Successful Communication: Successful Communication: Realistic Outcomes for Adults Who StutterRealistic Outcomes for Adults Who Stutter

NSANSA

Madison, Wisconsin Madison, Wisconsin

October, 2003October, 2003

Facilitator:Facilitator:

Stephen B. Hood, Ph. D.Stephen B. Hood, Ph. D. Proud NSA Member Since 1978Proud NSA Member Since 1978

Sheehan’s Iceberg of StutteringSheehan’s Iceberg of Stuttering

Core Features Repetitions Prolongations Blockages

Secondary Features

Escape Avoidance

Attitudes & Feelings Fear Guilt Shame Denial

Behavioral and Emotional DimensionsBehavioral and Emotional Dimensions

R ep etit ion sS ou n d /S yllab le

P ro lon g a tion sV o iced

V o ice less

B locksH ard C on tac ts

s ta rte rs /s ta lle rsIn te rjec tion s

reco ils

Typ e

D u ra tion

E ffo rt/In ten s ity

F req u en cy

B eh avio rsO vert

S h am eG u ilt

D en ia l

V ic timH e lp less

S cared /N ervou s

A n tic ip a tionE xp ec tan cy

A ttitu d es an d F ee lin g s

E m otion sC overt

S TU TTE R IN G

P re -D is ru ptio n F lue n c y D is rup tio n P o st D isr u pt io n

E m o t io n a l B e h a v io ra l B e h a v io ra l E m o t io n a l

A n t ic i p a t io n A v o id a n c e D is f l u en c y E m b a r ra s s m e n tE x p e c t a n c y P o s t p o n e m e n t F lu e n c y F a i lu re H u m il i a t io nF e a r W o rd S u b s t it u t io n S t u t t e r in g G u il tW o rry D is g u is e R e l i e fA p p re h e n s i o n A n t i e x p ec t a n c y A u d ib le - V o c a li z e d S h a m eA n x ie t y T i m e rs P a r t -W o rd R e p e t it i o n s W it h d ra w a lD re a d S t a r te rs W o rd R e p e t it io n s A n x i e tyW o rry P a u s e s P h ra s e R e p e t it io n s H o s t i l it yN e g a t iv e - C i rc u m lo c u t io n s S o u n d P ro lo n g a t io n s F ru s t ra t io n E m o t io n B o d y M o v e m e n ts A u d ib le -N o n v o c a l i ze d P e n a lt yA b u li a R e fu s a l P a r t -W o rd R e p e t it i o n s D e n ia l( e tc . ) (e t c .) S o u n d P ro lo n g a t io n s

D y s rh y t h m ic P h o n a t io n sIn a u d ib le - N o n v o c a li z e d

h a rd c o n ta c t st e n s e p a u s e ss il e n t b lo c k s

S t ru g g le - E s c a p eR e c o ilIn t e r ru p t e rsE f fo r t/ t re m o r / s t ru g g le( e tc .)

> > - - - - ra t e c h a n g e s - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - > >> > - - - - - - - - s p e e d in g a n d t e n s in g - - - - - - - - - - - - > >> > - - - - - - - -h o ld in g b a c k - - - - - - - - - - - - - - - - - - - - > >

(A f t e r H o o d , 1 9 7 8 . A s s e s s m e n t o f F l u en c y D is o rd e rs )f il e : \ m o m en t o f .s t\ (9 9 )

Time Sequencing of EventsTime Sequencing of Events

Explore Your OptionsExplore Your Options

ComponentsComponents• AttitudesAttitudes• FeelingsFeelings• BehaviorsBehaviors

– AvoidanceAvoidance

– StutteringStuttering

– EscapeEscape Goals/objectivesGoals/objectives

• Spontaneous FluencySpontaneous Fluency• Controlled FluencyControlled Fluency• Managed StutteringManaged Stuttering

Effective communicationEffective communication

Look For Clues

Study Your Options

Realistic Outcomes: : for Adults for Whom Stuttering Has Become for Adults for Whom Stuttering Has Become

Chronic and SevereChronic and Severe

To be able to talk any time, any place and to To be able to talk any time, any place and to any body---any body---

And to be able to communicate effectively And to be able to communicate effectively and efficiently---and efficiently---

And to be able to do so with little more than And to be able to do so with little more than a normal amount of negative emotion.a normal amount of negative emotion.

