, and engage in additional actions that at one time effectively masked the stuttering. Thus, one distracting behavior (the disfluency) has multiplied into several. Another problem with secondary behaviors is that their temporary effectiveness is seductive. Social penalties associated with stuttering need not be paid when no one can detect its presence. Thus, the child is reinforced for the behaviors and they increase in frequency. Although the momentary helpfulness of secondary behaviors is very real, so is the long-term damage. In using these behaviors to mask their stuttering, children continually associate stuttering (and all the fears and emotions that accompany it) with new words and situations. For example, the child who substitutes words as a secondary behavior might use the term automobile because it is easier to say than car. In time, this child will likely have difficulty with automobile. If he or she continues to substitute words, eventually vehicle, ride, and every other word or phrase that can be used to designate a car will likely present difficulty. Thus, the child goes from one problem word to many. As the stuttering worsens, the family cabal of silence strengthens and generalizes. The child or adolescent who stutters is often unwilling to discuss his or her condition with anyone, family or otherwise, and is even less likely to joke about it. Speech can become the most intensely personal aspect of this individual’s being. Even events tangentially related to stuttering, be it teasing from peers or an embarrassing oral report in class, remain internalized.

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As the emotions become progressively more interiorized, associated behaviors continue to increase. Older children and adults use different types of bodily movements (e.g., tensing of facial muscles, twitching their hands, tapping feet) to escape stutters. To avoid stuttering altogether, they may restructure sentences or substitute easy words for those difficult to produce. This often leads to some unwieldy phrasing (e.g., “a pair of eggs” used to avoid the word two; “this day” instead of today). Other associated behaviors are even more awkward. People who stutter might describe a concept rather than use a feared word. They feign accents, order food they do not really want, give themselves nicknames, purposely mispronounce words, and perform many other unusual behaviors, all for the sake of keeping their stutters secret. In some instances, avoidance behaviors can significantly impact their lives, from being afraid to make friends to turning down promotions because the new job would involve public speaking. Yes, stuttering is characterized by repetitions and prolongations. In the final analysis, however, it is far more than momentary breaks of speech. It is embarrassment, mockery, and loneliness. It is continual self-consciousness about speech, as reminders of past stuttering are present in nearly every utterance and speaking situation. And it is a condition that, to the person experiencing it, often seems beyond conscious control. Metaphorically, stuttering is not just another branch on the tree of life. It is more of a seasoning, a spice that flavors all ingredients in the mix.

STUTTERING: WHAT IT IS NOT Thus far, the focus of this chapter has been on what stuttering is. It is also important, however, to discuss what stuttering is not. After all, it is a condition surrounded by much misinformation. Many stuttering myths have nothing to do with recovery and/or are too ridiculous for discussion (e.g., stuttering is caused by tickling; people who stutter are descendants of the lost continent of Atlantis; stuttering can be cured by talking with a mouth full of pebbles). Others are so important to the recovery process that sections of or entire chapters have been devoted to them (e.g., parents cause stuttering; people who stutter are nervous and shy). This section is devoted to some of the remaining relevant misperceptions.

All Disfluency Is Stuttering Everyone who stutters has listened to non-stutterers declare that they 1) used to stutter or 2) stutter themselves sometimes. Even articles about stuttering are guilty of perpetuating the idea that all children stutter

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(Bender & Small, 1994; Brazelton, 1997), which, in turn, supports the belief that the best plan of treatment is to ignore it. Stuttering is, by definition, a communication disorder and therefore not part of normal development (Alvares & Williams, 1995). Although it is true that all young children present disfluencies, those of normally developing speech are different in quality and quantity from the disfluencies of stuttering (Guitar, 1998). Obviously, normal adult speech is disfluent too, filled with interjections, rephrasing, broken words, and other breaks in flow. However, these momentary bobbles do not call attention to themselves the way that stuttering does. In fact, listeners barely notice them. Moreover, normal disfluency does not carry the emotional baggage discussed above. This is an important distinction. Someone who “stutters sometimes” can no better identify with true stuttering than a weekend flag football player can relate to life in the NFL. It is also worth noting that not all abnormal fluency is stuttering. There are many disorders of fluency that vary from stuttering in terms of onset, development, and symptoms (both overt and secondary). Stuttering seems to be unique in how it infiltrates nearly all aspects of a person’s life.

Stuttering Is Psychological Another common misconception about stuttering is that it is a psychological condition. This myth is partly the result of repressed needs theories, a collection of hypotheses in which stuttering is viewed as the voluntary consequence of neuroses. People are disfluent in order to satisfy unresolved oral-erotic needs of childhood (Coriat, 1928) or because they are fixated at the anal-sadistic level (Fenichel, 1945). Stuttering is thus viewed as a pleasurable, forbidden oral experience or as symbolic diarrhea and constipation, depending on which end of the digestive tract one’s scholarship resides. Such theories are unsupported (Bloodstein, 1993) and no longer widely believed, clear attempts to force a misunderstood disorder into favored orthodoxy. Nevertheless, repressed needs hypotheses do arise from time to time, indicating that some people continue to place stock in them. The harm is in the perception of stuttering as an emotional disorder, cured, presumably, by fulfillment of basic needs. It is worth noting that attempts to eliminate stuttering via emotional counseling have not been particularly effective (Bloodstein, 1981). Related to repressed needs theories is the idea that stuttering results from some emotional occurrence in childhood. Seemingly harmless events, such as moving or changing babysitters, have been offered as causes. More serious situations, such as divorce or abusive parents, have

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also been implicated. In truth, there is little to support the notion that stuttering arises suddenly from one notable event. Again, the onset of developmental stuttering is gradual (Starkweather, 1987). This is not to say that significant events cannot further the development of stuttering. But that is very different than attributing one as the cause. Current theories (e.g., Smith & Kelly, 1997; Wall & Myers, 1995) view stuttering as arising from an interaction of nature and nurture. That is, it appears that certain children are biologically susceptible to stuttering. Such susceptibility, however, requires an environmental agent for manifestation and these agents have not been isolated. More to the point, children are exposed to numerous environmental stressors on a constant basis. Therefore, even if it could be determined that a child’s stuttering began right after Dad doled out some harsh punishment, this does not place the blame squarely on the child’s father. If the child was that predisposed, it is almost a certainty that if the punishment had not brought it out, something else would have. It is also worth noting that disfluent speech of sudden onset is more consistent with psychogenic disfluency than it is with developmental stuttering. Psychogenic disfluency is different from stuttering in terms of overt characteristics; it also responds to treatment faster (Deal, 1980). Thus, stories of disfluent speech beginning abruptly may well be true, but that does not mean that they reflect developmental stuttering. Probably the biggest reason for attributing stuttering to one causal event is human nature or, more specifically, the propensity of people to overgeneralize from minimal data (an idea that is further developed in Chap. 9). If a child’s stuttering began the summer the family stayed with grandmother, then it is surmised that Grandma caused it. In truth, had the child stayed home or gone to camp or been anywhere else, the stuttering may very well have occurred anyway. Of course, none of the evidence against sudden onset will stop people from asking an individual what happened to trigger his or her stuttering. The answer to this question is: nobody knows. The answer to what they are really asking is that the stuttering is nobody’s fault. The other side of the psychological continuum from repressed needs includes the idea that those who stutter are experiencing a sort of mental block, similar to the infielder who can no longer throw the ball to first base. In fact, many people who stutter have voiced this opinion. Usually it is phrased something like this: “I can speak fluently when I’m alone. In other situations too. That proves that I am capable of talking without stuttering. The fact that I don’t do it everywhere shows that it’s all in my head.”

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Actually, this proves and shows nothing, other than stuttering being variable across situations. It is just as easy to attribute this phenomenon to a physical difference than to a psychological one. Within the human brain lie literally hundreds of neural sites and generators involved in speech. The extent to which one site is involved in a given speech sample, or whether it is at all, depends on the circumstances surrounding the speech—the phrasing, emotions, body activity, and numerous others (Webster, 1999). Thus, if stuttering is the result of a microscopic neural deficit—which is entirely possible given that macroscopic damage would affect other motor areas in addition to speech—one would expect it to be situational.

Stuttering Is Simple The search for a simple solution has led to other theories as well. As with the psychological causes, there is little evidence that stuttering originates from any overt physical problem (e.g., a short frenulum), by the mouth moving faster than brain, or even by overanxious parents. Although the exact cause is, of course, unknown, current research indicates that stuttering results from a complex interaction of multiple factors—genetic, linguistic, neuromotor, environmental, and others—as previously discussed. Again, attempts to find a simple solution have led to unfairly blaming people who stutter or their parents.

People Who Stutter Eventually Stop Another common belief is that stuttering eventually goes away on its own. This idea is based on investigations of spontaneous recovery in children. And even this research is equivocal (Curlee & Yairi, 1997; Ramig, 1993b). That is, the actual rate of spontaneous recovery in children is unclear. For those older than preschool age, however, complete cessation of stuttering is rare (Bloodstein, 1981).

Nothing Can Be Done About It At the other end of spectrum from the idea of widespread recovery is the notion that stuttering is untreatable. In support of this idea is the fact that no universal cure exists (Conture, 2001). Also, it is true that some individuals have tried multiple therapies without experiencing any measurable success (Cooper, 1993; Jezer, 1997). Some of these people may even believe that treatment made their condition worse because the optimism experienced at the start of therapy resulted in magnified frustration at its completion.

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Despite the lack of a cure and individual reports of disappointment and dissatisfaction, however, it is also true that effective treatments have been documented (e.g., St. Louis & Westbrook, 1987). In fact, therapy is such an important component to the recovery process that a chapter of this book (Chap. 5) is devoted to it.

What’s True About My Stuttering Is True About Stuttering Stuttering affects no two people the same way. Yet many people who stutter do not realize this variability. The relevance of this misconception to recovery is that those who experience improved fluency might assume that what worked for them will work for everyone else who stutters. They attend gatherings such as support group meetings in order to preach their brand of recovery. Of course, given the variability across people who stutter in severity, reactions, and even possible causes, it is ridiculous to assume that one person’s experiences are universal. And because there is no collective stuttering experience, there is no definitive road to recovery. One argument that often emerges when someone advocates a personal cure is that with enough hard work, anyone can stop stuttering. This is not only untrue, but also insulting to those who continue to stutter, many of whom are effective communicators (Quesal, 1999). People who stutter are not too lazy or ignorant to stop, just as they are not mentally substandard, unable to break a bad habit, or victims of bad parenting.

WHAT IS RECOVERY? Given the number and strength of emotions involved in stuttering, how does one recover? The answer to this question depends largely on the definition of recover. If the question is how does one stop stuttering, my answer is “I have no idea.” Some people stop overt disfluencies as a result of therapy, although they constantly monitor their speech in order to remain fluent. Others stop stuttering spontaneously for reasons even the experts cannot determine with any certainty. As noted, for adolescents and adults, elimination of stuttering (for any reason) is extremely rare. For these populations, it is best to think of recovery in different ways. For example, individuals who put the disorder behind them (or at least no longer dwell on it excessively) may consider themselves recovered. That is, because stuttering is no longer the first thought upon awakening each morning, or the last worry before falling

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asleep at night, these individuals are able to address other aspects of life. They can stop withdrawing and can instead do and say whatever they want (and whenever they want to do and say it). And that, when all is said and done, may turn out to be their biggest accomplishment with respect to speech. Viewed in this way, recovery encompasses not only acceptance and self-esteem, but also seemingly less lofty attainments, such as arrogance, apathy, and an appreciation of imperfection. It is these types of ideals that form the basis of this book.

SYNOPSIS Stuttering includes overt and covert symptoms, both magnified by its course of development. The multitude of possible causal factors, along with people’s differing developmental histories, help explain why these symptoms are manifested in such a wide variety of ways. With all of this in mind, it can be said that stuttering is a complex developmental disorder that is both pervasive and individual. Viewed in this manner, it is clearly not a bad habit, psychological disturbance, or simple speaking breakdown that occasionally happens to everyone. Taking into account the multifaceted nature of stuttering, a single individual’s road to recovery may not be easy to find or to travel. Still, the journey is worthwhile, given that effective communication lies ahead.

Chapter

2

Eighth-Grade English Class

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Before we begin, let’s be clear about one thing: I hated junior high. Every inch of it. I recall it as one long inside joke with me on the outside, wondering what was so funny. In reality, it was 3 years of awkwardness and self-doubt that I wouldn’t repeat if the offer were made on my deathbed. Was it really all that bad? Was my school as fearsome as what I am about to relate? I don’t know and I don’t care. It’s junior high. It doesn’t deserve pinpoint accuracy. My distaste of junior high began the moment I first entered the school. Seemingly overnight (come to think of it, actually overnight), my previously safe and familiar world was gone forever. I remember that everything looked strange, which was bad enough in and of itself, but which also served as a prelude to more pervasive changes: harder classes, new teachers, and novel speaking demands every hour of the school day. The student body changed as well, the most obvious difference being one of size. My elementary school joined with three others to form a new and larger assemblage of classmates. This propagation, unnerving because it brought forth an increased number of peers unaccustomed to my way of speaking, was compounded by noticeable changes in the students themselves. Girls whom I had grown up fighting, mocking, or ignoring were now adorned with makeup and jewelry. They covered their legs with hip hugger bell-bottoms or nylons. I found them infinitely more interesting than before. These transformations improved their status in my eyes. We were no longer equals.

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The boys changed too, but in far less appealing ways. They were bigger and more aggressive. Elbows flew in the hallways. Blossoming thugs refused to alter their paths, forcing others to walk around them. Threats were yelled. Brawls were prevalent. Guys looked for any excuse to fight their way into manhood. “Camaros are nothin’. Trans Am rules.” “Trans Am? They ain’t even cool.” “You wanna fight about it?” And the fights themselves were not the old wrestle-till-someone-saysuncle type characteristic of elementary years. Fists flew. Skin broke open. Students appeared some mornings with faces that were swollen and scarred. Kids who did not want to fight (me, for instance) had to blend to avoid antagonizing anyone or providing anyone with a reason to antagonize them. Such fusion, I later realized, kept me from achieving even modest popularity. But at the time, I was more interested in avoiding physical pain. As one of the smaller kids in school, I was an easy target for anyone in need of a convenient punching bag on which to exhibit his toughness. It was in this environment that I had to leave class twice a week to attend therapy. Of all the crummy things about junior high, this was maybe the worst. I always departed quickly, in order to avert the questioning glances of my classmates. Nothing was more important than hiding from my peers the fact that I was a freak. When they would ask me later where I had gone, I would construct some sort of nebulous lie and quickly change the subject. “Some guy wanted to talk to me about some stuff. I don’t really know what he wanted.” “What did he talk to you about?” someone would invariably ask. “Oh, I don’t remember. Look, it’s not important. What’d you get on that math test?” Some secrets can’t stay hidden forever, of course, which brings me to eighth-grade English class. The incident that occurred there was not unique, either to me or to the general population of people who stutter. In fact, I would gladly place a parlay bet that 1) the majority of stuttering individuals can relate more horrific experiences and 2) I am the only one from the class who remembers even a single moment of that day. Why the memory lingers I’m not sure. Perhaps because it was junior high, when my goal each day was to find the center of the middle row and remain there unnoticed. English class was normally an anxious hour anyway, given that Fink (the teacher, Mr. Finnik) liked to have us read sentences aloud. Although this was a challenging task for all, I always assumed it was most difficult for me, the only student in the class who stuttered.

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One day the aforementioned Fink surveyed the opposite side of the room from where I was sitting, then asked Melanie Dobberstein, the first student in the first row, to read sentence number one and identify the subject and verb (or whatever the task was that day). Melanie, who fancied herself the class clown, read the sentence as fast as she could. Everyone laughed. Fink, being an individual of self-professed good humor, looked directly at the student seated behind her and joked, “Benny, can you read the next sentence any faster?” Benny read, “Thesignupforlittleleaguetookplaceindad’soffice.” “Beat her by a full second,” said Fink, staring at his watch. “Next.” Around the room it went, eighth graders reading sentences as quickly as they could, for reasons no longer even remotely related to syntax. A clear row-by-row order of performance was established, and I knew I would be reading sentence number 18. I looked at my textbook. 18. Susan and her boyfriend both wanted to go. I experienced a fleeting moment of relief. This sentence did not look so bad. The words I would most likely stutter in other contexts, boyfriend, both, and go, were well into the sentence. By the time I reached them, I reasoned, my speech would be so fast that I would be slurring anyway. My facade was one of confidence. As my turn grew near, I sensed this confidence flow from me like blood through an open wound. I began to feel sluggish and light-headed, but forced myself to study the sentence, to continue the search for possible problems. What I learned that day was that if you look for something hard enough, you’ll find it. The possible rough spot, I concluded, was the beginning. Susan was not a feared word, but starting a new sentence was a feared situation, a weird sort of paradox that might have seemed amusing under circumstances devoid of mounting panic. In any case, I began to review possible strategies. Unfortunately, none of the usual ones seemed suitable:
Using an interjected syllable, such as “ah” or “um, Susan . . .” was in-

appropriate under the circumstances, given that I was supposed to be reading the sentence quickly.
Replacing Susan with a word I knew I could say fluently was impossible because the class would be reading along silently.
Faking an illness would be too obvious in that, by the time I thought of it, the activity had already advanced to sentence 14.

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This was not going well. Somehow, I had to figure out a way past that first word (and figure it quickly). After that, I was reasonably certain I could fly through the rest of the sentence. (Notice that, in all my strategizing, I never once worried about the subject and verb. Not only was I driving myself to insanity, I wasn’t learning anything on the way.) (That lousy Fink.) Anyway, as sentences 15 and 16 were recited, I continued to reread 18, desperate to find a foolproof strategy. I was panicked by the brevity of time remaining, yet longed desperately for the exercise to be over. I could clearly sense my heart beating and feel dampness under my arms. My nerves continued to fray rapidly as sentence 17 was started by the student seated in front of me. Having to think fast, I somehow came up with the following. Just as sentence 17 was being completed, I would begin the initial /s/ in Susan, drawing it out very softly. Then, when Fink nodded at me, I would raise the volume and complete the sound, as well as the remainder of the sentence. It required exact timing, but, hey, I was about out of options. And time. By the time sentence 17 was halfway done, a prolonged “sssss” was coming out of my mouth at what I hoped was an imperceptible volume. I sounded like a leaking tire, but at least I was doing something that seemed constructive. I remember that my mouth was arid, surely a combination of nerves and the steady airflow required of an extended /s/. I was gripping the sides of my desk so hard that my hands had turned crimson. When 17 was finished, Fink said, “You young folks sure can talk fast,” or “Who was the fastest so far?” or—I don’t know what he said, but it completely threw off my timing. Short on air, I was forced to plug the leak and catch my breath. He then said, “Anyway, let’s see, where are we? Oh yes.” He was looking directly at me. I gazed down at my book (which was ridiculous, as by then I had sentence 18 long since memorized) and, in a loud and clear voice, said: “Sssssssssss, Ssssssssusan andherboyfriendbothwantedtogo.” The roar was immediate and reverberating. Every student except me was laughing. Mr. Finnik was giggling without restraint. When the students noticed this, they laughed even louder. For what seemed like hours (maybe 10 seconds or so), I sat with a forced smile on my face, like I was somehow in on the joke. After the noise finally abated, Fink commented, “I’d have to say Benny is still the fastest.” This reignited the bedlam of laughter. Suddenly an adult again, my esteemed teacher said, “All right, all right, let’s move on,” as he waved away the din. “Next sentence.” The student seated behind me did not immediately begin reading.

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“Ssssusan,” he said with a particularly cutting chuckle. “OK, I’m ready. ‘Republicansandlikemindedindividualswereattheconvention.’ ” Class ended after five or six more sentences. Humiliation did not. During my exit from the classroom, several students approached me, whispering, “Sssssssssss.” I continued to hear it the rest of the school day and as I fell asleep very late that night.

Chapter

3

How to Read Research (and Non-Research)

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If we knew what it was we were doing, it would not be called research, would it? —Albert Einstein

Advances in stuttering related to recovery (e.g., reports on the effectiveness of treatment techniques) are, for the most part, found in research journals. It follows, then, that anyone who wishes to keep up on such advances needs to read the research. For many, this is an unfortunate circumstance, given that they find research about as easy to comprehend as Winter Olympics color commentators. Remember something though, when you hear seemingly inane chatter like, “Germany II can save critical transition down time if the brakeman gets off the block without gouging the runners.” Although few individuals would comprehend a word of such rambling, everyone still understands the main point of the exercise, that is, to get down the icy track faster than the other sleds. Similarly, the point of most research studies is not that difficult to appreciate. The primary reason for this is that the purpose is overtly stated in nearly every study. In fact, the studies follow a standardized, and, some would say, dry format from start to finish, beginning with a literature review and followed by sections on methods, results, and discussion. An appraisal of these sections will hopefully help the reader solve the riddle of research.

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LITERATURE REVIEW Research is supposed to adhere to the scientific method—form, test, and modify a hypothesis. Or, as Robey and Schultz (1993) explain, theory building drives investigation. This means that the basis for research should not be we’ve-got-some-cool-equipment-let’s-hook-people-up-toit-and-see-what-happens. Rather, it is what we know up to now, the current state of theory, that determines what comes next. Ideally, then, the authors of a research study can make a case that their experiment is the foremost investigation to advance our understanding of stuttering at this point in time. In other words, everything that has happened in the past has led us to their experiment. They convince us of this important point via a review of the literature on which the theory is based. Because the literature review is meant to support the study in which it resides, it progresses deductively toward a purpose statement (explaining the purpose of the particular experiment). One result of this general-tospecific succession is that just about anything might appear at the beginning. Adding to the confusion is that this section necessarily includes numerous citations, which can make it difficult to read. Note the following example. For years, people have been examining the disorder of stuttering (Blaine, 2005; Blaine & Blaine, 2001; Blaine & Brennan, 1983; Blaine, Brennan, Brennan, & Blaine, 2002; Blaine, Brennan, Brennan II, Blaine, & Blaine, Jr., 1993; Brennan, 2002; Brennan & Blaine, 2003; Brennan, Blaine, & Blaine, 1977; Brennan, Blaine, Brennan, & Blaine, 2002; Brennan, Brennan, & Blaine, 1987; Brennan, Brennan, Blaine, Blaine, & Blaine, Jr., 2002; Brennan, Brennan, Brennan, Brennan, Brennan, Blaine, Brennan, Brennan II, & Cayley, 2004; Williams, 2003). While much of this literature was written to advance theoretical notions about the disorder (Cayley, 1995; Cayley & Blaine, 1991; Cayley, Blaine, & Brennan, 2002; Cayley & Brennan, 1999; Cayley, Brennan, & Blaine, 1993; Cayley, Brennan, Blaine, & Cayley, 1944; Cayley, Brennan, Blaine, Cayley, & Caysey, 2003; Williams, 2003), other researchers have focused on therapeutic techniques (Caysey, 2002; Caysey & Blaine, 2004; Caysey & Brennan, 2000; Caysey, Brennan, & Cayley, 2001; Caysey, Brennan, Cayley & Blaine, 2000, Caysey, Cayley, Brennan, Brennan, Blaine, & Caysey, 1999 . . . The numerous articles cited may have little in common, other than they are all related to the same general topic of stuttering. It is even possible, in fact, that some have only slight relevance to the study they are introducing. So why are they there?

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If questioned, the author would likely put forth variations of the following claims:
A broad overview provides a historical foundation for the theory un-

der test.
Classic studies form a basis for present research.
After the introduction is balanced with a discussion of the study’s relevance, the reader will understand how it adds to the overall knowledge base. Cynical observers might point out additional benefits of this format. For one, it gives the appearance that the authors have read numerous articles, even if in reality they only skimmed the abstracts. Second, they had ample opportunity to cite their friends, which one day could lead to reciprocation. Third, the accepted format for introducing a research study allows the authors to reference their own research. In many cases, it can even be cited it alongside the field’s most seminal works, suggesting that it belongs there. Much has been written on the topic of stuttering (Travis, 1931; Van Riper, 1973; Williams, 2002) . . . Note that nothing about this citation format gives away that I am grouping the genesis of a major theory, a landmark treatment text, and a reminder I wrote to myself in the margins of my lecture notes to make my anecdotes sound unrehearsed. Finally, the introductory paragraphs provide a place for the authors to mention articles with which they are unfamiliar or even dislike. This is an unfortunate albeit sometimes necessary evil of the publication process. Once a manuscript is submitted for publication, it is sent to experts in the field for review; often, these reviewers suggest that the author cite specific articles. The topic is worthwhile, but needs to be couched in a historical context, i.e., how does it further the landmark work of Frick (1999, 2001), Frack & Frick (2000), and Frick & Frack (2002)? Rather than risk annoying a reviewer by asking who Frick and/or Frack are, or waste time wondering which one the reviewer is, the authors might decide to include these works in the introduction. Thus, the authors can appease a reviewer without actually allowing the studies in question to interfere with the present one.

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It is worth noting that extraneous information added to placate reviewers is not limited to citations. Non-sequiturs appear throughout research articles. For example, when reading a study, you might come across a paragraph similar to this one. Because people who stutter present auditory processing differences when compared to nonstutterers (Dietrich, Barry, & Parker, 1995), it is possible that there is an underlying system difference related to both disorders. On the other hand, it should be noted that there were people treated by Frick and Frack (2002) who did not fit this pattern. Actually, it shouldn’t have been noted. But now you know why it was. Despite the potential for self-aggrandizement, the review process is a necessary element of the scientific method. Some (Bartley, 1984; Herbert et al., 2000) even view it as the most important feature of science. How better to advance a hypothesis than to feed it to ravenous critics who will tear it apart and leave the remains for theorists to reconstruct into a (hopefully) superior form? Does that mean the reader can trust the infallibility of published research? Read on.

PURPOSE The whole point of the introduction/literature review is to lead to the study’s purpose, a statement of how the outlined theory will be put to test. Given that the introduction becomes more specific as it progresses, the purpose statement can be thought of as the final point of specificity. For example, an introduction of stuttering becomes neurological research on stuttering, which leads to physiological research, which falls nicely into neurophysiology, which brings the reader to neurophysiologic research with equipment the author knows how to use, which, finally, results in the purpose statement for this particular study. Although the actual statement should be quite specific, purposes tend to fall under three basic categories. 1. Research to help determine the cause of stuttering. These statements are largely theoretical. For example, the following statement would fit nicely at the end of a literature review: . . . it follows from theory, then, that stuttering would interfere with subjects’ neurophysiology under test conditions. The purpose of the present study is to determine whether sample groups of adults

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who do and do not stutter differ with respect to alpha wave suppression under visualized speech conditions. 2. Research on the effectiveness of treatment methods. Writers generally bend over backwards to make these sound practical. Buzzwords are numerous. . . . Since treatment efficacy research clearly indicates that systematic and regular practice leads to improved performance on all of the aforementioned outcome measures, subjects who receive such practice should present greater therapeutic progress than those who do not. The purpose of the present study is to determine whether focused practice results in improved performance on objectives related to established outcomes. 3. Works written because the author needs a publication. These purpose statements are similar in form to those already mentioned, but they are far simpler in scope. . . . The literature is unclear with respect to how the general public would verbalize its feelings about people who stutter. We decided to address this lack of clarity in the present study, the purpose of which was to summarize answers from the first five people we saw to the question, “So what’s the deal with people who stutter?”

METHODS Whatever the purpose statement is, it generally concludes the introduction and paves the way for the next section, the one that describes the methods used to test the theory. Journals leave no mistaking where one ends and the other begins, as the methods section starts right under the heading Methods. Methods are necessarily presented in great detail so that other researchers can, if they so desire, replicate the study themselves. Unfortunately, this specificity may turn readers glassy-eyed as they plow through procedural descriptions, trying to absorb a general idea of how the experiment was set up without spending excessive time and energy concentrating on sentences like “Respiratory, electroglottographic, and air flow signals were digitized at 1000 samples per second by a 12-bit analog-to-digital conversion board.” This section should not, however, serve as a cue to stop paying attention, given the importance of the methods used to achieve the stated purpose of the study. Readers of research often pontificate on the topic of validity, wondering aloud whether the researchers really accomplished what they set out to accomplish. The Methods section is the focus of such pontification, the place where validity can be established. For example, determining genetic influences on stuttering by tracking gene markers would be far different to doing so by asking people, “Anyone else in your

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family stutter?” Moreover, it does not require excessive concentration to figure out research methods. For most, the trick is to lose the wall of resistance to anything scientific. Yes, it can be complex. So can a lot of things. Many will say they cannot keep such complexities straight, yet these same people can describe in great detail why the tight end went in motion on the fake screen on third and ten with 2:32 left in the second quarter. Or why Misty was crying when Bud responded with “Ditto” to the statement “I love you.”

RESULTS The Methods section is followed by the presentation and analysis of the study’s raw data. This section, headed Results, is where the researcher reports numbers, statistical analyses, and concrete observations of what happened when the authors’ hypothesis was put to test. Sounds good, right? I mean, what could be more objective than that? A lot of things, actually. Think of Results as the scripture reading before the sermon—a carefully selected foundation on which the subsequent message will be based. Although there is nothing inherently wrong with this sequence, there is, unfortunately, room for creative foundation building. See, there are many ways to present results. The means by which it is done in a given study might depend on whether or not the authors have a theory they are just dying to tell you about (see discussion in Park, 2000). And, believe me, many do. In fact, it is often possible to accurately predict the study’s conclusions knowing only the title and author’s name. The following list demonstrates different ways in which the same results can be reported.
The descriptive data indicate that the sample consisting of people who stutter

scored lower on all tests than did the nonstutterering group. However, when t-tests were applied to the sample means, it was found that none of the differences were statistically significant.
One obvious trend from the data is that the subjects who stutter scored consistently lower on all tests than did the nonstutterers. In fact, in all cases, these differences approached statistical significance. The first example informed the reader what happened. When the data were eyeballed, there appeared to be a trend. But when it was analyzed, the trend was not a meaningful one.

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In the second example, the writer is also reporting what happened, but in this instance, the trend is made to appear consequential. The problem with this example is that, by the author’s own criterion, the differences between the groups are not meaningful. That is, the author defined a difference as group means that vary to a statistically significant degree. That didn’t happen. Instead of simply noting that, the author decided to change the rules. Now the reader is told that any difference is suitable. It is equivalent to the NFL commissioner having a rooting interest in one of the Super Bowl teams, watching that team fall behind 14–3 late in the fourth quarter, and declaring that, starting three hours ago, touchdowns will count a point apiece while field goals will tally ten. Notice also that if the author leaves out the second sentence, the motive is even less apparent. One obvious trend from the data is that the subjects who stutter scored consistently lower on all tests than did the nonstutterers. Now the reader is being told that statistical analyses need not be applied (or at least not reported). Just take the author’s word that the difference is really a difference. This same strategy can be manifested in other forms. The following examples show the same results reported three ways.
Significant results were found for variables A, B, and C (p < .05). Analysis of

variable D did not indicate a significant difference (p > .05).
Significant results were found for variables A, B, C (p < .05), and D (p < .10).
Significant results were found for variables A, B, C (p < .05). In addition, significance was approached for D (p = .09). Before running any statistical analysis, an author will set a significance level, indicating the probability that any differences found could have occurred by chance alone (Neale & Liebert, 1986). In these instances, the level was set at .05 (a 5% probability, which equates to a 95% likelihood that the differences were real and not random). Using this very standard criterion, significant differences were found for three variables. Period. In the first example, the author says so. In the second, the significance level is changed in order to get a fourth difference. The third example is a little better than the second in that the author does not overtly fudge the significance level. It is likely, however, that the results are reported as such because, in the Discussion section, the author intends to sell the reader on four differences, not three.

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DISCUSSION The Discussion section exists for exploration of the study’s import. Prior to this section, the authors have given the reader an overview of current theory and research (literature review), the means by which they attempted to add to this body of research (methods), and what happened during this attempt (results). What’s left is to tie it all together, to explain how the current results complement present theory. In other words, what do the results mean? The interpretation of data can be a tricky business. For example, there is the problem of directionality (Neale & Liebert, 1986). Does A cause B or does B cause A? Does team camaraderie lead to winning or do teams that win tend to get along? Do differences in brain function cause stuttering or does stuttering influence how the brain functions? The answer might be none of the above. Sometimes there is a third variable influencing both A and B (Neale & Liebert, 1986). Does the presence of mittens cause an increase in car accidents or does a larger number of wrecks cause people to wear mittens? Probably neither, at least in any universe that includes an as yet unmentioned factor—snow—that could be responsible for both. Similarly, correlations between stuttering and concomitant disorders of auditory processing (Williams & Saul, 1996), articulation (Conture & Caruso, 1987), or language (Cullinan & Springer, 1980) might not reflect a causal relationship but, rather, some difference in the system that influences both. To be fair, directionality and third variable issues are difficult to assess. The same cannot be said for other forms of misinterpretation, however. We have all heard that, with statistics, anyone can say anything. Actually, inventive conclusions do not even require any statistics, as the following old joke illustrates. Two boys are playing football in Austin. Suddenly, one is attacked by a rabid Rottweiler. Thinking quickly, the other boy rips a big board off of a nearby fence, wedges it down the dog’s collar and twists it, breaking the dog’s neck. A reporter happens to be strolling by. He sees the incident and rushes over to interview the boy. “Young Texas Longhorn Fan Rescues Friend From Vicious Animal,” he starts writing in his notebook. “But I’m not a Texas Longhorn fan,” the little hero replies. “Sorry. Since we’re in Austin, I just assumed you were,” says the reporter. Crossing out his notes, he starts again. “Little Texas A & M Aggie Fan Rescues Friend From Deathly Attack.”

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“I’m not a Texas A & M fan either.” Puzzled, the reporter looks at the boy. “I assumed everyone who lives in Texas was either for the Longhorns or Aggies,” he explains. “What team do you root for?” “I’m an Oklahoma Sooners fan,” the boy replies. The reporter starts a new sheet in his notebook and writes, “Little Redneck Okie Kills Beloved Family Pet!” Of course, it is not just football rivalries that are subject to skewing. In a similar fashion, research findings can be viewed in a variety of ways. Take, for instance, a previous example of reported results: The descriptive data indicate that the sample consisting of people who stutter scored lower on all tests than did the nonstutterering group. However, when ttests were applied to the test means, it was found that none of the differences were statistically significant. The Discussion would, ideally, include a statement that no evidence was found of differences between groups and an examination of how this progresses or detracts from current theory. In this way, the results of the investigation have provided a legitimate foundation for the authors’ conclusions. Unfortunately, the ideal is not always the reality. If it were, I’d be fabulously wealthy and Bill Gates would be wrestling with issues of theory building. The reality here is that a shaky foundation is sometimes used to support a straw house. If the results are reported in a deceiving manner, expect the Discussion to follow in kind, likely spelling out the authors’ pet beliefs and favorite theories. Here are two additional examples from the previous discussion of results.
One obvious trend from the data is that the subjects who stutter scored con-

sistently lower on all tests than did the nonstutterers. In fact, in all cases, these differences approached statistical significance.
Significant results were found for variables A, B, C (p < .05). In addition, significance was approached for D (p = .09). What these examples have in common, as noted earlier, is that nonsignificant results are reported as meaningful. In fact, it is quite possible that the author will treat them exactly as he or she would have had they been significant, particularly in a Discussion section where numbers need not be listed. For example:

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One obvious trend from the data is that the subjects who stutter scored consistently lower on all tests than did the nonstutterers. In fact, in all cases, these differences approached statistical significance. The obvious question raised by these data is why the stuttering subjects were inferior with respect to every measure taken in this experiment . . . Actually, the more obvious question is this: Given that the authors did not find any differences, using their own ground rules for what constitutes a difference, why are they acting as if they did? The answer is that the authors simply know a difference exists and want to tell us about it. The problem is that they did not provide evidence for its existence. Believe it or not, fitting the results to the discussion (rather than vice versa) is even done when no differences are found whatsoever. In this instance, the reader may come across a sentence such as: Descriptive data indicate that the groups are roughly equivalent in their scores, a result unsupported by previous research. This raises the question of how this experiment differed from earlier ones. Perhaps it was ages of the subjects under test. Indeed, when the four oldest subjects are compared to matched control group subjects, distinct differences emerge. Nice try. But, again, a researcher is not allowed to create one set of rules and then play by another. Stated differently, one cannot set out to compare adults who do and do not stutter, then throw out the subjects who do not fit the predetermined conclusions the author wished to discuss. Can a real difference exist even if statistical significance is not reached? Sure. Any system based on probability is subject to some flaw. In fact, when authors report “mixed results,” they are often referring to differences that sometimes reach significance and sometimes fall short. For example, studies comparing how adults who do and do not stutter visually process language are mixed with respect to group differences (Hand & Haynes, 1983; Hardin, Pindzola, & Haynes, 1992; Moore, 1976). So is processing somehow related to stuttering? Quite possibly, it is. At the very least, it is a relationship worthy of additional exploration. It is perfectly legitimate to view mixed results from a body of literature in this manner. But that is far different than failing to find a difference in a single study and claiming that one exists nonetheless. Whether it is done fairly or unfairly, the discussion includes what the author feels the results mean and whether they support the current state of theory, add to it, or force reanalysis of it. This leads to a concluding sentence, which, more often than not, is a call for further research. For example:

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In attempting to determine the efficacy of the treatment program I named after myself, it appears that more questions were raised than answered. Thus, future research should focus on the types of clients best served by this treatment as well as its long-range efficacy. As far as I’m concerned, the inventor of the call for future research deserves to be immortalized in platinum. This helpful device can be utilized whenever the discussion gets so thick with theory that the author cannot find his or her way out. In addition to that, it can be dropped in if the author simply gets tired. In fact, it works best when both conditions are present. Even better, it doesn’t have to make sense. . . . This raises the obvious question of why the present study found A when each and every other study found B. Of course, the answer is impossible to determine at this time. Perhaps future research can examine issues of methodology and data collection procedures as they relate to sample variance. Or: This concludes the section on how to read research. Future investigation may one day add to our understanding of this important topic, as well as providing a suitable conclusion.

HOW TO READ NON-RESEARCH Obviously, there is much written on the topic of stuttering aside from that in research journals. Given that much of this material is not peer-reviewed or even much concerned with the scientific method, it should be divorced from the problems previously outlined, right? No, not right. Not even close. Actually, much of the material reviewed for this chapter presents the same problems and more. There are additional common themes as well, some of which are cause for concern. Others are well beyond concern. They are cause for running as far and as fast as possible. One of the most disconcerting commonalities is anti-intellectualism, a disregard for those who pursued the education and professional training necessary to research and treat stuttering. Disdain for those with conventional training takes many forms, from contempt for recognized experts in the field to a reliance on undefined “common sense.” Teach yourself to be careful when you come upon variations of the following phrases.

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Like Galileo, my ideas challenge the establishment.
So-called experts might not like me, but remember that they have a vested in





terest in maintaining the status quo. It is likely that my idea is so good because I didn’t study in the field. I don’t need to run studies. I stutter. That makes me a walking laboratory. What I do works. The happy faces of my clients tell me all I need to know. I don’t stutter when I’m alone or talking to my dog. So common sense tells me it’s not a physical problem or I’d be doing it all the time. That’s how I know it’s mental.

Let’s start with Galileo. Questioning stodgy and stale ideas can lead to positive outcomes, particularly when those holding the ideas have not experienced an original thought since their last show ’n’ tell. Challenging such individuals can be so worthwhile in fact, that it might one day result in a college football playoff. The problem, of course, is that simply defying old theory is insufficient evidence of a new theory’s viability. Remember that for every Galileo, there have been thousands of bad ideas, many of which were explained to only padded walls. It is interesting, not to mention ironic, when ideas that do not advance theory are nevertheless proclaimed as progressive (Hebert et al., 2000; Scott, Clark, & Brady, 2000). Often in these instances, the ideas’ proponents fall victim to one of the benchmarks of anti-intellectualism, the “maverick syndrome” (Saul, 1989). Numerous individuals who have been reprimanded, left unhired, criticized, or had their views rejected claim that their troubles are due to their insurgency. In all fields of study, countless bad ideas have been defended on the grounds that the originator is a rebel and, as such, subjected to unfair criticism from envious or repressive authoritarians. When someone suggests that there are flaws in the person’s thinking, he or she simply claims to be an iconoclast and, as such, unpopular because of a propensity to challenge authority (Quesal, 1999). This ignores the alternative explanation that there are flaws in the person’s thinking. There are probably countless reasons why unpopular ideas are defended as unfairly outcast. One is simple defensiveness. When a person takes ownership of an idea, he or she tends to protect it like a mother to a child or a face painter to his school’s athletic teams. Thus, when rejected, it is preferable to look for an alternative explanation than it is to admit that the idea is flawed. Attributing the rejection to an admired personality trait is perfect in that the idea’s originators can feel good about both the idea and themselves. This brings me to the second reason for the popularity of the maverick syndrome: Many cultures value boldness and confidence,

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the hallmarks of rebellion (see Chap. 9 for additional discussion of this issue). Thus, people like to think of themselves as rebels. Think about it— when is the last time you heard someone say any of the following?
I always did what I was told.
When someone gets in my face, I turn the other cheek.
I like to think of myself as a yes-man.

