Definition of stuttering
To recover from stuttering we better first define what stuttering is. Stuttering has observable and unobservable characteristics. Some deal directly with speech, others are based on avoidant, risk-aversive, behaviors that prevent the Person Who Stutters (PWS) living life to the fullest..
Observable Criteria at Moment of Stuttering
These criteria are discussed throughout the Speech and Language Professional (SLP) literature. They are divided into primary and secondary stuttering. Rational Emotive Behavior Therapy of Stuttering (REBTS) –which is based on Rational Emotive Behavior Therapy (REBT) the original Cognitive Behavior Therapy (CBT) adds a new category called “distortions of speech.” These are rarely, if ever, mentioned in the SLP literature as characterizing a Person Who Stutters (PWS).
Repetitions. As the common usage of the word indicates these consist of repetition of a whole word, a syllable, or a sound. The repetitions are involuntary, voiced, and sometimes co-occur with struggle or other secondary symptoms.
Blocks. Blocks are a stoppage of the forward movement of speech. There are both voiced and unvoiced blocks. Like repetitions, they are involuntary, can be voiced or unvoiced, and sometimes co-occur with struggle or other secondary symptoms.
Secondary Stuttering Symptoms
Stuttering is frequently accompanied by various superfluous or struggling behaviors that do not serve any superficially obvious, useful function in communication. To the stutterer, secondary symptoms feel automatic, i.e. involuntary. Indeed, at the moment of stuttering they are involuntary. The automaticity and involuntariness will be discussed later.
Eye blinks. This is one of the most common secondary symptoms that accompany the act of speaking.
Averting eye contact. During a stutter the speaker averts his or her gaze from the person or persons he or she is talking to. He or she does not look the other person(s) in the eyes as other speakers in Western cultures customarily do. At the moment of stuttering this is involuntary.
Snapping of fingers. This can be done by either or both hands.
Swinging of hands. Again this can be done by either or both hands.
Twitching or tensing various facial muscles. These can resemble the facial tics or be more pronounced and wide spread.
Jerking of the whole head. This can be quite severe.
Tapping of a foot. The speaker may tap either of the feet.
Swinging back and forth. The speaker may rhythmically sway back and forth or perform more jerking, swaying motions.
Idiosyncratic tensing or moving other muscles. There are many other ways that muscles may be tensed or moved, muscles that in normal people are not involved in forming speech.
Distortions of Speech
There are number of ways in which speech can be distorted that a trained listener can spot. Not all distortions are associated only with persons who stutter; some of them can also be perceived in persons who talk when they are under stress. Some of these may be involuntary; others may start out as a voluntary mechanism to avoid stuttering or even as part of stuttering therapy.
Rate of speech. The stutterer usually has a slower rate of speaking.
Tone. A person who stutters frequently speaks in a shriller or higher pitch when talking to other people than when he is by himself. Or on the other hand, he or she adapts a much lower pitch of voice to relax the speech-producing muscles.
Sing-song voice. Some stutterers talk in a sing-song voice. This is usually the result of outmoded therapy.
Unnatural prosody. The stutterer frequently talks in a flat voice without inflections. This may be the result of outdated therapy or an attempt at self-therapy.
Talking as if simultaneously chewing. This way of talking is usually a result of quack therapy or a way to hide the stuttering.
Idiosyncratic speaking manner. The dissertator believes that there are other ways in which the naturalness of voice has been either voluntarily or involuntarily altered. Not infrequently, a person who stutters will adopt an accent to, at least temporarily, hide his or her stuttering.
Criteria Not Necessarily Discernible by the Onlooker Occurring at the Moment of Stuttering
These criteria are discussed by some of the SLP researchers such as Van Riper, Guitar, Sheehan and Manning..
Avoidance Behaviors while Speaking
Avoidance of sounds. Many stutterers have more difficulties with certain sounds at a given time. Throughout the lifetime different sounds are designated in the stutterer’s head as “difficult” (i.e. sounds that he or she will probably stutter on). The stutterer will frequently avoid these sounds by substituting words or by the use of circumlocution.
Avoidance of words. Sometimes the fear is associated with a word and not a sound. In this instance the stutterer scans ahead and avoids words he or she has had difficulty saying in the past. Just as with sounds, the avoidance of a word can be accomplished by substituting words, circumlocution of words, or by inserting phrases that have nothing to do with expressing the original thought or answering a question.
Use of starter phrases, words, sounds or pauses. Starter phrases, words, or sounds are used as a means to avoid going directly to the feared sound or word. Sometimes, the “phobic period” can be “waited out” by clearing the throat, pausing, using “um” (or similar interjections), inserting a word such as “actually,” or a phrase “in my opinion.” A listener may, or may not, see the ruse.
Criteria Not Necessarily Associated with the Moment of Stuttering: Self-Limiting General Life Choices
These are especially pernicious for the covert stutterer, because his or her stuttering is not so severe as to call for these measures. In other words, the public would not disqualify, or even think of disqualifying, the individual from the activities that the person with stuttering disqualifies himself or herself from.
Situational avoidances. Every stutterer the dissertator has ever known has tried -- from time to time -- to escape talking in certain situations because they have experienced difficulties in these or similar situations in the past. Thus, he or she often remains silent in the classroom even when they know the answers. Although this is not an unusual behavior among people who talk normally, it is frequently exaggerated in those who stutter.
