working with attitudes & emotions noura embabi, m.a., ccc-slp

Working with Attitudes & EmotionsNoura Embabi, M.A., CCC-SLP

Fixing the roof before painting the spot

– Vivian Sisskin“ ”

Why it mattersWe know stammering involves more than meets the eye.

Source: stutteringtreatment.org

Accompanying emotions

• Can affect willingness to engage and decrease quality of lifeo Fear/avoidanceo Feelings of helplessnesso Shameo Fight or flight

Accompanying thoughts

Thinking along extremes – detrimental to growth

I can’t be who I want to be

because of my stammer.

I will never be accepted by

others because I stammer.

Stigma & Internalization

If I stammer, people will think I am “less

intelligent, nervous, confused, mentally

unstable/psychologically disturbed” (Boyle,

2012)

If people hear me stammer, they will feel “discomfort,

confusion, impatience” (Boyle, 2012)

Stigma & Internalization

• Due to social stigma, people who stammer can be vulnerable to bullying, teasing, and social rejection (Blood et al., 2011)

• Affects life choices involving school life & occupationo Retrospective reports of effects on school life and long-term effects on social

and emotional functioning (Hayhow et al., 2002; Hugh-Jones and Smith, 1999).

“If you thought about it, I’m sure you [could think of] a million things you

could have done every day if you hadn’t stammered. The telephone calls

you could have made. The times you could have gone out. You know, there’s

millions of them.” (Corcoran & Stewart, 1998, p. 10)

Addressing Attitudes & Emotions in Therapy

Eliminating preconceived notions• Perceived power

dynamicChild

helpless

sick

dependent

disordered

Therapist

professional

doctor

depended-on

fixer

• Healthy partnership

Child

expert

risk-taker

agent

Therapist

student

coach

facilitator

“Thinking better”• Equipping child with better ways of thinking about

stammering = more regulated emotions = more rational thoughts, and so the cycle goes on

FeelingsThoughts

Modeling critical thinking

• Challenging norms and expectations o “Society thinks I must be fluent. What do I think of that?”

• Examining beliefso Identifying “friendly thoughts” vs. “gremlin thoughts”

• “Does this thought help me in any way? Do I have to think this way?”

• Therapist can use reflective and “I wonder” statements o “What I understand from what you said is…”o “I wonder… do you think it’s possible to stammer AND ______”

Demystifying stammering

• Decreasing fear of unknown

• Learning how complex speech is

• Placing within context of communication: there’s more than “fluency”

Overcoming feelings of helplessness

• Understanding the speech mechanism• Verbalizing feelings

o Hindrance to verbalizing fear: • More instinctive, physiological, reactive• Hard to bring to level of consciousness• Child will often not verbalize feeling scared/afraid

• Losing “control”/feeling helpless in a SAFE environmento Like trust falls

Desensitization• Using the word “stammering” openly and without

shame• Self-advertising – feeling vulnerable and “owning”

it - reduce shame and embarrassment (Fraser, 2004)

• Working up a fear hierarchyo Van Riper, 1973; Murphy, Yaruss, & Quesal, 2007

• Feeling time pressure• Sitting in the moment of stammering

Using humor• To combat fear• To model a healthy way of dealing with

challenges• Helps maintain perspective (“It makes for a good

story”)• Acknowledging and facing the gremlin

Mind gymnastics• Identifying how

stammering may have been positive or helpful to growtho Better listenero More compassionateo Less judgmental

“If you stopped stammering all of a sudden, what would

you lose?”

“What is good about

stammering?”

Drawing analogies• Helps to gain perspective• Compare to other fears, rather than to disabilities• Allows child to be more objective • “De-awfulizes” stammering by comparing it to other

challenges

Create list of tips for someone who is afraid, rather than specifically for someone who stammers:

Encouraging risk-taking

• Model the risk takingo Phone callso Self-advertisingo Voluntary stammering

• Model having fun while stammering• Set up challenges/sense of competition

o “I’ll do it if you do it.”

Increasing self-confidence

• Highlighting child’s talents, including communicative talents

• Use of positive affirmations• Self-exploration, with and without stammering• Praising courageous acts/fear-facing

o Pointing out difficulty of tasks (empathy)o “Praise the showing up” – Vivian Sisskin

Cultivating a sense of ownership

• Having self-esteem, self-trust, and self-efficacyo Can draw from other parts of

life/character qualities, too

• Autonomyo Especially in thinking

• Feeling powerfulo Telling someone about

stammering without feeling ashamed

o Speaking in front of class for first time

• Optimism about futureo “I’m going to be president.”

• Righteous anger/indignationo “It’s not against the law to

stammer.”

[Boyle: Corrigan 2006; Lundberg et al., 2008; Rogers et al., 1997; Rϋsch et al., 2006; Sibitz et al.,

2011; Yamada & Suzuki, 2007]

Teaching self-advocacy

• Putting self in others’ shoes – what do they need to know?

• Equip with ways to respond to others, and not only bullieso Empathyo Humor

Finding support• Social support is one factor tied to resilience in

people who stammero Craig, Blumgart, and Tran (2011)

• Improved their “self-image and their acceptance of stuttering” o Yaruss et al. (2002)

Planting hope• “Hope is not a purely emotional phenomenon; it

is an emotional response that is rooted in cognition.”o (Zebrowski: Barnum, Snyder, Rapoff, Mani & Thompson, 1998).

• Exercise: Write letter to future selfo Verbalizes hopes, expectations, vision for future