Probably never. We tend to boast more about our independence and brazenness. Apparently, non-researchers are no different. In addition to its use as ego-feed, whining can also provide a substantial smoke screen. When the debate can be shifted away from ideas, it is always good for the more ambiguous ones (Green, 1996; Herbert et al., 2000). Even better for the self-proclaimed mavericks of the world, such manipulation is not particularly difficult to do. A: Your ideas are garbage, B. B: You don’t like me. A: This isn’t about you . . . B? Where’d you go? B is gone, telling the world what a nonconformist genius he is, based on the dislike he engenders in the “A”s of the world. Of course, it is possible that a valid concept was unfairly rejected. After all, Galileos do come along. And although there is no comparable story in the field of stuttering, it is true that good ideas have come from those with unconventional backgrounds and varied knowledge bases who looked at matters in new ways. The main point of all this is not that all outside suggestions need be accepted or discarded but, rather, that they should be approached carefully. Being an outsider should render someone neither instant scorn nor instant credibility. There is nothing wrong with raising questions from a fresh perspective. There is in declaring answers from a questionable knowledge base. This raises a question: When current research and theory are ignored, on what basis are the resulting ideas supported? The answers are testimonials and the accounts of the originators (Quesal, 1999), whether it is the proponents’ own experiences as walking laboratories or something they see in their clients’ faces. Such “evidence” is more emotional and, as such, may well be more convincing than data and statistical analysis (Herbert et al., 2000), particularly to consumers desperate for some relief from the struggles of stuttering. Even better, the use of personal accounts allows one to present the good and withhold the bad (Popper, 1965).

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To be fair, experiences and observations are important (Green, 1996), just not as a cover for poor substance. Often, such reports are not only missing objective support, they also display a disheartening lack of knowledge. The example statement implying that research studies need not be done when personal experience is readily available shows an ignorance of one of the primary characteristics associated with stuttering—its individuality. Whereas, generally speaking, some knowledge is better than none, incomplete knowledge leads to trouble when solutions are based on it (Quesal, 1999). We all know that in life, the people furthest removed from a problem have the easiest solutions. When Uncle Sid says, “Just tell her to hit the road the next time she bothers you,” you know this is easy for Sid to say, given that he doesn’t know that the person in question is someone you are dating in secret because she is the daughter of your boss. Similarly, limited knowledge of stuttering allows for definitive statements. Stuttering is filled with intricacies and gray areas. Myths, controversies, and mixed results abound. But if you ignore all that, solutions become rather easy. Unfortunately, simple and direct hypotheses are sometimes worn as badges of honor. This has been going on for centuries, dating back at least to the time of Occam’s razor, a philosophy frequently translated from its Latin origins as “The simplest explanation is probably the right explanation” (Occam’s razor, 2004). Oddly, simplicity has been used as evidence of a theory’s validity (i.e., my theory has to be the correct one because it is the simplest). While Occam’s razor has merit, there are at least three problems with its general use. Most obviously, it isn’t always true. A theory which teaches that people stutter because they don’t think before they speak is quite simple, yet is not in the same area code as the truth. Secondly, theories appear comparatively simpler depending on the reader’s knowledge base. Stated differently, simple is in the eye of the beholder. In the aforementioned attempt to explain variability (the guy who talks to his dog), the speaker knows something about environmental influences (or at least that they exist) and nothing about the neurology of speech. From his perspective, then, the former is a far simpler explanation for stuttering variability. Obviously, one’s unique perspective is a shaky scaffold on which to rest a theory. Finally, Occam’s razor, directly interpreted as “Entities should not be multiplied more than necessary,” may well be intended to instruct theorists to offer explanations that are as simple and direct as possible (Occam’s razor, 2004). That is, give us the easy version, not the more complicated one. This is not only good advice, it is a far different recommendation to choosing the simpler sounding of two competing theories.

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In addition to Occam, another frequent defense of simple theories is common sense. Although there is certainly nothing wrong with common sense, it is insufficient evidence for theory. For one thing, it has more interpretations than Occam’s razor. The theorist who converses with his dog is, after all, offering a common sense argument, based on his knowledge of the subject. To others, his argument may be common, but far from sensible. Regardless of the basis, one of the apparent offshoots of simple theories is guarantees. If stuttering is easy to understand, I suppose the thinking goes, it is easy to solve. Oddly, the simple solutions (based on simplistic theories) often require specialized training to implement. What they often boil down to is that if people do as they are told (generally for a price), they can stop stuttering. This not only implies a universal treatment for a highly individualistic disorder (Quesal, 1999), but also gets the author off the hook for poor results. He or she can take full credit for any therapeutic success (“I showed them how to stop”) while at the same time avoiding any blame for failure (“They didn’t do as they were told”). Finally, non-research is likely to make massive leaps from present theory (Bunge, 1967; Herbert et al., 2000). As a function of the scientific method, research is a step-by-step process designed to improve understanding gradually (Sagan, 1995). When the restrictions of the scientific method are not present, an author can make giant bounds beyond what is commonly accepted. Yes, research often points out the obvious. But that alone should not allow non-researchers to make uninformed rushes to judgment. Good researchers know they don’t have all the answers. What are the odds that non-researchers do? So how does a consumer, who realistically has not the time, resources, or interest to stay abreast of all research trends, know when to believe what he or she reads, particularly when theories and treatments based on pseudoscience will, by definition, appear somewhat scientific? Certainly, it is good to be skeptical of arguments based on antiintellectualism, lacking objective support, or that simply sound too good to be true. But how does one know? After all, people in all walks of life are capable of putting forth solutions that sound viable, yet may be nonsensical. A stockbroker could throw around enough terms like yield, options, and arbitrage to convince me to invest in Edsel Motors. A mechanic could match the name of anything that sounds like an internal engine part with the words leak or crack and I will assume a repair is needed. So how can I expect consumers from varied backgrounds to wade through speech science explanations and discern fact from fiction? Compounding the difficulty is the fact that no guarantee exists that published theories are viable or that treatments stemming from empirical research will be effective (or that those that didn’t will not be). Keep in

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mind, however, that ideas in research journals have at least been legitimized by a peer review process. With that in mind, I offer not a foolproof method of garbage detection, but, rather, a few suggestions.
Ask a specialist. A list of board certified specialists in fluency and fluency disorders is available on the Internet (www.ausp.memphis.edu/ sbfd/materials/specialist.pdf) or through the American Speech-Language-Hearing Association.
Communicate with consumers and professionals through a local support group chapter. If none is available, try an electronic one, such as Stutt-L. The Stuttering Home Page Internet site (http://www.mankato. msus.edu/depts/comdis/kuster/stutter.html) has instructions for subscribing.
Organizations such as the National Stuttering Association and the Stuttering Foundation of America have information on-line and in short, easy-to-read publications. The Stuttering Home Page is another source for information about all matters pertaining to stuttering. Finally, there are resources available in book form. One recent example is Living With Stuttering by Kenneth O. St. Louis (2001, Populore Publishing), with page after page of references, personal accounts, and information to help consumers find the right path.

Hopefully, these suggestions can help readers make informed opinions and decisions. In the meantime, they should be wary.

SYNOPSIS Research related to stuttering recovery follows (to varying degrees) the scientific method in order to advance theory. Although imperfect, this research presents far fewer problems than non-research writings, with their questionable bases and lack of rigorous evaluation. Those who wish to read up on stuttering should know the difference between research and non-research, as well as the idiosyncrasies inherent in both, in order to make informed decisions about what to accept and reject. Those who wish to follow developments in the field from afar require simpler advice: Don’t believe everything you hear.

Chapter

4

An Empirical Investigation: Analyzing the Effectiveness of a Self-Help Application Method for Treating Stuttering

U Over the years, stuttering has been a mystery (overtheyearsstutteringhas beenamystery.com, 2003). While many “therapies” have been attempted, none has demonstrated success (success=cure.org, 2004). Perhaps one reason for this lack of positive outcomes is the dearth of client-focused treatments. That is, both formal and informal therapies, and their corresponding manuals, center on what clinicians should implement, rather than on what clients should learn (A guy named Andy, 2004, personal correspondence). An example of a client-focused technique that has been ignored in the area of stuttering is self-talk. This is true despite the proven track record of this approach. Athletes, for example, have utilized positive self-talk for years (Fowler, Corso, & Herbstreit, 2003). Furthermore, self-talk has been used by other populations as well, ranging from actors (Howard, Howard, & Fine, 1933) to anarchists (Sacco & Vanzetti, 1920). The versatility of this approach is further evidenced by its varied utilization. For example, self-talk can be encouraging (Robbins, 2001), critical (Cowell, 2004), or even emotional (Lombardi, 1966). It can also, of course, involve combinations of these styles, such as tough-love (Schlesinger, 1999). While the value of self-talk is well documented, the term itself may be somewhat misleading. In order to be convinced that personal goals are achievable, one must not only say (i.e., talk) the appropriate words, but also think them (Rodin, 1880). For this reason, many scholars prefer the more encompassing designation of self-help (Williams, 2004), a term that

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will be used henceforth. For the purposes of this study, self-help is operationally defined as the elimination of problems by convincing one’s self that the problems can be and, subsequently, have been eliminated; this process involves both self-talk and thought. Given that the major deficit with stuttering is disfluency (Andy, 2004, personal correspondence; Pete, 1973, personal correspondence), it follows that this is what the person who stutters needs to convince himself or herself not to do. That is, if he or she can talk himself or herself out of it, his or her deficit would be eliminated, a result that would benefit not only him or her, but his or her significant others as well. This straightforward premise formed the construct for a treatment labeled by the present author as A Self-Help Application Method (Williams, 2004). This therapy, referred to by many as ASHAM, is basically a two-part procedure in which the client 1) tells himself or herself not to be disfluent and 2) stops. The apparent advantages of this approach over conventional therapies are numerous. For example, two steps are easier to learn than the many targets involved in most fluency shaping programs (ASHAM Manual, 2004). Moreover, stuttering modification can literally take years before it is effective (Unidentified speaker, personal correspondence, 1999–2004), a commitment that is unnecessary when therapy is ASHAM. Finally, the cost, while high at the start, is actually comparable to conventional therapy when one takes into account the relatively small number of sessions required. While the advantages seem obvious, the therapy has not yet been put to test empirically. The purpose of this study, therefore, is to do a comparative clinical study, thereby acquiring data to help future consumers decide between therapies that are established and ASHAM.

METHODS The subjects in this study consisted of four adults between the ages of 18 and 53. Subject age was determined post-hoc by sawing them in half and counting the rings. For all subjects, the diagnosis of stuttering was made via A Self-Help Application Method Evaluation (Williams, 2004), an assessment instrument commonly designated as ASHAME. Indicators of stuttering were documented on ASHAME Form D: A Self-Help Application Method Evaluation Differential Diagnosis (Williams, 2004). Once subjects were thoroughly ASHAMEDD, they were evenly divided into two sample groups. For 2 weeks, one group was administered conventional stuttering treatment and the other ASHAM therapy. Conventional treatment (CT) was defined as treatment received at a facility

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known to administer conventional treatment. Post-hoc investigation revealed that half of the CT subjects received stuttering modification therapy and the other half fluency-shaping. While numerous scholarly formats have dealt with ASHAM (ASHAM Manual, 2004; Unidentified speaker, personal correspondence, 2003; asham.org, 2004), an overview is instructive here. Upon entering the clinic room, subjects were first directed to tell themselves to stop stuttering. When necessary, this step was broken into sub steps in accordance with published directions (ASHAM Manual, 2004). More specifically, the subject was given a set of index cards face down. When the examiner determined that the time was suitable, the subject was allowed to turn the top card over and silently read the words, “I will not stutter (be disfluent).” For purposes of consistency of administration, each subject was then instructed to read the words aloud until such time as he or she meant it. At that point, subjects were allowed to read the second and final card, both silently and aloud. The latter card read, “Stop!” The dependent variables analyzed for this study were frequency of stuttering, defined as percent of syllable stuttered in the examination room, and client satisfaction, based on published indicators (ASHAM Manual, 2004).

RESULTS Following treatment, subjects were asked to provide a live speech sample to the author. These samples ranged from six to 258 syllables spoken. Frequency measures were recorded in percentages in order to control for this variability. Descriptive statistics show that frequency of stuttering was greater for the CT subjects than for those undergoing ASHAM therapy. While not part of the analysis, it is worth noting that half of the CT subjects actually presented increased stuttering following 2 weeks of treatment. When t-tests were applied to these data, the difference in mean frequency was found to be statistically significant (t = 3.01, p  .05). This analysis indicates that the treatment that best reduced stuttering under test conditions was ASHAM. The data pertaining to client satisfaction are also instructive. Unfortunately, the survey forms on which these data were based were not adequately completed by all CT subjects. More specifically, it was deemed by the present investigator that too many items were left blank or answered “N/A.” However, the experimental group members did complete the items. As Table 1 indicates, all indicated that “Yippee” was the term that

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best depicted their post-treatment emotion, with “Wow” chosen unanimously as the secondary reaction.

DISCUSSION When two modes of treatment were compared empirically, one was clearly more successful in terms of both reducing frequency and maintaining high client satisfaction. The approach for which these claims are made is, of course, ASHAM. This is logical, given the aforementioned evidence of the effectiveness of self-talk. While it would be easy to advocate ASHAM therapy on the basis of this investigation, it is also true that more research is needed. For example, future research questions could center on the specific factors responsible for its superiority. Is it effective because of the ease of learning it? Or is it because overt symptoms are more directly addressed? Also, given the revolutionary aspects of this approach, how can it best be promoted to insure that more speech-language pathologists become trained in its use? Indeed, a more comprehensive analysis of these and other questions is necessary if more clients are to 1) become ASHAMEDD and 2) be administered ASHAM therapy. Finally, despite these compelling results, replications of the present study are needed and are, in fact, being carried out by the present author. Only in this way can a convincing, empirical case be made for ASHAM.

Chapter

5

Recovery and Therapy

U

I’ve gone through treatments here and there. A few worked well for me. But will those few help someone who Might stutter differently? —Mete Schubert A Stuttering Poem

Note: This chapter is an overview of the treatment process and, as such, will likely be more informative to people who stutter than to speech-language pathologists. However, members of the latter group, if they’re anything like me, may salvage something worthwhile from these pages. Nearly every time I read or hear a treatise on therapy, I find an idea that (1) is worth trying and/or (2) I meant to employ, but somehow overlooked. Hopefully, this chapter can trigger some ideas of this sort. Additionally, some therapists might have different perspectives on various treatment-related issues, differences they may want to discuss with their clients who are reading this. Scholars in the field and anyone who read Chapter 1 understand, hopefully, that stuttering (school-aged and beyond, anyway) involves more than occasional breaks of speech. There are also fears, frustrations, anxieties, and all the other leeches lying in wait beneath the surface. In the face of such formidable foes, it follows that treatment should address both the speech and non-speech components of stuttering. But given the complexity, not to mention the individuality, of the disorder, how can this realistically be accomplished?

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GOALS OF THERAPY The first step in treatment, as with so many processes, is the setting of goals. With stuttering therapy, goal setting is a collaborative practice wherein the speech-language pathologist (SLP) and client discuss what is appropriate, taking into account the client’s wants (and their feasibility), motivation, severity, and any other data or characteristics pertinent to the individual. The SLP explains what is possible, given the limitations of scheduling, the setting, or whatever other confines exist (e.g., intensive therapy would not be possible if the SLP and client were only able to meet once a week). More importantly, the SLP provides professional guidance based on his or her knowledge base, experience, and philosophical perspectives on stuttering. But it is still the client’s plan, and, as such, he or she must be in complete agreement with it (Manning, 1999). In addition to being collaborative, the treatment plan should be dynamic. It is not a contract, but a starting point, a way of applying some initial structure to an imprecise process. It is important that plans be flexible enough to account for probable changes in direction and philosophy. For example, clients might decide that they do not care for the way they sound using certain speech techniques or that they would like to spend more time addressing feared situations. For reasons such as these, goals may well be added, deleted, and/or altered as therapy progresses. What the actual goals are vary from client to client, an obvious result, I suppose, of the considerable variability across people who stutter. Still, if someone asked me to state the primary goal of stuttering therapy, I would answer effective communication. That is, regardless of the techniques learned, clients should be able to say what they want to, not what the stuttering allows (Conture & Guitar, 1993; Hood, 2001; Williams & Dugan, 2002). As long as I’m generalizing, I will also add that there are some broad and overlapping ideas that, I feel, should be common to all treatment plans. And whereas some clients do not need much, if any, work on one or more of these areas, I believe it is important that the statements be part of a therapist’s general philosophical approach and that the client understand each one by the time therapy is complete. These statements are listed here.
It’s OK to feel bad about stuttering.
It’s OK to feel better about it too.
It’s OK to speak (and to stutter).
It’s OK to modify your speech.
It’s OK—no, it’s a must—to go elsewhere with new skills.

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It’s OK to Feel Bad About Stuttering When describing their stuttering, few clients use the word fun. Some might say (with varying degrees of honesty) that they don’t care about it one way or another. But I have yet to hear anyone compare it to Disney World. Instead, they are far more likely to talk of struggles, anxieties, failures, and embarrassments. They mention words to be feared, situations to dread, and tension that can be both physically and mentally exhausting. And it’s good that they do. Stuttering is bothersome, to say the least, and there is no reason to pretend otherwise. In fact, it is important that clients own up to this truth. After all, no change can take place from a perspective of denial. What’s needed is honesty. Frank identification of stuttering’s negative components can not only reduce anxiety in the short run (Cooper, 2003), but is also the first step to lasting change (Gregory, 2003b; Guitar, 1998; Sheehan, 2003). After all, the whole problem cannot be treated as long as part of it is kept hidden. It is thus important that the SLP and client discuss both the disfluency and the covert experiences that accompany it (Van Riper, 1973). This discussion often begins with open-ended questions, such as the following:
What situations are particularly difficult for you?
Why do you think these situations are hard?
What words are giving you trouble?
How do you feel when you’re approaching them?
Why do you think your stuttering has gotten worse this past month?
How do you react when you are teased about your speech?

Without identifying (and, eventually, addressing) the overt and covert aspects of stuttering, the problem is unlikely to improve and may, in fact, intensify. Ramig (2003) writes of a vicious cycle, whereby emotions such as shame and guilt lead to avoidance, which, in turn, lead to more shame and guilt. This is not only a problem emotionally, but, as noted in Chapter 1, the increased avoidance can also result in added disfluency. It seems, then, that exposing the negativity of stuttering can lead to something positive. The same can be said for discussing frustrations related to therapy (Cooper, 2003). After all, much of what clients learn about the process is not what they wanted to hear: There is no cure, progress is gradual, and tasks may be difficult and/or uncomfortable. The client should feel free to express dissatisfaction associated with these or any other treatment issues.

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TABLE 5.1 Rationale, Goals, and Tasks Consistent With the Philosophical Statement It’s OK to Feel Bad About Stuttering Rationale Negative emotions associated with stuttering cannot be addressed if they remain hidden.

Examples of Goals 1. Client will describe 3 emotions associated with stuttering. 2. Client will list 5 possible solutions for the problem of teasing.

Examples of Tasks 1. Talking about difficult issues related to stuttering. 2. Reading and discussing essays about stuttering. 3. Writing a letter to one’s stuttering. 4. Drawing a picture of one’s stuttering.

Whether the concerns are about stuttering or treatment, it is important that they be discussed in a productive manner. Fortunately for SLPs, there are many good resources available to help guide clients toward the identification and eventual resolution of their concerns (e.g., Cooper, 2003; Crowe, 1997; Shapiro, 1999; Sugarman & Yaruss, 2000). As this book is written for clinicians and people who stutter, detailed description of counseling methods is a tricky area to approach. As Sugarman and Yaruss (2000) note, “If a (person who stutters) is aware that the SLP is using a counseling technique, then the technique is certain to fail.” I will say that, as general rules, the client needs to have an opportunity to talk and the SLP needs to know how to listen. Additionally, both should be willing to go out on limbs, whether this means discussing deep seated emotions, brainstorming solutions, or thrashing out whatever else is relevant to a particular situation (Cooper, 2003; Yaruss, 2004). Because of a client’s denial or inability to formulate emotions into words, or an SLP’s difficulty with basic counseling methods, such discussion might not come easy. In these instances, clinicians can utilize activities designed to bring emotions to the surface (see Table 5.1). Writing letters to one’s stuttering, for example, can be an effective discussion starter, as can reading essays that deal with pertinent issues (see Chap. 20). Clients are sometimes surprised at how identifying (or identifying with) the more covert aspects of stuttering releases emotions they did not even realize were there (Eldridge, 1997).

It’s OK to Feel Better About It Too With identification should come improved understanding on the part of the client. This includes an understanding of his or her own speechrelated attitudes (Sheehan, 2003), listener reactions (Cooper, 2003), and

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the actual stuttering—what happens during breakdowns as well as how the disorder affects goals, ambitions, and quality of life (Cooper, 2003; Sugarman & Yaruss, 2000; Van Riper, 1973). As a bonus, therapy is also likely to be better understood. Improved understanding helps to demystify stuttering (St. Louis, 1999), that is, to make it both comprehensible and manageable. People who stutter often come to therapy with the idea that their disorder is some unwieldy and shapeless force that totally enshrouds them (Cooper, 2003; St. Louis, 1999; Zebrowski, 2003). They cannot begin to examine it because they can’t get hold of it long enough to even catch a glimpse. Systematic and structured examination of one’s stuttering makes the disorder less mysterious and therefore less powerful. The client can see that it is not a random calamity. There are patterns, be it situations where it occurs more or less often, sounds that are easy and difficult to produce, and/or actual disfluencies that are easier and harder to manage. With identification and a little discussion of these patterns (see Table 5.2), an idea often emerges in the head of the client: If stuttering can be comprehended, perhaps it can also be managed. Greater understanding of stuttering has additional benefits as well. Avoidance is less apt to seem like a good idea. In addition, there may be an appreciation of why treatment must be gradual and why it involves moving outside one’s comfort zone. Personalized discussions are also beneficial to the SLP, as they allow him or her to understand what the issues are with a particular client’s stuttering (Gregory, 2003b). Such an understanding helps guide therapy in the right direction. Furthermore, these discussions make therapy more enjoyable for both parties because the sessions are not exclusively drill work. Dialogue about fears, challenges, and successes are welcomed and enTABLE 5.2 Rationale, Goals, and Tasks Consistent With the Philosophical Statement It’s OK to Feel Better About (Stuttering) Too Rationale Through identification and understanding of its elements, stuttering becomes less powerful.

Examples of Goals 1. Client will list and rank order (from easiest to most difficult) 5 situations in which speechassociated emotion is high. 2. Client will identify and rate the effectiveness (from 1 to 10 where 10 is always effective) of 5 avoidance behaviors.

Examples of Tasks 1. Talking about the variability of stuttering. 2. Construction of hierarchies (e.g., easy-to-difficult words or situations). 3. Reading and discussing essays about stuttering.

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couraged (Cooper, 2003; Sugarman & Yaruss, 2000). It is important to note that these sorts of emotional topics are likely to arise throughout the course of treatment. Thus, counseling will be an ongoing process.

It’s OK to Speak (and to Stutter) It is hoped that the exploration of stuttering will eventually lead to selfacceptance on the part of the clients. They must become comfortable enough with the idea that they stutter that change can occur. The initial reason for this is straightforward: Because it is impossible to get better at something without ever trying it, it follows that, in order to improve communication, one has to communicate. The idea here is not that people need to practice speaking in order to learn how to stop their speech breakdowns, but, rather, that they need to talk and not consider such breakdowns as failures. Stuttering is not shameful and it is important that clients not view it as such (Sheehan, 2003; Zebrowski, 2003). Fears of communicating must be overcome if any real improvement is going to take place. Stated differently, if problem words and situations can be approached without trepidation, attitudes toward speaking will improve and avoidance of speech (and life) will diminish. In addition to feared words and situations, people who stutter should become desensitized to the sound and feel of their own speech (Conture, 2001). This is important in the short run (to get them talking, as previously noted) and also long term. Treatment in any form involves changing one’s usual manner of speaking. However well the learned speech techniques are mastered, however, the client must still be willing to speak the new way. Should the speaker be at all self-conscious about speech, such acceptance will not come easily. Open stuttering (i.e., without accompanying secondary behaviors) is one means (see Table 5.3) of confronting the emotional weights associated with speaking. Furthermore, it is easy in the sense that it can be reinforced from the first minute of therapy. For certain clients, the more severe the stuttering, the greater the reinforcement. Some SLPs (e.g., Hood, 2001) advocate voluntary stuttering (stuttering purposely on a word that could have been said fluently) in conversation, assigned speaking tasks, or even contests (e.g., who can produce the most severe or most frequent disfluency) (Dell, 2000; Guitar & Reville, 2003; Williams & Dugan, 2002). However it is done—discussion, joke telling, competitive stuttering, or some other task—the idea is to lift the shame normally associated with stuttering and replace it with a positive experience. In addition to being an effective desensitizer, open stuttering can be an efficient means of addressing secondary behaviors. That is, when the cli-

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CHAPTER 5 TABLE 5.3 Rationale, Goals, and Tasks Consistent With the Philosophical Statement It’s OK to Speak (and to Stutter)

Rationale In order to improve communication, one has to be willing to communicate.

Examples of Goals 1. Client will use avoidance behaviors with no more than 5% of disfluencies in conversation. 2. Client will voluntarily stutter with one new listener.

Examples of Tasks 1. Open stuttering: Stuttering without employing secondary behaviors designed to mask it. 2. Voluntary stuttering: Stuttering purposely on words that could have been said fluently. 3. Stuttering contests: Who can produce the most frequent or most severe stuttering. 4. Reading and discussing essays about stuttering.

ent speaks without using any “tricks” to not stutter, all of these behaviors are, in essence, being treated at once. Often, however, secondary behaviors require focused treatment, either because they have become habits or because the client feels such shame in stuttering that he or she continues to avoid it, even in therapy. In such instances, the reinforcement being used for open stuttering can be coupled with mild punishers. For example, a simple game in which a point is awarded for each open stutter and a point taken away for each avoidance or escape behavior sends two very clear messages:
There is no shame in stuttering.
Secondary behaviors are unacceptable.

It’s OK to Modify Your Speech Obviously, therapy must involve some sort of direct management of speech beyond open and voluntary stuttering. For this reason, speech goals will be part of any treatment plan. Such goals are rooted in two possible outcomes: shaping (i.e., achieving) fluency and modifying (learning to manage) disfluency. The process of shaping stuttering into non-stuttered speech may include the use of biofeedback devices such as delayed auditory feedback (St. Louis & Westbrook, 1987), but more often involves step-by-step in-

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struction of such fluency enhancing techniques as increased air flow, gentle initiations of voicing, and reductions in speaking rate (among others). The justifications for enhancing fluency (that is, decreasing stuttering) include the beliefs that 1) this is what most clients really want from therapy (Schwartz, 1999; Shames & Florence, 1980; Shenker, Kully, & Meltzer, 1998) and 2) stuttering involves learned behaviors that can be unlearned (Siegel & Gold, 1999) and replaced by those more conducive to fluency. Furthermore, proponents can point to published evidence of the effectiveness of such techniques, even with adults (Andrews, Guitar, & Howie, 1980; Davidow, Crowe, & Bothe, 2004). Despite these reports of success, however, there are concerns about fluency shaping approaches. Some (e.g., Ramig & Dodge, 2005) maintain that the learned therapy targets will not hold up in stressful situations. In addition, many clients report that the techniques result in speech that is limiting (or “robotic,” as one former client termed it) and/or requires too much concentration (Conture, 1996; Kalinowski, Nobel, Armson, & Stuart, 1994; Manning, 2001; Starkweather & Givens-Ackerman, 1997; Yaruss et al., 2002). They would rather take their chances with stuttering. On the other end of the philosophical spectrum is stuttering modification, an approach based in large part on desensitization and easy stuttering. Williams and Dugan (2002) phrased their modification goals as “stuttering in a way you can manage,” “talking without tricks or avoidances,” and “taking charge of the stuttering, rather than letting it continue to run your life.” The major goal of therapy was expressed as, “saying whatever you want to say, whenever you want to say it, even if you sometimes stutter.” These types of goals do not stress (or, for that matter, even mention) fluency, a drawback for some (Ryan, 2003; Shenker, Kully, & Meltzer, 1998), but an omission that is quite intentional. Stuttering modification advocates believe that, because stuttering is not curable (Conture, 2001), it is best managed in a way that lifts the shame, embarrassment, and other barriers to effective communication. If clients are going to speak, the reasoning goes, they are going to stutter; and since they are going to stutter, they may as well become desensitized to it and assume some control over how they stutter. Recent survey data (McClure & Yaruss, 2003) lend some merit to this reasoning, as they indicate client satisfaction with common stuttering modification components such as changing speech-associated attitudes and, to a lesser extent, modifying disfluencies. Besides, stuttering modification advocates have argued, fluency may well be a byproduct of therapy without being a goal (Sheehan, Williams, & Dugan, 2001; Van Riper, 1973). What they mean is that it often improves as a result of stuttering openly. This may be best explained by viewing stuttering as a behavior cued by certain agents in the environment (Brutten & Shoemaker, 1967; Ramig & Dodge, 2004). Once the fear of these

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agents—the words and/or situations that trigger stuttering—is removed via desensitization, they no longer serve as cues to stutter. And it follows that fewer cues could result in less stuttering. I have always viewed this as a central difference between the pure (and perhaps oversimplified) forms of fluency shaping and stuttering modification: The former attempts to rid clients of the emotional baggage by decreasing the stuttering; with the latter, this process is reversed. Despite the outward philosophical differences between the two approaches, both can be effectively merged into the same treatment plan (Dietrich, 2000; Gregory, 1991; Guitar, 1998; Ramig & Dodge, 2004; Tetnowski, 2003). In fact, the fluency shaping and stuttering modification camps are both spreading out so far from their bases that there is nearly as much overlap as there is segregation. For example, fluency shaping techniques are now often part of “integrated” approaches that include such stuttering modification-rooted goals as identification and desensitization (Cooper, 1987; Dietrich, 2000; Gregory, 1991; Guitar, 1998; Latulas, Tetnowski, & Bathel, 2003; Schwartz, 1999). Similarly, stuttering modification approaches utilize techniques from fluency shaping, such as full inhalation prior to speech and gentle onset of voice, to build manageable stutters (Donaher, 2003; Ramig & Dodge, 2004; Sheehan, Williams, & Dugan, 2001). It is even possible to effectively teach techniques from both perspectives to the same client. Kully and Langevin (1999) attempt to bring fluency to its highest possible level while simultaneously teaching clients to modify the “residual stuttering.” With Dietrich’s Tension Control Therapy (2000), clients choose whether to increase stuttering in order to enhance awareness and practice modification techniques, or to decrease stuttering to facilitate certain speaking situations. In programs such as these, clients learn that reduction of stuttering need not fly in the face of self-acceptance. The purpose of the change in speech is not to conceal the stuttering, but, rather, to communicate effectively by speaking in a manner that is comfortable. In fact, it is important that the disfluencies that do occur are managed openly and not hidden. It is avoidance when speech is altered for the purpose of covering up disfluency. Change is acceptable, however, when the speaker is up front about his or her stuttering. So how can a listener tell the difference? Sometimes, it is impossible. Only the speaker knows for certain. This discussion of fluency shaping, stuttering modification, and integrated treatment approaches raises the question of which is best. Unfortunately, there is no one answer to this question. Or, stated differently, given the variability across people who stutter, it is difficult to determine what type of treatment approach will work for a given client. Yes, data exist in support of techniques designed to increase fluency (e.g., Davidow, Crowe, & Bothe, 2004) and those that improve speech-associated attitudes

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and modify stuttering (McClure & Yaruss, 2003). But these are group data, not necessarily reflective of any given individual. At a recent National Stuttering Association workshop (Williams, 2003), I asked people to relate the most and least helpful advice they had heard with respect to stuttering (in therapy or elsewhere). Among the responses were the following:
Best: Take a breath before speaking and use easy onsets to help flu-

ency.
Worst: Worry about fluency.
Best: Learn to pause (in order to) slow speech.
Worst: Slow down speech.
Best: Practice speech techniques.
Worst: Focus on speaking.

Clearly, effective techniques are not universal and, just as clearly, treatment goals need to be individualized to each client. It is a rare case, however, where changing speech, by modifying the disfluency, improving fluency, or both, will work without some combination of identification, counseling, and desensitization (Ramig & Dodge, 2005). As a final note, no section on modifying speech would be complete without mentioning the importance of self-monitoring (see goal 3 in Table 5.4). Clients must learn to monitor and, in time, adjust their own speech if and when old behaviors (e.g., hard stutters, avoidance behaviors) return. Self-monitoring is a simple therapy task in that it usually consists of the SLP asking the client to judge his or her own productions (with accuracy TABLE 5.4 Rationale, Goals, and Tasks Consistent With the Philosophical Statement It’s OK to Modify Your Speech Rationale Tense, disfluent speaking patterns can be replaced with speech that is easier to produce.

Examples of Goals 1. Client will utilize preparatory sets in conversational speech at an 80% level of accuracy. 2. Client will use the targets of enhanced air flow, gentle initiations of voicing, and reduced rate in 90% of conversational speech. 3. Client will self-monitor productions of easy prolongations with 90% accuracy.

Examples of Tasks 1. Client reads words using speech techniques. 2. Client discusses a topic of interest, utilizing techniques while remaining on topic. 3. Ask client to judge his own productions.

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based on agreement with the SLP’s judgments). But while easy to employ, it is nevertheless an important part of the process of modifying speech. In fact, in one review of adult therapy (Williams, 1999), self-monitoring was one of two treatment components consistently associated with success for adolescent and adult clients. The other? Transfer/maintenance. This brings me to the final philosophical statement.

It’s a Must to Go Elsewhere With New Skills Transferring skills to different environments is perhaps the most difficult aspect of therapy (Conture, 2001; St. Louis & Westbrook, 1987). I believe that one reason for this difficulty involves the aforementioned notion of stuttering as a cued behavior. That is, much research has supported the idea that, for a given individual who stutters, certain words and situations are more likely than others to trigger disfluency (Brutten, Bakker, Janssen, & van der Meulen, 1984; Brutten & Gray, 1961; Brutten & Janssen, 1979). There are clinical implications to this. For one, speech will be easy in a clinic room that lacks these cues. Second, once the client exits this safe environment and faces real life, with all its reminders of past failure, implementation of therapy skills will be far more difficult. A key component to moving skills beyond the treatment setting is desensitization—to both the client’s own reactions and those of listeners. Without this particular aspect of therapy, clients are likely to use newly acquired skills with the SLP and no one else. Viewed from another perspective, if the speech-language pathologist teaches only novel speaking patterns to someone who is anxious about the way he or she speaks, the SLP should not be surprised when the individual is reluctant about employing those patterns in other environments. Without desensitization to reactions, there is little chance of transferring success. A home program is one means of extending therapeutic goals to different settings (see Table 5.5). Such programs can take a variety of forms, from word lists for practicing speech tasks to more informal activities, such as reading essays, watching videos, or searching for information on the Internet. It is important, however, that the SLP approve the essays, videos, and especially web sites (Shields, 2000), as many are not helpful or even accurate (see Chap. 3). Transfer of skills can also be aided by simply leaving the treatment room during scheduled sessions. In doing so, clients can employ speaking tasks with a variety of listeners. It is a powerful way to see up close that: 1. speech and/or stuttering does not need to be hidden because 2. most listener reactions are neutral and 3. those that aren’t can be handled.

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TABLE 5.5 Rationale, Goals, and Tasks Consistent With the Philosophical Statement It’s a Must to Go Elsewhere With New Skills Rationale Skills mastered in the treatment room are not necessarily mastered elsewhere.

Examples of Goals 1. Client will use preparatory sets in conversation with a new listener at an 80% level of accuracy. 2. Client will complete 90% of home assignments. 3. Client will use the targets of enhanced air flow, gentle initiations of voicing, and reduced rate in 90% of conversational speech outside the treatment room.

Examples of Tasks 1. New listener(s) brought into treatment room to talk with client. 2. As part of home program, client practices speech techniques in different settings and/or with different listeners. 3. Client and clinician conduct therapy outside the normal treatment room. 4. During role-play activity, clinician takes client’s order from a menu. 5. Reading and discussing essays about stuttering.

As with home programs, leaving the comfort of the usual treatment setting allows various locations to become associated with success. Cueing, after all, works both ways. When many settings represent success, fears about failure are reduced. There are also transfer activities that are possible to do in the regular therapy setting. Bringing in new listeners is one way to help the client confront situational fears. If, for example, a teen is susceptible to peer pressure (and what teen isn’t?), including fellow students in therapy can help desensitize the client to the reactions of contemporaries. Another in-session transfer activity is role-play (Susca, 1997). The therapist can take the role of the boss, peer, parent, or whoever else is involved in difficult speaking situations for a particular client. This can serve as an effective step toward 1) confronting cues of past failure and 2) developing strategies for addressing feared situations. Whether one is addressing transfer in or out of the treatment room, it is important for the speech-language pathologist to be the leader in all transfer activities (Ramig, 2003). This includes demonstrating (with new listeners) open stutters, easy voicing onsets, or any other task that the client is instructed to perform. Setting this type of example shows the client that the clinician believes in what he or she is teaching and that there is nothing shameful about speaking differently. As clients begin to habituate the therapy targets, they should be made aware that mistakes will be tolerated and even encouraged (for more on

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this, see Chaps. 13 and 14). Again, the idea is for the clients to keep talking, keep trying. They will make far more progress risking failure than always playing it safe. After all, those who never make mistakes cannot learn from them. On the other hand, those who embrace challenges can eventually progress beyond them (Hood, 2001). Another important, albeit oft unmentioned, component to skill transfer is development of a support system (Ramig, 1993a). This could involve the client’s family and friends, other people who stutter, or both. Although support systems (or, more specifically, support groups) are further discussed in Chapter 7, mention should be made here of their therapeutic value. They provide the client with listeners to help with the transfer of skills (e.g., an atmosphere of acceptance in which to practice speech techniques; observers to monitor use of secondary behaviors) and offer another outlet for expressing the fears, emotions, and frustrations associated with stuttering (Hunt, 1987; Krauss-Lehrman & Reeves, 1989). The SLP can help with the formation of a support system, by, for example, talking to family (or coworkers, friends, etc.), inviting them to therapy, or serving as a resource for support group information (see Chap. 7).

GROUP THERAPY One mode of treatment particularly conducive to support is group therapy. Members of therapy groups often experience a sense of belonging (Rollin, 1987), which aids in the implementation of many phases of treatment. For example, different viewpoints of stuttering allow for better understanding of the characteristics, emotions, and management associated with it (Ramig & Bennett, 1997; Van Riper, 1973). Participants can practice therapy targets with each other (Ramig, 2003). They can monitor each other’s speech and secondary behaviors (Williams & Dugan, 2002). And once a client feels comfortable performing speaking tasks with a peer group, movement to other settings becomes easier. In short, the client becomes motivated by the success of peers and empowered by their support. It is important that treatment groups follow a shaping group format (Leith, 1993) in which participants are encouraged to offer feedback to one another. In this way, each client stays involved throughout the entire session. This format assumes both open and equal involvement. All participants should feel free to contribute, but no one should be allowed to dominate the session (Ramig, 2003). Because of the interactive nature of shaping groups, small ones generally work better than those larger.

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PROGRESS IN THERAPY Regardless of whether therapy is in a group or one-on-one, progress is based, in large measure, on meeting goals. It is important, however, not to lose sight of the fact that clients can feel satisfied with their treatment even when formally stated goals have not been realized. For this reason, less formal indicators of therapeutic progress are also important to track. Signs that a client is becoming a more effective and independent communicator include the use of longer speech utterances, a willingness to talk in previously feared situations, and increased participation in classes, work settings, or social activities. Some clients perform tasks associated with even greater communicative stress, such as auditioning for plays or leading discussion groups.

COMPLETION OF THERAPY With progress, of course, comes the eventual completion of therapy. Although this sounds like an obvious point, it is not always so easy to determine when a client is ready to be dismissed. Because of the high relapse with stuttering (St. Louis & Westbrook, 1987), dismissal from therapy need not occur the moment speech goals are met. A better strategy is to end gradually, reducing the frequency of visits while monitoring progress. Increasing the time between sessions will assure both client and clinician that performance can be maintained without regular therapy. The course of action could be to ask a twice-a-week client to start attending therapy once a week. Then, frequency can be reduced to once every two weeks, then once a month. Should gains be maintained and the client discharged, follow-up telephone calls are recommended as a way to help monitor the client’s skills. Also, it should be understood that the therapist can be contacted in the event of any form of relapse (e.g., more avoidance or a reversion to previous disfluency level) that the client is unable to manage successfully. One means of controlling relapse from stuttering modification treatment is voluntary stuttering. Deliberate use of the easy stutters helps clients maintain their therapeutic gains. That is, should hard stutters or, worse, secondary behaviors, become more prevalent, voluntary stuttering can return the client to a mindset favorable to the production of open, manageable stutters. For this reason, some consider it to be the most im-

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portant tool obtained in therapy (Lewis, 2001; Starke, 1999; Tereva et al., 2004). Similarly, fluency shaping clients can help themselves by practicing (and putting into practice) the speech skills learned in therapy. Of course, time constraints and other restrictions can make it difficult to complete the requisite practice. Moreover, it is not always easy to maintain the awareness of speech needed to regularly employ fluency enhancing techniques. For reasons such as these, clients should be encouraged to not only maintain contact with their SLP, but also to attend follow-up/refresher visits as needed (Schwartz, 1999). Regardless of the techniques with which clients leave therapy, they should possess skills conducive to more effective communication. This means that they can say what they mean rather than some ineffectual version of it that the stuttering permits. Hopefully, it is now evident that proper therapy can significantly aid in the achievement of this goal if all aspects of stuttering are addressed.