Ideas From the InternetIdeas From the InternetAlong With Other SourcesAlong With Other Sources

I no longer need to chase the “fluency god.”I no longer need to chase the “fluency god.” I can live without constant fear.I can live without constant fear. I can speak well without scanning ahead for difficult words. I can speak well without scanning ahead for difficult words. I can speak for myself, rather than rely on others.I can speak for myself, rather than rely on others. I can explore and follow career opportunities that require talking.I can explore and follow career opportunities that require talking. I can make decisions in spite of stuttering, not because of it.I can make decisions in spite of stuttering, not because of it. I am not suffering or handicapped because of my stuttering.I am not suffering or handicapped because of my stuttering. I accept myself.I accept myself. I don’t feel guilty when I stutter, and I am not ashamed of myself for I don’t feel guilty when I stutter, and I am not ashamed of myself for

when I do sometimes stutter.when I do sometimes stutter. I have choices I can make that help me talk easily.I have choices I can make that help me talk easily. I can communicate effectively, and feel comfortable doing so.I can communicate effectively, and feel comfortable doing so. ““I’m really an o-k person” -- and I like being me.I’m really an o-k person” -- and I like being me.

Crucial Experiences:Crucial Experiences: (from Van Riper and Czuchna)(from Van Riper and Czuchna)

Stuttering can be deliberately endured, touched, maintained and studied.Stuttering can be deliberately endured, touched, maintained and studied. Avoidance only increases fear, and must be reduced.Avoidance only increases fear, and must be reduced. Struggled, hurried escapes and recoils from stuttering make it worse than it Struggled, hurried escapes and recoils from stuttering make it worse than it

needs to be.needs to be. It is possible to build barriers to destructive listener reactions.It is possible to build barriers to destructive listener reactions. Society in general rewards the person who obviously confronts and attempts Society in general rewards the person who obviously confronts and attempts

to deal positively and constructively with stuttering.to deal positively and constructively with stuttering. Every effort must be made to build up your ego-strength, self-confidence and Every effort must be made to build up your ego-strength, self-confidence and

self-respect.self-respect. When the moment of stuttering occurs it can be studied, and its evil effects When the moment of stuttering occurs it can be studied, and its evil effects

erased as much as possible.erased as much as possible. It is personally more rewarding to stutter easily and stutter fluently than to It is personally more rewarding to stutter easily and stutter fluently than to

stutter severely, and it is fun to be able to talk anywhere, even though you do stutter severely, and it is fun to be able to talk anywhere, even though you do stutter.stutter.

Ways to Talk Easily -- (Which ImpliesWays to Talk Easily -- (Which Implieshelpful prerequisite attitudes)helpful prerequisite attitudes)

Post-It NotesPost-It NotesAVMAVM Air-Voice-MovementAir-Voice-MovementKYMRKYMR Keep-Your-Motor-RunningKeep-Your-Motor-RunningRTSERTSE Remember-to-Start-EasilyRemember-to-Start-EasilyNNTHNNTH No-Need-to-HurryNo-Need-to-Hurry

Speech Rate -vs- Articulation RateSpeech Rate -vs- Articulation Rate““Slow it down -- to speed it up”Slow it down -- to speed it up”““Gearing down and gearing up”Gearing down and gearing up”

Speeding Tickets (car) -vs- Talking Tickets (mouth)Speeding Tickets (car) -vs- Talking Tickets (mouth)

Dealing With Time PressureDealing With Time Pressure

Ways to Talk Easily -- (Which Implies Ways to Talk Easily -- (Which Implies helpful prerequisite attitudes)helpful prerequisite attitudes)

Easy OnsetsEasy Onsets Light Articulatory ContactsLight Articulatory Contacts Reduced “articulation rate”Reduced “articulation rate” Cancellations (If you are brave enough)Cancellations (If you are brave enough) ““Freezing” -- holding on, then releasing graduallyFreezing” -- holding on, then releasing gradually Pull-OutsPull-Outs Releases from stuttering moments must be easy, gradual Releases from stuttering moments must be easy, gradual

and voicedand voiced Proprioceptive MonitoringProprioceptive Monitoring Preparatory SetsPreparatory Sets

Ways to Talk Easily -- (which impliesWays to Talk Easily -- (which implieshelpful prerequisite attitudes)helpful prerequisite attitudes)

Self TalkSelf Talk

Positive and Negative Positive and Negative

The Use of Language: action oriented verbsThe Use of Language: action oriented verbs

““What Happened” -vs- “What am I doing”What Happened” -vs- “What am I doing”

““Having a block” and “Getting Stuck”Having a block” and “Getting Stuck”

““Little men are fighting in my throat”Little men are fighting in my throat”

NownessNowness

Superstitious BehaviorsSuperstitious Behaviors

Safety MarginsSafety Margins

Adjustment to easy talking and fluency. No more secondary gainsAdjustment to easy talking and fluency. No more secondary gains

Openness: Openness:

AdvertisingAdvertising

Voluntary Stuttering, Pseudo-StutteringVoluntary Stuttering, Pseudo-Stuttering

Socially acceptable ways to acknowledge Socially acceptable ways to acknowledge acceptance of stuttering to your listenersacceptance of stuttering to your listeners

If someone asks you if you have any hobbies and interests, If someone asks you if you have any hobbies and interests, you can answer by saying:you can answer by saying:

• ““One of my hobbies is stuttering. I’ve been practicing, One of my hobbies is stuttering. I’ve been practicing, and am getting pretty good at it.”and am getting pretty good at it.”

