This short intensive course was developed by a specialist speech and language therapist, Jan Anderson, following her involvement with similar courses at The City Lit (London). The approach adopted is broadly termed stammer-more-fluently therapy and is based on aspects of Avoidance Reduction Therapy (Joseph Sheehan) and Block Modification Therapy (Charles Van Riper).
The course consists of five consecutive days, two weekends held after fairly short intervals, and a six week follow-up day. Participants are encouraged to view the breaks as an integral part of the course during which they can work on personal aims outside the course context. Follow-up therapy with a local speech and language therapist is always advised in order to support the progress made during intensive therapy.
The course combines working directly with stammering and attending to feelings and reactions towards stammering. Therapy consists of the following three main phases which are all addressed during the first five day block of therapy:
The three main phases of therapy overlap so participants move to and fro between them during the course. Working on your stammering is likely to be a long term project so it is not realistic to expect to "complete" any phase during the period of the course. It is likely that you will return to each stage at some point as you continue to work with your stammering in the future.
Each person has their own unique pattern of stammering and while course participants work through the programme as a group, each individual addresses their own aims during the course time. For example, some people may usefully work on desensitisation for the duration of the course while others may need to focus on modification.
The following sections are based on excerpts from the course workbook which provides information and exercises relating to the three phases of the intensive course.
The aim, during this phase of therapy, is not to speak as fluently as possible - but to find out as much as you can about your stammering. Identification involves examining the observable ("overt") aspects of your stammering and exploring your internal ("covert") feelings and reactions towards it.
It is important to know exactly what your stammering entails before you attempt to make any changes. Course participants are encouraged to collect as much information about their stammering as possible as it arises within and outside the context of therapy (eg. in addition to getting feedback from the therapist and other course members you might tape yourself on the telephone at home.)
Overt identification guidelines:
Identifying your stammering pattern in detail is a challenging task. It involves confronting what you are doing head on and this, in itself, serves to begin the process of desensitisation. Course participants undertake this task in a special environment in which stammering is accepted and welcomed and the experience is shared by others. If working alone, it is very important that you study your stammering carefully and at your own pace. Start by identifying your behaviours in an environment in which you feel most comfortable. Try to maintain a compassionate attitude towards yourself and your speech. Being harsh or critical in not helpful.
Getting to know your stammer tends to demystify stammering. As you become more aware of your pattern, you may begin to feel that stammering is something that you "do" rather than something which just "happens" to you. And if it is something that you do, perhaps in a while you will learn to do it differently...
Joseph Sheehan described stammering as like an iceberg. Only part of the problem can be seen (the overt stammering) while much of the problem lies below the surface. The area below the water-line, the covert area, represents your feelings and internal reactions to your stammering - what is not seen or heard by other people. The feelings associated with stammering are highly individual and will have evolved through your personal history and experience of stammering over the years. Your inner experience of stammering may have a profound impact on the way you live while this may seem invisible to people around you. Course participants are invited to draw their personal iceberg, representing the balance of iceberg above and below the water, and naming feelings associated with stammering in the area below. The stammering iceberg defies natural science! The water level that you choose relates to the extent to which you choose to show or conceal your stammering. The more you conceal your difficulties the larger the hidden area. Sheehan proposed that bringing more of the iceberg above the water allowed it to melt!
This exercise is used as the basis for a group discussion in which people are free to talk about their feelings and inner experience of stammering. If you would like to draw your iceberg, you may wish to consider:
Most people develop ways of avoiding or concealing their stammering. For some, concealment is so successful that there may be no, or minimal outward signs of disfluency. However, this rarely seems to be a satisfactory solution as the issue of stammering, or avoidance of it, often continues to dominate the person's personal and professional life. Indeed, Joseph Sheehan proposed that "avoidance" was at the very heart of the problem stammering.
Sheehan (1950) stated that "stuttering is a result of approach-avoidance conflict, of opposing urges to speak and to hold back from speaking. The `holding back' may be due to either learned avoidances or unconscious motives; the approach-avoidance fits both."
In other words, during speech a conflict arises between moving forward (speaking/stammering) and holding back (remaining silent). Sheehan believed that stammering arises when the person is caught between these two alternatives.
Sheehan was influenced by speech pathologists from the Iowa school, who viewed avoidance as a learned strategy for dealing with the fear of stammering, and b psychotherapeutic approaches which considered the role of unconscious motives in holding back.
Sheehan identified several distinct levels at which the approach-avoidance conflict is evident. These include:
In addition, Sheehan proposed further levels of conflict relating to the EMOTIONAL CONTENT OF WORDS, RELATIONSHIPS and the EGO-PROTECTIVE function of stammering. This last relates to his view that stammering can serve as a lifelong defence mechanism, keeping the person out of dangerous competition with its consequent threats of success or failure. For further elaboration of this theory, see:
Sheehan, J.G. (1953) "Theory and treatment of stuttering as an approach-avoidance conflict" in Shames, G.H. and Rubin, H. (Eds) (1986), "Stuttering then and now". C.E. Merrill Publishing Co.