SELECTING A THERAPY I suppose the next question, then, is how can a potential client know that the entirety of his or her stuttering will be managed appropriately? Or maybe a better one is this: How can one reasonably determine whether a treatment under consideration is likely to meet his or her objectives? As previously noted, there are published reports indicating client satisfaction with different treatment outcomes (Conture, 1996; Davidow, Crowe, & Bothe, 2004; McClure & Yaruss, 2003; St. Louis & Westbrook, 1987; Yaruss et al., 2002). And although these reports may be helpful, there are cautions that need to accompany their mention. For one, it is possible that a therapy approach that is effective for many will be unsuitable for one (Yaruss & Quesal, 2002). To make a simplistic example, a client with who is afraid to speak to anyone but family would likely benefit more from a treatment that includes desensitization than one stressing only fluency enhancement techniques, regardless of the success rates associated with the latter. It should also be pointed out that published analyses of effectiveness reflect the goals of the treatments in question, which may or may not coincide with the client’s goals. Evidence of reduced stuttering (to continue with the same example) tells us nothing about how natural the resulting speech sounds or whether clients successfully confront feared situations. Given the variability across both clients and treatments, it is sometimes difficult, though always important, to get a good client–therapy match. And while there are no guarantees of achieving this match, clients en-

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rolled in therapy should feel free to discuss the issue with their speechlanguage pathologists. Those still looking for an SLP, however, may not be sure what to ask potential therapists. Here are some possible suggestions (in no particular order).
What is your treatment philosophy?
How will you decide which goals are right for me?
Will I learn about stuttering?
Will I learn about my stuttering?
If so, how?
How will my speech change?
How will we get those changes from the treatment room to real life?

SYNOPSIS Treatment for stuttering can significantly aid the recovery process. While the specific goals of treatment should be individualized to each client, they will likely revolve around learning and talking about stuttering, modifying existing behaviors (speech and non-speech), and stretching the client’s comfort zone. Guidance from an SLP, support from friends and family, and hard work on the part of the client are all helpful toward accomplishing these objectives.

Chapter

6

The Depo

U

When I got the telephone call, I was in my office. “Hello,” I said. “This is Dr. Dale Williams.” “Mr. Williams?” asked a female voice. “Close enough.” For some reason, people never seem to think I should have the title of doctor. “I’m just surprised you answer your own phone,” the caller explained. The sudden change in respect level caught me off guard. I wasn’t certain how to respond. Yes I’m busy, but you just happened to call as I was forwarding the last e-mail joke of the day? The voice returned. “Please hold for Mr. Jones.” Seconds later came a male voice. “Dr. Williams,” it said. “This is Sean Jones, attorney with Dale, Christel, Christel, and Leach.” “Oh.” When that answer didn’t produce a response, I added, “Hi.” “How’re you doing? We’re interested in having you be an expert witness for a case involving stuttering.” “I’m fine, thank you.” “What? Oh . . . right. Glad to hear it. Anyway, we’re interested in having you be an expert witness for a case involving stuttering.” My mind was racing with questions. Me, an expert? Should I be flattered? Suspicious? What sort of case? Which side would I be on? Was someone mistreating someone else? Because of stuttering? And most important: How was I going to get out of this?

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I did not want to appear unsympathetic, but I had things to do. Let’s face it: e-mail jokes don’t forward themselves. And once that task was completed, I had to organize my schedule and come up with new ways to avoid projects with real deadlines. Was any of that the real reason I was hesitating? In all honesty, no. I was worried about being cross-examined and looking stupid. “Dr. Williams?” How was I going to excuse myself without appearing uncaring? I had to think fast. “Dr. Williams, are you there?” “I’ll do it,” I said. Thinking fast has never been my specialty. “Great,” said Mr. Jones. “And what is your usual fee for these services?” Usual? Here is my out, I thought excitedly. I can price myself right out of this job. I gave him an hourly rate that I thought was ridiculous. “Fine,” he said. Clearly, I wasn’t very good at this. The case involved a man who claimed to be disfluent as a result of a recent accident. After a thorough evaluation, I found him to be disfluent, a condition likely resulting from a recent accident. I wrote a report, which for some reason led to the scheduling of a perfectly awful activity known as a deposition. Jones informed me of this over the telephone. Actually, what he said was that we needed to do a depo, which seemed at the time to be a pathetic attempt to make a gathering of lawyers sound hip. He told me that he and opposing counsel would meet me in my office, on a day and time of my choosing. I chose a day and a time. He told me the day wouldn’t work. I chose another. That didn’t work either, but this time Jones gave me an alternate day and time. I said fine. “Do you and I meet first?” I asked. “I’ll come a little early so we can talk,” he said. This did nothing to reassure me. I called my sister, who is a trial attorney. “Sue,” I began. (Yes, a lawyer named Sue.) “Don’t witnesses get prepared before a deposi—a depo?” “Mine certainly do.” “How?” “Well, at the very least, they learn how to keep their answers brief, preferably ‘yes,’ ‘no,’ and ‘I don’t recall.’ ” That wouldn’t be easy with stuttering. As a topic, it doesn’t lend itself well to short answers and sound bites. “So why isn’t Jones preparing me?” I asked.

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“Well, some lawyers are . . .” Her voice trailed off. “Are what?” I asked. “Confident in their witnesses? Busy with multiple cases?” “No,” she said. “The word I was looking for was stupid.” Well, that was reassuring. “Make sure his check clears,” were her final words of advice. Jones was late for the preparation meeting, so his coaching consisted of the statement, “Just answer the questions and you’ll be fine.” “I’ll do that. Thanks,” I replied. The first 30 minutes of the deposition were actually quite easy, as Jones lobbed softball after softball right down the middle of the plate. Yes, I’m licensed. Yes, I’m certified. As a matter of fact, I do teach a class in stuttering. And so on. While I spoke, the opposing attorney, who looked to be about 12 years old, sat silently, save for the occasional nod. The only other person in the room was a court reporter, who was somehow typing every word on what appeared to be foot pedals from a church organ. Jones finished his questioning by asking whether I recommended therapy for the plaintiff, a recommendation that was already in the evaluation report he had supposedly read. I nodded. “Dr. Williams, please answer verbally,” he instructed. “The court reporter can’t record nods.” “Yes,” I said. Smith turned to Twelve. “Your witness.” Twelve looked at me, paused, then asked a lengthy question that was basically confirming the date I evaluated the plaintiff. I decided to try the yes-no-I don’t recall thing. “Yes.” And do you remember what time the evaluation took place? “Yes.” A long pause followed this confirmation. For the first time, the court reporter stopped typing. “And what time was it?” continued Twelve. “Ten a.m.” “I see.” Twelve shuffled some notes for several minutes, then launched into a string of questions about the tests I gave—what they’re for, how they’re given, and anything else he could think of. I think at one point he even asked me the test authors’ political affiliations. Jones objected a couple of times, although I never understood why. He always threw in Latin phrases, so his objections sounded like, “Basis for witness testimony E pluribus Unum.” After the endless questions about the testing, Twelve finally moved on.

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“It says here in your recommendations that the plaintiff suffers from disfluency. Could you define this for me?” “Yes.” This was getting fun. Twelve sighed. “Please do so.” “Disfluency is disordered fluency.” “I see. Is stuttering disordered fluency?” I nodded. “Dr. Williams, answer verbally so the court reporter can record your answer.” “Oh, right. And yes.” “So what you are telling me is that the plaintiff stutters. Is that correct?” “No.” At this, Twelve looked over the top of his glasses, the way older people do when they give meaningful advice such as “Sometimes it’s not what you do, but what you don’t do.” With Twelve, it had the desired effect of making him look more mature. At that moment, he could have passed for sixteen. “Please explain,” he instructed. I looked at Jones. Please explain is not something that can be answered with yes, no, or I don’t recall. I was thinking my attorney would jump up and say something brilliant, like, “Post mortem non grata!” Instead, Jones sat still, looking half asleep. “In my opinion, there’s a difference between disfluency as a result of a head injury and what we typically refer to as stuttering,” I said. “And what is this difference?” asked Twelve. “Different symptoms, different causes, and different responses to therapy.” “I see. Let’s start with symptoms. Please explain the difference.” I had to think hard about this one. I began to sputter about secondary behaviors, variability, and awareness. “I see,” was Twelve’s response to my explanation. “What causes stuttering?” It was my turn to sigh. Clearly, Twelve didn’t see anything. “I don’t know,” I said. “No one does.” “Surely there are some theories.” “Yes.” “Do some people feel it is psychological?” “That depends on what you mean by psychological.” He flashed me a condescending smile. “All right,” he said. “You define it for me.” As I really didn’t know how to define the word psychological, I said, “Let’s call it learned.”

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“OK, define that.” I launched into a lengthy explanation of how different combinations of various components likely lead some people to stutter, a different disorder, by the way, than the one suffered by the plaintiff. Sue would have slapped me, as I had by then ventured quite far from the yes-no-I don’t recall strategy. Twelve studied me closely during my lecture. He even allowed an extra pause after I finished, in case I wanted to talk more. “Dr. Williams,” he finally began, although it sounded like a statement in and of itself, a sort of confirmation that I still existed. I nodded. This time, there was no correction. “You recommended therapy as a result of your evaluation. May I ask why?” “Sure.” This answer seemed to irritate him. “All right, why?” he asked, his inflection more pronounced. “Because I thought that, you know, the client could benefit from therapy.” “And what would be the nature of this therapy?” “I don’t understand the question,” I said. “Which word didn’t you understand?” he asked derisively. “The individual words were OK. It was the way you sequenced them that was dopey.” OK, I didn’t really say that. I didn’t have to say anything, in fact, because Jones was already objecting. Something about ad nauseum de facto parte. Twelve responded by tearing his glasses off his face and vehemently citing “The Newark Five versus the Ford Freeway Commission!” or some such thing. This seemed to settle the matter, as Jones resumed his nap. As I watched the court reporter pedal away, I was glad she couldn’t record my thoughts. Twelve continued his questioning. “Allow me to rephrase the question,” he said patiently. “What types of things would you be doing in therapy?” He stressed the word things so everyone would know he was talking to an idiot. “Well, there’s desensitization, for one th—, uh . . . there’s desensitization.” “And what is desensitization?” “Activities designed to reduce negative emotion. In this case, negative emotion associated with speech.” “I see. And what sorts of activities accomplish this?” “Well, typically, we do uh, well we do things like expand the number of listeners, expand the types of speaking situations, and role play.”

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“Let me get this straight,” Twelve said. He attempted to peer over the tops of his glasses again, until he realized he hadn’t put them back on. I have to admit, though, he recovered quite nicely. “Let me get this straight,” he repeated. “You cure stuttering by having people talk to different listeners?” “Again, we’re talking about a neurogenic disfluency here, not stuttering. And no, desensitization is not designed to cure stuttering.” “Would it be safe to say that you can’t cure stuttering?” “I guess.” “So you try to reduce negative emotion instead?” “Among other things.” “We’ll save the other things for later.” Twelve smiled at me, although I found nothing even remotely amusing about his statement. “Tell me,” he continued, “is there any proof that desensitization works?” “If you mean absolute proof that it will work with each and every case, the answer is no.” “I see. Dr. Williams, do you watch Health On Wheels?” This stopped me. He was referring to a local television show about medical and allied health-related issues. It consisted of interviews conducted on a cheap set (two office chairs and a paneled backdrop), interspersed with wiggly video clips apparently shot by a monkey on espresso. “Not regularly,” I answered. Twelve turned his head toward me, making eye contact. “You’re a rehabilitation expert and you don’t watch Health On Wheels?” “I see it sometimes when I’m flipping around,” I said, trying to be helpful. “I see. Dr. Williams, are you familiar with ASHAM?” No, it didn’t actually happen that opposing counsel referenced a treatment program that I made up two chapters ago. But the one he actually mentioned was similar in scope. And purpose. And, unfortunately, credibility. I told Twelve that I knew of the program to which he referred. “It was recently featured on Health On Wheels,” he informed me. “Oh.” “Are you familiar with the success rate of this treatment?” “You mean their claims of success?” Twelve turned dramatically. “Please explain the difference,” he said. I sighed. I thought of Sue and decided I wouldn’t babble. “I’m familiar with their claims, yes.” Twelve let it go. “Is there a reason why you didn’t recommend such a highly successful treatment?” he asked.

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I nodded. “Please don’t nod. The court reporter can’t record nods.” “Uh huh,” I answered. “Please do explain,” said Twelve with a smile. “Tell us why you would advise a stuttering client against a likely stuttering cure.” I sighed. “Once again, we’re not talking about stuttering here, but a neurogenic disfluency. Second, we don’t necessarily make decisions on group data, but on what’s, in our professional opinions, best for the individual client.” “I see. So, in your opinion, he wasn’t one of the overwhelming majority who would benefit?” “Yes, in my opinion, he is not like those reported to be successful.” “What’s the difference between the plaintiff and those who experience success?” “Well, for one thing, the plaintiff exists.” Here again is something I didn’t actually say. Instead, I rambled on more about how success rates can be misleading and don’t necessarily apply to a given client, particularly when said client is suffering from a different disorder. When I finished, Twelve asked, “Is desensitization part of your usual stuttering therapy?” “Yes.” “This technique is part of stuttering modification, is it not?” As the questioning was again going toward developmental stuttering, and away from neurogenic disfluency, I tried to coax Jones into objecting. I looked straight at him as I replied to the question. “When you say stuttering modification, are you referring to the therapy approach designed for stuttering?” Jones sat still. “Are there other stuttering modifications?” asked Twelve. “No, I was just surprised that you would ask about a stuttering treatment.” I was still looking at Jones. My attorney, however, was busy drawing storm clouds in the margins of his notes. “I asked whether desensitization is part of stuttering modification,” Twelve reminded me. I nodded. “Please answer verbal—” “Yes.” “What else makes up stuttering modification?” “Identification, modification, and stabilization.” “Let’s start with identification. What is that?” “In essence, the client learns about his stuttering and, in doing so, loses some fear of it.”

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This clearly did not interest him. “And modification?” “Learning to modify the stutter.” He smiled. This was clearly what he was looking for. “And how does one modify a stutter?” he asked, although he clearly had a good idea. “Basically, you learn to stutter with less tension.” “I see. So, essentially, what you’re saying is, you teach stutterers how to stutter.” “I teach them to more easily manage their stuttering.” “What’s the difference? On second thought, here’s a better question: Why teach people how to stutter when they already know how? Why not teach a cure?” “Well, for one thing, there isn’t a cure.” Twelve smiled again. “OK, why teach people how to stutter when there are other approaches with high success rates?” Jones suddenly returned to life, speaking for the first time in twenty minutes. “We’ve covered success rates,” he said impatiently. “In a general sense, yes,” Twelve responded. Turning toward me, he continued. “But I can’t help but wonder what the success rate is for teaching people how to stutter. Excuse me—how to stutter in front of new listeners.” I looked at Jones to see whether I had to answer. He appeared ready to resume his artwork. “We don’t know,” I admitted. “I see. But presumably it does work sometimes.” “Yes.” “Why?” “Some clients meet the goals and become more effective communicators.” “No, I mean why does it work with some and not with others?” “Many factors.” I was all set to list them but, to my surprise, Twelve didn’t ask. “I see,” he said. “To sum up your testimony, then: You don’t know the cause of stuttering, you don’t have a cure, you don’t know if your therapy is going to work, and, when it does, you don’t know why.” “It’s not an exact science.” “I guess not,” he said. “No further questions.” Jones’ response to this was, “I guess we’re done then.” As he stood up to leave, I noticed that he avoided eye contact with me. Apparently, the parts of my testimony he didn’t sleep through hadn’t gone as well as he’d hoped. “Don’t talk about the case.” This instruction was directed at me, but spoken to a blank wall.

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I think my response was something like, “What do you think I’m going to do—write a book chapter about it?” The case was settled before going to court. At least I assume it was. The truth is, I never heard from Jones again. I did, however, recently see a picture of Twelve in the paper. He was at some benefit, laughing it up with other donors to Save the Rich or whatever the cause was. I noticed he had mixed some gray coloring into his hair, a pathetic attempt to add some years to his looks. The effect was to make him look like that one kid in every high school who goes prematurely gray. In any case, because of the presumed settlement, I was spared from having to answer more questions about stuttering for a case that wasn’t about stuttering. In a way, that’s too bad. After the depo was over, I thought up some new responses for Twelve:
“Take it from me dude, the more you know the less you know.”
“My professional opinions put food on the table. Remember that,

punk, the next time you get the urge to say ‘I see.’ ”
“With humans, sometimes two and two doesn’t equal four, you know?”
“You want guarantees? Go to Wal-Mart.” And, when all else fails:
“Oh yeah?!”

I even ran these responses by Sue. She recommended against them.

Chapter

7

Support Groups

U

I know that I’ve some things to share, Things I wish I’d heard said. Like we’re not here on earth that long. We lead lives, then we’re dead. —Mete Schubert A Stuttering Poem

In Chapter 5 it was noted that support systems can be an important adjunct to therapy and, more importantly, to the recovery process itself. This raises an important question. What are support systems? In the earlier chapter, they were seen to be assemblages of family, friends, and/or people who stutter, all of them accepting of disfluent speech and willing to discuss it. Such a definition differentiates support systems from another commonly used term in this realm, support groups. The term support groups, as generally defined, refers to a specific type of support system (Ramig, 1993a). Richardson and Goodman (1983), for example, stated that such groups are made up of “people who have a common problem and have joined together to do something about it.” This simple and straightforward definition captures the essence of the typical stuttering support group. They tend be small (fewer than 12) collections of adults between the ages of 25 and 40 years (Hunt, 1987) who meet regularly in the same setting to discuss issues related to stuttering.

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Of course, the Richardson and Goodman definition is general enough to also encompass group therapy. This chapter, however, does not as that particular topic was already discussed in Chapter 5. Here I deal with groups that meet for the purposes of mutual aid and emotional support. In Chapter 5, support groups were said to provide an important adjunct to therapy and, more importantly, to the recovery process itself. Specifically, they were noted to serve two therapeutic functions:
Open discussion about stuttering (Hunt, 1987; Krauss-Lehrman &

Reeves, 1989), including its patterns, variability, evolution, and whatever else is on participants’ minds.
A setting in which to practice therapy targets with new listeners (Gathman, 1983; Manning, 2001; Ramig, 1993a; St. Louis, 2001). The former function can aid the desensitization process and the latter transfer. That is, participants can come to better understand stuttering and to speak openly. And once a client feels comfortable performing speaking tasks with sympathetic listeners, transferring skills to other settings may well become easier. Interestingly, when support group participants were surveyed, accessorizing therapy was seen to be the least important function of such groups (Krauss-Lehrman & Reeves, 1989). Benefits associated with mutual aid were considered paramount. In light of the development sequence outlined in Chapter 1—the cabal of silence within families, the embarrassment among friends, and so forth—this makes perfect sense. For someone who stutters, feeling alone is feeling different. Luckily, the converse (the old bit about strength in numbers) is also true. As one local support group member said, “I felt like there was nothing wrong with me when I saw there were lots of us out there.” This statement touches on three overlapping benefits of support groups—acceptance, socialization, and empowerment (Gathman, 1983; Manning, 2001; Ramig, 1993a). Prior to group participation, many feel as if their fight against stuttering is unaided. For these individuals, support meetings offer the earliest glimpse that it need not be faced alone, that there are others who share the experience (Hunt, 1987; Manning, 2001). For the first time, they have the opportunity to talk about issues such as teasing, embarrassment, shame, and other difficulties related to stuttering. They can express suppressed emotions with listeners who are interested, who understand, and who might even offer some insight regarding how to handle such difficulties (Gathman, 1986). This sort of reciprocity among group members—get help, help others—not only allows them to socialize and make new friends (Hess, as cited in Gathman, 1986), but can also lead to improved selfconcept, greater self-acceptance, and decreased anxiety (Ramig, 1993a).

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Additional reasons that people join stuttering support groups include learning about stuttering (Gathman, 1983; Hunt, 1987) and about treatment, both good and bad (Conture, 2001; Hunt, 1987). Groups often link participants with stuttering organizations and therapists (Hunt, 1987). For others, the group is their therapy (Manning, 2001). That is, people without the time or resources for traditional therapy use support groups as their sole source of help. Finally, some people are attracted to support groups for their advocacy efforts (Hunt, 1987; Manning, 2001). Although media advocacy has been a function of large organizations such as the National Stuttering Association (Zimmerman, 1993), people tend to use local meetings for less public concerns. For example, those who feel they have been discriminated against may be looking for information about what their rights are, if and when to take action, and any helpful contacts the group members can offer. As there are so many reasons that people become involved with support groups, it should not be surprising that meeting agendas vary from group to group and meeting to meeting (Hunt, 1987). Often, in fact, groups convene with no planned agenda. People come to discuss speaking concerns and accomplishments, as well as seemingly unrelated matters (weddings, babies, promotions, you name it). Indeed, even having an agenda is no guarantee that it will be addressed. Nor does it need to be. It is important not to lose sight of functions such as acceptance and socialization simply for the sake of staying on schedule. “Forest for the trees” should mean something in a support group setting. It can ostensibly be argued that support groups offer something for everyone. It is strange, then, that so few take part. Given the standard prevalence rate for stuttering of around 1% (Shapiro, 1999), that means that there are well over two million people who stutter in the United States alone. America’s largest support organization, the National Stuttering Association, has approximately 3,500 members (Lowman, 2003, personal correspondence). There are additional organizations (such as Speak Easy International and Passing Twice) with smaller memberships. But even if the total membership for all support groups is estimated at 5,000 (a generous total, considering that many hold memberships in multiple organizations) and even if it is assumed that there are 5,000 more who attend meetings without joining the parent organizations (another liberal estimate), that still means that far less than 1% of people who stutter are involved with support groups. Taking into account the total possible pool from which members could be drawn (people who stutter, family members, interested professionals, etc.), the percentage of those who take part in the support movement is miniscule. So where is everybody?

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They’re elsewhere, of course, and for a variety of reasons. The most obvious one is that many do not know that support organizations even exist. These are small groups without marketing budgets. As such, they rely on flyers, free public service announcements, and word of mouth. Obviously, such low profile advertising does not reach everyone in the targeted audience. It is also the case that some individuals who stutter are simply not in dire need of support. This is not to say that they disregard support groups or that such groups could not help them in some way. It’s just that everyone has to prioritize their lives and, for some, this is not a top concern. There are scheduling clashes or babysitting issues or other conflicts that must be placed before support. Of course, some do discount support groups and not all who do so are being truthful. As noted in Chapter 1, shame often accompanies the development of stuttering. Attending a stuttering support group meeting might involve answering questions such as “Where are you going?” or “Where were you last night?” or “What is/was the meeting about?” The easiest way to avoid such questions is to skip the meetings. Perhaps related to shame is denial. Many people who stutter are unwilling to admit that their speech is abnormal or to associate with others who stutter (Hunt, 1987). They do not wish to be viewed as people who need help, but, rather, as “strong” enough to take care of their own problems. When invited to a meeting, they respond with, “I don’t need it.” The idea that support groups are made up of relatively fragile souls is one of many common misperceptions. Another is the notion that meetings are emotional events (Gathman, 1983), full of tears and expressive outbursts. “Not my thing” is a common response when the subject of support groups is raised. I can honestly state that I have never experienced a support group gathering that degenerated into a weeping festival. On the contrary, the close camaraderie that develops among members is more akin to a gathering of old friends than it is to a Barbara Walters interview. This is as it should be. No one feels empowered, accepted, or helped when they leave depressed. Another reason some might avoid support groups is the advice of their speech-language pathologists. I have been told, for example, of SLPs who discourage participation because they believe that professionals in attendance will attempt to steal their clients. A more common concern is that involvement will be counterproductive. Because it is not uncommon for meetings to include individuals who are critical of therapy (Hunt, 1987; Manning, 2001), support groups have developed something of a reputation for being anti-treatment (Gathman, 1986). In most cases, this reputation is erroneous. Still, groups should take great pains to avoid even the perception of this sort of enmity. As previously noted, support groups can

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work effectively in conjunction with therapy. Furthermore, professional involvement should be welcomed, not discouraged, as this can aid the group functions of skill transfer and serving as an information resource, among others. Although groups should not be anti-therapy, they shouldn’t attempt to be therapy either (Gathman, 1986). Yes, participants should feel free to practice therapy targets in this setting. But the purpose of the meeting is not to give or receive feedback on speaking skills. Not only does this shift the meeting focus away from what is being said (to how it is being said), it ignores the reality that the majority of participants are not qualified to administer treatment. A final reason for low membership is that local groups often dissolve. One study found that only a few last longer than 2 years (Hunt, 1987). The causes for this instability are not difficult to discern. For instance, one of the reasons why people don’t join in the first place—their SLPs discourage it—also affects retention of members. To use one common example, if the prevailing philosophical approach within the group greatly contrasts that of the therapy being administered, the SLP may feel that the client’s continued participation is detrimental to recovery. Philosophical differences can also arise among members (Ramig, 1993a), which might cause people to drop out. For example, some may be seeking fluency whereas others view this as a fruitless quest. Not only will disagreements develop, but the former group—those searching for a cure—is unlikely to be helped much by group attendance, given that there is little that can be done to improve fluency in a support group setting (Hunt, 1987). Thus, it is doubtful that those fixated on this goal will attend regularly. Another previously cited reason for missing meetings, scheduling conflicts, also results in the departure of members. People of young adult age may start families, enroll in college courses, or change work shifts, to name just three examples of factors that can either limit available time or directly conflict with meetings. In some cases, such factors result in relocation, which obviously furthers group withdrawal. Despite the reality that even the best chapters lose members, there are steps that support groups can take to remain viable. One is establishing and maintaining stable leadership (Ramig, 1993a). Those who guide the meetings need to be dedicated, as they are looked upon to organize the meetings and lead the discussions. Equally important, they need to be available to both regular attendees and those considering their first meeting. Chapter leaders will be called upon to answer questions ranging from directions to the meeting site to how to prepare for a public speaking engagement. (And, by the way, if you are thinking of starting a chapter but feel you cannot answer such questions, “I don’t know, but I’ll help you find out” is a perfectly valid response.)

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Stability of meeting place and time is also helpful to group maintenance. As noted, most groups engage in some sort of low cost advertising, usually members posting flyers wherever allowed. Once this task is completed, the basic meeting information (days, times, setting, and contact people) is public and difficult to change. Furthermore, consistent meetings are easy to remember. If they are always, say, the first Wednesday of the month at 7 p.m. in the Dale Williams room of the Community Center, those who haven’t attended in awhile can easily rejoin the group. It is also important that the site be conducive to disciplined discussion (Hunt, 1987). Meeting in a restaurant or pub might sound like fun, but quickly leads to loss of discipline, and, in time, group identity. That is, the entire purpose of the group—to meet about a common interest—becomes lost in the consumption (and discussion) of food and drink. Support of speech-language pathologists (Hunt, 1987) can also aid in a group’s survival. SLPs cannot only refer their clients to the meetings, but their own attendance may well attract other attendees. Considering that people come for education about stuttering, there is an obvious appeal to the availability of educated opinions. Because some groups meet just once a month (Hunt, 1987), reminding people via telephone or e-mail can be helpful toward keeping the meeting on their personal schedules. Special activities (social or educational) can also help attendance, but, as with all of the other aforementioned ideas, their effectiveness is both limited and variable. Perhaps future market research will enable support groups to advertise effectively to both people who stutter and speech-language professionals. Specifically, examination of what people are looking for in the way of support could be coupled with effective description of how groups offer such services. This would not only heighten the appeal of support groups, but also help to combat the misconceptions about them. Such research is important because support groups are important, enough so that both people who stutter and speech-language pathologists should get involved (Conture, 2001). The former group receives self-help and mutual aid while SLPs hear first-hand what their stuttering clients experience, as well as observe how therapy goals are implemented with new listeners. Getting involved with support groups is not only advisable, it is easy. Despite the transience of local groups, many geographic areas include strong chapters. These can generally be found through practicing SLPs or the closest university communication disorders program. Another convenient source is the National Stuttering Association ([email protected] or 1-800-364-1677), which helps individuals find or even start local chapters. There are also various Internet sources available for support. They are

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listed on the Stuttering Home Page at http://www.mankato.msus.edu/ depts/comdis/kuster/stutter.html.

SYNOPSIS Support groups add more to the recovery process than serving as therapy adjuncts. If assembled and maintained with care, they can provide a place for people to learn, socialize, feel empowered, and be with those who understand the experience of stuttering. These features benefit not only people who stutter, but speech-language pathologists as well.

Chapter

8

The Meeting

U

I recently asked a colleague, a prominent researcher of neurological systems, why my brain goes to autopilot whenever I am asked about support group meetings. She thought for a moment, and then replied, “Because you’re an idiot.” Whatever the veracity of this analysis, my rote response about support groups is very real and always includes the phrases “informal meetings,” “no agenda,” “young adults,” “shared experiences,” and “free HBO.” Those who show up in spite of my idle ramblings and outright falsehoods discover that the actual common denominator across meetings is exactly what they expected in the first place. In a nutshell, we talk about stuttering. As my six-year-old would say, “Well, duh!” What I mean is we discuss it, wrestle with it, argue about it, joke about it, and try in vain to figure it out. Often, we also lose sight of it and find ourselves debating such pressing matters as the designated hitter rule and who would win a debate between your average radio talk show host and a Tickle-Me Elmo. But the tangents always make it back around to the main topic eventually, proving that stuttering has a large impact on even those with the attention span of plankton. Despite my own stutter, my initial enthusiasm about participation in such a group was roughly equivalent to that of the average teen forced to spend Friday night watching C-SPAN with Great-Aunt Blanche. It began when someone named Marlon contacted me about attending a meeting.

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He was apparently calling from 1969, as he stated a desire to get some “cats” to “rap” at his “pad.” I told him that while the idea was not without its grooviness, I couldn’t help but wonder how he had gotten my name. “From everyone, man,” was his reply. Apparently, my stutter was a common topic of conversation in his circles. In any event, I agreed to come because I saw an opportunity to help others and, in turn, be helped myself. That and Marlon promised free food. From this passionate beginning, I began getting more and more involved in the group. This involvement had little to do with concern for others and a lot to do with the meetings themselves. Always poorly prepared, loosely constructed, and imprecisely executed, they were totally without structure or even agenda. In other words, I felt at home from the get go. Marlon had assumed the leadership position within the group. In totality, this involved 1) welcoming everyone at the start of the evening and 2) closing the meeting, usually with an observation like, “Your bogus rap is starting to bum my high. Why don’t you all book?” In between these responsibilities, he mostly sat back in his beanbag and studied the antique flip-flops that hung loosely from his sullied feet. Introductions, Marlon’s idea for a “primo tradition” that lasted exactly one meeting, marked my initial exposure to the regular participants. We were in Marlon’s basement, an apparent storage space for broken lava lamps and faded Peter Max posters. Marlon presented himself first that evening, saying his name while anxiously stroking his graying ponytail. He told us that he worked as a sales rep for a local radio station “to pay the man.” But his real passion was a book he was writing about stuttering. It was a novel involving a string of murders culminating in a bloody battle scene in which stuttering modification advocates and fluency shapers end up killing each other. The sole survivor unfortunately develops amnesia as a result of his battle fatigue. He thus returns to his commune to create stuttering therapy without his previous biases. Marlon was sure this story would one day be a top seller. After recounting his proposed fiction, Marlon pointed to his right. At the end of his finger was a man who appeared to be the anti-Marlon, closely cropped and wearing a Heroes of NASCAR novelty necktie. He said that his name was Paul and that he was a speech-language pathologist who 1) did not stutter and 2) had no literary aspirations. Next was my turn. Taking my cue from Paul, I was similarly brief, struggling through my name and the words “between jobs.” The second I finished, a guy to my right jumped to his feet, spread his arms, and said, “Stan Fey. Drama student.” A pause followed this declaration, albeit a quick one. Apparently, Stan was not one to let silence linger.

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“Now, you may be thinking, ‘A stuttering actor?’ ” he continued, although, I, for one, was experiencing no such thought. “Think about it!” Stan ordered demonstratively. “When I’m on stage, no one else is talking. No one is interrupting. I don’t stutter because I can talk any bloody way I please!” “Bloody,” Marlon repeated. “The English rock, man.” Stan bowed in the direction of a young man of slight build and calm demeanor. Knowing better than to compete with Stan’s vibrant introduction, the man said only that he was Tim, a college freshman who stuttered. When pressed for something personal, he added that he liked to collect “quiet things,” whatever that meant. At that point, the rotation had arrived at the sole woman of the group. I watched closely as she began to speak. One does not often have an opportunity to observe adult females who stutter, so, from an academic perspective, this was a rare chance to learn. OK, she was pretty. My awe changed to disappointment when Ciara, as she introduced herself, actually spoke. I still would have dated her, mind you, but her frequent prolonged sounds and inaudible gasps of silent tension distracted me. All I remember of her introduction was that she was a recent business school graduate with a lengthy job title that included a lot of terms like assistant, associate, vice, and one or two forms of the word control. Next to Ciara was the oldest and largest individual in the room. With droning yet flowing speech, he told us that his name was Charley. He was a retired police officer who still appeared powerful enough to subdue even the most crazed of criminals. Charley explained that he originally joined the group to tell others about his success in therapy. I thought that the monotonous nature of Charley’s speech could have been used as an argument against the treatment he received. Given that his wrists were roughly the size of my head, however, I kept this thought to myself. Charley’s introduction brought us to a subject that would prove to be recurring, that of treatment. Everyone always had therapy war stories to share. Except for Charley, the stories were all happy tales of short-term success and angry accounts of long-standing defeat. “It’s not easy to get a tailored fit in the off-the-rack world of stuttering therapy,” said Paul. “Tailored fit don’t feed the bulldog!” yelled Stan, for no apparent reason. Charley restated his satisfaction with speech that was uninterrupted. His slow and controlled speaking manner, however, was not for everyone. Stan, for example, said he would rather have his lips stapled shut than talk like that. Like the rest of us, however, he too longed to discover his treatment match.

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“Hit and miss,” was Marlon’s solution. “Talk about not feeding the bulldog,” said Charley. “Really,” I said. I made it a point to agree with Charley whenever possible. What followed was a discussion of other solutions to stuttering. Stan began by reciting the litany of advice so familiar to us all. Slow down. Think about what you’re going to say. Take a breath and try it again. Just say it. Spit it out. “L-like any of that’s going to help,” he added. “Like none of it ever occurred to us,” intoned Charley. “Exactly,” I said. “Aaaanother . . . thing I hear all the . . . time,” said Ciara, “is, ‘What causes that?’ ” “Usually followed by question number two,” added Charley. “Why doesn’t Mel Tillis stutter when he sings? I don’t know and I don’t care.” “People are stupid,” Stan informed us. As if to confirm this, Ciara related that she had once been coached to replace talking with singing. Charley mentioned that he had been told by his parents to stop stuttering “or else.” As luck would have it, however, neither Mary Poppins impersonations nor vague threats turned out to be much help in the long run, the same result as when Marlon was hypnotized. I mentioned that a therapist had once advised me to substitute easy words for those I could not say. This tip amused some of the others. I did not mention that I eventually took this idiotic advice, a decision that eventually led to more complications than a truth-in-lending document. “Why do we put up with this?” asked Stan. “Because wwwwe get . . . desperate enough to believe anything,” answered Ciara. “Believe me, the way mmmmy in-laws looked at me the fffirst . . . time I met them, I’d have . . . gotten hypnotized if ssssomeone had offered.” “You’re married?” I asked. “I once convinced a girl to d-dump me because I stutter,” said Stan. “Why?” Ciara asked, apparently oblivious to my question. “B-because I wanted to date her roommate.” “And . . . ?” “Just adding to your p-point about how stuttering can affect people socially.” There was a pause that allowed me to catch up to the present conversation. I looked at Stan, who was grinning like a toddler by an unguarded cabinet. “I’m afraid of wwwwomen,” Tim suddenly announced. “Those are tough for me too,” said Marlon. “Those?” asked Ciara.

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“Aaaand phones stink like anything,” Tim added. “There’s a sentence you don’t hear every day,” I said. “Drive-throughs stink like anything too,” Stan remarked. “Also . . . tape recorders,” said Ciara. As she said this, she placed her hands on the table and I noticed the ring. Small stone. I would have done better. Had I been working, that is. “Nonstutterers have speech issues too,” said Paul. “I get more stressed when I’m being recorded or talking on the phone or at a drive-through.” “Yeah, but you don’t sound more stressed,” replied Stan. “Good point, man,” said Marlon. “People hear us and assume we’re social misfit flakes.” “And n-not real bright,” added Stan. “Are we sssocial misfit flakes?” asked Tim. “Don’t forget not bright,” I corrected. “Not a chance,” said Paul. “The only thing experts know to be true about all people who stutter is that they all stutter.” “We’ve come a long way,” I observed. Paul ignored me. “I remember reading once that listeners react to the anxiety intrinsic to any disfluency in such a way that the anxiety impacts their opinions of you.” “Sure wish you came with subtitles,” said Stan. “Try it again,” added Charley. “Some of us aren’t fluent in academese.” “I’m not fluent in any language,” I joked. I was disappointed when no one laughed. “What he means,” said Marlon, “is the listener picks up anxiety vibes that he ties to the speaker.” He turned to Paul, “That right, Mr. Big Word Meat?” Paul nodded with a slight grimace, evidently not altogether comfortable with his new nickname. “It p-p-p-probably doesn’t help th-that all of the stuttering . . . p-ppeople on . . . TV are misfits,” said Tim. Stan agreed. “In a mystery,” he said, “b-b-bet the house that the stuttering character did it.” “I’ve seen plenty of sympathetic portrayals of people who stutter,” Paul argued. “. . . Did they ssstutter l-l-like me?” asked Tim. Stan laughed. “No way. If the character is likable, they not only make the st-stuttering mild enough to be cute, but they cure it in an hour. The guy falls in love or stands up to the authority figure or the mother-in-law moves out and—voila!—the stuttering is gone.” “OK, some writers are idiots,” said Paul. “I thought we already established that about people in general. But, hey—what can you do?”

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“We . . . can get involved and make them ssstop it, Meat” answered Tim. “Whoa there, Mr. Ed,” said Marlon, moving forward in the beanbag. “What about freedom of speech? Censorship gives me the winnie.” Charley laughed, an apparent sign that he understood what Marlon was saying. “I love that argument,” he said. “How about Tim’s freedom to speak out? Isn’t freedom of speech a two-way street?” “Uh huh,” I agreed. “. . . Don’t you th-th-think ignorance of stuttering is a factor in how we get . . . treated?” Tim asked, looking directly at Marlon. “Yo,” our leader admitted. “Sssso shouldn’t we fight it?” “If Twisted Sister stuttered, that’s what they would do,” Stan informed us. He commenced humming We’re Not Gonna Take It. “If people think we’re wimps, they’ll treat us like wimps,” said Charley. “I’m guessing that’s never actually been a concern for you,” I answered. “Well . . .” Charley smiled. “There was this one guy I arrested. First he mimicked me, then told me ‘Speak or forever hold your peace.’ ” Stan stopped humming. “What did you do?” “First I asked him, ‘Do you stutter too or do you just have a death wish?’ Then I handcuffed him and tossed him in the squad car.” Stan’s story was better. His family moved when he was twelve. As the new kid, he was paid a visit by Gene, the neighborhood tough guy. Stan was in the family garage, pretending to grease the chain on his bicycle, but actually hiding some magazines of which his mother did not approve. “Gene shows up to say how he ran the neighborhood and that crossing him could ‘get you killed.’ Those were his words: ‘Get you killed.’ ” Stan laughed easily at the memory. “Hhhhow’d you handle it?” asked Ciara. “I t-told him I wasn’t scared of anyone with a girl’s name. The thing of it is, I st-stuttered when I said it. He grabbed the front of my shirt, made a fist, and said, ‘Suh, suh, say it again, freak.’ ” “Did you?” asked Paul. “N-no I didn’t, Meat. I grabbed a handful of grease off my bike chain and smeared it in his face. Most of it went into his mouth. He doubled over and started r-r-ralphing big time. Then he ran home. I got in trouble, but Gene n-never bothered me again.” “That’s awful,” said Ciara. I was not so sure. There had been times in my life when some nearby bicycle grease might have come in handy. “I want everyone to stop calling me Meat,” announced Paul.

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“Sure thing, Mr. Big Word,” said Stan. “I’m not wild about that one either.” “Too bad,” answered Stan. “Mr. B the SLP has kind of a nice ring to it.” A few people laughed, but not me. I was still annoyed that my fluentin-any-language joke had fallen flat. “Good note to book on,” said Marlon, which apparently signified closure, as he added, “Catch you cats next month.” Despite Marlon’s occasional lack of focus, not to mention his questionable intelligibility, I usually came away from meetings understanding stuttering in ways unseen in textbooks. Yes, our support group was mostly “young adults” who “shared experiences” in “informal meetings” with “no agenda.” And, yes, on the most basic of levels we talked about stuttering. But there’s more to it than that, and the additional part is what’s important. Unfortunately, it is also difficult for me to explain. Maybe I am an idiot.