If someone asks you if you stutter, you can say:If someone asks you if you stutter, you can say:

• ““Yes, I sometimes stutter. As a matter of fact, I am Yes, I sometimes stutter. As a matter of fact, I am actually getting to be pretty good at it.actually getting to be pretty good at it.

If someone asks you if you have stuttered all your live, answer If someone asks you if you have stuttered all your live, answer by saying:by saying:

• “ “Not Yet.”Not Yet.”

Socially acceptable ways to acknowledge Socially acceptable ways to acknowledge acceptance of stuttering to your listenersacceptance of stuttering to your listeners

If someone comments on your stuttering, you might sayIf someone comments on your stuttering, you might say

• ““Sure I stutter. What are you good at?”Sure I stutter. What are you good at?”

• ““Sure I stutter. Want me to teach you how to do it?Sure I stutter. Want me to teach you how to do it?

• ““Stuttering is ok, because what I say is worth repeating.Stuttering is ok, because what I say is worth repeating.

• ““Stuttering is ok, and I have permission to do it.”Stuttering is ok, and I have permission to do it.”

(Now: (Now: Try to come up with some of your ownTry to come up with some of your own))

Hood’s Hopefully Helpful HintsHood’s Hopefully Helpful Hints

Although you may not have a choice as to WHETHER you stutter, you have a Although you may not have a choice as to WHETHER you stutter, you have a choice as to how you stutter.choice as to how you stutter.

Attempting to hide, repress, conceal, avoid stuttering makes it worse than it Attempting to hide, repress, conceal, avoid stuttering makes it worse than it needs to be.needs to be.

Stuttering is something you do, not something that happens to you.Stuttering is something you do, not something that happens to you. The things that may have originally caused stuttering are not the same as the The things that may have originally caused stuttering are not the same as the

things that influenced its development -- and are not the same as the things things that influenced its development -- and are not the same as the things that are now serving to maintain the problem.that are now serving to maintain the problem.

Fluency is more than the absence of stuttering.Fluency is more than the absence of stuttering. It is important to understand the process of talking.It is important to understand the process of talking. The process of desensitization is two fold: both emotional The process of desensitization is two fold: both emotional ANDAND behavioral. behavioral. It is better to do more and more things to talk easily, than more and more It is better to do more and more things to talk easily, than more and more

things to try not to stutter.things to try not to stutter.

Preferred Client OutcomesPreferred Client OutcomesASHA - SID - 4: DraftASHA - SID - 4: Draft

1. I am satisfied with my therapy and its Outcome.1. I am satisfied with my therapy and its Outcome.

2. I have increased my ability to communicate effectively.2. I have increased my ability to communicate effectively.

3. I feel comfortable as a speaker.3. I feel comfortable as a speaker.

4. I like the way I sound.4. I like the way I sound.

5. I feel I have an increased sense of control over my speech, including 5. I feel I have an increased sense of control over my speech, including stuttering.stuttering.

6. My speaking skills have become more automatic.6. My speaking skills have become more automatic.

7. I have an increased ability to cope with variability of stuttering, 7. I have an increased ability to cope with variability of stuttering, including relapse.including relapse.

8. I am better able to reach social/education/vocational potential and 8. I am better able to reach social/education/vocational potential and goals.goals.

9. My knowledge of self-help/support groups has increased.9. My knowledge of self-help/support groups has increased.

Final Outcomes from Therapy: Goals, Final Outcomes from Therapy: Goals, Options and ChoicesOptions and Choices

H ig h S tim u lu s S p eech

P u ll-O u ts , P rep ara to ry S e ts

P rio riocep tive M on ito rin g

"F lu en t S tu tte rin g "

M anaging Stuttering

B reath s tream M an ag em en t

E asy O n sets -L ig h t C on tac ts

F lu en cy E n h an c in g B eh avio rs

P rec is ion F lu en cy S h ap in g

M anaging Fluency

Hom e Free

Norm al Spontaneus Fluency

F in a l Th erap y O u tcom es