Therapy starts with a single client working with a clinician to become more fluent with speech and gain a more comfortable attitude about stuttering.
Daron Bolat, 22, a senior criminal justice major at the University of Maryland, sits with his hands clasped on the desk in front of him. As he speaks, he smiles and laughs and his fingers flex and squeeze. Across from him is Amy Williams, a graduate student clinician in the college's department of hearing and speech sciences. She's placed a clipboard on the table in front of her and records tic marks on a chart when Bolat speaks.
In an observation hallway adjacent to the therapy room, behind a one-way mirror, is Vivian Sisskin, an instructor with a master's of science in communication disorders degree and a certificate in clinical competence from the American Speech-Language-Hearing Association. She teaches student clinicians in the Speech and Hearing Clinic at College Park how to help people who stutter. Sisskin watches from behind the glass to evaluate her student therapists, jotting down notes on how they might better help their clients. This is also an opportunity for her to see how the clients are progressing. Since 1949, the Speech and Hearing Clinic at College Park has provided speech, language and hearing services throughout Maryland. The clinic is operated as both a training and research facility.
As part of this week's therapy, Williams asks Bolat to talk about something he's done that week. While he speaks, she watches his face intently, concentrating on his fluency, making notes on her chart when he completes certain tasks they've outlined together. He's talking about audiotapes he transcribed. The first time he tries to get out the phrase World War I, he gets stuck on the w in "world." According to Sisskin, Bolat anticipates the fear of the w before he gets to it, and his fear rises as he gets closer to having to say it. But after Bolat stretches out the w sound — a way of modifying his stuttering — and gets through the word, he repeats World War I in his very next sentence without the slightest hesitation. Sisskin says this is common for someone who stutters, that pronouncing an individual word or letter is not really the problem, rather it's the anticipatory fear that causes the stumble. Once Bolat surmounts the fear in the first sentence, forcing his way passed the block by sliding the "w" sound, he can say it in the next sentence without blocking on it.
Bolat next talks about something he saw in the news, that the folks who created professional wrestling are now starting a football league. As he talks — "I think the WWF is a soap opera for men" — he raises his index finger each time he stutters, signaling the times he's performing a voluntary stutter, a deliberate stutter that's supposed to help reduce his fear of stuttering by exhibiting his stuttering when he does not have to.
"Working one-on-one in private therapy is the first step in reducing a client's fear of speaking in public," Sisskin says. Stuttering originates with some physical component, a misfiring of the brain mechanism that controls speech, but piled on top of that physical disorder are all the negative social attitudes about stuttering.
The late Joseph Sheehan, a stutterer, speech pathologist, clinical psychologist, professor at UCLA , researcher, and author of books and articles on stuttering, has always stressed in his writings the importance of overcoming "avoidance techniques." He describes a vicious circle: The stutterer hits a block in his speech, a block he perceives as a failure (stuttering affects four times as many males as females, hence the male pronoun). The stutterer then struggles not to stutter again, causing the fear and anticipation of the next block to grow ever larger, leading to even more stuttering.
Step two in the therapy process at the University of Maryland is for individuals to join a group of people who stutter for therapy and support. Being among people with the same issues reduces the fear of speaking openly. Stuttering isn't something that makes anyone in this group uncomfortable — as a speaker or a listener.
The final step in therapy has the individual taking the many fluency strategies learned and practiced in individual and group sessions out into the real world. Speaking outside of the sheltered comfort of the speech department helps the stutterer become desensitized to the often-debilitating anxiety that accompanies public speaking.
According to the Stuttering Foundation of America , therapy goals vary by individual, but might include:
In individual and group sessions, Bolat has learned to reduce and even eliminate many of the stuttering behaviors he had when he entered therapy three semesters ago. "When Daron first came to us he'd never make eye contact when speaking and he made severe facial grimaces when he was trying to get words out," says Sisskin. That description does not fit the man today. Maintaining a steady gaze with his therapist, Bolat never blinks or twitches.
Although he had some therapy earlier in his life — off and on during elementary school and a little during his senior year of high school — Bolat made real gains only in the last year and a half. "I definitely did not speak up as much as I wanted to when I was younger because of my stuttering," he says. "I think it was pretty clear to other people that I stuttered. I had a lot of tricks that I used, but none were very good at hiding my stuttering." In contrast to his first days in the program, when Bolat could barely maintain eye contact, his gaze when speaking now is steady, even when his stuttering gets in the way. "A lot of my improvement over the last two semesters came from monitoring my behaviors, becoming more aware of them," he says. Part of the reason he avoided eye contact was that he didn't want to see the reactions of the people he was talking to. Over time, he learned that avoiding eye contact helped him get through a dysfluency with less anxiety. Avoiding eye contact over and over again strengthened the behavior to the point where he almost never looked someone in the eye while speaking.
You would think, then, that talking on the phone would be easier. Not so. Sisskin says talking on the phone is a common fear for those who stutter because they cannot see the reaction of the other person, so they assume the worst and their fear increases and, consequently, their stuttering. One of Bolat's homework assignments this week was to talk to someone over the phone. This is an item on his fear scale he's working to overcome. "I'm going to Chicago and I had to order plane tickets," Bolat says. At one point in his conversation, the agent attempted to finish a sentence for him when he started stuttering. She guessed the wrong word.
Unlike Bolat, most people who stutter are not fortunate enough to live close to a speech therapy center or university teaching program. Their lives are often significantly different from the lives of those who engage in therapy. Without some form of therapy (individual, group, guided self-help), many people who stutter struggle with their disorder. Some live sheltered lives, even choosing occupations that remove them from public contact. To help these folks, the Stuttering Foundation of America has published "Self-Therapy for the Stutterer," a thin volume packed with tips and advice from leading professionals in the field. You can order the book — publication number 12 — from the foundation's Web site.