Chapter

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The Stereotyping of People Who Stutter Dale F. Williams, Ph.D., CCC-SLP & Carlos F. Diaz, Ed.D.

U Some people are so “open-minded,” they can’t listen to anyone who isn’t. Deb Dart

Note: Carlos F. Diaz, Ed.D. is a professor in the College of Education at Florida Atlantic University. In addition, he is a member of the Board of Examiners for the National Council for the Accreditation of Colleges of Teacher Education. A native of Cuba, Dr. Diaz has published two books and numerous articles and book chapters on multicultural education. His next book, Touch the Future: Teach, is due to be published in the spring of 2005. Specific areas of interest include prejudice and stereotype reduction. Let’s begin with a gross oversimplification. We exist in a diverse world, one swirling with intricacy and multiple shades of gray. Unfortunately, the only weapon we are given to combat the complexities we face is a brain no larger than a fist, housing a finite number of cells responsible for a multitude of functions. So how do we make sense of a world we’re ill equipped to understand? In essence, we classify. We develop categorization schemes to impose structure onto a complex environment. It is a natural process that begins in the earliest stages of language development. A child learns a word, for example dog, and every animal is, for a while, called dog. In time, the child learns other animal names and, thus, small animals may all be classified as mouse, water animals fish, and so on, until the child has developed a com-

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plex categorization scheme for animals that includes numerous species and means of classification.

STEREOTYPES BASED ON SPEECH Viewed against this background, stereotyping can be seen as misclassification schemes applied to people. We group our fellow humans according to such characteristics as race, weight, age, attractiveness, and a multitude of other traits, including speech. Literature from the field of linguistics, for example, links differing stereotypes to various accents and languages (de Klerk & Bosch, 1995). Among American listeners, facility in Standard English is associated with relatively high mental capacity, whereas regional American and foreign accents are not generally viewed as positively (Gollnick & Chinn, 2002). In addition to articulatory differences, voice and resonance characteristics have also been allied with specific personality traits, with disorders in these areas often being perceived negatively (Blood, Mahan, & Hyman, 1979; Gilmore, 1974).

STEREOTYPING OF PEOPLE WHO STUTTER Not surprisingly, people who stutter also fall victim to stereotyping. In 1970, Yairi and Williams determined that speech-language therapists identified children who stutter as anxious, nervous, shy, quiet, and withdrawn, among other comparable traits. Subsequent studies of speech and language professionals have yielded similar results (Cooper & Cooper, 1985; Woods & Williams, 1976). Moreover, people who stutter also have been stereotyped in this manner by the general public (Craig, Tran, & Craig, 2003; Silverman & Paynter, 1990), employers (Hurst & Cooper, 1983a), vocational rehabilitation counselors (Hurst & Cooper, 1983b), teachers (Yeakle & Cooper, 1986), school administrators (Lass et al. 1994; Kiser et al. 1994), college professors (Dorsey & Guenther, 2000), nurses (Silverman & Bongey, 1997), and pediatricians (Yairi & Carrico, 1992). Different researchers have speculated on the existence of this “stutterer stereotype” (White & Collins, 1984). That is, why are those who stutter viewed as wallflowers as opposed to something louder or more assertive? The most obvious explanation is that they really are natural introverts, a speculation put forth by Woods and Williams (1976), then quickly dismissed by the same authors as overly simplistic. There is, after all, no evidence to support such a characterization. Woods and Williams (1976) also hypothesized that listeners react to the high anxiety of the stuttering moment, then generalize that the speaker is

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always anxious. A different explanation for the stereotype was offered by Thatchell and associates (1983), who concluded that the perception of stuttering speakers is a function of their poor eye contact, though the authors offered no evidence to back the contention that eye contact is abnormally low. Finally, White and Collins (1984) suggested that all people experience anxiety and tend to withdraw when they are disfluent. Thus, people overtly and abnormally disfluent are often seen as perpetually anxious and withdrawn. Perhaps the most sensible speculation for the stutterer stereotype emerges from the research on attitudes toward speech. From an early age (somewhere around seven), people who stutter present increased speechassociated anxiety in comparison to non-stutterers (DeNil & Brutten, 1987). Given their negative experience histories with speech, it makes sense that stuttering individuals are, overall, less likely to be verbally outspoken or serve as the storytellers within their peer groups. From this, it is an easy overgeneralization to assume that similar traits exist in nonspeech situations. Based on current knowledge, it is also incorrect. The lawyer who stutters will not negotiate less aggressively than fluent opposing counsel. A teacher may well be a strict disciplinarian, even if he or she stutters. Stuttering athletes are as apt to battle to the finish as their nonstuttering opponents. This notion of overgeneralization, basing conclusions on limited or no evidence, is common to all of the possible stereotype derivations cited. Similar mental shortcutting serves to maintain stereotypes once they are set. We tend to assimilate observations into our pre-existing schemes. In other words, we interpret data in ways that make us comfortable (i.e., see what we want to see). Observations that support our view of the world are cited, those that do not are ignored or viewed as exceptions to our rules. With people who stutter, as with any group, it is possible to find individuals who fit the stereotype to varying degrees. Those are the examples we remember. The result of this selective classification is a view of life that is orderly and easy to grasp. Communication becomes more compact as well, if one assumes that terms such as feminist, doctor’s kid, or stutterer convey an abundance of valid information in just a few syllables. Our behaviors influence our classifications and vice versa, a cycle that serves to further maintain the stereotypes we develop. White and Collins (1984) wrote of a self-fulfilling prophecy whereby stuttering clients are induced to behave in a manner consistent with the speech-language pathologist’s beliefs about them. For example, a clinician who believes a new stuttering client is likely to be shy might conduct a session filled with lengthy instructions and closed-ended questions. This plan may alleviate some worries about the perceived shyness, but it also limits the client’s speaking opportunities. Thus, after the session is completed, the percep-

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tion of the shy stutterer has been reinforced. Of course, such a process is not limited to therapists. Anyone holding the aforementioned stereotype might talk more than usual around someone who stutters, reasoning that it is necessary to do so with those who are naturally quiet. The stereotype is thus supported when the person who stutters is forced into the passive conversational role. Media portrayals of those who stutter are also worth mentioning. Although the merits of specific portrayals have been debated without conclusion (e.g., Benson, 1988; Zimmerman, 1988), evidence does exist that, in general, media depictions influence beliefs about groups. In fact, Mackie and associates (1996) wrote that, along with friends and family, the media are the “most powerful transmitters of cultural stereotypes” in Western societies. Shapiro (1999) argues that the pervasiveness of the stutterer stereotype in arts and literature (e.g., Benecken, 1995) indicates that people who stutter are widely typecast (although it is unclear which is the chicken and which the egg in this argument: Do media depictions influence society’s beliefs or merely reflect them?). Finally, there is the frequently cited matter of the self-esteem of the person who engages in stereotyping. Although the relationship between selfesteem and stereotyping has been debated (Stangor & Schaller, 1996), there does seem to be a link between individuals’ feelings about themselves and the groups (e.g., cultural, gender, fluency) to which they belong. Denigrating other groups can be used to enhance one’s view of self. Thus, it may follow that the stereotype associated with stuttering is particularly susceptible to maintenance in cultures where passivity, nervousness, and the like are socially unacceptable traits. People will look for a reason to attach such characteristics to others. When a speaker points out that someone is bland, the primary purpose of the remark may actually be to show that he or she (i.e., the speaker) is not. The United States serves as a good example of a culture in which the stuttering stereotype is undoubtedly a negative one. Americans value boldness and confidence, reserving far less admiration for reticence. In this respect, we are far from unique. Although other cultures may be more forgiving of the kind of traits associated with people who stutter, it is doubtful that anyone anywhere wishes to stutter for the resulting increase in esteem.

EFFECTS OF THE STEREOTYPE One question raised by this discussion is “So what?” More specifically, of what real importance is the stuttering stereotype? After all, there are certainly other groups presented in far more negative ways.

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So what? is a difficult question to answer, as published research has focused more on the makeup of the stereotype than its effects. Speculation is possible; firm conclusions are not. Despite the lack of empirical evidence, however, it would be ingenuous to believe that the effects are none. This is simply never the case with negative stereotypes. Social interactions, for example, are changed when one has to work past others’ misperceptions. Inaccurate media portrayals may lead to embarrassment or even ridicule. More disconcerting than the inconveniences of a negative stereotype, however, are the professional opportunities potentially lost. Many people who stutter feel that their speech negatively impacts performance evaluations and judgments of their capabilities, some reporting that they were told that it was the reason they were not hired (Rice & Kroll, 1994). In addition, employers agree that job opportunities are decreased for those who stutter (Hurst & Cooper, 1983a). It is also worth mentioning that initial research on role entrapment (Gabel et al. 2004), defined as “when the group in power defines those roles that the minority group can fulfill,” indicates that adults tend to view people who stutter as less suited for certain careers. While it is unclear from this research whether the lost chances are related to stereotyping or the actual presence of stuttered speech, there is logic to the notion that potential advancement could be adversely affected on the basis of perceived personality traits. A middle manager viewed as nervous and passive would have difficulty being promoted to vicepresident, particularly if the president (or whoever is deciding the promotion) considered himself or herself to be fearless and aggressive. We do, after all, tend to think of ourselves in socially appropriate ways, and devalue characteristics that are inconsistent with our self-perceptions (Rosenbaum, 1986). It is also a fair question to ask whether academic advancement is affected by the stereotype in question. To the extent that children who stutter are not placed in leadership positions within the classroom, are not allowed to speak as often as their peers, or are perceived negatively by teachers, academic progress is adversely impacted. Unfortunately, more research is needed to determine whether these scenarios are commonplace. Compounding the potential lost opportunities is the speculation that individuals will, over time, modify their own self-concepts to match the perceptions held by others (McCrosky, Daly, Richmond, & Falcione, 1977). Although it is unknown how often this occurs with people who stutter, at least one study (Jones, 2004) offers evidence that stuttering negatively impacts self-perceptions. For speech-language pathologists, holding a stereotype of their stuttering clients has its own set of dangers. Lacking a true understanding of

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those you treat may well decrease effectiveness. Also, there is the issue of credibility. Many people who stutter are knowledgeable about their disorder. It is doubtful that these individuals will be impressed with trained professionals who present a limited understanding.

CONTROLLING THE STUTTERER STEREOTYPE Given that stereotyping has invaded the area of stuttering with at least some negative effects, the next question is: What can be done? Stereotypes are, after all, extraordinarily resistant to change (Nachbar & Lause, 1992; Pettigrew, 1979). It seems that once a categorization scheme is set, it quickly becomes ingrained. Probably the best place to start looking for solutions is to study what has been done to combat other stereotypes. Past attempts to broaden individuals’ classification schemes have included both education about the groups being stereotyped and exposure to those from such groups. The first of these means, education, has been effective in changing dimensions of stereotyping alluded to above (i.e., organizing and simplifying the social environment; justifying actions toward those who are different; creating distinctiveness across groups) (Worchel & Rothgerber, 1997). For some people, learning about different groups can expand their classification schemes and even change existing stereotypes to more positive ones. For others, unfortunately, education will have little effect. It is important to note that the outcomes of educational efforts are not solely dependent on the individual being educated. They are also functions of the information conveyed. If, for example, a news story reported that 90% of people who stutter tally perfect scores on their SATs, the change in the existing stereotype would likely be quick and widespread. Unfortunately, no such information exists. Informing people that stuttering individuals have been successful in all walks of life, including those necessitating courage and outspokenness (which, unlike the SAT example, is true) will have a more gradual and limited effect. Another positive corrective to stereotyping is exposure to those from the groups in question. Indeed, Klassen (2001) found that friends and colleagues of people who stutter tended to have less stereotypical attitudes associated with the disorder. To be maximally effective, however, the exposure must occur in situations of status similarity (Mannheim, 1960). A wealthy student is less likely to change his stereotype of people who stutter if his family’s maid suffers from the disorder than he is if assigned a disfluent roommate in medical school.

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Assuming status similarity, it can be said that the more exposure to individuals of the stereotyped group, the more variability one sees. Narrow classification schemes thus become more difficult to justify and keep. But although the variability across people who stutter is enormous, such exposure is nevertheless difficult because of the low prevalence of the disorder. Whether the battle against the stutterer stereotype takes the form of exposure, education, or some combination of the two, creative strategies are needed. Individuals who stutter, members of their support systems, researchers, speech-language pathologists, and others can all aid the effort. Information can be conveyed via conversations, workshops, written materials, videos, formal presentations, and numerous means not yet considered. The following goals, while not an exhaustive list, may help in the development of an initial strategy.
Demonstrate that stereotyping is tied to the normal classification
















schemes used by all people. Intellectually, broader schemes take some effort, but they also afford greater understanding. Allow people to arrive at their own conclusions. Research on stereotyping and prejudice indicates that people cannot be forced into changing their attitudes about stereotyped groups (Pate, 1992). Provide an understanding of how stereotyping denies people their individuality. No one wants to be judged solely on his or her group identity. Focus on the numerous abilities of people who stutter, that is, their accomplishments in varying contexts. This allows for the possibility of expanded classification schemes. Expose others to how people who stutter feel—be it embarrassment, frustration, anger, or other emotions—when patronized or pushed into the background of a conversation. Such information may sensitize some people to their own unrealized but inappropriate behaviors. Listen to people and observe how they respond to these educational efforts. Through constructive feedback, more specific and effective goals can be developed to replace those already listed.

Finally, people who stutter can help their own cause by simply presenting themselves positively (see How do people who stutter get listeners to behave properly? in Chap. 11). Although those who stutter do not necessarily need to change their behavior to suit others, it is also true that the more they present themselves confidently and competently, the harder it will be for others to hold onto the existing stereotype.

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SYNOPSIS As is the case with those presenting other speech differences, people who stutter are often stereotyped. Specifically, they are seen to be shy, withdrawn, nervous, and anxious, among other similar traits. Such a stereotype is potentially damaging for a number of reasons, the foremost being lost opportunities educationally and professionally. Given that recovery is likely to include continued stuttering in some manner, it is important that people who stutter are aware of how they may be perceived, the potential costs of these perceptions, and what they can do about it.

Chapter

10

A Visit From St. Notker

U

Attendance at support group meetings had been lower than my undergraduate GPA. To rectify this situation, I covered the town with flyers, newspaper announcements, and public access TV spots promoting the group. For the next meeting all of three people showed. And one of those was Marlon, the host. He and I were joined by Stan, a college senior majoring in drama. The three of us were in Marlon’s basement, seated in vinyl beanbags flanking an oval area rug with the words Keep on Truckin’ imprinted in faded brown letters. “Where is everyone?” I asked. Marlon shrugged. “Usual story,” he said. “Cats call and say they’ll come. But when it’s time to boogie, they’re nowhere men.” “Guess no one needs us.” “Maybe someone cured stuttering and no one bothered to tell us,” suggested Stan. “Maybe everyone lost their hearing,” said Marlon. “That’s supposed to stop stuttering.” “What?” yelled Stan. “Maybe they’re all singing everything they say. That would work for me,” I said. “If it didn’t make me feel like an idiot, that is.” “Maybe everyone is rapping at once,” said Marlon. “Or whispering.” “Or acting,” said Stan. “I’ve noticed that when I t-t-take a role, I don’t stutter.”

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“What if you take the role of someone who stutters?” I asked. “D-d-don’t think it would matter.” Marlon appeared to think deeply about this. “Let’s see,” he said. That sounded like fun. Of course, I’m defining fun here as something better than sitting around Marlon’s basement doing nothing. “OK,” I said. “I’ll go first. I’m—” “Don’t tell us!” said Stan. “Fine. I’ll be the guy who p-pl-played John Gage—” “It won’t work unless you are that person. Talk like he would.” “All right. Let’s see . . . Here goes: ‘Gee, it sure was fun playing John Gage on Emergency! . . . d-d-during the seventies.’ It didn’t work. I’m still stuttering.” “Hey Randolph Mantooth,” said Stan. “You stink at this game.” “OK, you try it if you think you can do better.” Stan smiled. “Ready any time.” “So start.” “Ask me who I am,” he said. “Who are you?” “I won’t say. But here are some hints. I was a noted musician, teacher and poet . . .” “Was?” “Jim Morrison?” guessed Marlon. Stan shook his head. “I probably wrote Gesta Caroli.” “You’re not sure?” I asked. “Notker Balbulus,” said Marlon. “The patron saint of stuttering.” “In the flesh.” I looked at Marlon. “How in the world did you know he was—” “What’s happening, St. Notker?” asked Marlon. “You tell me. Maybe there’s a reason I’m here today.” “St. Notker or Stan?” I asked. “Play along,” instructed Marlon. “OK,” I said, “Hey St. Notker—why aren’t you stuttering?” “I’m dead, you idiot.” “Oh,” I said. “You know, you’re not very nice for a saint.” He smiled. “Just making sure I have your attention.” I took a moment to reflect on the meaning of his previous statement. “So there’s no stuttering in the afterlife?” “Depends on where you go.” Just in case Stan knew something, I made a mental to note to listen closely to next Sunday’s sermon without thinking about where I can get discount tacos on the way home. I looked at Stan. The smile had not faded, but there was a strange intensity to his expression. I noticed that his eyes were a piercing brown and tried to remember if they had always looked that way.

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“So St. Notker,” I said, unsure how to continue, “how you doing these days? How’s, you know, death and stuff?” He rolled his eyes, then asked, “Why did you ask me about stuttering?” “Well, for one thing, this is a stuttering support group meeting,” I pointed out. “. . . B-b-besides, it’s what you’re known for. According to Marlon here, you’re the patron saint of stuttering.” “Notker Balbulus. That means Notker the stammerer,” added Marlon. “I know what it means!” Our pseudosaint grimaced. “Why couldn’t I be remembered as a great composer? Or as the Shakespeare of my time?” “Shakespeare lived after you,” I reminded him. “So?” “So technically, you wouldn’t know about him.” “You came after me too,” he said. “Yet here I am.” “Good point.” “It’s strange,” he began as he sat forward in his beanbag. “They called me Balbulus when I was alive and it never really bothered me.” “That’s what’s strange?” I asked. “Not the fact that you’re sitting here pretending to be a thousand something-year old saint?” “I suppose today a lot of people would find it humiliating to be called ‘the stammerer,’ ” he added. “Whatever,” I said. “You guys ready to do something else now?” “On the other hand, you have Stuttering John.” This brought me back to the activity. “Saints follow pop culture?” “Not really,” he said. “We just know things.” “How?” “It’s complicated.” For some reason, Marlon nodded in understanding. “Listen,” I said to Stan, “it’s just like you were whining about a few minutes ago. People don’t want to be identified by their stuttering. “First of all,” he began as he leaned back in the beanbag, “what I said was that I wanted to be remembered for my accomplishments. Secondly, if people recognize that stammering was one part of me, I have no problem with them noticing it. Third, I wasn’t whining.” I sighed. “Well, maybe it wasn’t a problem in ye olden days,” I said. “But in today’s world people get touchy about being recognized by their problems.” “So I gather.” “Dudes want folks to realize there’s more to them than the bogus stuff,” Marlon explained. “. . . Th-they don’t want people to think they’re imperfect,” I added. “Not to mention shy, introverted, nervous, and everything else that goes along with stuttering,” said St. Stan. “I guess.”

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“In my day—during which, by the way, we never said ye olden—being introverted was like being right-handed. It was just a trait with no value attached.” I yawned. “The good old days, eh?” “Never talk down to a saint,” he warned, like it was some new sin he just invented. “I wasn’t. I just wish people today were as calm.” “Which people do you mean? The ones being labeled or the ones doing the labeling?” “Both.” He paused and, for a moment, I thought we were finished. I was glad too. The transformation from Stan to Notker Balbulus was starting to weird me out. As luck would have it, however, he was just resting up for another monologue. “I agree that things are better when humans are judged according to whom they are than by traits they can’t control,” he began. “But since stereotyping occurs, those on the wrong end of it have a right to point it out. Otherwise, how will they ever escape the process?” “Here’s an idea,” I said, straightening my back and moving forward in the beanbag. “They could prove their detractors wrong.” “How?” “B-b-by not being passive, shy, and nervous.” Our visiting saint dismissed the idea with a wave of his hand. “Wouldn’t work,” he said. “Once a stereotype is set, it’s hard to remove.” “How do you know?” He looked at me for a full second. “Oh, right. The saint thing.” “Give me an example of a stereotype,” he commanded. “People who stutter are passive, shy, and nervous.” “A different one. One you’re not as close to.” This was quite a trial for my lethargic mind. Besides, I needed to save what few working brain cells I had for work tomorrow. Not to mention the morning drive through the never-ending Boca road construction. That’s it! Boca! Of course! “Here’s a stereotype,” I said. “The Boca mom.” “Ah yes,” St. Notker replied. “The parent supposedly too busy with the social registry to actually raise her children, yet nevertheless brags about their brilliance to the plastic surgeon, tennis instructor, and everyone else she regularly comes into contact with. Meanwhile, the nanny does the real work, freeing Mom for important duties, such as gossiping about who used the wrong salad fork at the club luncheon. Is that about right?” I nodded. “Basically.”

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“Now give me an example of a stressful situation,” St. Notker instructed. “Hmm, let’s see . . . a job interview.” “A spork lodged in your tongue,” offered Marlon. “Let’s go with the interview,” said Notker. “Imagine yourself in that situation, and all you know about the interviewer is that she’s a Boca mom. What are your thoughts?” “Well, you can’t judge people based on such a small amount of information—” “Oh spare me the insincere tripe! Your thoughts are that you’ll fly through this interview because you’re talking to someone shallow and barely able to function in the working world.” “So what’s the point?” I asked. “Stay with me. Now let’s say the interview doesn’t go as expected. Say that this interviewer made points you couldn’t refute and asked questions you couldn’t answer.” “If I do, can we do something else?” “You leave the interview feeling crushed.” “D-d-does this story have a point?” “Now, let’s say that 3 weeks later you have another interview. All you know about the interviewer is that she’s another Boca mom. What are your thoughts? “I’ll tell you what they are,” he continued, without giving me a chance to answer. “You’re thinking that you’ll fly through this interview because you’re talking to someone shallow and barely able to function in the working world.” I yawned. “So I didn’t learn anything?” “Oh, you might remember the first interview and readjust your thinking. But the point is that your initial reaction will be right back to the original stereotype.” “My default position.” “I hate how computers are influencing the language.” “You’re pretty good at this,” I had to admit. “Of course I am,” said the attending saint. “I mean, I may well have a better chance in the second interview. Think about it: What are the odds of finding two sharp Boca moms in a 3 week span?” He sighed. “Then again, you might not learn anything from your experience.” I pretended to consider this before responding. “Well, thanks for the visit,” I said. “But you’re beginning to get tiresome.” “You know,” he continued, “in some ways being called a stutterer is worse than being labeled a Boca mom. Why, you ask?”

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“I didn’t ask anyth—” “Because people are so embarrassed about it. Thus, they are not only stereotyped, but, when they are, they don’t speak up.” “You haven’t been paying attention to my century,” I said, somewhat ridiculously. “They are speaking up. Loudly. Some are even carrying protest signs, for crying out loud.” “I’m paying plenty of attention. Tell me, what are they protesting?” “Bad meat?” guessed Marlon. “Negative media portrayals, mostly,” I said. “And who’s doing the protesting?” asked St. Notker. “A dozen of the 60 million people who stutter? That leaves a fair number who are staying quiet. Not only are they embarrassed, they’re scared that if they speak up, they’ll be accused of whining.” “They are whining,” I mumbled. “So what if they are?” he asked. “What’s wrong with a little whining? People today don’t stand up for themselves because they’re so afraid of being labeled whiners.” “Not 10 minutes ago you yourself objected to being labeled a whiner,” I pointed out. He glared at me in a way that, for a moment, made me think sainthood was not in my future. “All I’m saying,” he continued evenly, “is that people need to gripe now and then.” “Even if I buy that, wouldn’t you agree that griping can be carried to an extreme? Ever hear of political correctness?” His maddening smugness returned. “Ah yes,” he said. “You contemporary people and your PC arguments.” “Not in your day, huh?” “I lived in a monastery. Of course we were expected to think a certain way.” “Monastery sounds scary,” declared Marlon. “Like monster.” “Then you understand the problem,” I said to Notker. “Problem?” “Yes, problem. People are actually politicizing a speech difference like they’re an ethnic minority or other group who experiences real discrimination. I mean, what is that all about?” “You’re saying they’re going too far?” “I’m saying that and more. In trying so hard to be victims, they’re being divisive. Us against them. The downtrodden versus the empowered.” “Are you not sensitive to the plight of people who stutter?” “Oh give me a break, saint-boy. I’m as sensitive as anyone else. That doesn’t mean I have to buy everyone’s claims of victimization.” St. Notker reflected on this. “Let me ask you something else,” he said. “Is it possible to be empathetic toward people who stutter while still dismissing the issue of their sensitivity to how they’re portrayed?”

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“Stop talking like a saint.” “Fine. Can you feel for people, yet disregard their feelings of victimization?” I had to think about that one. “It should be possible,” I concluded. “But you get labeled as one of the victimizers if you don’t buy their political rhetoric hook, line, and sinker.” “You keep using the term political.” “What would you call it?” “Well, I’d call it people attempting to educate others about themselves. I’d call it people trying to gain control over how they are portrayed.” “You say boloney, I say bologna,” I said. “Hmm.” St. Notker scratched his head. “In all my centuries, I never heard that one. But anyway, explain to me how this is political. No one is getting elected. No one is asking for a handout.” “Not yet.” “So you admit it’s not actually a political issue. So am I to conclude that you’re trying to force politics-of-victimization rhetoric into the matter without first seeing if it fits?” “Oh please. Can you honestly say they’re not playing the victim?” “Some are,” he admitted. “But, you know, even the most pathetic ones are trying to educate their opponents.” “You sure about that? Keep in mind they have media advocates now.” “I’m aware of that. Quite astounding really.” “I’m not sure that’s the word I’d use.” “Think about it: A group who grows up learning to be ashamed of their disorder now not only telling the world they stutter, but standing up to those who shame them. This certainly couldn’t have happened in my day.” “I should have lived your life.” “Yeah, you’d do great in a monastery.” “Are saints supposed to be sarcastic?” I asked. “There’s some license with that. Anyway, getting back to media advocates, let me point out that they have been around since roughly 4 minutes after media were invented.” “Mildew has been around a long time too. That doesn’t make it good.” “What’s your problem with media advocates?” “They’re unrealistic. People aren’t perfect. Why should any group be portrayed without faults?” “Do you really think media advocates are trying to limit portrayals to only heroic ones?” “No?” “Of course not. Their role has always been to point out even the smallest affront to a group’s sensitivities. It’s to remind people that someone is

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watching, thus assuring that, if nothing else, portrayals will not be exclusively negative.” “You’re giving them a lot of credit. Personally, I don’t think they put that much thought into it. It’s just more hypersensitive PC garbage that isn’t going to change anyone’s mind.” St. Notker allowed himself another moment of reflection. “Are you sure you’re putting a lot of thought into it?” he asked. “Because here, in a nutshell, is your argument. You are sensitive. Therefore, anything that does not offend you is not insensitive. And anyone who is offended is, by definition, hypersensitive. And finally, anyone that hypersensitive is undeserving of sympathy and, instead, worthy of ridicule.” “It sounds kind of illogical when you say it,” I admitted. “Not to mention arrogant. Worst of all, though, is that it’s superficial. You’re ignoring the real issue here. A far more pertinent and interesting question than who’s right is why some individuals are so touchy. What is it about their experiences, the impact of stuttering on their lives that make them sensitive to negative portrayals?” “Hypersensitive,” I corrected. “Again, that’s true of some,” St. Notker admitted. “And guess what. Many of them are indifferent to whatever issues that flare your temper.” “Like how people shouldn’t whistle in the workplace when others are trying to concentrate?” “Um, I guess. My point is that we all have issues we care about more than others. Issues that don’t have right or wrong answers.” “So I’m free to disagree. That’s what I’ve been saying all along.” “You can disagree, but do so respectfully. Listen, I didn’t live at a time when Porky Pig was popular. No one in the Abbey used that to mock me.” “Abbey,” repeated Marlon. “Hey saint dude—did you ever meet the Beatles?” “Others experienced this sort of teasing and didn’t like it one bit,” continued Notker. “Who am I to tell them that their feelings aren’t real and that their concerns are trivial? It’s not my call.” “You’re getting kind of preachy,” I observed. “I’m a monk, you discourteous scalawag!” “Scalawag? In what century did you pick that one up?” “Furthermore,” he continued, “even preaching beats putting your head in the sand and ignoring everything you can label as PC. It’s what you people today call a cop-out. When someone doesn’t want to deal with an issue, he calls it politically correct, like nothing more needs to be said. Then he doesn’t have to address it.” “He or she,” I corrected. “Don’t bait me. What I’m saying is that some discussions need to move past this level of debate.”

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“Fine. I’ll put some more thought into it.” “That’s all I ask.” At this point the saint and I both looked at Marlon. I guess we were both unsure how to proceed. “Monster is a cool word,” Marlon told us. After a short pause to digest this information, Stan said, “I guess we’re done. What’s next?” It was kind of creepy how quickly he reverted back to his old self. “I’ll be Gary Lovetro,” said Marlon. “Who’s Gary Lovetro?” Stan and I asked in unison. “Duh. The original bassist for the Strawberry Alarm Clock? Hello?” “Time for me to go,” I said. I started to look at Stan, but he was already out the door, taking St. Notker with him.

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How did you know it would give me a spool of faith? You liked my poem about the blue sky and asked me to recite it in a tape recorder for parents’ night. That afternoon after school you handed me a small mic and I read the poem. I read it: each word whole I read it: each line complete I read it and did not stutter once my words sailing into the bull’s-eye of myself and then I saw your hands unclench themselves from your mouth— your whole face radiant like an open sky William Palmer A Spool of Faith —letter to my fourth grade teacher

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Reactions to stuttering range from derisive to pandering, with proper listening falling somewhere in between. This assortment raises a number of questions. Let’s begin with the most obvious. 1. Why do listeners react in so many ways? Stuttering is different, a speech pattern people are not accustomed to hearing. As such, it catches them by surprise. It is perhaps this reason that stuttering often elicits reactions of confusion. Listeners are unprepared for it and many are confounded as to how to proceed. Although such a reaction seems unsophisticated, it is actually quite normal. People are programmed to react to unfamiliar, unexpected, and/ or unsettling differences as they would to known danger (Miller & Sammons, 1999). Anyone who says he or she does not see such differences is lying, a small child, or missing a basic survival mechanism. Of course, after the initial split-second neurological reflex come responses that are learned and voluntary (Miller & Sammons, 1999). This is where we see the listener’s sophistication with respect to differences. Or don’t see it, given how often it is missing. One common, albeit rather unrefined, response to stuttering is best termed flight. The reactor does not actually flee the setting as if confronted with genuine danger; he or she will, however, look for an opening to exit. They might do so out of disdain (feeling that the speaker is responsible for the stuttering) or, more likely, guilt (Liveneh, 1982). With the latter cases, the source of the guilt may be the listener’s own ability to speak normally (Liveneh, 1982). In such an instance, a listener is likely to be uncomfortable in much the same way one feels when approached by someone holding a Will Work For Food sign. We can’t do all that we feel is necessary to help and the quickest way to appease the sense of culpability is to move on and stop thinking about it. It is also possible that listeners worry about “guilt by association” if they befriend someone with a known disability (Livneh, 1982). That is, they are concerned about being perceived negatively if they are seen with someone different. Thus, they flee the scene before this can occur. Of course, not all listeners flee from stuttering. Many try to help (Makas, 1990). Unfortunately, their attempts may be viewed as condescending. For example, comments such as “Slow down” or “Take your time,” although intended to be supportive, may be received as patronizing. Helping someone requires placing him or her in a needy position (Makas, 1990). In order to be aided, the individual who stutters must be relegated to a subordinate role in the interaction, conversing not as an equal, but as someone in need of rescue. This is the source of the resentment that frequently ensues in these types of interactions.

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It is also worth noting that sometimes listeners intend to respond in a simplistic manner. If they believe, for example, that stuttering is symptomatic of a more widespread problem (e.g., see Livneh, 1982), they may well converse in a rudimentary manner, as if the speaker is slow to understand. Whether one tries to help, flees, or responds more appropriately is largely based on factors that stem back to early childhood. Some children are taught to be tolerant and doing so is quite natural for them. Although this conditioning does not exclude reactions of flight or condescension, it is likely that some measure of compassion will remain into adulthood. On the other hand, if childhood influences emphasized health and normalcy above all else, there may well be an aversion to those without them (Livneh, 1982). Our life experiences further shape our reactions. For example, listeners who do not speak normally, or who present other differences, are likely to have compassion for the struggles of stuttering (Miller & Sammons, 1999). This is particularly true if they were teased about their own distinctive traits. Similarly, those with close relatives or good friends who stutter may well have an understanding of how to respond. Related to this point are media images, which we can assume affect responses to some degree (Livneh, 1982; Miller & Sammons, 1999). Sympathetic images can lead to like reactions. Conversely, negative portrayals serve to legitimize reactions about which listeners might otherwise have felt guilty. One final point should be made with respect to how listeners respond, that being the reactions of children. Remember from Chapter 9 that classification schemes generally expand as people get older. One offshoot of this is that the reactions of children are unpredictable. Stuttering is not necessarily viewed as a difference if a child has not been conditioned to think of non-stuttering as normal. Thus, the reaction might be slight or even non-existent. However, if it is seen as a outside of normal, the resulting reaction might be strong, given that children have less understanding of why some people present differences. In other words, after the initial reflex, there is no rational thought to utilize. They might fear that stuttering is contagious or wonder why it has not been fixed (Miller & Sammons, 1999). Whatever their thoughts, they are often quick to mention them and to ask questions adults would not dream of asking. But they have an excuse. They’re kids. By the time one reaches adulthood, there should be better strategies available for responding to differences such as stuttering. This brings up the next question. 2. How should listeners behave?

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Obviously, each speaker has his or her own idea of what proper listener conduct entails. For people who stutter, these ideas generally include such behaviors as responding to the content of speech (without commenting on its delivery) and demonstrating acceptance and patience (Whaley & Golden, 2000). That is, good listeners don’t smirk or fidget or add time pressure by finishing sentences, asking multiple questions, or interrupting. They respond with a relaxed speech rate (not slow motion, just relaxed) without offering demeaning and unhelpful advice such as “Slow down” or “Relax” (“How to react,” 2003; Whaley & Golden, 2000). Some people who stutter are more comfortable when listeners acknowledge their difference (Starkweather & Givens-Ackerman, 1997; Whaley & Golden, 2000). Of course, there are appropriate and inappropriate ways of doing this. In general, when the listener lets the speaker know that he or she does not mind the stuttering, the speaker feels more comfortable (Starkweather & Givens-Ackerman, 1997). However, if it is not relevant to the conversation, acknowledgment can be not only insensitive, but can send a message that the listener is interested in how speech is being produced, not what is said (Miller & Sammons, 1999). Another common listener suggestion—maintaining normal eye contact (“How to react,” 2003; Whaley & Golden, 2000)—also requires clarification. While clearly one should not avoid eye contact just because a speaker stutters, the listener must also understand what normal eye contact is. It is not an unwavering stare. It is occasional, enough to regard, to let the speaker know that he or she is being acknowledged (Miller & Sammons, 1999). Of course, one person’s acknowledgment is another’s discourtesy, and thus it is not always easy for the listener to know that he or she is doing the right thing. Furthermore, it has been noted that the listener’s accommodations could be interpreted as condescension by the speaker. This leads to a third listener issue. 3. Do speakers perceive reactions that aren’t there? Each year, I give my graduate students pseudostuttering assignments, whereby they engage in voluntary stuttering in a variety of settings. When they report their experiences, many of them read like this: I walked up to a salesperson in the mall and stuttered as I asked him where the tennis shoes were. He showed me, but I could tell he was put out. He didn’t smile or engage me in conversation (other than saying “Follow me”). I couldn’t tell if it was because he didn’t want to hear more stuttering or because he thought I was “slow.” Either way, I felt really embarrassed . . .

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A quick review of this account informs us that 1) the student stuttered and 2) asked for tennis shoes, which led to 3) the salesperson directing the student to the tennis shoes. In terms of facts, that’s pretty much it. Everything else reported is perception. Was the store employee really “put out?” And if so, was it because of the stuttering? Was his lack of effusiveness due to annoyance? Are people normally verbose when directing someone to a specific location? And finally, is it possible that he was not as concerned with the student’s stuttering or intelligence level as he was with showing her where the shoes were? Before anyone thinks of this example as representative of the entire pseudostuttering experience, it should also be pointed out that students have reported reactions of outright mockery, as well as people walking away and other clearly negative listener reactions. Moreover, people who stutter have reported responses as extreme as demands to speak correctly or not at all. Clearly, stuttering sometimes evokes responses that are negative. But stuttering also stirs up reactions within the speaker—nervousness, embarrassment, anxiety, and the like—which can alter perceptions. Thus, the demeaned speakers should ask how much of their emotion is due to the reality of the situation, and how much to their own perception. Given that some portion of negative reactions are very real, however, we have to ask ourselves another question. 4. How do people who stutter get listeners to behave properly? Starkweather and Givens-Ackerman (1997) offer suggestions for teaching familiar listeners how to conduct themselves. In short, they can be told about stuttering in general and about the speaker’s specific stuttering patterns (what’s helpful and what’s not). Fortunately, this sort of teaching can be done in everyday conversation. A lot of education occurs with simple statements such as, “Please don’t finish my sentences,” or “Just so you know, telling me to ‘slow down’ doesn’t help.” Given how the stutterer stereotype affects listener perceptions (see Chap. 9), it makes sense that anything that reduces the stereotype—in this case, education—would also reduce negative reactions. And because we know that stereotypes are resisted via exposure as well, it follows that people who stutter help their cause by simply going about their daily lives. That is, talking to people familiarizes them with stuttering which, in turn, increases habituation, a term used by Miller and Sammons (1999) to indicate when differences are so familiar that they become part of the listener’s comfort zone. The way in which speakers present themselves can reinforce or challenge the existing stereotype and, by extension, the reactions they receive (Lew, 1998). Those who display vulnerability or timidity are likely to be

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treated differently than those who do not. Interestingly, as individuals become more desensitized and less concerned with how they are perceived, they often report more positive reactions (and/or fewer negative ones). Perhaps listeners become more wary as they perceive less vulnerability. Similarly, those who present a sense of humor about their own stuttering are likely to put the listener at ease and reduce any potential anxiety (Lyttle, 2002; Orben, 2001). With children, it is often best to discuss the stuttering. Their questions might be direct, but they are also innocent. They have no agenda beyond wanting to know why the person is speaking differently. Because they want to learn, it follows that they can be taught. Additionally, they can be reassured that stuttering is not something about which they need to be concerned. In the video Voices to Remember (Suncoast Media, 1992), a pediatric dentist relates an occurrence during which a young boy told him, “You know, you talk with an echo,” and responding with, “Hey, that’s very good! That’s exactly what’s going on!” With this simple agreement, the stuttering individual served to lower the child’s anxiety and answer his concern. 5. What about listeners who are idiots? Of course, education, habituation, exposure, humor, and reassurance won’t work with everyone. Sometimes, reactions are at the extreme end of negative. Four of five stuttering children, for example, have to deal with teasing or bullying at some times in their lives, as opposed to about half of school aged children in general (Langevin, 2001; Mooney & Smith, 1995). This is not particularly surprising, given that stuttering is associated with perceptions of insecurity, nervousness, and passivity, traits bullies often target in their victims (Blood & Blood, 2004). Who better to pick on than someone who is unlikely to retaliate? Bullying is, of course, not always limited to childhood. And even when it is, the effects can nevertheless be long-term. It can lead to loneliness, depression, social isolation, loss of self-confidence and self-esteem, and even health problems such as weight loss (Dake, Price, & Telljohann, 2003; Murphy & Quesal, 2002; Roth & Beal, 1999; Starkweather & GivensAckerman, 1997). It is also not, as some might argue, a necessary part of growing up (or of life as an adult). In fact, widespread anti-bullying programs (e.g., Colorado’s No-Bully program; Success Unlimited) exist on the basis that it can and must be stopped. Such programs stress empowerment for those being bullied, coordination among the involved individuals (e.g., the parents, teachers, and children within a given school system), and proactive and reactive advice for diminishing instances of bullying.