Avoiding talking to certain people. Every person has avoided talking to some people at some time because he or she felt uncomfortable. The stutterer tends to do this more often -- even when the stakes are high, such as talking to a boss, trying to get to know a person whom he or she would want as a friend, or talking to someone with whom he or she would like to be involved romantically.
Role avoidances. The stutterer will frequently not attempt to be in the role of a leader or somebody who does a lot of public speaking. Again, here we can distinguish between socially phobia and stuttering phobia. The avoidance of a role may be the same, but the reason for the avoidance is different. Some persons are shy or social phobic; the person who stutters does not want to let others know that he or she stutters (although, he or she may be shy or have social phobia as well).
Vocational delimitation. Many stutterers will not attempt to pursue certain vocations because they believe that their stuttering would prevent them from being an outstanding -- or even adequate -- performer in their profession or work of their choice.
Avocational delimitation. Many a stutterer will severely delimit their social life because they believe that the stuttering would lead to rejection after rejection and they could not bear these rejections.
REBTS Asserts That Self-Defeating Attitudes and Unhealthy Negative Emotions Are an Integral Part of All Stuttering
The REBTS theory has proposed and the REBTS practice has demonstrated that all the stuttering behaviors described above are propagated by unhelpful self-talk and unhealthy negative emoting. This is further explained below.
REBTS posits that self-defeating ideation (irrational beliefs) and self-talk propagates stuttering. The main culprits can be summarized as : 1) demands of any kind, including the demand for perfect speech, the demand to impress people and be respected, 2) belief that stuttering is awful and precludes the PWS from enjoying life; 3) belief that “I can’t stand stuttering”, 4) self-talk that “stuttering makes me less worthwhile as a person”; 5) validation craving “I have to be respected by all the persons I meet”, 6) time urgency or “I need to hurry in my speech so as not to inconvenience others and so that I get out everything I want to say before they interrupt me, and 7) the always and never beliefs such as “if I have stuttered or reacted in certain ways in the past I will always continue to do so. I will never get better.”
The above irrational beliefs and self- talk lead to unhealthy emoting habits that include feelings of shame, inferiority, anxiety, guilt, time urgency, low tolerance of frustration and discomfort, anger at self or others, and feelings of helplessness/hopelessness.
The Recovery from Stuttering
The focus of REBTS is to manage the unhealthy emotions. (Remember that the PWS does not stutter when talking to himself, because he has not made himself anxious about his speech.) The emotions, such as anxiety, are managed using the well-established techniques taken from the vast experience in REBT and CBT. These techniques focus on finding and disputing the unhelpful/irrational beliefs and replacing them with more rational and helpful beliefs.
At the same time the PWS is taught to use easy Iowa bounces to take out the tension from individual Stuttering Like Disfluencies (SLDs). To assure that the clients stay motivated progress especially in managing the emotions is noted.
The therapy is based on the philosophy and techniques in the books: From Stuttering to Fluency by Neiders and Ross and SOS Help for Emotions by Clark which are a required reading. Right from the beginning the client is taught how to be his or her own therapist.
The step by step directions of how a REBTS counselor guides the PWS is being documented and will be the subject of future blogs and later published in a book form..
Remember that the preferred outcome of REBTS is recovery from stuttering. Recovery is contrasted to cure. Cure implies that once therapy is completed all genetic traces or conditioned responses are permanently eliminated. Recovery, on the other hand, means that the client is no longer negatively impacted by stuttering as described below. In recovery the client:
- No longer feels shame, fear, anticipatory anxiety, anger, and other unhealthy emotions over stuttering. It means that he/she can joke about stuttering. He/she enjoys talking.
- No longer feels a need to avoid sounds, words, and situations.
- May well have some Stuttering Like Disfluencies (SLDs), but these SLDs are reduced in frequency and severity. If there are SLDs they are effortless and forward moving. It means that infrequent disfluencies do not concern him/her, and are considered to be part of his/her speech. Frequently they are indistinguishable from normal disfluencies.
- The outcome is operational fluency. That is natural sounding speech without monitoring. Easy bounces are welcome, because there is no struggle in them and they approximate how the client talked before he started to stutter.
- There is no demand to become perfect speakers. Chasing the witch goddess of fluency may lead to relapse.
- The client no longer constantly thinks about stuttering. It is no longer the central theme in his/her existence.
- When a non-expert hears the client talk he or she will not single the client out as a PWS.
- The client no longer defines himself as a PWS. He/she understands that he/she is a complex person with many character traits. He/she understands that no single characteristic—such as stuttering--defines him/her. Therefore he/she avoids labeling himself or herself.
- The client is able, willing, and committed to acknowledge to all people that on occasion he/she has and may have an easy repetition or a stutter. This is done in a dignified manner from a position of strength that starts with unconditional self-acceptance of himself/herself whether or not he/she stutters.
- The client is willing and able to live life to the fullest by pursuing any career and seeks out romantic and social relationships without stuttering interfering with his/her choices.
REBTS yields the best when there is a counselor who knows REBT is involved. However, a therapist or coach can learn the fundamentals of REBTS from the books From Stuttering to Fluency and SOS Help for Emotions while he or she is working with the PWS. The upcoming blogs should also be of help. While I recommend that at the start a counselor or SLP be involved some people have reported to me that they have recovered by reading and working through the two books without any counselor or therapist helping them.