Sheehan believed that "avoidance is the pump of fear" - without avoidance, he stated, there would be no stammering. Hence, he proposed that the solution to this conflict was to strengthen "approach" strategies and weaken "avoidance" strategies.
Course participants are invited to consider the extent to which they conceal or avoid stammering with reference to Sheehan's levels. This completes the identification stage and leads on to the next phase.
In this phase of therapy you are encouraged to deal with your stammering more openly and to become more robust in the event of stammering. If you begin to approach some of the words and situations you have avoided you will be able to test out and re-evaluate long held fears and hopefully begin to overcome them. Course participants set individual aims based on what they need to tackle to become more desensitised to stammering. Desensitisation is approached very carefully, with early steps taken within the therapy context. For example, course participants might stop censoring "feared" words, thereby showing their stammering more openly in the group. Alternatively, someone might concentrate on going for words directly, rather than delaying stammering by introducing extra sounds/words.
This phase prepares people to work on modifying stammering. If you are trying to avoid or pull back from stammering it is more difficult to deal with it. If you can accept and tolerate your stammering you can work through it more easily. Desensitisation can be a difficult process which may take a very long time. It is not neatly completed during the course. You will need to continue to chip away at your iceberg gradually on an ongoing basis.
Summary of desensitisation aims:
Voluntary stammering can be an effective way of becoming more desensitised to stammering. It involves repeating or prolonging the initial sound of some words in a slow, deliberate manner. It is, to all intents and purposes, stammering without tension and struggle.
How to do it?
This section describes how to practice techniques proposed by Charles Van Riper for modifying stammering. Three stages are outlined, which involve working through struggle and tension:
This means correcting your stammering after you have stammered. The process involves finishing the word you are stammering on, taking a good pause, and then repeating the stammered word again. However, Do not simply say the word fluently. Make a careful, deliberate repetition, moving through the sounds slowly and surely. Try to make a strong contrast between the repetition and the stammered version of the sound. Try to feel yourself smoothing your way through the sounds - positively savour the sounds as you say them!
e.g.. I went to the pictures on F-F-F-F-Friday.........Friday night.
This involves modifying your stammering while it is actually occurring. As soon as you recognise you are stammering you can aim to control the way you release the sound and ease into the rest of the word. If you ease through the stammering successfully there is no need to cancel the stammering as well. It is important to try to keep your speech moving forwards. Try not to break off and start again when you experience tension. Instead, try to hold the sound you are stammering on and work towards a more appropriate way of making and releasing it. This may involve unscrewing your face, reducing the tension in your lips or tongue etc. Initially you may need to deliberately prolong your stammering while you work through it. It may take time to disperse the struggle. However, as you become more confident about releasing stammering you can aim to grab hold of your stammering earlier. Ultimately you can change the moment of struggle into a slow, forward-moving release as soon as possible after recognising that you are stammering.
In conclusion, try to change the course of your stammering while you are stammering and you will gain confidence in your ability to confront and deal with your stammering.
This involves taking action on the approach to stammering. When you anticipate stammering you should aim to pause just prior to the feared word and plan how to go for the sound easily. Think about how the sound is produced. Relax your mouth and throat. Go for the first sound without tension and effort. Take your time and feel the sequence of movements. Say the whole word slowly and deliberately.
e.g. I went to the pictures on .........Friday night.
It is vital that the pause is not used as a postponement device. Pause to plan not to put off! When you are ready move slowly into the word.
If you find it difficult to anticipate stammering and take steps to release any tension you probably need to spend more time desensitising yourself to your stammering.
In conclusion, these are three potential ways of working through your stammering. They represent a tool kit for dealing with your speech. You may choose to use different strategies at different times. If you anticipate stammering in advance you can aim to change the way you approach the potentially stammered word. If this is not possible, you can change the way you deal with stammering as it arises. Lastly, if you are not satisfied with the way you release your stammering you can aim to cancel the stammered word. In many ways the second approach is the most important as if you can take steps to successfully deal with your stammering when it arises you need not fear your stammering so much. Each time you ease forwards you reinforce your confidence that you can work through stammering. This experience of "controlling" stammering rather than being controlled by stammering will help to reduce your sensitivity further.
Remember, however, do not loose sight of the close link between feelings and behaviours. These techniques are only practical if you are able to approach your stammering in fairly objective way. You need to be desensitised enough, to be able to tolerate your own stammering enough, in order to deal with it effectively! You should continue to work on desensitisation alongside any modification strategies.
Initially you are advised to concentrate on stages one and two, post- and in- block modification. Focusing on pre-block modification may represent an attempt to suppress stammering in a hurry before you have become sufficiently desensitised.