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Similar focal points are present in resources designed for people who are bullied on the basis of their stuttering. For example, empowerment is often addressed early, by educating stuttering individuals that 1) the stuttering is not their fault, 2) they don’t deserve to be mocked for it (Murphy & Quesal, 2002), regardless of whatever shame they have experienced or are experiencing as a result of their disorder, and 3) they are not isolated individuals; many people are teased and bullied about a variety of differences (Lew, 2000). In addition, it helps the stuttering individuals to understand that bullies do what they do for reasons of insecurity (that is, they need self-validation or attention) and ignorance (Lew, 2000). This information helps in the formulation of a solution. When confronted with bullying, there are a number of options. An alltoo-common one is avoiding. That is, the individual hides from the tormentor or stays in crowds, given that bullies rarely pick on groups. Of course, the latter technique is difficult to employ for someone who is socially isolated. Groups will be hard to form, mostly because others fear being teased themselves if they socialize with an outcast. Also, avoiding a persistent bully may require costly sacrifices (Roth & Beal, 1999). Missing school or work, for example, is a high price to pay to hide from teasing. One can also ignore it (Lew, 2000; Murphy, 2000) in the hopes that the bully will stop because he or she is not getting the desired attention or selfvalidating reaction. While this may work, it will undoubtedly take awhile. Furthermore, the severity of the teasing is likely to increase before it does (Roth & Beal, 1999). In the meantime, the self-esteem of the people being teased is negatively affected. They wonder about their own courage then and long after the bully has gone. One oft-mentioned solution is to confront the bully (Dugan, 1998; Lew, 2000; Murphy, 2000; Roth & Beal, 1999). Confrontation can take many forms. Successfully challenging the bully verbally or physically is probably everyone’s dream scenario, but this is not recommended. After all, the bully has likely chosen the stuttering individual on the bases of an inability to talk back quickly and/or a comparatively small stature. Perhaps because of these reasons, children who stutter rarely defend themselves (Roth & Beal, 1999). Of course, confrontation need not be quite so direct. A reply can be forceful without challenging the bully to any sort of battle (Dugan, 1998; Lew, 2000; Roth & Beal, 1999). “Yeah, I stutter. Big deal.” is an example, as is asking the bully to stop teasing. This technique fits with the aforementioned advice that people who stutter present themselves with assurance and confidence. Remember too, however, that in Chapter 5 it was pointed out that this often requires a lengthy process of desensitization. Those who are not desensitized will obviously have a tough time projecting the

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necessary assurance and confidence to successfully discourage a bully (Roth & Beal, 1999). Using humor against a bully is advocated by some (Lew, 2000; Manning, 2001; Starkweather & Givens-Ackerman, 1997). However, responding with “OK, so I stutter. You’re ugly. At least my problem can be managed,” or something milder such as “That’s not how you stutter. Let me show you again,” is fraught with potential problems. For one, the speaker is relying on verbal skills, which is the source of the bullying problem to begin with. Second, it was discussed in this chapter how unanticipated events cause people to freeze as they would to danger. Consider that, with a bully, the person who stutters is confronting an actual danger. When the same reflex takes over, expecting the child to have the presence of mind to create and implement a witticism may be outside the bounds of reality. Another means of confrontation, education, can combat the ignorance on which much of teasing is based. This can involve explaining stuttering, either in general terms or those traits specific to the individual (Lew, 2000; Murphy, 2000). Again, a level of confidence is needed that might not be present. Moreover, if the bully’s goals are self-validation and attention, he or she is not likely to be interested in learning about stuttering. With children, it can be helpful to educate the entire class about stuttering. This can be done by the child’s speech-language pathologist (Murphy & Quesal, 2002), adults who stutter (Manning, 2001), or the classroom teacher (Silverman, 1996). Possible topics to be covered include famous people who stutter, why stuttering is no one’s fault, and the fact that no universal cure exists. Bullies and others can learn how unfair teasing about stuttering is. It is important to note that, as with confrontation, the stuttering child needs to achieve a high level of desensitization before he or she is comfortable with such a presentation (Williams & Dugan, 2002). Education about teasing itself is also instructive (Lew, 2000; Murphy, 2000). The information related in this sort of presentation is general. For example, everyone has something about which they are sensitive (and, therefore, anyone could be teased). The damage done by teasing can be spelled out as well. Bullies can get some idea of how it feels to be on the other side. Unlike education about stuttering, relating information on teasing can help people who stutter without drawing undue attention to them (they may, remember, be quite self-conscious). The idea is to not only end the teasing, but also to create an atmosphere in which stuttering is accepted. As with other strategies, it will be more effective with some bullies than with others. An accepting atmosphere is also the goal of the final strategy: Getting help. The person being teased can tell someone what is happening (Lew, 2000; Murphy, 2000; Roth & Beal, 1999; Starkweather & Givens-Acker-

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man, 1997), thereby decreasing his or her social isolation by forming a helpful alliance. Of course, the danger is that the alliance might turn out to be anything but helpful. That is, those in supervisory positions may not understand the potential danger of bullying and take inappropriate (or no) action. For example, Roth and Beal (1999) point out that, although parents are willing to help children bullied at school, teachers are often not able to do so effectively. In these instances, it is difficult to persuade people to report bullying. Even when the punishment for bullying is severe, it may go unreported. Victims understand the value of doing so, often stating that they will report it, but then do not. They may feel that getting help shows weakness, an admission that they cannot solve their own problems (although we all ask for help with other problems all the time). There is also a fear of retaliation, that the bullying will become more severe if trouble is caused for the perpetrator (Lee, 2003). Reporting can be increased if there is a formal anti-bullying program put in place. Such a program would make help readily available, allowing not only for easy reporting but also instilling in bullies the knowledge that they will be punished. Ideally, such programs would also involve education about bullying. This would undoubtedly decrease the frequency of its occurrence and help those in authority learn to deal with it effectively. Obviously, however, many settings do not have these types of programs. Furthermore, they would take time to create. Thus, informing may be neither a perfect nor a quick solution. Just as obviously, the same can be said for all the other solutions to the problem of bullying. On the plus side, however, enough information exists that, in general, speech-language pathologists and people who stutter can effectively address the problem together.

SYNOPSIS People react in many ways to stuttering. A listener might flee, try to help, or tease, to name just a few possible responses. Because recovery is so closely tied to effective communication, it helps for people who stutter to be proactive with respect to listeners. They need to distance themselves from their own perceptions, decide how they want listeners to act, and let the listeners know. In some cases, such as dealing with bullies, people who stutter may be better served by seeking help.

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Stories of Listeners

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STORY 1 In nearly all respects, it was an average day in junior high. The hallways were crowded with overly aggressive boys and overly decorated girls, both, in their own ways, thinking they appeared grown up. Talk was sparse, the heaviness of peer pressure keeping all but a few mouths shut. The teachers were alternately stern and silly, seemingly deriving great pleasure from both controlling and amusing us. Just another day, it seemed, as I walked toward my next class. It was then that I discovered my path blocked by Clete VanBraagt. Clete was roughly twice my size and sported a three day growth of beard, a feature few other seventh grade boys could match. As I moved to bypass him, he repositioned himself to barricade my new route. “Where you goin’ Fool?” he asked. I laughed to indicate that I received this snarled insult as good-natured ribbing. “To class,” I said, still walking. He grabbed my arm, which suddenly felt like it had become wedged in a giant tree branch. “T-t-to class,” he repeated, mimicking the stuttering he was evidently hoping to hear. “I g-gotta go,” I said, as if I were apologizing for having to excuse myself from a discussion.

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“Where? To learn how to talk? With the other fools?” He tightened his grip on my arm, something that, until that moment, I did not think was possible. “You ain’t goin’ nowhere,” he sneered. I was silent, terrified of Clete and of stuttering if I spoke, which would have exacerbated the situation. I stared at my tormentor, confused by my panic. “What are you lookin’ at? You getting’ ready to try something?” he asked, his voice sufficiently loud to draw the attention of passing students. “You think you want to fight me?” With that, he slammed me into a nearby locker. I quickly processed my predicament. A giant bully had me pinned to a hard metal surface. Peers were awaiting my response. My choices were humiliation or pain. Common sense dictated the former, but before I could act on this decision, I heard a voice. “Boys, boys.” It was our History Teacher, Mr. Van Horn, acting as though we were small children roughhousing too close to a pool. “Don’t you boys need to be in class and not out here fighting?” Clete released me. As I walked away, I heard him say, “Boy, are you gonna get killed after school. Van Horn don’t protect fools outside.” My sense of initial relief quickly changed to fear. I spent the remainder of the day watching the hands on the clock move slowly toward the final bell, my brain contaminated with images of Clete, his knees holding my arms to the ground as his fists pounded my face bloody. I was unable to concentrate on classes or hallway conversations. When the last class was finally over, my nerves were whittled raw and my stomach knotted. I hurried to my locker, but soon lost whatever time I had gained by doing so. My hands were shaking so violently that I took twice the usual time to remove the books and folders I needed. Once that task was finally completed, I ran to the bus, sat down, and looked out the windows, scanning the crowd of students, hoping not to see a large one. After several minutes of viewing, I decided that Clete must be waiting by a different exit. I relaxed slightly, hoping the bus would leave soon. Maybe tonight I would think of a means to avoid him tomorrow. Perhaps I would figure out a way to fight him. I looked out the window again. There he was. He was easy to spot as he stood in a group of the popular kids, his head seemingly a full foot above the others. I could see him laughing. He was not even thinking about me, I thought as the bus began to pull away. Although it upset me that I had spent the past five hours worrying for apparently no reason, I was also relieved that Clete cared so little that he could forget about me.

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I maintained this mistaken assumption for about two weeks. Then, one day in the cafeteria, Clete addressed me again. “Hey Fool,” he said. “You got any money?” “No.” “Give me 15 cents or I’ll kill you.” I gave him 15 cents. “You ever lie to me again I’ll kill you.” Over the next 6 months, he took my money, books, pencils, and whatever other supplies he wanted. When I did not present the desired items, he amused himself with such activities as spitting on the front of my shirt and knocking books and folders from my hands. I spent much of that school year in a state of anger. I was mad at Clete for regularly humiliating me. I was annoyed at every peer who told me to stand up to him, then languished out of sight whenever Clete appeared. Most of all, I was angry with myself. How, I wondered, could I be letting this happen to me? I was a strong kid. My fists could do some damage. I had never punched anyone, but I had been in fights before. Yet here was this beast daring me to battle him, giving me every reason to do so. In response, I did not lift a hand. I was certain that I was history’s only victim of a bully. This was junior high, a time when many young men are initiated into manhood via fist fights. I had witnessed such battles, entranced by the taunting, the bone cracking punches, the invigorated combatants, the inevitable blood. Why did the thought of such an encounter seem to frighten only me? Life outside my little world appeared to be equally violent. TV and movie stars, human versions of comic book superheroes, were physically threatened unremittingly. In response, they mostly smirked and cracked wise, displaying no fears of harm or abasement. It was always the bad guy, the worthless scumbag, who backed down. Why? Because that is what worthless scumbags do. Just another reason to abhor that character. Other entertainment industries cultivated their own versions of ruggedness. Rock stars, many appearing pale and sickly thin, were described in reviews and album liner notes as “manly,” “tough,” “extremely macho,” and “all man.” Every song on the radio seemed to be about either putting people in their places or physically punishing the uncool. I had never done either. I was clearly one of the uncool. Sports, my favorite diversion of all, offered the least comfort. Athletes interviewed on TV, be they boxers, catchers, offensive linemen, or goalies, handled the subject in pretty much the same manner. “I never ran from a fight in my life,” the answer usually went. “And I ain’t gonna start now.” Sometimes brawls erupted during televised sporting events. Fueled by rage, the principals struck each other furiously. Other players grabbed

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and pushed opponents, apparently establishing some sort of positional advantage. Even coaches, presumably older and wiser, joined the fray. My father would do his part to help the players on the home team. “Get in there!” he would instruct the images on the television screen. “You back down from a fight and they know they gotcha!” One time he turned to me and said, “Respect doesn’t come gift wrapped. It has to be earned!” I began to question whether I was rugged enough for adulthood. “Once a guy kicked me in the shins while playing soccer,” added my older brother David. “I told him to watch it and he threatened me. I got him back. He took a swing at me. We duked it out. Had to do it.” My dad nodded throughout this story. I wondered if I was tough enough for high school. “How’d you know how to handle a b-b-bully?” I asked. David and my father looked at each other. “Is somebody picking on you, son?” “Someone said some things awhile back,” I lied casually. “I ignored it.” “Well, if it ever happens again,” said David, “don’t back down. You got to stand up to guys like that.” My dad agreed. “You see son, bullies are cowards. When they see you won’t take it, they slither away to go torment someone else.” To my disappointment, my brother was nodding. I expected this sort of stupid advice from a parent. But David? I thought he would be of more help. After this conversation, I decided there were now two topics about which I could not confide in family: stuttering and Clete. I was nowhere near ready to challenge Clete. I also did not wish to face the resulting disappointment that would surely radiate from my father and brother. After the school year ended, I spent the summer thinking about revenge. One day I went to a Tai Kwan Do studio and approached the instructor. “I want t-to learn k-k-karate,” I told him. “We don’t teach karate,” he snapped. “I want to learn what you do.” “Why?” He eyed me suspiciously. “There’s this g-guy in school and I, uh, well, I really want to, you know—beat him to a pulp.” The instructor denied my request. He did, however, allow me to observe his class. I watched as the students, mostly average looking adults, fought with their feet as well as their hands. They turned their fists and shouted with each punch. Some could break boards with their hands. One woman did so with her head. The sounds of fractured wood and limbs

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striking protective pads became familiar to me, as I returned to watch subsequent classes. I spent hours that summer practicing the kicks and punches I had witnessed, violently punishing imaginary attackers in my bedroom. As these illusory foes enlarged in both size and number, I did pushups to build up my arms. Twice a week I jogged to strengthen my legs and increase my stamina. I returned to school in the Fall physically prepared to confront Clete. I decided that I would wait and let him approach me. “Hey Fool,” he would say. “Give me your new pen.” “You want my new pen?” I would reply, a slight smile crossing my face. “You heard me.” Then I would hit him square in the mouth. The element of surprise would give me such an advantage that I would hit him twice more before he recovered. Then I would yell, “If you ever talk to me like that again, I’ll knock that hairy chin of yours right through the back of your head!” As I walked away from his fallen body, applause from my fellow students would follow me down the hall. From that day forward, I would be one of the cool. The first school bus ride of Fall threw me into contemplation. As the bus rolled to and from the various stops, fetching students in their new school clothing, I concluded that I was properly prepared to remove the fear of bullying from my life. This thought I held for most of the ride. When I saw the school from the approaching bus, my confidence began to wane. Everything about the place reminded me of past failures with Clete. I saw students who had witnessed him repeatedly degrade me. Through an open door, I saw lockers identical to the one into which he had first slammed me. The area where the buses parked was where I had fled from him, even when he was not chasing me. I felt my hands shake for the first time in 3 months. I exited the bus and tried to strut confidently into the school. I conversed with students in homeroom, poised to attack viciously if any of them commented on my stuttering. No one did. It was not until the school day ended that I heard the news. The VanBraagt family had moved away. Far enough away, I found out, that I would never have to see him again. The bullying was over! I could walk through the halls and classrooms without fear. I was free! This bright side eventually darkened. As I reflected on my interactions with Clete, I was uneasy. I had a sense that there was nothing I could do to

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quench my desire for retribution. There was no giant I could slay, no success I could experience, that would truly even the ledger. Clete’s memory would always be lurking, asking why I did not fight back hard and repeatedly until he stopped his harassment. Years later, I am still without an answer.

STORY 2 In the small town where I grew up, high school basketball was king. In the wintertime, it was, literally, the only game in town. When I was twelve, I attended a game with some friends. I remember that I was having a bad day speaking. Actually, “bad day” doesn’t do it justice. It was nothing short of horrible. I was blocking a lot anyway in those days and had developed a secondary and very visible tongue thrust to try to push the words out. On this particular day, both were happening even more than usual. Compounding my lousy speech day was the fact that our team lost the game. In my frustration, I wondered what else could possibly go wrong. I was about to find out. After the games, it was customary for hundreds of fans to walk across the street to the local pizza establishment. It was my turn to buy the pizza, so I went to the counter while my friends found a table. I remember I was the fifth or sixth person in a line of about twenty. The owner of the establishment was behind the counter taking orders. When it was time for me to tell him what I wanted, my stuttering kicked in big time—there was no sound, just a lot of struggle, tongue thrusting, and panic. The owner became upset and told me that, because of my inability to speak, he was losing money and did not appreciate it. I stepped aside and told him to wait on another customer until I could order. When I again attempted to state my order, my stuttering returned to block it. At this point, the owner became visibly agitated. He came around the counter, yelling at me for being “stupid” and not able to speak. He finished his tirade by telling me to leave his restaurant. When I tried to argue, his agitation turned to fury and he grabbed me by the back of my belt and physically threw me out the front door. I landed flat on the sidewalk. Forty years later, I vividly recall the embarrassment and frustration that accompanied this incident. I was punished publicly, yet had done nothing wrong. And my friends, while stunned, did not understand why I could not communicate a simple order. It took me years to get over not just the humiliation, but also the feeling that stuttering was unacceptable. I guess I did though, as I am now employed as a teacher, speaking to (and stuttering in front of) large groups daily.

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By the way, the pizza shop closed about a year after this incident. Given the owner’s customer service skills, I was not particularly surprised by this news.

STORY 3 It was one of those rare events that make a person question, well, just about everything. And it probably didn’t help that I was feeling vulnerable at the time anyway, having just broken up with both women I had been dating simultaneously. I miss those days. In any case, it was a third woman who finally sent me into a state of uncertainty. Billie was my assistant, someone I was personally training to work with children with communication impairments (a situation I now look back on with some irony). I spent my vacation that year visiting my sister in New England and Billie offered to pick me up at the airport upon my return. All I had to do was call her at her boyfriend’s house and give her the flight information. When I made this call, the boyfriend’s roommate answered, immediately laughing when he heard me stutter. I placed him in the jerk file of my brain, but otherwise ignored this bit of discourtesy. Roommate told me that Billie was unavailable, but he took my number and promised to have her return the call. When Billie called back, I was in the shower. Unbeknownst to me, the answering machine two rooms away responded to the call before I did. Thus, by the time I said, “Hello?” the conversation was being broadcast to my empty kitchen. Given that I was dripping wet and holding a towel around my waist, I made the conversation a quick one. I gave Billie the flight information, said goodbye, and hung up the phone. A few seconds later, I was back in the bathroom, but everything had clearly not returned to normal. I swore I was hearing voices. Even worse, they weren’t familiar ones. At first, it was a very surreal experience, as I wondered if I might not be alone or if the voices were originating in my head. Neither option was particularly welcoming. Upon investigating, I localized the voices to the kitchen and, more specifically, the answering machine. From there, it quickly became clear what was happening. Billie evidently had not hung up her boyfriend’s telephone properly, leaving the line between his place and mine wide open. A new voice, which I assumed belonged to Boyfriend, filled my kitchen. It was explaining that the guy who just called and could hardly talk (me) is—of all

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things—a speech pathologist! And he actually works with people who stutter! These punch lines elicited loud laughter from his audience. What happened next was even more shocking. Through her giggling, Billie agreed with Boyfriend’s learned analysis of who is and is not qualified to treat stuttering. At that point, Billie, Boyfriend, and Roommate took turns pretending to stutter, each attempt apparently funnier than the last. The voices ceased abruptly when the telephone line was finally disconnected. For a couple of hours after that, however, I was shaken. Blame it on the irrationality of emotions, blame the two former girlfriends, blame my own insecurities—I don’t really know the reason—but I actually began to question myself about what I was doing and whether there really was something wrong with me. Keep in mind that many of the cutting words I had just heard were uttered by someone trusted. Of course, I eventually arrived at the conclusion that the comedy act I had just witnessed was performed by three pathetic losers lamely attempting to navigate the cesspool of their miserable little lives. The selfquestioning, however, did not stop. I had been stuttering for 30 or so years at the time. Thus, it was not my first exposure to ridicule. But, I wondered, what about those with less experience history to draw upon? If it took me hours to conclude that I wasn’t a misfit just because a group of idiots said so, how long would it take a younger adult? How about a teen obsessed with fitting in? Sometime later, I told Billie what I had heard and asked her why she had said the things she did. Her response was to cry and apologize at great length. But she never explained her behavior. Billie continued to work with me for several months. Her assignments were restricted to busywork, as I felt a professional duty to keep her away from individuals with communication disorders. She did not like this arrangement much, but others tell me I was too easy on her.

STORY 4 Troubled by the vague and seemingly unfocused direction of my treatment, I went to see the center’s new lead speech-language pathologist. She was seated in a plush office chair when I arrived, busying herself with a mound of paperwork layered across a giant desk. Despite being nowhere near a laboratory, she wore a lab coat over her silk blouse and dark slacks. Her face held thick glasses with heavy black frames. “Yes,” she said impatiently when she noticed me waiting by the office door. Dr. Smith, I tried to say. All I actually uttered was “D-d-d-”

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“You’re the stutterer, right?” she interrupted, apparently responding to whatever she thought I was going to say. I was momentarily confused. She sensed this and explained. “You’re used to people in this clinic waiting for you to speak, right? Well, I prefer to move fast, talk fast, work fast. No time for delays.” “As impressive as that is—” “Nothing against your stuttering,” she interrupted, angering me. “Stutterers, nonstutterers, doesn’t matter. I treat everyone the same.” Like garbage? “L-li-li-like—” “So far I like it here fine. Some stuff went on before that won’t fly with me, but isn’t that the way it always goes?” I forced myself to remain quiet. If she sensed my growing anger, she did not acknowledge it. “How do you like the therapy program I designed for you? Now you’re being treated with 21st century methods.” She laughed, provoking me further. It stinks. “It sssss-” “It’s what? Never mind, I’ll tell you what it is. It’s one heck of an improvement. After one session, you should already be seeing results. Just remember two words—concentrate and practice.” Now I’ve got two words for you. “Now I’ve g-g-” “You’ve got to go. I understand. I’m busy too. Come by again some time. Maybe we’ll talk longer.” With that, she abruptly returned to her work, signifying that the conversation was over. My response was to quit therapy. When asked, I said I could not commit the time, given the demands inherent with such brilliant therapy. This she accepted without question.

STORY 5 The support group meeting began. Seven people were assembled in the basement meeting space with me. Of the seven, there was only one I did not recognize, a slight man of college age with a cheerful countenance and a mop of blond hair. Group leader Marlon began the meeting with an announcement. Ciara, one of our regular members, had received a promotion at work. For this, her name and picture were in the local newspaper. Copies were passed out. Murmurs of congratulation followed. I then noted that our group was

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cited in the Community Bulletin Board of the same paper. This seemed to please a few members. After the announcements, a series of short discussions transpired, the group veering from tangent to tangent for several minutes. Topics such as jobs, mutual friends, and familiar places were addressed superficially, generating modest interest and little insight. We chatted like acquaintances waiting for a bus, instead of a group meeting for a common purpose. In doing so, we excluded the young man I did not recognize. Turning toward him, I said, “Our meetings aren’t always like this.” “You spa-oke very fluently,” he answered quickly. “Thanks,” I said flatly, uncertain of his motive for scrutinizing my speech. “I bet it’s not that way in all situations.” “Of c-c-course not.” “A-ha! Say that again and this time I’ll show you how to do it fluently.” I started to ask him what he thought he was doing, but Stan, the most direct member of the group, broke in. “Who are you?” The new guy smirked, then introduced himself as Steven. Steven had come to the meeting in order to share with us nothing less than the solution to stuttering. He proceeded to explain that those who stutter need to decide that they are going to stop being defeated by the disorder. “When you are in the middle of a block, just stop stuttering.” “Just like that?” asked regular member Paul, frowning. Steven laughed. “No, no. But I can show you.” As a speech-language pathologist of 10 years’ experience, Paul clearly did not appreciate Steven’s condescending manner. “Anybody can get someone to stop stuttering temporarily,” he said. “The trick is making it last.” “That’s why this method is so great!” said Steven excitedly. “You can stop any stutter, not just those in a therapy room!” “I’m guessing there’s not much in the way of research support for being able to just will away stuttering,” said Stan. “Research,” scoffed Steven. “Yes, research,” said Paul. “There’s research out there on the neurological, behavioral, and physiological aspects of stuttering. I can tell you with no uncertainty that it’s not just a bad habit.” I looked at Steven, who was carefully listening, but clearly unconvinced. “We can’t just decide to stop,” added Marlon. “Listen man, nobody chose to stutter. No one wants to. Ask anyone who stutters what he wants and ‘no more stuttering’ will be at the top of the list.”

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“You just lost the argument.” Steven snickered. “Wha-a-t I’ve been saying all along is that this therapy can help them to stop. I offer a real-world solution, not some ivory tower neurobabble.” He turned confidently to the rest of the group and said, “Two words: It works.” Ciara interjected. “It wwwworks for you. Look, I’m . . . glad you found ssssomething you’re happy with. I really am. But you can’t be sure it will work for everyone.” “That’s right,” said Paul. “Stuttering is different for different people. What you’re proposing is not only simplistic, it’s insulting. You’re telling those who stutter that they’re too stupid to realize they can stop and you’re telling researchers and speech-language pathologists that they’re wasting their careers looking for answers.” Steven was silent, apparently unwilling to pursue the issue. Taking advantage of the quiet, regular attendee Tim spoke for the first time. “Ssssince this is a sssupport group, I need s-sssome advice on ssssometh-someth-th-thing.” “That’s what I used to sound like,” said Steven. “Even worse. Tha-ank God I now know the secret.” “You still stutter,” I pointed out. He agreed. “Even I still stutter sometimes. That pro-oves what a tough disorder it is. So why not take the help I’m offering?” Ciara attempted a different approach. “I think we need to . . . get away ffffrom judging each others’ speech,” she said. “This isn’t a therapy group. It’s a support group.” “Let Tim talk,” said Stan. Tim was obviously intimidated by Steven. He began tentatively, his eyes moving quickly, searching the room for approval. Assured he could speak, Tim told us about a co-worker who repeatedly mimicked his stutter. Apparently, the colleague thought it was all in good fun, but Tim didn’t see it that way. “It bugs me,” he said. “I think about it all the time.” As he spoke, he cast his eyes downward. “Am I being too sssssensitive?” Tim was obviously wrestling with conflicting emotions, looking as if he might tear up at any moment. All of the group regulars sat motionless, wanting to carefully craft any response we might offer. Then Steven spoke. “Just think how much better you’d feel if you cleared up your speech.” Several people began to protest, but Steven held up a hand. When the room quieted, he said, “My only advice to you is this. Rely on yourself. You can do anything if you set your mind to it. Stay away from speech pathologists. You know why they don’t guarantee anything? Because they can’t do any good. Tra-a-aditional therapy is worthless. They’re bound by standards of ineffectiveness.”

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“Don’t t-take this wrong,” Stan said. “B-but you’re an idiot.” “Wish I’d s-s-said that,” I added. “You can’t argue with the results, can you Mr. Authority? Severe stuttering to this.” He looked directly at me and pointed to his mouth. After glancing impatiently at both Stan and me, Paul turned to Steven. “Let me elaborate on what Ciara said earlier. First of all, everyone is truly happy that you found something that works for you.” “I’m not,” said Stan. “Me either,” I agreed. I was thinking that Steven was probably easier to take when he was more disfluent and less sanctimonious. With a sidelong glance toward us, Paul continued. “Look around the room. All you see are adults. These people have been thinking about their stuttering for years.” “Here it comes,” said Steven, rolling his eyes. “It’s insulting for you to waltz in here and say that what they needed to be doing all along was to just stop stuttering and, instead, talk fluently.” “There’s more to it tha-an that if you’d just let me explain,” protested Steven. No one was interested. Paul stood up. “I apologize, but I have to leave early tonight. See you all next month.” Stan and Ciara both indicated that they too wished to depart. That would have left us with four participants, three of whom had no desire to listen to Steven. Marlon decided to end the meeting early. As an epilogue to this story, it is worth mentioning that Steven did not attend the next support group meeting. Neither did Ciara, Paul, or Tim. Fortunately, the latter three eventually returned.

STORY 6 I met her in the university cafeteria. I was standing in line for lunch, holding a plastic tray and trying to order a cheeseburger. “Ch-ch-ch-” “Take your time,” came a soothing voice behind me. As I turned around to glare in annoyance, my eyes met those of a young woman. She met my stare with light blue eyes and a smile. I looked away, unaware, as usual, how to respond to a woman’s gaze. I ordered my cheeseburger and sat down. Within minutes, the woman approached my table. “May I join you?” she asked.

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I nodded toward one of four empty chairs and she flashed another smile. She introduced herself as Felicia, then waited patiently while I struggled with my name. “I could tell that I made you uncomfortable. I apologize. I meant no harm.” “D-d-don’t worry about it.” “No, I had no right. I’m not like that. I’m, like, the most sensitive person in the world when it comes to disabilities.” At the time, disability seemed a harsh categorization for an inability to quickly order a cheeseburger. I kept this thought to myself as she continued. “I’d like to make it up to you.” Before I could ask how, she explained. “Let me buy you dinner.” “Sure,” I said, certain that the date would be forgotten by the time lunch was over, now that her conscience was appeased. “See that student over there?” She pointed to a young man in a wheelchair. He looked our way and she waved. Slightly embarrassed, he moved his fingers in a meager return greeting. Before I responded to the question, she began her story. “One day he was in here with an armload of books. He couldn’t hold on to them all and make it up the ramp. He was stuck, basically.” Suddenly, her voice intensified, startling me with its rage. “And people were just walking by!” she exclaimed. “I was the only one who stopped to help. I was so ashamed of my fellow students, I was crying. Literally crying! I don’t want to be like the people who just walked by. I don’t want you to think I am.” I wanted her emotion to wane, uncomfortable taking part in a conversation so charged with righteousness. Misreading my silence, she spoke again. “Don’t worry. You don’t have to talk. Lord knows I’m the last person who would force you to do that.” Then, quite suddenly, she changed the subject. “Tell you what,” she continued. “You can drive.” “What?” “To dinner, I mean.” She said this as if it were some kind of honor. Perhaps she thought people who stutter are not usually granted such a privilege. My annoyance with her condescension was balanced by thankfulness for the company. I took her address and agreed to dinner the following night. The next day at seven o’clock, I went to Felicia’s apartment. She was waiting near the door, anxious to leave. In the car, she engaged in small

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talk. She spoke of classes, her hometown, politics, and campus events. I listened and drove. “What did you think about that professor who got fired?” she asked at one point. I had no clue what she was talking about. “I’m surprised it took so long,” she added. “What?” “I’m surprised it took so long.” “No, I mean, why do you say that?” “Professors express unpopular ideas. I’m surprised more of them don’t get canned. I heard this one talked down the Governor or something. That took guts. It’s a wonder he didn’t get beaten to a pulp.” “B-b-by roving bands of Republican thugs?” “You never know.” I considered Felicia’s general theory. “Sometimes research does lead to unpopular theories,” I said, thinking aloud. “I hadn’t thought of that. You know, you’re really intelligent.” We reached Lochs, the perfect date restaurant, featuring an elegant interior and food a college student could afford. When we were seated, Felicia discussed the menu exclusively. What’s good here? What do you like? What are you in the mood for? What do you plan to order? When the waitress arrived, Felicia ordered for both of us. I watched patiently, stewing in an anger that was close to boiling over. Not wishing to cause a scene, I remained silent until the waitress left. “D-d-d-” “Everything looks so good here. Thanks for choosing such a great place.” “-on’t ever do that again!” “What?” My anger compounded as I found myself in one of my most troublesome situations, needing to repeat a difficult word. In the past, I would have altered the utterance to avoid stuttering. On this occasion, I changed it in order to sound less angry. “I know you meant well, but please don’t ever do that again.” “Don’t ever do what again?” she asked, oblivious to my simmering anger. “Order for me.” She pouted. “I was just trying to help.” “B-b-b-,” I began, looking at Felicia. She was nodding, her smile dull and patronizing as she stared intently into my eyes. “-b-but I’m not helpless.” She appraised my protest, actually remaining silent for a few seconds. “You’re right,” she concluded.

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“Thank you.” Ignoring my sarcasm, she continued. “There’s nothing you can’t do if society lets you.” I considered this a truce and let the matter drop. “I’m really, really enjoying this evening,” she said. The following morning—Saturday—I woke up contemplating whether to telephone Felicia. Would calling so quickly appear desperate? Was I, in fact, desperate? After all, it wasn’t as if I liked her. Does a need for companionship, I wondered, outweigh personal principles? Is demeaning behavior always a negative? On Monday, Felicia phoned. She had been busy all weekend, she explained, and had not had a chance to call. Felicia assumed that I had trouble placing telephone calls—no offense intended, she assured me—but was sure that I had enjoyed our first date as much as she had. “Come over Friday,” she suggested. “I’ll make you dinner.” I paused too long. “Take your time,” she instructed. My weekend meditations had reached a gateway from which only a decision could emerge. “I’m busy,” I replied, effectively ending the 5-day relationship.

STORY 7 It was, I think, during sophomore year. My roommate Bob and I were walking through the snowy campus toward Education 201, quizzing each other on such pressing matters as, “True or false: Outcome measures necessitate empirical support unless approval is both documented and unequivocal within the substructure of the relevant multidisciplinary strategic imperatives.” “Huh?” answered Bob. “I said, outcome measures necessitate—” “Oh, who cares? Listen, it’s an essay exam in education. Just work the words rubric and pedagogy into every answer and you’ll be golden.” “Sounds good to me,” I agreed. “Hey,” said Bob, changing the subject. “Remember that guy who lateregistered for the class?” “Th-th-the one who always wears gray sweats?” “Yeah, that’s him.” “OK, I know who you mean. So what?” “Have you talked to him?”

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“No.” “He’s got quite a stutter. It was like, ‘Ih-ih-ih-ih-is thih-thih-thih-this Dr. Ri-ri-ri-rikan’s class?” “I can’t believe you’re saying this to me.” “Why?” “B-b-b-b-because I stutter too, you idiot.” “But this guy really stutters.” “So do I!” Bob rolled his eyes. “You don’t understand,” he said.

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Friends, Family, and Significant Others

U

Did you know whenever I called home and you answered I fought to say “Hello”? “H . . . H . . . H . . .” each time my mouth stuffed with fear until I split the word like a block of oak between my lips— “lo.” Then you did most of the talking. On your birthday or Father’s Day a tree grew in my mouth and I talked through branches that trembled. If you called me I could say “Hello” because I wouldn’t know it was you. William Palmer Calling Home

It should be clear at this point that the wall of recovery need not be scaled without supports. It is equally apparent, however, that such supports are not always easy to find. Given, then, what a lonely disorder stuttering can be, a fair question to ask is this: How can someone who stutters involve those closest to him or her—siblings, friends, significant others, and parents—in the recovery process?

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With respect to the former two groups, my discussions with people who stutter have convinced me that they present eminently solvable problems. Sure, some brothers or sisters might experience guilt about their own roles in the development of their sibling’s stuttering and need reassurance that they are not at fault. Others could possess lingering resentment if they perceive that the stuttering child received extra attention. It is also true that the person who stutters might find it awkward to talk about a trait that was hidden from friends and a prohibited topic with siblings. For the most part, however, people report that, once they pick spots where these conversations can be broached comfortably, things generally proceed smoothly. Where exactly these spots are vary greatly among different families and friendships. The other two groups—significant others and parents—pack more emotion. Let’s address them one at a time.

SIGNIFICANT OTHERS The first issue with significant others is, of course, finding them. This involves entering the dating scene, where things do not always proceed as smoothly as we might hope. For people who stutter, dating scenarios often progress along certain tracks (see Fig. 13.1). Someone interesting is met and a connection is made. During the course of this connection, the stuttering was either displayed or kept hidden. In the latter cases, the individuals who stutter will then wonder if and when to come clean about their speech difference without driving away potential partners. The easy answers are these:
It should never have been kept hidden in the first place.
One should admit it right away for filtering purposes (that is, anyone

so shallow as to be bothered by stuttering is not worth wasting additional time on). Although there is some validity to both answers, they ignore several realities. For one, it is possible that the stuttering was not hidden intentionally. Maybe the situation surrounding the first meeting was fluency enhancing (e.g., a noisy environment). In such a scenario, is it reasonable to expect someone to voluntarily stutter on the off chance that the future love of his or her life is within hearing distance? Of course, stuttering is often concealed deliberately, either out of shame or convenience (that is, in order to have the opportunity to talk and not be verbally trampled). This is harmful to any potential recovery, yet it is also

FRIENDS, FAMILY, AND SIGNIFICANT OTHERS

FIG. 13.1. dating.

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Actions and possible results for stuttering individuals who are

understandable. The dating years are no fun for those who do not take part. Furthermore, if one views his or her stuttering as unattractive, the tendency will be to avoid, given that we rarely make ourselves less appealing voluntarily. But if stuttering is hidden (for any reason), is there a responsibility to own up to it later? I have heard two arguments on this topic. They are 1) logical, 2) valid, and 3) contradictory. The first is that there is no reason to “own up to” anything, no cause to assume that anyone would have a problem with stuttering. It is, on balance, just one trait of many. Why discuss it at all? After all, there is little to no dating talk about shoe size, mouthwash preference, or other personal characteristics on which people do not typically dwell. Why should stuttering be any different? Viewed from a different angle, desensitization, an objective discussed in this very book as crucial to recovery, is designed to make stuttering less of a big deal. So why purposely make it a big deal now? Others argue that, although discussion may not be necessary, somehow the stuttering should be displayed. For one thing, recovery necessitates dis-

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continuing avoidance behaviors. And even if avoidance is not the issue, the health of the relationship requires disclosure. It is true that some who stutter have reached a point where it is just another part of life. However, they still need to know if it is more than that to potential partners. If the significant other leaves after hearing it, he or she is the jerk. However, if the person who stutters enters a relationship with dishonesty (even if only perceived), that individual shares culpability if the relationship fizzles. I have not seen any resolution to the argument over which is the better strategy. As with most issues pertaining to dating, it depends on the people involved. Once a relationship has been established, the significant other presumably has accepted the stuttering. Nevertheless, it can still be a basis of conflict. If, for example, the non-stuttering partner is making all of the telephone calls, placing all restaurant orders, and handling all necessary meetings, such unbalanced responsibility can lead to resentment (Kendall, 2000). Resentment also stems from shame. If the stuttering becomes a bigger issue in the relationship, either because of a change in severity or in the partner’s attitude, the partner may resent the imperfect life he or she now has to lead. Kendall (2000) noted that spouses of disabled individuals may actually experience a period of grieving over the loss of their dream lives. And, as with all grieving processes, it may not be pretty. Anger arises when spouses feel cheated. Depression can also result. Although grieving is a normal process that, hopefully, leads to acceptance (Crowe, 1997), it still needs to be monitored. Obviously, associated emotions such as those already noted—resentment, anger, and depression—can, if allowed to linger, negatively impact communication between couples. Making the partner a part of the recovery process can help keep the communication lines open (Boberg, 1997). This involves everything from educating the partner about stuttering to allowing him or her to voice frustrations. Many speech-language pathologists will involve the significant other in treatment, another effective means of facilitating communication. Of course, not all significant others react negatively to the stuttering. Many become accustomed to it. Others may actually embrace it. For example, those who view their role as protector or nurturer will welcome the added responsibility of a stuttering partner. Difficulty in these relationships may occur during recovery. That is, tensions emerge as the role of the non-stuttering partner becomes diminished. I have heard reports of this sort of change in dynamics taking place even in marriages. That is, the nonstuttering spouse must relinquish the control that comes with being the sole spokesperson for the unit. Whether

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the spouse feels a loss of power, or is simply resistant to change, greater equality may be a difficult adjustment. Again, communication is the key to overcoming difficulties emerging during recovery (Boberg, 1997; Kendall, 2000). The more the partners understand the process, the more they understand the importance of changing their roles.

PARENTS For the parents of people who stutter, the road to acceptance is filled with even higher emotion than that of a significant other. It begins with the elation of the newborn child and progresses to (and hopefully past) worry, frustration, guilt, anger, and/or a host of other conflicting and often simultaneous emotions. Babies might all look like Winston Churchill, but to the parents they are perfect, bundles of joy and limitless possibilities. Any faults—the noises, the smells, the helplessness—simply reinforce what they are and pose no limitations on their boundless potential. The jubilation continues throughout the developmental milestones— first steps, first words—as the baby gradually becomes more of an individual. But while the child is still viewed as perfect, the parents see themselves as anything but. Along with the joy of parenthood come responsibility and insecurity about doing the job well (Starkweather, 2000). Love for the child is so great that parents can get caught up in irrational thoughts and worries. They wonder if their child will develop normally. They fear for his or her safety, imagining their baby falling from windows or stumbling onto sharp objects. While this sort of worrying serves as a protective mechanism (encouraging motor and speech development and keeping baby away from open windows or sharp objects), it is nevertheless a reflection of parents’ fears about anything bad happening to their kids. What happens, then, when the little bundle of perfection begins to stutter? Well, the worries certainly expand. Will my child be teased? Will it affect school performance? What about making friends? New emotions also emerge, such as disappointment, confusion, sadness (Buscaglia, 1975; Wright, 2002), and, most of all, guilt (Crowe, 1997; Kendall, 2000). With stuttering, as with any disorder, there is an initial shock that something is wrong (Webster & Ward, 1993). Some parents grieve the loss of the perfect child (Crowe, 1997; Kendall, 2000; Webster & Ward, 1993; Wright, 2002), a process similar to what spouses and significant others experience.

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An early stage of the grieving process is denial. This can involve denying the disorder, concern about the disorder, or, illogically, both (Buscaglia, 1975; Wright, 2002).
“It’s nothing, really.”
“It’s just a phase.”
“He doesn’t really have a problem and besides, it doesn’t bother us.”

Although denial is part of the grieving process, it cannot go on indefinitely. When it continues too long, the child does not receive the needed intervention (Wright, 2002), a potential source of later guilt for many parents. In Chapter 1, it was noted that stuttering is both episodic and misunderstood, both of which lend themselves to denial. That is, if parents believe that the condition is part of speech development and responds to a wait-and-see approach, they are unlikely to view it as a problem, particularly when it periodically goes into remission. Thus, a parental judgment call can result in later difficulties for the child, not to mention remorse for the parents. When the disorder can no longer be denied, frustration and even anger may arise. The anger can be directed at a variety of sources, including the parents themselves for not being sufficient advocates for their children, professionals for lacking information or guarantees (Wright, 2002), or life in general (“Why me?”). Whereas anger is basically an aggressive response, depression, another emotion common to grieving, is marked by submission and retreat (Crowe, 1997). Some parents who blame themselves seem to experience a diminished sense of self-worth and, as a result, accept unquestioning whatever professionals tell them. And although it is true that, just as with anger and denial, feelings of depression are often part of the path to eventual acceptance, they can also lead to later guilt if bad recommendations were followed. There are additional feelings often present with parents, regardless of whether they experienced the grieving process. A common one is confusion (Buscaglia, 1975; Wright, 2002). Something is happening about which they know little to nothing. As a result, the parents simply do not know what to do. Although the pediatrician is the usual default resource, confusion mixed with desperation and an increased reluctance to trust their own instincts will often lead parents to also consult friends, neighbors, family members, textbooks, the Internet, and anyone or anything else that might possess some insight about raising children. Several problems may result from this. One is that, if a large amount of information is obtained, it may be both overwhelming and contradictory, adding to the confusion. In addition, when parents are sensitive about their role in the child’s stutter-

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ing, they might take any advice as criticism (Kendall, 2000). They respond defensively, as if they are being accused. “It’s important to talk to him in a relaxed manner.” “I’m always relaxed!” Another problem is the high probability of receiving questionable advice. As noted in Chapter 1, many myths surround this disorder. Upon such myths lie some really bad pieces of advice.
“Every kid stutters. It’s just a phase. Don’t worry about it.”
“All I’ll tell you is that when my kid stuttered, I told him to knock it

off or else. I never heard it again.” When such advice does not work, guilt results. The source of the guilt is either the perception that the recommendations were not followed correctly, that time was wasted pursuing a suggestion that did not work, or both. Guilt colors numerous parts of the parental experience. Parents wrestle with feelings of inadequacy as their child’s disorder develops (Buscaglia, 1975). As previously noted, learning more about stuttering introduces more gray areas. They are unable to make sense of the contradictory information, screen out the misinformation, or address the questions that have no definitive answers (starting with Why does it happen? and What do we do about it?). Parents are overwhelmed, yet feel a responsibility to handle the situation perfectly (Kendall, 2000). When new hassles emerge—the teacher insensitive to stuttering, the demands of an extensive home program from the speech-language pathologist—more guilt ensues with respect to how well these added responsibilities are managed (Wright, 2002). Parents may also feel responsible for the disorder itself. With any childhood difference, parents wonder whether they should have done something differently during pregnancy (Kendall, 2000) or the child’s formative years (Crowe, 1997). Learning theories of stuttering certainly do not help, particularly when all parents know about them are quotes such as “stuttering begins not in the mouth of the child, but in the ear of the parent” (Johnson, as cited in Williams, 1992). As noted earlier, child rearing is often associated with irrational fears. Ensuing guilt, then, may also reside outside the reasonable. One parent confided to me, “I wondered a lot about the cause, like did the babysitter yell at my daughter too much. I knew it was extremely unlikely, but irrational stuff goes through your head.” Other parents wonder whether they could have prevented the disorder’s onset with higher morals (Crowe, 1997). Some even experience guilt upon learning about new methods of early intervention, as if they should have figured them out themselves.

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Guilt can lead to, among other problems, overprotectiveness, depression, and loss of self-esteem (Crowe, 1997; Wright, 2002). Moreover, it can be a lengthy process, given the constant reminders of parental imperfection, such as the questions people ask about stuttering and the fluency observed with other children. It is also important to note that parents get labeled too. Professionals refer to them neurotic or unrealistic or overprotective, as if these are ingrained traits and not steps toward acceptance (Buscaglia, 1975). These sorts of labels comprise another outside force that can increase parental guilt. For instance, parents might view their labeled overprotectiveness as a precipitating factor in their child’s stuttering. Given that guilt is based on perceived responsibility for both causing stuttering and not curing it, it is clearly unfounded. With proper education about stuttering, parents can generally understand this on an intellectual basis. Emotionally, however, such acceptance does not come easily. Given what parents experience, this is quite understandable. It is important to be sensitive to demands that were placed on parents (McFarlane, Fujiki, & Brinton, 1984) and to what they experienced emotionally. Although I do not feel that, in general, people who stutter resent their parents, in many cases the lines of communication on the subject are not exactly wide open. Because of the way stuttering develops—the embarrassment, the avoidance, the family cabal of silence rooted in guilt— people who stutter are often unwilling to discuss their condition with anyone, especially parents whom they think they have disappointed. Even into adulthood, the person who stutters is often reluctant to broach the topic with parents. When this topic arose in a support group meeting, one attendee simply stated, “I won’t go there.” Others reported that they did go there, but it took awhile. Still, they were glad they made the trip. Unresolved issues with parents can, after all, interfere with the recovery process (Starkweather, 2000). If, for example, a person cannot fully accept his or her own stuttering because of parental shame or disapproval (real or imagined), this matter needs to be addressed. When parents are unable or unwilling to be involved, psychotherapeutic techniques can be employed to help resolve the situation. For example, Starkweather (2000) suggests having the adult who stutters engage in an imaginary conversation with the parent (taking both sides) and/or writing letters to the parent that are never sent. Again, one can see the value of communication between the person who stutters and those important to him or her. Just as communication can keep a cord of silence from separating the stuttering individual and his or her significant other, it can help unravel a developed cord between parents and children. In doing so, a barrier on the path to recovery is removed.

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SYNOPSIS For many individuals who stutter, unresolved issues with those closest to them can stand in the way of recovery. The disapproval of friends, family members, and significant others can lead to avoidance behaviors, hinder the establishment of an effective support system, and disallow complete acceptance of one’s own stuttering. The solution is communication, a willingness to discuss with loved ones the stuttering itself and the emotions surrounding it.

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The Family Dinner

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I remember the first time the dreaded topic was raised with my family. It was Thanksgiving dinner and the entire clan had made it home for the holiday. That it was, in fact, a holiday was evident by the unusually strict adherence to terms. For one thing, we were dining in the actual dining room. And the tablecloth was real cloth. The glasses were glass and the silver was—well, OK, the silver was stainless steel. But it was still a special day, and I, for one, was determined to treat it as such. As in many homes, Thanksgiving offered a time to set aside the everyday and catch up on one another’s lives, accomplishments, and aspirations. It provided a rare opportunity to contemplate past, present, and future, by virtue of an occasion founded on introspection and spirituality. There was always something, it seemed to me, almost poetic about spending Thanksgiving with family. “The dressing looks like cat puke,” announced my brother Arden as we all gathered at the table. My youngest brother Will followed this proclamation by saying grace (“Thank you for the food and, um, trees and stuff. Amen.”) and we began passing the turkey, mashed potatoes, gravy, cranberries, rolls, and some sort of mystery casserole that consisted of, among other ingredients, deep fried onions and mushroom soup, as well as vegetables in more recognizable forms. Everyone deferred on the dressing. “So how’s that school going?” my mother asked me, a means of both steering the conversation away from feline vomit and getting an obliga-

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tory subject out of the way early. It was classic approach/avoidance: Mom felt a maternal duty to ask about my life, but she really did not want to hear about it. My chosen field of speech-language pathology clearly stirred feelings of uneasiness in her. “That school?” asked Arden, his mouth half full of turkey, roll, and various other substances, all of which had turned different shades of brown. “I got straight A’s,” said Will, as if anyone were talking about him. Poco, the family cockapoo, scratched the back door. He liked to go outdoors. In fact, the only thing he seemed to enjoy more was coming back indoors several seconds later. I got up to attend to him. “You didn’t get straight A’s,” Mom said to Will. “I was being figurative,” he explained. “Figurative?” I asked, returning to the table. “No, wait.” His face grew thoughtful behind the mountain of mashed potatoes on his plate. “Not figurative. What am I thinking of?” “Anyway, my school is going fine,” I said, deciding to let the other matter drop. “What do you do there?” asked Arden. I saw Mom wince. “Well, right now it’s kind of interesting,” I began. “I see clients in the clinic—” Poco scratched to be let back into the house. I walked toward the door. Arden used the interruption to ask what was really on his mind. “Do you get to do that burping thing?” he yelled to me from his place at the table. “Esophageal speech?” I called back. No immediate answer was forthcoming. As I re-entered the dining room, Arden was staring blankly at his overflowing plate, as if he expected something to move. Poco again scratched at the back door, apparently deciding he liked it better outside. I turned around. On my way back toward the dog, I heard Will say something that sounded like, “Orwor ruh.” “Don’t talk with your mouth full,” commanded Mom. After a pause, he tried again. “Arden stinks,” he said. “Figuratively?” I asked from my location near the back door. “No, I mean he really stinks.” It was time once again for Mom to change the subject, a task which clearly caught her off-guard. She waited until I had retaken my seat before speaking. “So that’s all that’s going on at school?” “Well, no. I work with an adult who had a stroke, a kid who can’t say his /r/’s—” “Teaching someone to burp would be sweet,” said Arden. Will packed an entire roll, half a turkey leg, and a forkful of casserole into his mouth before saying, “Duhduh dee uhda bawawa dosah?” My

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mother looked repulsed. I thought it was actually quite an accomplishment to have transferred any sound at all past that conglomeration of food. “Huh?” I asked. Noisily gagging down the massive bolus, Will asked, “Do you teach any other bodily noises?” “William Charles!” scolded my mom. “If so,” he continued, “maybe Arden could guest lecture some time.” I decided to rescue Will from the double-barreled warning. Mom had just addressed him by his full and middle names, either of which by itself usually meant trouble. “Esophageal speech isn’t burping,” I began. “It’s a means of speaking without a voice box.” Poco’s familiar scratching indicated his wish to come back inside. This time, Will rose and headed toward the door. As no one picked up on my esophageal speech explanation, I decided it was a good time to put the avoided topic on the table. “I also work with a kid who stutters,” I said. “Arden, take a shower!” said my dad, waving a forkful of cranberries in the general direction of the downstairs bathroom. He was, as usual, several light years behind the present conversation. Will returned to the table. “That’s not why he stinks,” he informed us upon taking his seat. “That’s disgusting!” said Mom. “So why does the kid stutter?” asked Arden. “Why does anyone stutter?” I answered off-handedly. “OK, why does anyone stutter?” “No one knows.” For several minutes we all ate in silence, save for Will’s smacking and chomping noises. Suddenly Mom said, “I do.” There was a pause, interrupted only by Poco’s incessant scratching. I pretended not to notice it, focusing instead on using my fork to break the dam of mashed potatoes that had allowed the gravy to pool. As the flow began to encircle the mystery casserole, Arden stood up. His subsequent movement toward the back door seemed to stir something in my dad. “For heaven’s sake, Arden, stop being so disgusting!” Dad said over the sound of the back door closing. “We’re eating here! A moment later Arden reappeared in the dining room, just as the scratching began anew. “How could that stupid dog have done anything in the four seconds he was out?” he asked as he turned back toward the door. “Sometimes he just goes out to check the weather,” explained Will. “It’s because of overbearing mothers,” said Mom.

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“Poco’s stupidity?” asked Will. “Come on, Mom. I know you like to take the weight of the world on your shoulders, but I hardly think you’re to blame for—” “I’m not talking about that,” she interrupted, “I’m talking about that other thing—what we were talking about before.” “Stuttering?” I asked. “Yes, that. It’s caused by overbearing mothers.” “That’s crap,” I responded. “Oh, how do you know?” “How do I know? I’m in a graduate speech-language pathology program! What kinds of things do you think they teach us there?” She didn’t back down. “Why do I keep hearing that parents are to blame?” “I don’t know. I suppose for the same reason parents were once blamed for schizophrenia, autism—” “What about the burping thing?” asked Arden, trying to be helpful. “Arden, let the dog in,” commanded my dad. “Dear, he already let him in,” said Mom. Turning to me, she added, “You’re just saying what you think I want to hear.” “Mom—” “If what you say is true, why didn’t you tell me before?” “When?” I asked. “You never once spoke of it before now.” “Somebody let the dog in,” said Dad. “He’s already in!” said at least three of us simultaneously. But Poco’s scratching indicated that he was, indeed, outside. Arden, Will, and I looked at each other. “How did he get out?” I asked. “More importantly, why does he keep bothering us if he knows how to get out on his own?” added Will. “Training exercise,” said Arden between chews. “In case he ever really needs us.” I looked at my mother, who was silent. Her plate was full, yet she was not eating. I thought I should comfort her, but it was my turn to open the door for Poco, who was by then growling at the delay. Besides, I had made my point. In that, I took some measure of satisfaction, for I was actually young enough—and naïve enough—to believe that two words (“That’s crap”) could triumph over 2 decades of guilt. But it was another phrase— “It’s caused by overbearing mothers”—that was to be repeated on numerous occasions when the subject again arose. But that was later, on different days, in different situations. “Please pass the cat puke,” said Arden, officially closing the first family conversation about stuttering.

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Self-Improvement Is Worth the Risk

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The crab says when you see it walking clumsily, it does not mean that it has lost its way. Ghanaian Proverb

The topic of risk-taking is one that is often overlooked in discussions of recovery. And yet it is as crucial as any other aspect of the process. Although risk-taking is generally viewed as a process garnering shortterm rewards (e.g., the thrill of the moment) (Zuckerman, 2000), that is not the case in this chapter. Jumping off a cliff to see what happens might afford an adrenaline rush, but it is unlikely to be of much help with stuttering. Within the context of recovery, risks need to provide long-range benefits. For example:
Saying “I stutter” without knowing what the listener’s reaction will

be, thereby decreasing the temptation to use avoidance behaviors.
Voluntarily stuttering with a stranger in order to become more desensitized to the reactions of others.
Using therapeutic techniques in daily life, even if the resulting speech seems unusual or uncomfortable, the idea being that it will never seem usual or comfortable as long as it remains unused.
Standing in line at the coffee shop, deciding to order “Decaf” even though the speaker knows he or she could not say a /d/ word flu-

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ently to save a life. Ordering is unnerving, but is done anyway, in an attempt to lessen the fear of that particular sound. In other words, the risks taken have to have discernible and eventual goals, be it less avoidance, better speech-associated attitudes, fewer stutters, more control of speaking, or whatever other objectives are desired. Reaching the goals may be difficult and uncomfortable, but the reward is worth the pursuit. All of the old clichés apply: take one step backward to get two steps forward; nothing ventured, nothing gained; the only way not to fail is not to try; take your shot; step up to the plate; go for it; and so forth. There is a story I like about tennis player John McEnroe. I have no idea whether or not the story is true, but it has stuck with me since I first heard it. As a teenager, the story goes, McEnroe was locked in a tight match with a higher seeded opponent in a major junior tournament. The match came down to two crucial points. Both times McEnroe could have kept the ball in play. Both times he went for the big shot and both times he missed, costing him the match. When I first heard the story, I was sixteen years old and my response was something along the lines of, “What an idiot.” I could not understand how someone could gamble away such an opportunity. He had the chance to upset a highly regarded player and blew it. My problem was that I was only thinking short term. Had McEnroe had played it safe, he might have won that particular match. But McEnroe, as we all know now, had bigger fish to eventually fry than some unknown junior player who happened to have a high seed. He could afford, in fact had to try, some risky shots in pressure situations early in his career. Otherwise, how would he ever learn to hit them? What does John McEnroe have to do with stuttering? Technically, nothing. But the central message of the story is practical for those struggling with the disorder. In any given point of a tennis match, there are likely to be safe plays that can be made without error. But if the player selects the prudent strategy in every one of these instances, he or she will not improve. Stated differently, the higher skill will never be developed if it is never attempted. Moreover, the player will not immediately excel at this new skill when he or she does decide to try it. Thus, facing challenges (sometimes unsuccessfully) is a necessary part of improvement. Likewise, people who stutter can ask for the safe (that is, easy to say) food from the menu or order what they actually want. They can avoid the telephone or call whomever they need to contact. They can skip class or show up on the day of oral reports. In each case, the former strategy has

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the immediate reward of getting the individuals through the moment safely (albeit at a cost of reinforcing some unhealthy fears, as discussed in Chap. 1). The riskier tactics may be initially uncomfortable, but they could lead toward lasting benefits, such as loosening the grip of the feared word or situation (Zebrowski, 2003). In this way of thinking, a feared circumstance is an opportunity for growth, a chance to test out new skills (Hood, 2003). The person who stutters can even attempt to create atmospheres in which risks are mandatory—ordering the most difficult item to say on the menu or making the telephone call when an e-mail message would suffice. The idea, of course, is not to handle these situations perfectly the first time out. In some ways, it is just the opposite. The person who stutters should expect setbacks (e.g., feelings of discomfort or struggles with speech), but try again, knowing that with enough persistence, feared words and situations can become less intimidating. The idea of taking chances for long-term gain raises many questions. It is my hope that, in addressing these questions, the reader can better understand the concept and apply it to stuttering recovery. If risk-taking guarantees long term rewards, why doesn’t everyone do it? First off, risk-taking doesn’t guarantee anything. If it did, it would not include the word risk. The point is that playing it safe does not progress one toward any goal and may even escalate problem areas by increasing feelings of helplessness (Jeffers, 1988). But a better question than Why don’t we take risks? is Why do we start playing it safe? As toddlers, we learned to talk by making numerous mistakes with language and plugging ahead with enthusiasm, paying no mind to those who laugh at us. Even children given a second language do not become flustered or self-conscious. They simply learn it. In fact, there is some evidence to suggest that children who are cautious tend to be slower language learners than those more impulsive (Goldfield & Snow, 2001; Horgan, 1981). This appears to be true in the learning of second languages as well (Fillmore, 1979). It appears, then, that children utilize varying levels of impulsivity to learn to speak. But sometime around the age of seven years, those who stutter begin to develop negative attitudes about speech (DeNil & Brutten, 1987). They lose confidence in their ability to do it well. A common solution is to withdraw. They would rather hide their stuttering than experience the negative—be it embarrassment, ridicule, self-doubt, or simply parents’ visible reactions of disappointment. In time, hiding errors becomes paramount. There are two reasons for this. First, for many people who stutter, anything is better than having

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others find out their most personal secret. Second, they are reinforced for playing it safe, as their withdrawal behaviors get them through many a tough moment. Isn’t this idea rather simplistic? Or, stated differently: Is risk-taking supposed to be some kind of cureall for people who stutter? In Chapter 2, the reader was introduced to a young boy in a fearsome situation, having to read aloud in class. Almost paralyzed by anxiety, he is unable to speak fluently before his peers, causing humiliation that lasts well beyond the resulting laughter. My question is this: How would you now tell this kid that all he needs to be doing is taking risks? That chancing failure is the key to happiness? It is simply the last thing he wants to hear, the last thing he would consider doing. One possibility is to tell him that taking risks beats the alternative. Attempting to hide the stuttering will make it worse. Then again, why scare him? A less frightening proposal would be to explain that risks can be taken one at a time. Start small. One need not go from total fear of speech to testifying before a Congressional Committee on Ethics. Go step by step. Dan Marino did not throw a perfect spiral before he learned how to hold a football. It took a plan, some practice, and, sorry to say, time. Using this same general idea, perhaps people who stutter can attempt therapeutic techniques with good friends. Then they can do the same in small groups, then larger units as they work their way toward using them in situations as fearsome as reading in class. What if I’m not Dan Marino? Or even John McEnroe? In other words, is it fair to compare the speech of people who stutter with the skills of natural born athletes? Face it, their risks have two likely outcomes. They will succeed or barely miss (and probably look good doing it). The attempts will not be embarrassing and are unlikely to call attention to themselves in ways that seem abnormal. After all, professional athletes are taking risks in order to improve skills that are already highly proficient. While all this is true, it is also clear that risk-taking helps with skills that do not come naturally. There are examples from many walks of life in which proficiency is learned. In the Peace Corps, I was assigned to Ghana and had to learn the local language. Part of this training involved going into town and conversing with the local citizens. Most of the volunteers in my group played it safe, speaking in short utterances and using only the vocabulary with which we

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were most comfortable. There were a few in the group, however, who embraced this task. They attempted to carry on real conversations with the Ghanaians. Most of the time, they failed miserably, much to the amusement of the rest of us. Over the course of the training, however, the strides they made in learning the language were remarkable, much greater than those of us who delighted in their early awkwardness. In hindsight, I see their willingness to take risks as one reason for their success. Is risk-taking ever a bad idea? I have never been impressed with the statement that, when confronted with two choices, a person should always take the riskier one. Sometimes, there is too much at stake. Like anything, taking chances can be carried to an unhealthy extreme. No one needs to put themselves in positions where they are certain to be mocked or embarrassed. And sometimes, the price of risk may be even higher, such as losing a promotion. In at least one case that I know of, it cost a man his job. Personally, I have never been denied employment because of stuttering (although I am sure that, in some cases, doing so during interviews did not help my chances). I do, however, remember a less significant example in which I let the risk go untaken. It was prior to the 2001 Orange Bowl. I was dressed in my Oklahoma Sooners sweat shirt, OU cap, and OU face paint. (I’m kidding about the face paint.) Riding the stadium escalator with some other alums, we were greeted by a group of loud Florida State fans who questioned, among other things, our heritage, hygiene habits, and notion that our team might actually win the game. As I listened to their assessment of us, I began to wonder about what would happen if I responded. There is no conceivable way that a stutter would have gone unnoticed in this situation, no chance that it would not be mocked. Do I speak up anyway? And if I do not, am I playing it safe? Do I let these opinions about me go unchallenged? Their arguments were hardly irrefutable, after all. In this case, I was not about to say anything, even if I could be guaranteed fluency. Why? Because a stupid argument can lead to getting thrown out of the stadium, which I was not about to risk. Yes, I played it safe. I felt there was too much to lose. But while instances such as this, as well as situations as serious as loss of employment, are very real, it is also true that people who stutter often limit themselves. They play it safe, making assumptions about dangers that are not present. Yes, sometimes taking risks is not advised. But such instances are not as frequent as people who stutter tend to believe.

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DEVISING A PLAN In summary, the process of recovery involves taking some risks and getting outside of one’s comfort zone. This is a three-part process. 1. Set goals: The person who stutters should decide what his or her personal objectives are. Risks without goals might help, but it is akin to beginning a journey without a map. Thus, each individual should decide what he or she wants, be it decreased concern about listener reactions, less stuttering, both, or something else entirely. 2. Take chances that make sense: A better way of phrasing this goal is “Take chances that make sense for you.” The risks, after all, are supposed to move an individual toward his or her personal goal or goals. Again, the risks embarked upon must be feasible, such as open stuttering or using therapeutic techniques with a spouse or at a support group meeting. Those who are already comfortable in these situations can try out their goals with a co-worker or a stranger. As noted throughout this chapter, the idea is to expand one’s comfort zone in small increments. Will this continual expansion eliminate fear? No, fear comes with uncomfortable situations (Hood, 2003). But confronting fear should, in time, reduce the number of such situations, which in turn reduces feelings of helplessness (Jeffers, 1988). 3. Allow yourself to make mistakes: Nobody likes failure, but there is a difference between hating it and fearing it. If mistakes are viewed as inevitable and necessary toward achieving goals, they are not necessarily discouraging. Even those furthest along the recovery road will be embarrassed occasionally by their stuttering. Most probably catch themselves avoiding words or situations. These infrequent failures, however, do not dominate their thoughts or change their goals. They persevere, developing new skills and learning from past mistakes. Losing to an unknown junior player today does not mean that Wimbledon cannot be won tomorrow. As a final point, it is important to realize that plans will be implemented differently with every individual who stutters. Some will embrace risk-taking, whereas others will approach it with trepidation. Certain individuals might choose to have fun with their speech, to stutter with a sense of humor. Others may work on convincing themselves that what they are saying is more important than what listeners are thinking and, as a result, stutter with an attitude. Still others will need to continually explore the concept of risk-taking, addressing ideas such as the acceptability of having fears and/or how speech risks are analogous to other aspects of

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life. Every person who stutters is an individual and, therefore, requires his or her own plan.

SYNOPSIS Because recovery from stuttering involves both learning new skills and transferring them to an ever-expanding array of situations, people who stutter need to develop some risk-taking skills. Although withdrawing to the safety of one’s comfort zone is understandable, given the negative attitudes that develop with stuttering, it is nevertheless possible to expand this zone one degree at a time. I recommend that this be done with an individualized plan that includes goals, a means of achieving them, and a willingness to learn from the inevitable mistakes.

Chapter

16

The Match of a Lifetime

U

When I was an adolescent, the best tennis player in the district was named Jay. This is not to say that everyone who achieved the number one ranking was renamed Jay (because, after all, what would be the point of that?), but, rather, to indicate that one player—Jay—dominated the sport in my region. In fact, the top tennis echelon consisted of Jay and no one else. There was one very good reason for this. Nobody beat Jay. Not ever, as far as I know. I and numerous others made up the second tier of players, which is less impressive than it sounds when one considers that west Michigan is to tennis what college students are to sobriety. I mention my status only to point out that, because Jay had to play someone, it was inevitable that he and I would one day meet on the tennis court. This occurred one picture perfect afternoon—warm, sunny, slight breeze—a seemingly ideal time to challenge Jay’s status as unbeatable. Yes, I was one confident fool. We met by the assigned court and shook hands, my first chance to see him up close. He was tall, lean, and tan, with a mane of blond hair that would stay in place through a nor’easter. I was short, skinny, and the possessor of more cowlicks than a feeding trough. But I was cooler. OK, I wasn’t, but my dog liked me better and would have even had he met Jay. As we donned our gear and began warming up, hitting stiff shots with little regard to their placement, I was thinking This is Jay? His shots were easy to handle and not particularly accurate. McHaircut (the aforementioned dog) can do more with a tennis ball than this guy! I guess you could say

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I was less than thoroughly impressed with his game. Or maybe I was overly impressed with my own. In any case, I carried a vat full of confidence into the first set. His prowess improved as the set began, but not enough. I was reacting to everything, hitting shot after shot past him for winners, with nary a thought that I might miss. Serves, groundstrokes, volleys—you name it, I could do it. I was in the proverbial zone (which, until that day, I had considered a myth. Like Bigfoot or Ohio). The ball was easy to hit and totally submissive—a little brother wrapped in yellow felt. By our third changeover, with me ahead 4–1, I took stock of just how darn good I was. My backhand was unbelievable, my forehand good (it had never been great, even when I was rolling), and my reservoir of stamina was so full that I actually hurried back on to the court, so eager was I to resume my thrashing of Jay. I noticed a small crowd gathering beside the windscreens. Surely they had come to watch Jay, but I was far too impressed with myself to let him be Hawkeye to my Frank Burns. “At the very least I’m Trapper!” I yelled. This, of course, made no sense at all to anyone outside my own thoughts. Jay and I split the next two games, as I hit some more amazing backhands and passable forehands. The game I lost, however, was due to two consecutive weak forehands that allowed Jay easy put-aways. The second of these shots was so awkward that I thought I heard people in the crowd laughing. I glared in the general direction of the tittering, a fleeting glance just long enough to look tough without actually risking a punch in the snout. During the next changeover, Jay remarked, “I don’t often see players whose backhands are better than their forehands.” “There’s nothing wrong with my forehand,” I snapped. Whether or not Jay believed me, he did not change his style of play. He fortunately hit me enough backhands to balance the numerous feeble forehands I suffered while winning one of the pair of games. That gave me the first set 6–3 and I desperately wanted to stop the match right then, solely for purposes of gloating. “Good playing,” said Jay during the changeover between sets. “When I want your opinion, I’ll ask for it,” I answered. Jay laughed comfortably, as if I were kidding. I was on top of the world, having won a set from the great Jay with my superb play and cunning. I could hardly get over how smart I was, how effectively I was hiding that nasty hitch in my forehand from the best player I would ever face. The secret, I figured, was my intense will to win. Losing, after all, could send me into fits of yelling, object tossing, lost sleep, and other behaviors found commonly among tennis players and

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toddlers. All of that had been rendered unnecessary, however. I had the game figured out. The key was errors, as in don’t make any. Sure, that wasn’t an attainable goal, but so what? The fewer mistakes I made, the more success I would experience. What could be more logical? Nobody beats Jay? Keep watching, I wanted to shout. I had a vision of the future and saw curators of a tennis museum fussing over a statue of me. “Throw away those sculptures of Laver, Tilden, and Hoad,” one of them said. “The Williams is here.” (This was before McEnroe and Sampras; and Borg was still so young he was losing two to three matches a year.) The inscription on my likeness would begin, “As a youth, figured out how to beat Jay. From then on, conquering the world was easy . . .” I wondered if anyone had taken a set from Jay before. Later that day, someone in the assembled crowd would tell me that plenty of others had. But that’s getting ahead of the story. I was only to the second set. Let’s see, how to describe set number two? Numerous adjectives come to mind. There’s humiliating. And embarrassing, degrading, frustrating, and disastrous. Then the words that really tell the story: Six Oh (the score). I didn’t die, but that’s about as silver as the lining gets. I tried every conceivable means of propelling forehands back across the net, including topspin, backspin, and even flipspin, a stroke I made up on the spot. The first two worked a few times, offering false hope that was quickly dashed when Jay’s deep and powerful shots again brought out the wimpiest forehand since Aaron Burr slapped Alexander Hamilton with a silk glove. The idea with flipspin was to hold the racquet vertically, then move the strings completely around the ball during the course of the swing (if that’s hard to picture, I wouldn’t worry; it’s not a stroke that’s likely to make anyone forget the Rafter volley). Sadly, albeit unsurprisingly, the flipspin did not even get the ball to the net, much less over it. Other forehand attempts included pushing the racquet like an oar and swinging it two-handed like a bat. Once I jumped up on one leg like a ballerina and tapped the ball gently (I looked as if I were trying to swat a fly without actually harming it). When those plans of attack failed, I began ridiculously running around my forehand to hit more backhands. Please think about that for a moment. I was running around my forehand. Nobody runs around a forehand. It’s the easiest shot in tennis, every player’s bread and butter. It’s the first stroke every youngster is taught, for crying out loud! Any infant with a paddle can hit it! But there I was, purposely removing it from my arsenal rather than continue my clumsy prancing and patting. In keeping with my luck at the time, however, all this new strategy really accomplished was to hinder my forehand and my backhand.

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I thought about all those hours in my youth spent hitting tennis balls against cement walls. How easy it was to strike punishing and accurate forehands in the absence of a real opponent. Facing only the wall, I could swing the racquet fiercely, striking the ball on the rise, blasting it with an audible pop. My reflexes were primed, my confidence high, my shots accurate, my game unrecognizable. I remembered the warm up with Jay just an hour or so earlier. Those shots had also left my racquet fluidly regardless of how I struck them. If I can do it sometimes, I wondered, why can’t I do it now? I tried pretending Jay wasn’t there, an attempt to return to my wall strokes of old. This turned out to be an astonishingly stupid strategy when applied to someone who was setting the pace of play and, not coincidentally, dominating me like, um, like—oh never mind, I hate trying to think up similes. There’s about as much chance of me drawing an apt parallel here as there is of Maria Sharapova dropping by my house to borrow a cup of Cheez Whiz. In my desperation, I recalled Coach Florin from the first summer I took lessons. What had he said to the class, that group of youngsters with no real concerns beyond armpit noises and the relative merits of Batman and the Green Hornet? Foot forward (actually it sounded more like fute fawd through the clipped speech and Romanian accent with which he barked at us), hit the ball, reach for the balloon. I never understood why the followthrough was “reach for the balloon.” Maybe it’s common for inflatables to hover over tennis courts in Romania. Or maybe Florin learned to play at a T.G.I.Friday’s. In any case, I tried the instructions of the old coach the next time Jay knocked the ball to my right side. I stepped my left foot forward, struck the ball, and followed through high enough to graze that giant floating Garfield from the Macy’s Thanksgiving Day Parade. The resulting shot was perfect, rocketing by my opponent like good writing past a journal reviewer. (Do I sound bitter? I’m not. Can I help it if the editors of JNOWAY—or whatever the acronym is—wouldn’t know quality research if it slammed into them like a Roddick serve?) “Nice shot,” said Jay, as he watched the ball nick the sideline for a winner. “Don’t be so condescending,” I answered. “Don’t you be so sensitive. I thought it was a good shot.” I finally had my forehand restored. It was simply a matter of returning to basics, of discarding bad habits and relearning what I was naturally programmed to do. I would have kissed my old coach right then and there had I seen him. Two missed shots later, I decided Florin was an idiot.

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Why, you ask (or even if you didn’t), couldn’t I hit a normal forehand? Was there something wrong with my arm? My noggin? My karma (whatever that is)? I don’t know, I don’t know, I don’t know, and I certainly don’t know. None of that really mattered at the time. What did was getting the ball back over the net some way, somehow. Between new forehand ideas, when I was left with the hitch, I pretended to laugh off my errors, an attempt to mislead anyone who cared that this most recent failure was caused by the moment, my opponent, the constellation Orion—anything but the truth. The crowd was no help during my humiliation. Those who reacted did so with a mix of mockery and sympathy. Most fell into the latter group, trying to encourage me with supportive and/or patronizing smiles. Then came the dumb advice. “Think about what you’re doing.” “Come on. Just hit the ball.” Gee, thanks guys. Why didn’t I think of that? Near the end of the degradation that was the second set, I thought I heard someone in the crowd hissing. That’s right—hissing. In the ’70s! Come on, what was there to hiss about? I mean other than puka shells. And shirts that read “I’m With Stupid.” And that Clint Holmes song I could never get out of my head (My name is Michael, I’ve got a nickel . . .). OK, so there was plenty to hiss about. And had I been watching, I might have joined in. My opponent was bouncing me around like a cow on a bungee chord (I warned you about the simile thing). Jay was better, simple as that. No external elements were hindering me. It was one-againstone and I was losing. It was time to admit that I might not be good enough, to take responsibility for my performance. “The sun’s in my eyes,” I explained to Jay during the next changeover. He glanced up at the sky. “It clouded up 15 minutes ago.” “Oh. Well, I—um . . . shut up.” “Your play’s dropped a little,” he said, ignoring my suggestion. “Want some advice?” I nodded. I had certainly run out of ideas. “You’re playing it too safe. Like you’re afraid to lose.” Technically, that’s not advice and, besides that, it sounded stupid. First of all, I’m supposed to be afraid of losing. Otherwise I’d never be a winner, right? Secondly, my problem wasn’t “playing it too safe.” It was a forehand that smelled like Mojave roadkill. As I returned to the court, however, I began to wonder if maybe there was a kernel of truth in Jay’s babbling. It was possible, after all, that he hadn’t always been so good, that he’d had to learn to hit those winners

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that were too frequently blasting past me. Perhaps, my revelation continued, guys like Jay aren’t born 62 with the confidence of a cat in a carpetstaining contest. If that was the case, even the mighty Jay must have, once upon a time, regularly missed those shots he now stroked without worry. Maybe he didn’t, as he said, “play it safe,” and instead developed a variety of tactics he could employ to help conquer any opponent. I was on the other end of the spectrum, with no plan beyond the next forehand (unless you count always putting my underwear on the same way before each match). As a result, I was faced with an opponent controlling every point and a forehand controlling me. I resumed play with a change in strategy that was, for once, a change in strategy (as opposed to simply finding new means of deceit). I stopped focusing on every forehand, then dying inside each time the ball sank gently downward like a south Florida luxury car to the bottom of a swimming pool. (You’ve heard of inside jokes? That was an inside simile. So inside, in fact, I don’t completely understand it.) In retrospect, I can see that my new attack plan was four-pronged: (1) don’t flinch, (2) allow yourself to miss, (3) go for the shots you really want to hit, and (4) lose. Eight points into the third set, I was behind 2–0. Yet I continued on my new track for a number of reasons. For one, I was tired of the deception involved in conjuring novel forehands, which, by the way, hadn’t fooled anyone and, in a related note, looked ridiculous. Besides, the third set results were really no worse than before. I was simply losing a new way, one that at least had some logic to it: I had been devising tricks to avoid mistakes; take away the tricks, increase the mistakes. But the new way also increased the fun. I could stop obsessing over one lonely feature of the game. Also amusing was the thought of Jay wondering why the guy with the arrested forehand was playing so cocky. The final, and perhaps most important reason for my newfound devotion to risk taking was that confronting the feared forehand diminished its spell over me. It was the cruelest irony I could imagine—that stupid hitch did not start to dissipate until I stopped being so concerned with whether it would. You see, I did gradually develop a forehand that day. Not a spectacular or even average one, not one consistently void of a hitch, but it was a forehand. It was my forehand, something I could live with, like my short stature, my cowlicks, my inability to write a decent simile. Still, while I accepted the hitch, I did not have to like it. I certainly would have never sprayed any sunshine its way. Then again, name me anyone who admits to being a sun of a hitch. (Sorry, but it’s been several paragraphs since I’ve written something really dumb.)

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During the third set, I did hit a few nice forehands. One, in fact, completely eluded Jay’s outstretched racquet. “Nice shot,” he said. “Thanks,” I answered humbly. Other points went my way as well. In fact, for the first time in a set and a half, I was winning whole games. The crowd appreciated my effort and improved competitiveness. I even heard claps and saw nods of appreciation. One or two idiots laughed at some missed shots, but idiots laugh at everything. They tell us to in the meetings. Alas (a term of French derivation meaning “Am I pretentious or what?”), my stamina was down a quart during that final set. Jay, meanwhile, looked as fresh as a new simile. Although my play was internally satisfying, my opponent was, unfortunately, competing on the outside. By the time we finished the match, dark clouds were threatening the sky. The court was quiet and the crowd gone. They had been curious how I would fare, but all along even the idiots knew what the outcome would be. After all, nobody beat Jay.

Chapter

17

Odds ’n Ends

U

There’s so much that I’ve dealt with here: The myths, the looks, the jokes, The tricks, the fears, the sympathy My speech sometimes evokes. Mete Schubert A Stuttering Poem

By this point in the book, you, the reader, are probably thinking that there is more to recovery than what has heretofore been addressed. That recovery is multifaceted and, this being the case, some of the facets have not been included. And you would be right. In fact, all possible variables related to stuttering recovery are unlikely to be covered in any single text. And I can’t even come close to tackling all of the specific factors related to a single individual’s recovery. What I can do is address some additional recovery-related topics. This I will do here, in alphabetical order.

ADVERTISING Within the realm of stuttering recovery, the term advertising refers to selfdisclosure, that is, revealing one’s stuttering to listeners. This revelation

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can be carried out in a variety of ways. For example, open stuttering is, by definition, a form of self-disclosure. Hood (2003) suggested exhibiting items such as National Stuttering Association buttons or coffee mugs that say “I stutter.” Hicks (1997) wrote about prominently displaying a poster about stuttering on the wall of his office. This raised many questions from co-workers, thereby forcing him to tell people what had until then been a secret. And, of course, there is the easiest and most direct way of advertising—simply saying, “I stutter.” Advertising may well be taught in therapy and, as a desensitization technique, can be quite effective (Guitar, 1998). Putting one’s stuttering out in the open allows the speaker to experience the initial reactions immediately (in other words, get them out of the way early) and reverses any inclination he or she might have to avoid (Hood, 2003). There are additional benefits as well. Wong (2003) noted a feeling of improved selfesteem from confronting stuttering and felt that listeners were more sympathetic when they knew what his speech difficulty was. Ramig (2003) stated that, with advertising, the communication situation becomes more open and comfortable and less frustrating, distressing, and embarrassing. He also noted that advertising can, over time, lead to less stuttering for some individuals. Ironically, some may choose not to advertise for the same reason others do so—desensitization. That is, if one is truly and completely desensitized and cares not a whit what the listener feels, why would that person advertise? Following this logic, one could look at open stuttering (entirely open stuttering) as further along the acceptance continuum than advertising. Keep in mind, however, that one reason for advertising is to reduce listener confusion. After all, desensitization need not preclude any consideration of listeners’ feelings. One can be desensitized and still be courteous. In fact, accomplishing both makes for more effective communication.

ARROGANCE Although courtesy to listeners is important, it is also true that the desensitized client develops a certain arrogance about his or her own speech. That is, relatively more value is placed on what the speaker has to say and less on what others might think about how he or she is saying it. In modest amounts, then, arrogance can be good. I can remember waiting in a fast food line, trying to decide what to order. My options, as I saw them, were to 1) order the item I actually wanted to eat or 2) order something I could say. As I continued waiting, I began to, as usual, lean toward the latter option. The server might not like the way I talk, I reasoned. She might be impatient. She might look amused when I

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spoke. I might hold up the line and inconvenience the teens behind me who, for all I knew, were in a hurry to pierce their last remaining undecorated facial skin. For reasons I still do not completely understand, I was unable to convince myself to avoid on this particular occasion. I felt more worthy than usual of the greasy, processed food that I desired. I thought of all that time spent in therapy—and for what? Here I was about to let the stuttering win again. Not this time, I decided. I was paying, after all. When my stutter forked over some cash, then it could decide what to order. Irrationally, I looked at the woman behind the counter and began to feel resentment. How dare she dictate what I order by her mere presence? She’s there to serve me, not vice versa. I was going to order what I wanted, regardless of how long it took. The longer I waited, the more the resentment built. She will wait for me, I decided conclusively. Then a funny thing happened. I scanned the mental image of my upcoming order and realized that I wouldn’t stutter on it. Somehow giving myself permission to stutter had caused the stuttering to vacate the premises. Not wishing to conclude my irrationality at this point, I began to feel anger about this new development. I decided I would stutter when I ordered, even if I had to force it. That would show the self-important server. When it was finally my turn, I looked her square in the eye and let loose a voluntary prolongation that was longer than some graduation speeches. Her indifference was matched only by her bored expression, as she filled the order without reaction. I, however, felt like I had really accomplished something. In retrospect, what I accomplished with my newfound arrogance was not superiority, but, rather, equality. The server had to listen to my order, spoken the way I spoke it, just as she did with everyone else in the line. Before closing this section, I should point out that arrogance need not be limited to fast food servers. I could have conjured up the same resentment talking to my Dean or even more eminent authority figures, such as the Queen of England or my wife. After all, who are they to decide how I talk?

AUDITORY FEEDBACK Various types of acoustic feedback can induce fluency in people who stutter. Probably the best-known and most widely researched of these is delayed auditory feedback (DAF). DAF lengthens the time (by anywhere

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from 50 to 500 milliseconds) between the actual production of speech and when the speaker hears it. Those who have experienced this effect often describe it as speaking “with an echo.” Although this delay causes disfluency in most speakers (Lee, 1950), it results in improved fluency in many who stutter. In addition to DAF, there are other types of auditory feedback that have been utilized clinically, based on their capacity to reduce stuttering. These include masking noise (see Murray, 1969) and frequency altered feedback, the electronic conversion of vocal frequencies to make a speaker’s voice sound different to him- or herself (Hargrave, Armson, Kalinowski, & Stuart, 1993; Kalinowski, Stuart, Wamsley, & Rastatter, 1999; Stuart et al., 2004). The reason for the observed increase in fluency under these conditions is unknown, although hypotheses abound. Researchers have speculated that it results from either a forced change to a slower, more prolonged speech pattern or because the very source of the stuttering has been eliminated (Starkweather, 1987). The latter supposition is based on theory which maintains that people who stutter possess faulty means of monitoring their own speech (Shapiro, 1999). Thus, speaking under any condition that disallows or changes this flawed monitoring system will reduce stuttering. Although neither the observed speech change nor the proposed sensory defect seem wholly sufficient to explain the phenomenon (Borden, 1979; Stuart et al., 2004), these theories are consistent with the customary clinical applications of auditory feedback. For example, therapists utilize acoustic procedures to help them teach fluency-enhancing techniques, after which they fade the feedback (e.g., Ryan & Van Kirk, 1978). Alternatively, numerous portable electronic devices have been designed to deliver continuous feedback during speech (Merson, 2003), thus allowing people who stutter to speak under conditions known to enhance fluency (such as masking noise and altered auditory feedback). By way of example, someone who is fluent when speaking simultaneously with others can experience a similar effect under frequency altered feedback, thus presenting improved fluency whenever this condition is present (“Devices are,” 2004). Theoretically, then, electronic devices can afford people who stutter a solution that is both quick and enduring. Even so, however, most do not use them. The primary reasons for their relative scarcity are high cost, a lack of research demonstrating long-term effectiveness, and skepticism that they will work in the first place (“Results of survey,” 2004). Those who do use electronic devices report varying success. In one survey, 38% indicated that their experience was not at all successful; 44% said their experience was somewhat successful; and 18% reported their experience was very successful (Reeves, as cited in Kuster, 2004). Although the

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exact reason or reasons for this discrepancy remain unclear, there are anecdotal reports that may cast some light on the issue. It appears that some users are simply less bothered by (or more willing to put up with) factors such as unusual auditory feedback or background noise (Molt, 2002). Success might also be affected by the characteristics of one’s stuttering, such as primary type of disfluency and tendency to use avoidance behaviors (“Devices are,” 2004; Kehoe, 2004). Also, because the effects of such devices wear off in some who stutter (“Devices are,” 2004), perhaps they become, over time, more of an avoidance technique than a fluency enhancer for these individuals. Finally, a number of those experiencing success used devices in conjunction with therapeutic techniques (“Results of survey,” 2004). As some undoubtedly have easier access to therapy than others, this might also account for some of the variability across users. Given these factors, it appears that electronic devices can offer hope to some people who stutter. Issues of who will benefit and for how long remain unresolved.

AVOIDANCE Yes, avoidance has already been discussed, and at great length. By this point in the book, it is clear how I feel about it. In short, it is harmful to any long-term recovery. But does that mean one should never avoid? Ideally, yes. But how realistic is that? In Chapter 15, there was reported an incident that took place at the 2001 Orange Bowl in which the risk of stuttering before abusive listeners was deemed too high to outweigh any benefits. Looking at the story from a different angle, it could also be said to show that avoidance may well be the better option in such an extreme instance. I can remember watching a man who stuttered being interviewed by a local television reporter in a public setting (a sports arena). A curious crowd formed around the scene, listening to every word the man uttered. Clearly surprised (and uncomfortable) at being in such a spotlight, he began engaging in numerous avoidance behaviors in order not to stutter. Should he have advertised? Sure, that would have been a better option. Would he have been better off stuttering openly instead of hiding it? Of course. Would I have handled the situation differently? Um . . . The truth is that I honestly don’t know.

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Obviously, a television interview is both an intense and unusual situation. So let’s tackle a more common question: Is avoidance ever justified in everyday life? One of the most severe cases of stuttering I ever encountered was a research subject who, for experimental purposes, was asked to utter a series of 4-word phrases. This she was unable to do. In fact, she never completed even one of them. For most people, stuttering involves one-second interruptions of speech (Sheehan, 1974). For this individual, the involvement was much greater. Given her inability to speak at all, would I have allowed her to engage in avoidance behaviors just to take part in the experience of human communication? Not as a permanent solution, no. But temporarily, before we reached a stage of therapy where avoidances had to be abandoned? Yeah, I probably would have. Whether the situation is everyday or unusual, avoidance is bad. But there are also instances where it is understandable. Given that it will happen in spite of its long-term harm, it is important that people who stutter understand the consequences of avoiding. Then they are at least not fooling themselves into thinking that they are beating the disorder. They should know that there will always be a price to pay for avoiding. That way, if and when they choose to do so, they make the choice with full and accurate information.

BIOFEEDBACK Biofeedback is the utilization of visual, auditory, or tactile information to help clients monitor and, in time, gain conscious control over physiological processes (e.g., Bryant, 1991; Haynes, 1992; McGrady, 1994). With stuttering, biofeedback is used to train fluency enhancing speech techniques. For example, the Computer-Aided Fluency Establishment Trainer (CAFET1), allows clients to monitor their breathing and voicing for the onset and subsequent production of speech (Bakker, 1997). One clear benefit of biofeedback can readily be seen with CAFET: Clients whose stuttering is tied to deficient diaphragmatic breathing and abrupt phonation learn to make their own adjustments based on the signals (representing their breathing and voicing) that they view on computer screens. The term electromyographic feedback has also been used in stuttering treatment research. Although electromyographic (or EMG) feedback is 1

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CAFET, Inc. 4208 Evergreen Lane, Suite 213 Annandale, VA 22003

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defined as feedback from electrical current generated by active muscles (Nicolosi, Harryman, & Kreskeck, 1989), the actual signals perceived by the client are delivered through auditory or visual channels. Guitar (1975) converted muscle currents to tones that changed as muscular activity (i.e., tension) changed. Craig and Cleary (1982) used light displays that corresponded to varying amounts of muscle tension. Both methods were found to be successful in reducing stuttering. Because of the equipment needed and, in many cases, the expense, biofeedback-based treatments are not widespread. Still, it does appear that these systems hold promise for treating stuttering.

BOTULINUM TOXIN Botulinum toxins are the most poisonous compounds known to man (“Botulinum Toxins,” 2004). So why, you might wonder, would anyone use such a seemingly vile substance with stuttering? The reason is that one form of botulinum has been found to relax (actually, it induces temporary paralysis in) muscles that contract excessively or inappropriately (Blitzer & Sulica, 2001). For this reason, botulinum injections have been used to treat a variety of conditions—voice disorders (Ludlow, 1990), tics (Jankovic, 1994), and migraines (Blitzer & Sulica, 2001), to name a few— including stuttering. With stuttering, preliminary findings involving injections into subjects’ vocal folds were somewhat promising in that fluency was improved (e.g., Ludlow, 1990). There were, however, many drawbacks that kept people from coming back for additional treatments. These drawbacks include the following:
The compound can only be administered via an invasive procedure.
The procedure is expensive.
Although stuttering decreased, normal levels of fluency were not

achieved.
The obtained results were only short-term, meaning that repeated injections were needed in order to maintain the improved fluency.
Subjects experienced side effects, in particular breathiness (think Marilyn Monroe voice).

COVERT STUTTERING Covert or interiorized stuttering was a term used originally to denote individuals who rarely present disfluency, but experience stuttering in the

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form of anticipation (Freund, 1934, as cited in Bloodstein, 1981). For years, the primary features of this stuttering subtype have been reported as avoidance at all costs and a need to pass as a fluent speaker (Douglass & Quarrington, 1952; Hood & Roach, 2001). These features are perpetuated by factors such as fear (of stuttering, of not conforming, and/or of the stuttering secret being discovered), guilt (about stuttering and/or about making listeners feel uncomfortable), shame (for being a person who stutters), and denial (of stuttering, of an inability to manage stuttering, and/or that anyone can detect the stuttering) (Douglass & Quarrington, 1952; Hood & Roach, 2001). Negative experience history has convinced covert stutterers that their difference must be kept hidden at all times (Hood & Roach, 2001). Covert stuttering is sometimes defined as a total concealment of stuttering (Nicolosi, Harryman, & Kreskeck, 1989). I have heard arguments, in fact, in which people who stutter bicker over who is really covert (i.e., who avoids skillfully and consistently enough to pass for “normal”). Some seem to take a peculiar pride in calling themselves covert. In reality, however, interiorized stuttering is nothing to be proud of. It can be a severe problem, as covert individuals pay a hefty price for their avoidance, from missed activities and opportunities to the psychological effort required to constantly monitor and alter speech. Emotionally, these individuals can be a mess, as their fear, guilt, shame, and denial often lead them to confusion and mental exhaustion. Another mistaken impression is that covert stuttering is just a mild form of stuttering (Hood, 2003, personal correspondence). For one thing, someone can stutter mildly without being covert. The converse is also possible (Douglass & Quarrington, 1952), although it is clearly easier to be covert when the stuttering is mild. Notwithstanding the false impressions surrounding covert stuttering, at least one thing is certain. Given the vast amount of emotion involved, these individuals may be more impaired and thus more in need of recovery, despite being less overt than others who stutter. Complicating the recovery, of course, is determining how to help people overcome the many factors that allow stuttering to run their lives. Given the fear, guilt, shame, and denial that perpetuates this condition, the most obvious solution from a therapy standpoint is desensitization. Being obvious, however, does not mean it is easy. It is a long road from covert to open stuttering, voluntary stuttering, advertising, and all of the other types of desensitization that will seem nightmarish to these individuals. There is another, equally complicated, issue to consider as well. Sometimes stuttering covertly really does seem necessary. Hood and Roach (2001) report of an instance when a supervisor told the second author to “do something” about his speech if he ever expected

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to advance professionally. Although rare, this sort of incident is hardly isolated. Just within the past year, I have heard support group participants cite high costs of stuttering: A music teacher who was losing paying customers, a pilot who could not risk displaying any “weakness” for fear that no co-pilot would wish to team up with him, a salesman who was dismissed from his job. Were all their perceptions accurate? In other words, was their rejection really due to stuttering? I do not know and, besides, it really does not matter; on this issue, perception may as well be reality. In every one of these instances, the people involved increased their avoidance, feeling that their professional reputations and financial security necessitated that stuttering remain hidden. Can such a vicious cycle ever be broken? In the case reported by Hood and Roach (2001), it was years later before the stuttering individual decided to “honor my expectations, not everyone else’s” and stop hiding. But he also admitted that such a decision would have been far more difficult as a young professional with big aspirations. As noted in the section on avoidance, there are times when people will not stutter openly. Again, they must, at the very least, have an understanding of avoidance in order to weigh the costs versus the benefits of this decision. And, in the case of covert stuttering, they need to learn that such occasions are not as widespread as they fear.

DATING It would be safe to say that most consider stuttering a drawback to dating (see Chap. 13). However, there is another viewpoint on this topic. I have heard several support group attendees actually describe it as beneficial. “Girls love it,” was the way one phrased it. He went on to theorize that his stuttering was viewed as a sign of vulnerability, which, for reasons he did not care to examine, made him more interesting. His wife, also present at the meeting, agreed, as did another member, who went so far as to say that his spouse would have never noticed him were it not for his stutter. For what it’s worth.

JOB INTERVIEWS Within the realm of stuttering, discussions about interviewing are in many ways similar to those on dating (see Chap. 13). That is, the issues are when to let people know and what the potential costs and benefits are.

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One question that arises consistently is this: Should stuttering be mentioned on the employment application or resume? If it is, one could argue, the interviewer will not be surprised when it occurs. Plus the job seeker will not have to waste time with managers who do not like stuttering. Maybe so, but I would advise caution on this matter. Most advertised openings elicit a slew of applicants. Typically, prospective employers will actually interview only two or three candidates (Kinner, 2001). This means that the interviewer has to eliminate numerous applicants almost immediately. Given that the stereotype associated with stuttering is not necessarily consistent with a manager’s perception of an ideal employee (see Chap. 9) and that stuttering makes some people uncomfortable (Chap. 11), listing it on an application or resume may well offer an employer a means of eliminating the stuttering person from consideration. This leads to a number of questions. Does this mean that stuttering should be kept hidden from prospective employers? Not necessarily. It just means that there is a difference between listing, say, Stuttering Support Group Chapter Leader under the heading Volunteer Positions and writing stuttering in the Personal Information section. The former is, to my way of thinking, positive and forthright; the latter unnecessary, given that individual traits are not typically included on applications (e.g., would you list baldness? Astigmatism?). What about the interview? By all means, be open about stuttering during the interview. But do it right. Advertise with confidence. Let the new boss know that stuttering will not hold you back. Isn’t this inconsistent with the advice given about the resume? After all, the interviewer can eliminate the stuttering candidate at this level instead of the previous one. What’s to stop him or her from doing so now? Certainly it is possible that someone could be eliminated from contention because of stuttering presented during the interview. It is also possible, however, that the applicant could combat the stutterer stereotype by making a positive impression, an opportunity unavailable when only sending a resume.

MOTIVATION TO CHANGE Sometimes the motivation to make necessary changes is present and sometimes it is not. Sometimes such motivation can be developed, sometimes not. And sometimes people think it is there, but when it comes time to really move outside the comfort zone, they find it is not. Such disparities are related a number of factors, including the strength of the support system, the severity of the stutter, and topic to be addressed next.

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PERSONALITY Personality traits can affect an individual’s progress in therapy (Conture, 2001) and, likely, their overall recovery. By way of example, someone who is cautious, sensitive to external stimuli, and afraid of making mistakes will probably have a longer path to recovery than those more impetuous, adaptable, and bold. This is not to say that the former individual has no hope, but merely that 1) some comfort zones expand more easily than others and 2) some will require more expanding before they include involvement in all desired communication events and activities. Perhaps related to this topic is the trait of intelligence. It has been noted that gifted children are reticent to attempt new tasks because they will not excel at them (Silverman, 2003). Given the importance to recovery of ideas such as risk-taking, adaptability, and expanding one’s comfort zone, it would seem that highly intelligent clients would be less likely to experience recovery. Yet, experience suggests that this is not always the case. To draw a parallel, graduate students in speech-language pathology, a smart bunch by any standard, are often afraid of attempting new tasks, for fear of making mistakes. It is also true, however, that the most intelligent students usually do well eventually. Their intelligence helps them realize when to go against their instincts. I believe the same holds true with stuttering recovery: Once the goals are understood, progress toward them becomes feasible.

PHARMACOLOGICAL AGENTS For decades, people have been reporting on pharmacological agents and stuttering (Kent, 1963; Meduna, 1948; Molt, 1998). These reports have outlined the effects of such classes of agents as antipsychotics, neuropleptics, and sedatives (Molt, 1998). Although recent research shows promise that some forms of stuttering may one day be treatable with medication (e.g., Maguire et al., 1997), there are several points to keep in mind:
Much of the research involved small sample sizes and soft science

(Molt, 1998), making it difficult to know how far the results can be generalized. Stated differently, what works for one will not necessarily help another.
Pharmacological agents can produce side effects, some more unpleasant than stuttering (Wells & Malcolm, 1971).
Although reductions have been noted (Brady, 1991), no agent has been found that eliminates stuttering in test subjects (Molt, 1998).

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In a sense, the topic of pharmacological agents is similar to that of electronic devices. No universal cure has been found, but it is nonetheless a potentially promising area of research.

PUBLIC SPEAKING When thinking about speaking in public, many people, stuttering or not, conjure images of anxiety, fear, and humiliation (Albach, 1994; Horowitz, 2002). The audience will be bored, or won’t laugh at the jokes, or will snicker at the shallowness of the main themes. Then the speaker is left alone to wallow in public embarrassment. While I suppose all of that could happen, it is certainly more the exception than the rule. Moreover, for people who stutter, there is much that is good about speaking to an audience. No one else is talking and, thus, no one is exerting time pressure. The speaker can employ speech modifications without the usual distracters. He or she can stutter openly, stutter easily, employ fluency enhancing techniques, or do whatever else is consistent with his or her personal objectives. For stuttering individuals, public speaking offers a rare opportunity for complete control over how speech is produced. In addition, it provides a chance to control what is said. Wait a minute, you’re saying. If I’m asked to present on my company’s quarterly earnings, I can’t very well stand up and talk football. Maybe not, but you do have a chance to mention stuttering before starting in on the budgetary considerations. In fact, there are a number of ways that advertising can be quickly and effectively done in such a situation. For example:
Sarcastic: “Let me first just mention that, for someone who stutters,

this kind of presentation is a dream come true.”
Sardonic: “Our beloved boss needed someone to verbally deliver the report and decided, in his ultimate wisdom, ‘Hey, how about the guy who stutters?’ ”
Warning: “Think these things usually drag on too long? Well . . .”
Honesty: “First off, I should probably tell you that I stutter, so you don’t have to wonder what’s going on.” A local support group member and health professional was recently asked to give a presentation to a hospital staff. The day before her scheduled speech, she called me in a panic, stating that could not stop thinking about the embarrassment she was going to suffer the following morning. I suggested that the first words out of her mouth could advertise her stut-

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ter, in order to make subsequent stuttering easier. I even offered some examples of things to say. “I guess I could try that,” she said, her tone a mix of disappointment, desperation, and skepticism. She called the next day to tell me that the presentation was a success and that she came up with an introduction about stuttering that was far funnier than any I had suggested. The resulting laughter put her at ease because, she explained, the audience was on her side. This reported surge of confidence never waned throughout the presentation.

SENSE OF HUMOR Like numerous terms used in this treatise on recovery (covert, acceptance, motivation, and even stuttering and recovery, among others), sense of humor is defined differently by different people. Often, in fact, the criterion is whether one laughs at the definer’s jokes. If not, the listener is said to have “no sense of humor,” a statement which, of course, ignores another perfectly obvious explanation. Given the social, psychological, and even physiological correlates associated with humor (Freud, 1960; Lyttle, 2002; Martineau, 1972; Sultanoff, 1995), it is doubtful that anyone could actually be missing this trait altogether. This is fortunate, as many functions of humor can also be helpful to the process of recovery from stuttering (Manning, 2001; Williams, 1999). Treating a personal subject with humor shows an ability to view it from perspective other than high emotion (Lyttle, 2002; Manning, 2001; Sultanoff, 1995). That is, one can distance one’s self from the issue and observe it from a more objective point of view. Some might even say that the individual rises above it (Lyttle, 2002). New vantage points allow for new insights (Kuhlman, 1984), as opposed to repeating the same old complaints (e.g., expressing how embarrassing stuttering is). Distance also keeps the speaker from dwelling on mistakes or overrating achievements (Morreall, 1982), both of which could hinder the process of recovery. In addition to objectifying a deeply personal matter, humor also helps with managing it (Orben, 2001). New understanding leads to changed behaviors when the illogic of the old ways becomes apparent (Lyttle, 2002). Expanding the proverbial comfort zone also becomes somewhat easier when one can have some fun doing it. It is empowering, for example, when the speaker can turn the tables and see the ridiculousness of listeners’ reactions (Lyttle, 2002; Martineau, 1972). A colleague of mine does a lot of group therapy in schools. His groups often amble through the hallways, cafeteria, and even reception areas, voluntarily stuttering with any-

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one they meet. Then they discuss (and sometimes make fun of) the reactions they get. They have so much fun at this activity, in fact, that nonstuttering students have asked to join the group. In other words, through humor, they have utilized a trait often associated with negativity to create an activity envied by their peers. It should be noted that humor can reduce not just the stress of the speaker, but that of the listeners as well (Lyttle, 2002; Orben, 2001). A regular attendee of my local support group related that, when he serves as a substitute teacher, the first thing he does is write his name on the chalkboard. Mr. K-K-K-Keith When he begins speaking, students react not with the typical confusion and anxiety, but with smiles of acknowledgment. Given all the benefits of humor, why don’t more people utilize it? Because, simply stated, sometimes stuttering is not funny. The boy in Chapter 2 who was humiliated in front of his peers would undoubtedly find little to laugh at. True, an eighth grader is unlikely to have achieved the emotional distance needed for any sort of acceptance, but it is important to remember that humor should not be viewed as the highest form of acceptance, as a reflection of the best attitude one can have about stuttering. As noted in Chapter 15, some people learn to stutter with a superior attitude. Others stutter openly and learn to ignore the reactions. Yes, humor can help some people. But they have to decide that it’s for them.

SEVERITY Research has indicated that the severity of an individual’s stuttering can predict his or her relapse after therapy (Craig, 1998; Hancock & Craig, 1998). That is, those most severe are most likely to relapse. For this reason alone, severity is an issue relevant to the process of recovery. It is important to note that, in these studies, severity was based solely on stuttering frequency. Although common, this limited view of severity has been called into question (Manning, 2001). Yaruss (1998) described stuttering in terms of the World Health Organization’s three-part classification scheme, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH). Based on the ICIDH, impairment includes “. . . any . . . abnormality of psychological, physiological, or anatomical structure or function.” Disability is “. . . any restriction or lack of ability to perform an activity in the manner or within the range considered normal . . .” Finally, handicap refers to “. . . a disadvantage . . . resulting from an impairment or a disability, that limits or prevents the fulfillment of a role that is normal . . . for that individual.”

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Viewed in this manner, severity could be based not only on the impairment of stuttering (the overt speech disruptions), but also the disability (inability to perform specific communicative tasks), and handicap (inability to fulfill occupational or economic needs). After all, one can present limited disfluency, yet have a severe problem if he or she is withdrawing from life (see section entitled Covert Stuttering in this chapter). Whatever way severity is defined, however, it makes sense that it would correlate with relapse. Those with more overt stuttering (a greater impairment, in ICIDH terms) who seek to reduce it must be extremely vigilant in the use of speech techniques in order to maintain improved fluency. Similarly, those for whom acceptance is a major issue (that is, who present a severe disability and/or handicap) may well have a difficult time sustaining open stuttering and other desensitization techniques. This is not to say that those more severe are low risk for recovery. There are simply too many examples of such individuals who became effective communicators. But the road may be longer and it may be bumpier, particularly if traveled alone.

SPEAKING ON THE JOB The topic of finding employment has already been addressed in this chapter. But what about after getting the job? Surely, there will be communication demands placed on the person who stutters. How will he or she deal with them? The issue of stuttering halting upward mobility was touched on in the section on covert stuttering. Just as important, however, are the everyday responsibilities, such as relaying information to the boss, answering the telephone, and approaching a customer. Again, go back to the previous discussions of dating and public speaking. Be honest, open, and aware that stuttering can be beneficial as well as costly. That is, tell listeners what you are doing, do it freely, and, if possible, utilize it. A support group member related a story about talking to a harried customer on his office telephone. The following conversation took place. Customer: Group member: Customer:

“Can you please answer my question? Do you think I have all day?” “I’m sorry ma’am. I stutter.” “Oh my. I didn’t know. I apologize.”

I asked him whether he made the sale. He replied that he had, adding that this customer reacted as many others do. When she found out about his stutter, she assumed that he was different from the salespeople with whom

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she typically dealt. Thus, she was willing to listen to his pitch. When pressed to explain, he admitted that he took advantage of the stutterer stereotype (allowing the customer to think he was too passive to be capable of a hard sell), but also stated that, in his opinion, the fact that he displayed a perceived weakness openly made him seem worth listening to. So stuttering should be used in the workplace to manipulate people? No, of course that is not what I am saying. Well, not totally, anyway. My main point is that stuttering may well allow the speaker a chance to be heard and, when this occurs, he or she should take it.

SPEECH NATURALNESS Whatever form recovery takes, the resulting speech is unlikely to sound like that of the average non-stutterer. If, for example, recovery means desensitization (only), speech will contain hard stutters. If one’s road to recovery includes stuttering modification therapy, the resulting speech will be characterized by easy stutters which, like it or not, are not equivalent to fluency. If the treatment of choice was fluency shaping, speech may be more fluent than it was prior to therapy, but it can also sound more controlled and less lively than the speech of nonstutterers (Conture, 2001). The speech naturalness of people who stutter has generated research interest for decades. Much of this research was conducted to examine naturalness after fluency shaping therapies and, quite consistently, listeners rated post-treatment speech as more unnatural sounding than the speech of fluent speakers (Ingham, Gow, & Costello, 1985; Ingham & Packman, 1978; Kalinowski, Noble, Armson, & Stuart, 1994). To be fair, when subjects are asked to listen to speech and rate how natural it sounds, it is unclear whether the said speech really stands out as unnatural to listeners in general, or if they rate it so only after being asked. In other words, do the research procedures result in perceptions that may not otherwise have been there? In addition to vague conclusions, naturalness research suffers from low reliability (Onslow, Adams, & Ingham, 1992). That is, individual judges are inconsistent in their ratings. Still, given that a clear trend has emerged from this research (namely, that treated speech sounds less natural when compared to normally fluent speech), its potential impact on recovery should be considered. Kalinowski, Nobel, Armson, and Stuart (1994) found that the speech of adult subjects was actually rated as more unnatural following treatment than before it started, despite being more fluent. Thus, it appears that treated speech not only sounds less natural than that which was never stuttered, but also when compared to speech that is. Whether or not this finding is important depends, I suppose, on one’s objectives. It could be

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argued that naturalness is not a critical issue if 1) the primary goal is easier or more fluent speaking, 2) the speaker can effectively implement therapeutic techniques, and 3) he or she is desensitized to listener reactions. But one could also make a case that if the main objective is effective communication, the further one gets from natural sounding speech, the less he or she is meeting this goal.

SPONTANEOUS RECOVERY As was noted in Chapter 1, people can stop stuttering during adolescence and adulthood, often for no clear reason (Cooper, 1972; Finn, 1996). So when I am asked about this, I have to tell clients that, yes, it can happen. But don’t count on it. There is no reliable estimate of how many adults experience spontaneous recovery, but all indications are that it is a rare occurrence. Estimates are difficult, in part because some who claim to have recovered likely never stuttered in the first place (Lankford & Cooper, 1974). Adding to the problem are different definitions of recovery. Some view recovery as an immediate and complete cessation wherein they never stutter, never think about stuttering, and know they will never stutter again. Others use different criteria. In an investigation by Finn (1996), eleven of fourteen subjects self-reported as recovered continued to practice speaking with a modified speech pattern. In a separate study using many of the same subjects (Finn, 1997), nine of fifteen “recovered” subjects stated that they still had a tendency to stutter. So while a spontaneous and total cessation of stuttering can happen, it is atypical by any definition and, by some, requires diligent adherence to speech modifications. In any case, these modifications, along with motivation to change, were reported as the biggest factors in the recovery of the subjects noted above (Finn 1996). Motivation was also found to be important in a study by Quarrington (1977), in which 20 of 27 subjects attributed their recovery to attitude change. From the research, then, one can say that changes in speech and a desire to improve can lead someone to declare himself or herself recovered. Given that both factors are common to many people who stutter, however, most of whom never make such a declaration, adult spontaneous recovery remains a mystery.

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The Bottom Line

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“What’s the bottom line?” he asked, a slight repetition of /b/ once again revealing his stutter. Placing my hands behind my head, I lay back in the soft leather chair and gazed at the hideous nacho cheese colored walls of the examination room. “I suppose that’s up to you,” I finally answered, “After all, you’ve undoubtedly heard a lot of treatments and theories. Some are logical. Others make less sense than those sideline interviews they do during football games. Most work for some. Some work for most. None work for all. You’ll decide what works for you. “And when something works,” I continued, “you’ll reach a point where stuttering isn’t the first thing you think about when your eyes pop open each morning. Nor will you fall asleep every night rehashing the day’s failures. “So perhaps acceptance is the bottom line. Maybe that’s what it’s all about—accepting what you are. Sure, you should always try to improve, but part of improvement is understanding your limitations. That way, you can set goals that mean something. “Listen, no matter how hard I try, I’ll never outpedal Lance Armstrong across the French Alps. I’ll never stroke a fiddle like Nicolo Paganini or cuss like a rock star. Then again, Ozzy probably couldn’t hook up an electroglottograph—call it a hunch.

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“My point is that everyone can’t do everything. Take stock of your strengths and weaknesses and do the best you can. “And remember—accepting something doesn’t mean loving it. It just means living with it.” “Like Keats’ Endymion?” asked a student observing the session. I nodded. I had been planning to use the example of when Peter Parker first realized he had Spidey powers. “You might always feel nervous when you’re asked to introduce yourself or make a phone call or order that Egg McMuffin at the drivethrough,” I explained. “But you accept that as part of the deal. Sometimes, you even embrace these situations as challenges. “Come to think of it, that might be a better bottom line—the need to challenge yourself. Get outside your comfort zone and learn to confront your feared situations. Take some risks. You can’t learn something without ever trying it. And you can’t improve without occasionally failing. After all, even Peter Parker makes mistakes.” “Peter Parker?” the student asked. “Never mind. Tell me: Why do we take risks? Courage? Desperation? I don’t know, probably a little of both. All I know is that as we grow older, the phrase ‘I’m not ready yet’ is gradually replaced by ‘Life is short.’ “And speaking of self-growth, here’s a bottom line for you: Those tricks used to hide stuttering—all that rephrasing and word substitution and pretending to be shy, those foot taps and eye blinks and armpit noises— don’t fool as many people as you think. When you realize that, you’re left with the thought that maybe people like you for who you are, stuttering and all. “Not only do the tricks not help,” I continued, “they hold you back. So while I may be having some trouble finding a bottom line, I know what it’s not. Let’s just say that none of us will be spending our shuffleboard years saying, ‘I wish I’d spent less time living and more time hiding.’ “Yes, stuttering is tough and solutions aren’t easy to come by. But it’s worse to avoid life, hoping things will miraculously get better. Sure, it could go away. Anything is possible. Homer Simpson could one day be declared U. S. Poet Laureate. But who wants to put his life on hold waiting for that particular likelihood? “See, stuttering is as cruel as it is ironic. It doesn’t really start to go away until you stop caring so much about whether it’s going to go away. “So be proactive. Avoid the avoidance. Learn to stutter in ways you can live with. “Any way you look at it,” I continued, “it all comes down to being open. “Open with yourself, for starters. In order to get past the fear, embarrassment, nervousness, and other emotions, you have to admit they’re

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there. Thinking of stuttering as occasional lapses of speech is like thinking that politicians really only want to be public servants. There’s a lot beyond what you see and hear. “But it’s about being open with others too. “It’s about soothing the consciences of guilt-ridden parents who never truly believe they’re not to blame. It’s about admitting something embarrassing and seeing who your real friends are. It’s about finding people who will give you more support than you ever thought possible, often without even trying. “And, yes, it’s even about dealing with listeners who aren’t so accommodating. “Just remember that the idiots who tease, laugh, and mock are actually quite rare. They just tend to stand out more than the normal folks. They’re the ones who see us as vulnerable and easily molded into forms that are idiot-friendly. “Know that life is more than a series of bullies. And realize that you’re stronger for dealing with them. “There are listeners who snicker and don’t hide it well. Assume they’re only one small link up the food chain from the bullies and move on. “Some listeners take pride in how quickly they talk because they want you to think their brains are digital while yours is analog. Thus they interrupt and finish your sentences. No need to get worked up over these bozos either. People that insecure won’t benefit from you yelling at them. “Of course, there are also the listeners who care a little too much. The ones with the condescending nods, as if everything you say is oh-soprecious because you stutter. The ones afraid to look away and, as a result, engage in eye contact equivalent to that of a cobra preparing to bite the face off its cornered prey. “Then there are the ones like you who are certain what’s true about them is true about you and consequently act as if they’re Magellan and you’re the Flat Earth Society. “But before you decide that all listeners are shower curtain mildew, remember that most would truly like to help. They simply don’t know how. “And by the way,” I added, “they’re not the only ones who’d benefit from helping others. You have an opportunity to do so yourself. Embrace it. Give others the support you know they need. “I mean, think about the self-satisfaction that comes from helping people. It’s the closest you or I will ever get to hitting a forehand like Serena, singing an aria like Pavarotti, or balling out the Gilligan’s Island castaways. “It’s a two foot hole in the side of a boat! Just fix it and go home! “So anyway, maybe that’s the bottom line—helping yourself by helping others. In this way, we learn compassion through empathy. And, sometimes, the other way around.

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“My guess is that the compassion is already there, that you have a lot of patience with other people’s struggles. “Remember too, to have some with your own. “Develop a sense of humor about the one thing you’re conditioned to both loathe and fear. It’s OK to have fun with it. “Of course, sometimes a sense of humor isn’t enough, given that some listeners are about as cheery as projectile vomit. My solution? Arrogance. Assume that what you have to say is more important than any squirming your listener feels the need to do. Like all of us, you have to patiently listen to a lot of stupid things. They can take the time to listen to you. “So I suppose what it all comes down to is this: Say what you want to say, when you want to say it, even if you sometimes stutter.” I snapped my fingers and sat forward. “That’s it right there! When all is said and done, that, my friend, is the bottom line!” I leaned back with the satisfaction of a question well answered. After a lengthy pause, my ophthalmologist spoke again. “Perhaps I should rephrase my request,” he said with a sigh. “Please look at the chart and read the bottom line.” “Oh,” I said, moving forward in the chair. “Let’s see: A, backwards E, the Greek symbol for nitrate, a P with a ponytail . . .”

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Questions for Discussion

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If there are no stupid questions, then what kind of questions do stupid people ask? Scott Adams, Dilbert cartoonist

PROLOGUE
If you ruled the world, what changes would you make to help people

who stutter?
What does stuttering recovery mean to you?

CHAPTER 1
How do you define stuttering? Do you view it as a problem with

speech or do you feel there is more to it than that?
Do you find the topic of stuttering to be a difficult one to talk about? If

so, why? If not, what would you say to someone who does?
How would your life be different without stuttering?
Is it possible that we could one day live in a world where stuttering is accepted by all? Where everyone who stutters does so openly? What would have to happen for such a world to exist?

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What is the worst age to stutter? Explain your answer.
What is the most ridiculous comment/advice/theory you ever heard
















about stuttering? Why do you think people believe or believed this? Why do you feel that weird beliefs about stuttering persist to this day? What are your thoughts when you hear someone say that he or she “stutters sometimes”? Is there a problem with thinking that all breaks of speech are stuttering? Explain your answer. Some people view stuttering as a bad habit. What would you say if someone told you that all you need to do is slow down? Or try harder to stop? Or just get over it? Why do you think there is no known cause of stuttering? Why do you think there is no cure? How do you feel when people who stutter want to impart their “cures” to you? What would you say is the difference between fluent speech and effective communication? Why do you think stuttering looks different in everyone who stutters? What do you think your stuttering looks like? What characterizes your stuttering aside from what people can see? The following is an old joke. Explain how it might relate to stuttering theory in general and psychological theories in particular.

A woman notices a man on his hands and knees searching for something under a streetlight. “Excuse me,” the woman says. “Do you need some help?” “I’m looking for my car keys,” the man replies, and gestures toward his idle car in the darkness half a block away. As she kneels down to assist, she asks, “Where exactly did you lose the keys?” “Over there by the car,” he replies. She pauses, looking quizzical. “If you lost your keys over there, why are you looking here?” The man replies, “The light’s better over here.”

CHAPTER 2
Describe a personal experience similar to the event in this story. In-

clude in your description the emotions that you experienced.

QUESTIONS FOR DISCUSSION

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What is your most embarrassing stuttering moment? Does the mo-

ment seem less embarrassing now than it did at the time?
Why did the children in this story laugh at the boy’s stuttering?
What would this boy’s reaction be to advice such as “learn to stutter

openly without using any tricks to avoid it”? What advice would you give to him?
Was there a better way for him to handle this situation?
What would you do next (that is, after class is over) if this happened to you?

CHAPTER 3
What is the most helpful statement you ever read or heard about stut-







tering? How about the least helpful? What is the weirdest? Where did you read/hear these? Why do misleading statements get passed along as if they were true? Give an example of a statement you once believed about stuttering but no longer do. Is it possible that a simple solution to stuttering exists? Explain your answer. Where do you typically go to get information on stuttering? What are the strengths and weaknesses of this particular source?

CHAPTER 4
Pretend that you are a reviewer for a scientific journal. Analyze this

study, starting with the basis and methods. Do the results support the author’s primary assertion? Is the Discussion section convincing or can you identify some (or several thousand) flaws in the author’s logic?
Let’s turn this idea around: What would a real research study look like presented as pseudoscience?

CHAPTER 5
What are your goals for therapy (or, if you are not in therapy, what

would they be)? Have these goals changed over time? If so, how?

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What would you change with respect to any previous treatment you

experienced?
Do you (or would you) prefer individual or group therapy? Why?
What are the most important goals of therapy?
Discuss how you might get therapy skills to work outside the treat-

ment room.
What are some indications that an individual has had enough therapy?

CHAPTER 6
If you were asked to give a one-sentence answer on how best to deal

with stuttering, what would you say?
Can you think of some ways in which stuttering defies standard

logic?
Do you think that therapy success rates are important? Why or why not?
Are claims of success, however valid, convincing to a lot of people? Are they convincing to you? Why or why not?
What does the term cure mean to you? Can someone cure himself or herself of stuttering?

CHAPTER 7
Do you have a support system? If so, name those who comprise it.
Do you attend support group meetings? If yes, why? Has this reason

changed over time? If you do not attend such meetings, why not? What would it take to make you go?
Who are stuttering support group meetings for (that is, who should attend)?

CHAPTER 8
Have you ever been to a support group meeting? If so, was your ex-

perience similar to that reported in this chapter? How so? If not, does your image of a typical meeting match this story?

QUESTIONS FOR DISCUSSION

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Speculate on how the following people might have become involved

with a stuttering support group: 1) Marlon 2) Charley 3) Ciara 4) Tim 5) Stan
Would you prefer meetings with this sort of freedom or would you like more structure? Explain your answer.
How could this meeting have been improved?
If you had attended this meeting, would you return to the group? Why or why not?

CHAPTER 9
Given that everyone classifies and overgeneralizes to some extent,









can you name any stereotypes that you hold? Are you impressed by certain types of speech? Are there some that strike you as unimpressive? Can you think of any reasons for these reactions? What is your worst experience being stereotyped? Is there ever an advantage to being stereotyped? What features of stuttering (severity, type of disfluency, or something else) do you feel impact stereotyping the most? Do you agree that the “stutterer stereotype” affects people academically and professionally? Explain your answer. Devise strategies to combat the stutterer stereotype, both at a personal level (that is, a strategy that could help you) and globally (for all people who stutter).

CHAPTER 10
Under what situations or conditions does your stutter disappear?

Why do you think this happens?
How do you feel about “person-first” language (or, more specifically,

about the use of person who stutters rather than stutterer)?

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Is calling someone introverted (or shy or quiet) a simple description,















no different than noting that he or she is right-handed? Explain your answer. Do people in general complain too much about being persecuted and treated unfairly? Do people who stutter? What is the difference between whining and standing up for yourself? Have you ever experienced discrimination? If so, how did you react? Was this reaction effective? If you have not, create a scenario in which someone treats you unfairly because of your stutter and explain how you would handle it. Is it possible to be empathetic toward people who stutter and still feel that they are overly sensitive about how they are treated? Explain your answer. When people who stutter express feelings of victimization, do you characterize it as a legitimate complaint or as political correctness run amok? Explain your answer. What issues are you passionate about? How do you feel about those who do not share your passion?

CHAPTER 11
List all of the ways that people respond to your stuttering, from most

to least common.
What is the best response to stuttering? What is the worst?
What was the funniest response you have ever received? What was

the most peculiar? Any other notable responses?
Why do you suppose people respond as they do?
Do you like it when people respond with patience? How about when

they acknowledge the stuttering?
How can you induce them to respond in the most favorable ways?
How do you respond to stuttering in others?
Do you think media images affect people’s responses to stuttering?

Explain your answer.
Discuss how eye contact between speaker and listener is or is not important.
Do you feel that your own assumptions about listeners affect the ways in which you communicate? Did you ever read a listener wrong? Explain your answers.

QUESTIONS FOR DISCUSSION

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Does the passivity inherent in the stutterer stereotype help to explain

any of the reactions from listeners?
Have you ever dealt with a bully? How? Were your methods effec-

tive?
How would you deal with a bully at your school or workplace today?
If you designed an anti-teasing program, what would it entail?
List some guidelines you could give to the listener who is truly interested in communicating appropriately with people who stutter.

CHAPTER 12 Story 1
Have you ever dealt with someone like Clete? How did/would you

handle it?
Do you have any long lasting regrets over past situations you wish







you had managed differently? If so, what are they and how would you handle them if you could do it over again? At one point, the storyteller wants to use violence to solve his predicament. Is this a good idea? Why or why not? What part(s) of story did you relate to? Explain your answer. Would the storyteller have eventually stood up to Clete had he not moved away? Explain your answer. How might these events affect the storyteller later in life?

Story 2
What is the most similar event to this story from your past? How did

you handle it?
Is waiting in line to give an order a stressful situation for you? If so,

why? If not, describe one that is.
Would you have gone back into the restaurant? Why or why not?

Story 3
Did you ever find out that someone close to you had mocked you be-

hind your back? How did/would handle it?
Would you have confronted Billie as the storyteller did? Why or why

not? If yes, how would you have done so? If no, what would you have done instead?

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Story 4
How would you have interacted with this speech-language patholo-

gist?
Do you know people who do not let you finish your sentences? Does it bother you? Why or why not?

Story 5
How do you feel about listeners who judge your speech? How do/

would you handle them?
How about those who claim to have all the answers?
Why was Steven given such a chilly reception by the group?
Why do you think Steven did not return to the group?
Why do you think that three regular members did not return to the

next meeting?

Story 6
How would you describe Felicia? What do you think motivates her?
Have you ever dealt with someone like her? How did/would you?
Why doesn’t the storyteller seem to like her?
Would you have given her another chance? (For that matter, would

you have given her the first chance?)
What, if anything, do you relate to in this story?

Story 7
Are there people in your life who do not view you as a person who

stutters?
What is the source of the communication gap in this story (that is, what is it that the storyteller doesn’t “understand”?)

CHAPTER 13
Have you ever talked to friends and/or family about stuttering? If so,

what happened? Was it what you expected? If you have not, why not?
Who have you spoken to about stuttering? Looking back on the conversation, would you change anything?
If you had the chance right now to talk about stuttering, what would you say to a:

QUESTIONS FOR DISCUSSION

1) 2) 3) 4)

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Good friend? Sibling? Parent? Spouse (or girlfriend/boyfriend)?

CHAPTER 14
Was this family discussion similar to yours? Or, if you have never









discussed stuttering with family, is this scenario similar to how you envisioned it? How does familiarity with listeners alter a discussion? Why did the storyteller’s mother not wish to hear about his studies in speech-language pathology? Is it understandable, unreasonable, or both that the mother was blaming herself for her son’s stuttering? What is the difference between intellectual understanding and emotional acceptance? How does that apply to this story? Did this conversation accomplish anything? The storyteller characterizes it as a start. Where should he go from here? The storyteller’s mother did not want to talk about his stuttering, yet later pursued the topic. Can you explain this inconsistency?

CHAPTER 15
Create a plan for self-improvement, complete with goals, means of

achieving them, and mistakes that might be made.
Relate an experience from a realm other than stuttering in which tak-

ing chances led to eventual gain.
Are you a risk taker? Explain why you answered as you did.
Give an example of a situation in which you did not take risks. Or, if you cannot think of one, compose a scenario in which you would not take risks. Explain why you feel risk taking is inappropriate in the situation you described.
How would you suggest dealing with fears that are strong?

CHAPTER 16
Why is this story in a book about stuttering? What does a tennis

match have to do with a speech disorder?

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What does Jay represent to you? How about the match itself—what

does that symbolize?
When does the forehand begin to go awry? Why then?
The storyteller effectively worked around the troublesome forehand










throughout most of the first set. Why couldn’t he just continue doing so? Can you relate this story to anything else in your life? What do you think of the storyteller’s contention that one must be afraid to lose to fully focus on winning? What does the storyteller mean by “a change in strategy that was, for once, a change in strategy”? What is the significance of: 1) The storyteller playing well while warming up? 2) The storyteller playing well for nearly a set? 3) Avoiding one shot and finding that this strategy has a negative impact on other shots? 4) Pretending that the forehand was fine when it clearly was not? 5) The storyteller’s improved play in the third set? What did the storyteller learn? And if he learned something, why did he lose the match?

CHAPTER 17
Would you advertise your stutter? If yes, how? If no, why not?
Think of a situation in which you felt supremely confident (or even










arrogant), for example, a time when you thought that everyone should listen to you or that you were the most important person in the room. How did you feel about speaking? Is there a lesson to be learned from your experience? Given your daily responsibilities and activities, what price(s) would you pay if you constantly avoided stuttering? Would you try an electronic stuttering device if it changed the way you heard yourself talk? How about if it changed the way you heard the world around you? Explain your answers. Would you list stuttering on a résumé? Why or why not? Would you openly stutter during a job interview? Why or why not? Would you take a pill if it would eliminate stuttering? What if the side effect was an inability to concentrate? How about if it resulted in impaired judgment? Explain your answers.

QUESTIONS FOR DISCUSSION

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How would you handle a public speaking opportunity, knowing

that, one way or another, you would have to deal with stuttering?
Is stuttering ever funny? If yes, can you think of an example? If no, ex-

plain why not.
How do you deal with speaking demands at work or school?
How would you define “natural sounding” speech? Is it important to you? Why or why not?

CHAPTER 18
With respect to your stuttering, what is your bottom line?
Do you believe that stuttering doesn’t start to go away until you stop

caring whether it will go away? Why or why not?
Rate these from most to least important:

1) Self-acceptance 2) Challenging yourself 3) Speaking (and stuttering) openly 4) Having a sense of humor 5) Displaying a positive attitude 6) A willingness to take risks 7) Helping yourself by helping others 8) Saying whatever you want to say.
Explain your rankings.

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Other Essays

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As long as researchers keep publishing their results, as long as speechlanguage pathologists share case reports, as long as people who stutter recount their experiences—in short, for as long as people keep writing about stuttering, there will be reading material to help people who stutter and their speech-language pathologists navigate the road to recovery. While this book has attempted to provide such material, more is available elsewhere. Better yet, much of it is easily accessible, particularly for anyone with a computer. Indeed, easy-to-read stories, essays, poems, and informational material about stuttering are posted on a variety of Web sites. Three are listed here:
The Stuttering Home Page: http://www.mankato.msus.edu/depts/

comdis/kuster/stutter.html
Pacesetters (an Australian stuttering organization): http://

www.ideal.net.au/~wicksp
The International Stuttering Association: http://www.stutterisa.org The Stuttering Home Page, a good place to begin an essay search (or, for that matter, a search for anything related to stuttering), is accessed easiest by typing most any combination of the words stuttering, home, and page (including just stuttering) into a browser. Not only are recoveryrelated writings available, but links to other sites and stuttering organizations are as well. Also accessible from the Stuttering Home Page are the

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International Stuttering Awareness Day (ISAD) Conferences, the Internet exchanges that take place each year between October 1 and 22. Prior to each year’s conference, researchers, therapists, parents, people who stutter, and others are invited to submit short papers, which are posted on the ISAD site every October 1st. For 3 weeks, conference attendees not only have the opportunity to read papers designed for the general public, but also to post questions and comments for (and receive feedback from) the authors. After October 22nd (the actual International Stuttering Awareness Day), the papers and discussions remain on-line. I recommended reading both for a more in-depth understanding of the topics presented. The Internet also allows one to order relevant materials. To Say What Is Ours (Ahlbach & Benson, 1994), a book available at the National Stuttering Association Web site (http://www.nsastutter.org) includes personal accounts and essays from both people who stutter and speech-language pathologists. A similar work is Good People (Hughes, 1997), published by Speak Easy, Inc. of Canada (http://www.speakeasycanada.com), which contains stories, poems, editorials, and even debates related to stuttering (and recovery). Finally, Advice to Those Who Stutter (Hood, 2000) is a book about therapy, written by people who both stutter and specialize in the treatment of stuttering. It is available through the Stuttering Foundation site (http://www.stuttersfa.org/default.htm). All three of the aforementioned organizations also publish monthly newsletters with essays, poems, and/or information. Similar newsletters are published by Speak Easy International (http://www.speak-easy.org) and Passing Twice, an informal network of gay, lesbian, bisexual, and transgender people who stutter (http://passingtwice.com). Organizations that post their newsletters on-line include the Canadian Association for People Who Stutter (http://www.webcon.net/~caps) and Speakeasy of South Africa (http://www.speakeasy.org.za). In addition to those mentioned, there are many other stuttering organizations around the world, many of which publish materials suitable for the general reader. The Stuttering Home Page is the best resource that I know for finding these groups. Of course, stuttering organizations are not the only ones publishing reading material. There are books on stuttering from other sources as well. For recovery-related topics, a prime example is Living With Stuttering (St. Louis, 2001), a collection of personal accounts that help the reader understand not only the experience of stuttering, but the disorder itself. Other books I could recommend for those interested in recovery include A Stutterer’s Story (Murray & Edwards, 1994), Stuttering: A Life Bound Up in Words (Jezer, 1997), Knotted Tongues: Stuttering in History and the Quest for a Cure (Bobrick, 1995), and Dead Languages (Shields, 1998). It should be noted that books such as these—two autobiographical ac-

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counts, an historical anthology, and a novel, respectively—are a bit trickier to use clinically, given that they are designed to be read front cover to back. Still, speech-language pathologists will almost certainly find sections in the first three works that are relevant to their clients. Dead Languages would likely have to be read and discussed a chapter at a time. Stuttering textbooks, while generally written for graduate students, sometimes offer case reports that are instructive. Two examples of such texts are Clinical Decision Making in Fluency Disorders (Manning, 2001) and Stuttering Intervention: A Collaborative Journey to Fluency Freedom (Shapiro, 1999). Finally, other media can be useful toward understanding and managing stuttering. These include videotapes (available through the Stuttering Foundation of America and other organizations), and e-mail listserves (see the Stuttering Home Page to get started). Specific examination of the aforementioned resources has, predictably, led me to many I can recommend. Although I hesitate to do so on the grounds that I will surely forget to mention numerous worthwhile examples, I feel this chapter is incomplete without some more specifics. So, with advance apologies, here are some of my favorites, in alphabetical order.
A Parable . . . (1997). In M. Hughes (Ed.), Good people: The best of speak-

ing out. St. John, N. B. (Canada): Speak Easy. This brief (less than one page) tale says a lot about the importance of stuttering clients taking an active role in therapy.
Ahlbach, J. (1994). A Reflection on Public Speaking. In J. Ahlbach & V.

Benson (Eds.), To say what is ours: The best of 13 years of letting go. Anaheim Hills, CA: National Stuttering Project. This short and humorous take on public speaking would be cathartic for any person who stutters and is approaching a situation that involves talking before an audience.
Bobrick, B. (1995). Knotted tongues: Stuttering in history and the quest for

a cure. New York: Simon & Schuster. This book is chock full of information about stuttering, but there are particularly memorable sections covering old theories and strange treatments (including surgery, psychoanalysis, and mutilation). Discussions based on why people believed what they did and why some of these be-

OTHER ESSAYS

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liefs persist to this day can, hopefully, help lead to awareness of how stuttering is perceived by others.
Carlisle, J. (1997). Beware the Speech Therapy Evangelists. In M.

Hughes (Ed.), Good people: The best of speaking out. St. John, N. B. (Canada): Speak Easy. This nicely written essay provides the reader with needed warnings regarding treatments, both good and bad. I would use this piece to support my statements about the complexity of the therapeutic process and, more specifically, why there are no easy answers.
Carpenter, M. C. (2001). The Gift My Stuttering Gave to Me. In K. O.

St. Louis (Ed.), Living with stuttering: Stories, basics, resources, and hope. Morgantown, WV: Populore. Much related to recovery is covered in this short essay, including the client’s responsibility in therapy, how stuttering can be positive, and the author’s tale of acceptance.
Chmela, K. A. (1997). Thoughts on Recovery. Available on the Stut-

tering Home Page at http://www.mankato.msus.edu/depts/ comdis/kuster/casestudy/path/chmela.html. Another encompassing entry, this one addresses recovery from a personal standpoint. What really stands out here is the importance of gaining control of one’s life back from stuttering.
Eldridge, K. (1997). A Conversation With My Stutter. Available on

the Stuttering Home Page at http://www.mnsu.edu/comdis/ kuster/casestudy/eldridge.html. An adult addresses his stuttering in a letter and the result is an intensely personal and emotional invective. One of the most striking elements of this letter is that the author is knowledgeable about stuttering and his own speech and has, by any standard, achieved a level of acceptance for which many would strive. Hatred of stuttering clearly dies hard.
Heite, L. (1997). Stutter. Available on the Stuttering Home Page at

http://www.mankato.msus.edu/depts/comdis/kuster/Creative expression/heite.html. This poem, just four stanzas long, offers great insight into the experience of stuttering from the speaker’s point of view. Yes, people who stut-

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ter suffer through uncomfortable moments with their listeners. How can they move past that?
Hicks, R. (1997). In On the Lighter Side, Stuttering Home Page, at:

http://www.mnsu.edu/comdis/kuster/humor.html#hicks. This short story provides a good example of a needed message: Advertising one’s stutter will not necessarily lead to emotional and/or uncomfortable situations, but may instead result in everyday exchanges that can even be humorous.
Hood, S. (2003). Desirable Outcomes From Stuttering Therapy. Inter-

national Stuttering Awareness Day Conference. Available at: http:// www.mnsu.edu/comdis/isad6/papers/hood6.html. A concise essay, but one that covers a lot of ground: desirable outcomes, advice for achieving them, and examination of many contemporary issues surrounding treatment (e.g., fluency shaping vs. stuttering modification).
Hood, S., & Roach, C. (2001). “I’ve Got a Secret—And It’s Scaring Me

to Death! (The Story of a Covert Stutterer).” International Stuttering Awareness Day Conference. Available at: http://www.mankato.msus. edu/dept/comdis/isad4/papers/hood.html. There is very little reported on covert stuttering, and even less written for general readership. I like this one because the experience is conveyed honestly and the authors do not shy away from tackling the tough questions.
Jezer, M. (1997). Stuttering: A life bound up in words. New York:

BasicBooks. As this book illustrates how stuttering impacts all phases of life, it would be worthwhile to read and discuss it a chapter at a time. If this is not possible, I would recommend starting with the four chapters on therapy experiences. These offer objective analysis and thoughtful insights about both treatment programs and Mr. Jezer’s specific outcomes.
Love, B. (1994). Keeping the Dream Alive. In J. Ahlbach & V. Benson

(Eds.), To say what is ours: The best of 13 years of letting go. Anaheim Hills, CA: National Stuttering Project.

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This entry contains excerpts from a speech delivered by former professional basketball great Bob Love. The idea of never giving up, even when life is at its darkest point, has never been illustrated better.
Murphy, B. (1994). Hello, Fart Face. In J. Ahlbach & V. Benson (Eds.),

To say what is ours: The best of 13 years of letting go. Anaheim Hills, CA: National Stuttering Project. If you ever need an example of how stuttering openly is preferable to using avoidance tricks, you will not find a better one than this humorous essay by Bill Murphy.
Murray, F. P., & Edwards, S. G. (1994). A stutterer’s story. Memphis,

TN: Stuttering Foundation of America. An autobiographical account of Fred Murray, one of the foremost authorities the field has ever known, is a worthwhile read in its entirety. If you have to choose only one chapter for therapeutic discussion, a good choice would be Acceptance, the story of Dr. Murray’s personal growth as it relates to stuttering. It is not only useful for anyone who wishes to come to grips with his or her stuttering, but it is easy reading as well, as the chapter is presented in short vignettes.
Quesal, B. (1998). What Is “Successful” Stuttering Therapy? Interna-

tional Stuttering Awareness Day Conference. Available at: http:// www.mankato.msus.edu/dept/comdis/isad/papers/quesal.html. The various goals of recovery are addressed (e.g., fluency, acceptance, effective communication) with the idea that different goals suit different people. This essay provides an understandable explanation of the complex issue of therapy.
Quesal, R. (2002). Some People Just Don’t Get It. International Stut-

tering Awareness Day Conference. Available at: http://www.mnsu. edu/comdis/isad5/papers/quesal5.html. An “expert” in stuttering takes the author to task for not achieving a degree of fluency the so-called expert deems appropriate. Although Dr. Quesal’s response is thorough, direct, and a fast read, it is not for the faint of heart. It will unquestionably generate discussion about the purpose of therapy and what recovery really means.

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Quesal, R. W. (2001). The Red Rabbit Ran ’Round the Room. In K. O.

St. Louis (Ed.), Living with stuttering: Stories, basics, resources, and hope. Morgantown, WV: Populore. Dr. Quesal not only describes experiences relatable to anyone who stutters, but also provides a thoughtful and straightforward explanation of the role confidence plays in the recovery process.
Ramig, P. R. (1997). Various Paths to Long-Term Recovery From Stut-

tering. Available on the Stuttering Home Page at http://www.mnsu. edu/comdis/kuster/casestudy/path/pramig.html. In this insightful piece, Dr. Ramig outlines specific factors responsible for the recovery he experienced. There is much to learn here, regardless of the reader’s level of recovery.
Waggott, G. (2004). Wall of Silence: What Your Kids Won’t Tell You

About Bullying. International Stuttering Awareness Day Conference. Available at: http://www.mnsu.edu/comdis/isad7/papers/ waggott7.html. Bullying is described not as a subject of theory and research, but through the eyes of the victim. In an account that is both touching and disturbing, the experiences, the emotions, and the aftermath of bullying are related frankly and honestly.
Yaruss, J. S. (1998). Documenting Treatment Outcomes in Stuttering:

Measuring Impairment, Disability, and Handicap. International Stuttering Awareness Day Conference. Available at: http://www.mankato. msus.edu/dept/comdis/isad/papers/yaruss.html. Dr. Yaruss discusses how the impairment of stuttering—the speech breakdowns—does not fully define the disorder, nor is it the only aspect to address in therapy.

OTHER MEDIA
Bondarenko, V. (1992). Voices to Remember. Belleair Bluffs, FL:

Suncoast Media. Six adults are portrayed in this slick, well-produced videotape. It is interesting to observe up close how different people handle the disorder, and to see the impact of and on their significant others.

OTHER ESSAYS

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Stutt-L

One of several listserves devoted to stuttering, Stutt-L is an active blend of people who stutter, significant others, speech-language pathologists, and researchers. One need not search very long to find discussions and personal stories relevant to the process of recovery. Subscription instructions are available on the Stuttering Home Page, as is access to the Stutt-L archives.

MAILING ADDRESSES Finally, for individuals without ready access to the Internet, the following is a list of relevant addresses. Canadian Association for People Who Stutter (CAPS) PO Box 444 Succ. N.D.G. Montreal QC H4A 3P8 CANADA 1-888-STUTTER (1-888-788-8837) International Stuttering Association (ISA) Peter Benoitlaan 44 B-9050 Gentbrugge BELGIUM National Stuttering Association 119 W. 40th Street 14th Floor New York, NY 10018 USA 1-800-WESTUTTER Pacesetters Attn: Peter Wicks PO Box 119 Campbelltown, NSW 2560 AUSTRALIA +6146 25 6516

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Passing Twice PO Box 91267 Durham, NC 27708 USA Speak Easy Inc. 95 Evergreen Ave. Saint John, NB CANADA E2N 1H4 Speakeasy Stuttering Association PO Box 72147 Parkview 2122 SOUTH AFRICA 011-788-3299 Stuttering Foundation of America 3100 Walnut Grove Road Suite 603 P.O. Box 11749 Memphis, TN 38111-0749 USA 1-800-992-9392 or 1-901-452-7343 Suncoast Media 2938 West Bay Dr. Suite B Belleair Bluffs, FL 34640 USA

References

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A Parable . . . (1997). In M. Hughes (Ed.), Good people: The best of speaking out. St. John, N. B. (Canada): Speak Easy. Ahlbach, J. (1994). A reflection on public speaking. In J. Ahlbach & V. Benson (Eds.), To say what is ours: The best of 13 years of letting go. Anaheim Hills, CA: National Stuttering Project. Ahlbach, J., & Benson, V. (Eds.). To say what is ours: The best of 13 years of letting go. Anaheim Hills, CA: National Stuttering Project. Alvares, R. L., & Williams, D. F. (1995). Students with speech and/or language impairments. In R. L. Taylor, L. Sternberg, & S. B. Richards (Eds.), Exceptional children: Integrating research and teaching (pp. 191–216). San Diego, CA: Singular. Andrews, G., Guitar, B., & Howie, P. (1980). Meta-analysis of stuttering treatment. Journal of Speech and Hearing Disorders, 45, 287–307. Bakker, K. (1997). Instrumentation for the assessment and treatment of stuttering. In R. F. Curlee & G. M. Siegel (Eds.), Nature and treatment of stuttering. Boston, MA: Allyn & Bacon. Bartley, W. W. (1984). The retreat to commitment. New York: Albert A. Knopf. Bender, P. E., & Small, L. L. (1994, May). A top pediatrician explains stuttering. Parents. Benecken, J. (1995). On the nature and psychological relevance of a stigma: The “stutterer” or: What happens when “Grace Fails”? In C. W. Starkweather & H. F. M. Peters (Eds.), Stuttering: Proceedings of the First World Congress on Fluency Disorders, Munich, Germany. Nijmegen, Holland: Nijmegen University Press. Benson, V. (1988). But so is everyone else in the movie! Letting Go (Newsletter of the National Stuttering Project), 8(9), 2. Blitzer, A., & Sulica, L. (2001). Botulinum toxin: Basic science and clinical uses in otolaryngology. Laryngoscope, 111(2), 218–226. Blood, G. W., & Blood, I. M. (2004). Bullying in adolescents who stutter: Communication competence and self-esteem. Contemporary Issues in Communication Sciences and Disorders, 31, 69–79.

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Quotation Source List

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The Chinese proverb was retrieved from About.com at: http:// quotations.about.com/od/stillmorefamouspeople/a/ChineseProverb1.htm Page 1: Reprinted with permission of the author. Page 16: Retrieved from Thinkexist.com at: http://en.thinkexist.com/ quotation/if_we_knew_what_it_was_we_were_doing-it_would_not/ 10118. html Page 36: Reprinted with permission of the author. Page 61: Reprinted with permission of the author. Page 75: Overheard at a family reunion, circa 1985. I attributed it to Deb because she was, as usual, the funniest person in the room. Page 92: Reprinted with permission of the author. Page 117: Reprinted with permission of the author. Page 130: Retrieved (well, heard actually) during my time in Ghana, 1981–1982. Page 144: Reprinted with permission of the author. Page 165: Reprinted with permission of the author.

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Author Index

U

A Adams, R., 159 Ahlbach, J., 155, 177 Althouse, M. T., 79 Alvares, R. L., 6 Anad, V., 50 Andrews, A., 43 Armson, J., 43, 147, 159

B Bakker, K., 46, 149 Barry, S. J., 19 Bartley, W. W., 19 Bathel, J., 44 Beal, D., 87, 98, 99, 100 Bender, P. E., 6 Benecken, J., 78 Bennett, E. M., 48 Benson, V., 78, 177 Blitzer, A., 150 Blood, G. W., 76, 79, 97 Blood, I. M., 97 Bloodstein, O., 6, 8, 151 Boberg, J., 120, 121

Bobrick, B., 177, 178 Bondarenko, V., 182 Bongey, T. A., 76 Borden, G. J., 147 Bosch, B., 76 Bothe, A. K., 43, 44, 50 Brady, J. P., 154 Brady, M., 27 Brazelton, T. B., 6 Brinton, B., 124 Brutten, E. J., 2, 43, 46 Brutten, G. J., 3, 46, 77, 134 Bryant, J., 149 Bunge, M., 30 Buscaglia, L., 121, 122, 123, 124

C Carl, B., 50 Carlisle, J., 179 Carpenter, M. C., 179 Carrico, D. M., 76 Carter, J., 3 Caruso, A. J., 23, 43, 50 Chinn, P. C., 76 Chmela, K. A., 179

199

200

V

AUTHOR INDEX

Clark, C., 27 Cleary, P. J., 150 Collins, S. R. C., 76, 77 Conture, E. G., 4, 8, 23, 37, 41, 43, 46, 50, 63, 66, 154, 159 Cooper, C., 76 Cooper, E. B., 8, 38, 39, 40, 41, 44, 76, 79, 160 Coriat, I. H., 6 Costello, J. M., 159 Craig, A., 76, 150, 157 Craig, M., 76 Crowe, B. T., 43, 44, 50 Crowe, T. A., 120, 121, 122, 123, 124 Cullinan, W., 23 Curlee, R. F., 8

D Dake, J. A., 97 Daly, J. A., 79 Davidow, J. H., 43, 44, 50 Dayalu, V., 147 de Klerk, V., 76 Deal, J., 7 Dell, C. W., 41 DeNil, L., 3, 77, 134 Dickinson, A., 3 Dietrich, S., 19, 44 Dodge, D. M., 43, 44, 45 Donaher, J., 44 Dorsey, M., 76 Douglass, E., 151 Dugan, C., 98 Dugan, P., 37, 41, 43, 44, 48, 99

E Edwards, S. G., 177, 181 Eldridge, K., 39, 179

F Falcione, R. L., 79 Fenichel, O., 6 Fillmore, L. W., 132 Finn, P., 160 Florence, C. L., 43

Franklin, D., 154 Freud, S., 156 Fujiki, M., 124

G Gabel, R. M., 79 Gathman, B., 62, 63, 64, 65 Gilmore, S., 76 Givens-Ackerman, C. R., 43, 95, 96, 97, 99 Gold, C., 43 Golden, M. A., 95 Goldfield, B. A., 132 Gollnick, D. M., 76 Goodman, M., 61 Gow, M., 159 Gray, B. B., 46 Green, G., 28, 29 Gregory, H. H., 3, 38, 40, 44 Guenther, R. K., 76 Guitar, B., 6, 37, 38, 41, 43, 145, 150

H Hamilton, D. L., 78 Hancock, K., 157 Hand, C. R., 25 Hardin, C., 25 Hargrave, S., 147 Harryman, E., 150, 151 Haynes, S. N., 149 Haynes, W., 25 Haynes, W. O., 25 Heite, L., 179 Herbert, J. D., 19, 27, 28, 30 Hicks, R., 145, 180 Hood, S., 132, 135, 145, 151, 152, 180 Hood, S. B., 37, 41, 48, 177 Horgan, D., 132 Horowitz, B., 155 Howie, P., 43 Hughes, M., 177 Hurst, M. A., 76 Hurst, M. I., 76, 79 Hyman, M., 76

I, J Ingham, R. J., 159

AUTHOR INDEX Jankovic, J., 150 Janssen, P., 46 Jeffers, S., 132, 135 Jezer, M., 8, 177, 180 Jones, T. J., 79

K Kalinowski, J., 43, 147, 159 Kehoe, T. D., 148 Kelly, E., 7 Kelly, E. M., 4 Kendall, D. L., 120, 121, 123 Kent, L. R., 154 Kinner, R. H., 153 Kiser, A. M., 76 Klassen, T. R., 80 Kluetz, B., 43, 50 Krauss-Lehrman, T., 48, 62 Kreskeck, J., 150, 151 Kroll, R., 79 Kuhlman, T., 156 Kully, D., 43, 44 Kuster, J., 147

201

M Mackie, D. M., 78 Maguire, G., 154 Mahan, B. W., 76 Makas, E., 93 Malcolm, M. T., 154 Manning, W. H., 37, 43, 62, 63, 64, 99, 156, 157, 178 Martineau, W. H., 156 McClure, J. A., 43, 45, 50 McCroskey, J. C., 79 McFarlane, S., 124 McGrady, A., 149 Meduna, L. J., 154 Meltzer, A., 43 Merson, R. M., 147 Miller, N. B., 93, 94, 95, 96 Molt, L., 148, 154 Molt, L. F., 43, 50 Montgomery, R. W., 19, 27, 28, 30 Mooney, S., 97 Morreall, J., 156 Murphy, B., 98, 99, 181 Murphy, W. P., 97, 98, 99 Murray, F. P., 147, 177, 181 Mussa, A. M., 76 Myers, F. L., 7

L Langevin, M., 97 Langevin, M. J., 44 Lankford, S. D., 160 Lass, N. J., 76 Latulas, M., 44 Lause, K., 80 Lee, B. S., 147 Lee, G., 100 Leith, W. R., 48 Lerman, J., 77 Lew, G. W., 96, 98, 99 Lewis, F., 43, 50 Lewis, F. A., 50 Liebert, R. M., 22, 23 Lilienfield, S. O., 19, 27, 28, 30 Liveneh, H., 93, 94 Lockhart, P., 76 Lohr, J. M., 19, 27, 28, 30 Love, B., 180 Ludlow, C. L., 150 Lyttle, J., 97, 156, 157

V

N Nachbar, J., 80 Neale, J. M., 22, 23 Nicolosi, L., 150, 151 Noble, S., 43, 159 Noll, K., 3

O Occam’s razor, 29 O’Donhue, W. T., 19, 27, 28, 30 Onslow, M., 159 Orben, R., 97, 156, 157

P Packman, A. C., 159 Pannbacker, M., 76 Park, R., 21 Parker, D., 19

202

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AUTHOR INDEX

Pate, G. S., 81 Paynter, K. K., 76 Perkins, W. H., 2 Pindzola, R., 25 Popper, K. R., 28 Potkin, S., 154 Price, J. H., 97

Q Quarrington, B., 151, 160 Quesal, B., 9, 27, 28, 29, 30, 181 Quesal, R. W., 43, 50, 97, 98, 99, 181, 182

R Ramig, P. R., 8, 38, 43, 44, 45, 47, 48, 61, 62, 65, 145, 182 Rastatter, M. P., 147 Reeves, L., 43, 48, 50, 62 Reville, J., 41 Rice, M., 79 Richardson, A., 61 Richmond, V. P, 79 Riley, G., 154 Roach, S., 151, 152, 180 Robey, R. R., 17 Rollin, W. J., 48 Rosen, G. M., 19, 27, 28, 30 Rosenbaum, M. E., 79 Rosselli, F., 78 Roth, I., 87, 98, 99, 100 Rothgerber, H., 80 Ruscello, D. M., 76 Ryan, B. P., 43, 147

S Sagan, C., 30 Saltuklaroglu, T., 147 Saul, R., 23, 27 Schaller, M., 78 Schmidt, J. F., 76 Schmitt, J. F., 76 Schultz, M. C., 17 Schwartz, H. D., 43, 44, 50 Scott, J., 27 Shames, G. H., 43

Shapiro, D., 3, 39, 63, 78, 147, 178 Sheehan, J., 2 Sheehan, J. G., 38, 39, 41, 149 Sheehan, V., 43, 44 Shenker, R. C., 43 Shields, D., 46, 177 Shoemaker, D. J, 2, 43 Siegel, G. M., 43 Silverman, F. H., 76, 154 Silverman, L., 154 Small, L. L., 6 Smith, A., 7 Snow, C. E., 132 Springer, M., 23 St. Louis, K. O., 9, 31, 40, 42, 46, 49, 50, 62, 177 Stangor, C., 78 Starke, A., 50 Starkweather, C. W., 7, 43, 95, 96, 97, 99, 147 Starkweather, W., 121, 124 Steiner, D., 50 Stuart, A., 43, 147, 159 Sugarman, M., 30, 31, 39 Sulica, L., 150 Sultanoff, S. M., 156 Susca, M., 47 Susskind, J., 78

T Tellis, G., 79 Telljohann, S. K., 97 Tereva, J., 50 Tetnowski, J., 44 Thatchell, R., 77 Tolin, D. F., 19, 27, 28, 30 Tran, Y., 76

V Van Kirk, B. A., 147 Van Riper, C., 2, 38, 40, 43, 48 vandenBerg, S., 77 vans der Meulen, S., 46

AUTHOR INDEX

W Waggott, G., 182 Wall, M., 7 Wamsley, L., 147 Ward, L. M., 121 Webster, D. B., 8 Webster, E. J., 121 Wells, P. G., 154 Westbrook, J. B., 9, 42, 46, 49, 50 Whaley, B. B., 95 White, P. A., 76, 77 Williams, D., 45, 50, 123 Williams, D. E., 76 Williams, D. F., 6, 23, 37, 41, 43, 44, 46, 48, 99, 156 Wong, D., 145 Woods, C. L., 76

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203

Worchel, S., 80 Wright, P., 121, 122, 123, 124 Wu, J. C., 154

Y Yairi, E., 8, 76 Yaruss, J. S., 2, 30, 31, 39, 43, 50, 157, 182 Yaruss, S., 43, 45, 50 Yeakle, M. K., 76

Z Zebrowski, P. M., 40, 41, 132 Zimmeran, I., 63, 78 Zuckerman, M., 130

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Subject Index

U

A Advertising, 144–145 Advice to Those Who Stutter (Hood), 177 American Speech-Language-Hearing Association, 31 Anger, 120, 122 Anti-bullying programs, 97, 100 Anti-intellectualism, 26–28 Arrogance, 145–146 Auditory feedback, 146–148 Avoidance behavior, 3–5, 98, 148–149

B Babies, 121 “Beware the Speech Therapy Evangelists” (Carlisle), 179 Biofeedback, 149–150 Botulinum toxin, 150 Bullies and bullying, 97–100 stories about, 101–106

C CAFET, see Computer-Aided Fluency Establishment Trainer Canadian Association for People Who Stutter, 177, 183 Children responses to stuttering, 94 teaching about stuttering, 97 Children, stuttering response of parents to, 121–124 withdrawal behavior, 132 Common sense, 30 Computer-Aided Fluency Establishment Trainer (CAFET), 149 Confrontations, 98–99 Confusion, of parents, 122–123 “Conversation With My Stutter, A” (Eldridge), 179 Covert stuttering, 150–152, 180

D DAF, see Delayed auditory feedback Dating, 118–120, 152 stories about, 112–115

205

206

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SUBJECT INDEX

Dead Languages (Shields), 177, 178 Delayed auditory feedback (DAF), 146–147 Denial, 122 Depression, 120, 122, 124 Desensitization, 41, 145, 151 “Desirable Outcomes From Stuttering” (Hood), 180 Dialogues, 40–41 Discussion sections, in research studies, 23–26 Discussions, personalized, 40 Disfluency misperceptions regarding, 5–6 psychogenic, 7 “Documenting Treatment Outcomes in Stuttering” (Yaruss), 182

E Electromyographic (EMG) feedback, 149–150 Electronic feedback devices, 147–148 EMG feedback, see Electromyographic feedback Eye contact, 95

H Habituation, 96 “Hello, Fart Face” (Murphy), 181 Home programs, 46 Humor, 99, 156–157

I ICIDH, see International Classification of Impairments, Disabilities, and Handicaps Imaginary conversations, 124 Individual recovery plans, 135–136 Integrated treatment, 44–45 Intelligence, 154 Interiorized stuttering, 150–152 International Classification of Impairments, Disabilities, and Handicaps (ICIDH), 157–158 International Stuttering Association, 176, 183 International Stuttering Awareness Day Conferences, 177 Internet sites, 176–177, see also Stuttering Home Page “I’ve Got a Secret” (Hood & Roach), 180

F Families, see also Parents; Siblings stories about, 126–129 Feedback, see also Biofeedback auditory, 146–148 electromyographic, 149–150 Flight response, 93 Fluency, as therapy byproduct, 43–44 Fluency shaping, 42–43, 44, 50 Frequency altered feedback, 147–148 Friends, 118

G “Gift My Stuttering Gave to Me, The” (Carpenter), 179 Good People (Hughes), 177 Grieving, 120, 121–122 Group therapy, 48 Guilt, 123–124 “Guilt by association,” 93

J, K Job interviews, 152–153, see also Workplace “Keeping the Dream Alive” (Love), 180 Knotted Tongues (Bobrick), 177, 178

L Letter writing, 124 Listeners behaviors toward stuttering, 95 bullies, 97–100 pseudostuttering experiments and, 95–96 responses to stuttering, 93–94 stories about, 101–116 teaching about stuttering, 96–97 Literature reviews, 17–19 Living With Stuttering (St. Louis), 31, 177 Love, Bob, 180–181

SUBJECT INDEX

M Marriages, 120–121 Masking, 147 “Maverick syndrome,” 27–28 Media, portrayals of stuttering, 78 Media images, reactions to, 94 Medications, 154–155 Methods sections, in research studies, 20–21 Motivation to change, 153 Murray, Fred, 181

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207

“Red Rabbit Ran ’Round the Room” (Quesal), 182 “Reflection on Public Speaking, A” (Ahlbach), 178 Relapse, 49, 157, 158 Research studies how to read, 16–26 parodied, 32–35 Resentment, 120 Results sections, in research studies, 21–22 Risk taking, 130–134 stories about, 137–143 Role entrapment, 79 Role-playing, 47

N National Stuttering Association, 31, 63, 66, 183 Naturalness of speech, 159–160 Noise masking, 147

O Occam’s razor, 29 Open stuttering, 41–42, 145 Overprotectiveness, 124

P Pacesetters, 176, 183 “A Parable . . .”, 178 Parents, 121–124 Passing Twice, 177, 184 Pediatricians, 3 Peer pressure, 47 Personal accounts, critique of, 28–29 Personality traits, 154 Pharmacological agents, 154–155 Pseudostuttering assignments, 95–96 Psychogenic disfluency, 7 Psychological theories, of stuttering, 6–8 Public speaking, 155–156 Purpose statements, in research studies, 19–20

R Recovery plans, 135–136

S Secondary behaviors, 3–5 open stuttering and, 41–42 Self-acceptance, 41–42 Self-disclosure, 144–145 Self-esteem, 78, 98, 124, 145 Self-monitoring, 45–46 Self-talk studies, parodied, 32–35 Sense of humor, 156–157 Severity of stuttering, 157–158 Siblings, 118 Significant others, 118–121 Skills, transferring, 46–48 SLPs, see Speech-language pathologists “Some People Just Don’t Get It” (Quesal), 181 Speak Easy, Inc., 177, 184 Speakeasy Stuttering Association, 177, 184 Speech modification, 42–46 Speech naturalness, 159–160 Speech-language pathologists (SLPs) counseling techniques and, 39 questions to be asked of, 51 self-monitoring techniques and, 45–46 stereotyping of clients, 79–80 stories about, 108–109 support groups and, 64, 65, 66 support systems and, 48 therapy goal setting, 37 transference of skills and, 46, 47 Spontaneous recovery, 8, 160 Stereotyping based on speech, 76 effects of, 78–80

208

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SUBJECT INDEX

Stereotyping (cont.) of people who stutter, 76–78 solutions to, 80–81 stories about, 83–91 “Stutter” (Heite), 179 Stutterer’s Story, A (Murray & Edwards), 177, 181 Stuttering characterized, 2 development of, 3–5 exposing the negativity of, 38–39 improving the understanding of, 39–41 misperceptions regarding, 5–9 self-acceptance and, 41–42 speech modification and, 42–46 stories about, 11–15 theories of, 6–8, 29–30 variability of, 9 Stuttering Foundation of America, 31, 184 Stuttering Home Page, 31, 67, 176 Stuttering ( Jezer), 177, 180 Stuttering modification, 43–44 Stuttering organizations, 176–177, 183–184 Stuttering recovery author’s comments on, 161–164 definitions of, 160 notions of “recovery” and, 9–10 spontaneous, 8 Stuttering textbooks, 178 Stuttering therapy completing, 49–50 goals of, 37–48 selecting, 50–51 tracking progress in, 49 Stutt-L, 31, 183 Suncoast Media, 184 Support groups agendas and, 63 benefits of, 62–63 defined, 61

finding, 66–67 leadership and, 65 number of people attending, 63 practices for maintaining, 66–67 reasons for low membership, 64–65 stories about, 68–74, 109–112 Support systems, 48

T Teasing and bullying, 97–100 stories about, 101–106 Tension Control Therapy (Dietrich), 44 Theories of stuttering psychological, 6–8 simple, 29–30 “Thoughts on Recovery” (Chmela), 179 To Say What Is Ours (Ahlbach & Benson), 177 Treatment plans, 37

V “Various Paths to Long-Term Recovery From Stuttering” (Ramig), 182 Voices to Remember (Bondarenko), 97, 182 Voluntary stuttering, 49–50

W “Wall of Silence” (Waggott), 182 “What Is ‘Successful’ Stuttering Therapy?” (Quesal), 181 Withdrawal behavior, 132–133 Workplace, speaking at, 158–159 World Health Organization, 157