Confessions of a Stuttering Speech-Language Pathologist

CAPS Ottawa '93 Conference
July 29 - August 1, 1993

Keynote Address July 30, 1993
Confessions of a Stuttering Speech-Language Pathologist

Dr. Ted Peters
Professor Emeritus
University of Wisconsin - Eau Claire

Summary prepared by Jaan Pill

Ted Peters remarked that he and his wife have enjoyed Canada on many trips. They have visited all the provinces except Newfoundland.

Dr. Peters said his original title for the talk was "Confessions of a stuttering speech therapist," but that a title that was even more apt was "Recovery from stuttering: Some thoughts from an old stutterer." His main topics were:

o his own story;
o his experiences as a clinician; and
o his thoughts on strategies for adults who stutter.

Dr. Peters remarked that while the contemporary term is "person who stutters," he's been using the term "stutterer" for 25 or 30 years. "So if I occasionally use the word 'stutterer,' I hope I don't offend anybody."

He has come across the term PWS, the initials for "person who stutters." He said he's rather not be called a PWS -- which as an acronym is pronounced something like "pwuss." He said: "I'd rather be a stutterer than a 'pwuss.'"

Early history

Of his early years, Ted Peters noted that he began stuttering in his pre-school years. His first vivid memory is from age 7 or 8 when, one morning, his dad was shaving and Peters was talking about Christmas. He happened to stutter on the word "Christmas," and his father told him to say it again.

So I went "C-C-C-Christmas," and he said, "Now take your time," like we've all heard -- "Now think what you're gonna say." So again: "C-C-C-Christmas."

And I don't know, maybe the fifth or sixth time, I got the word out. Like we all know, if we say it enough times eventually it comes out okay.

And then he said, "That's good; that's the way it ought to be. Now say it once more and then you can go."

Well then I said, "C-C-C-Christmas," and the whole damn thing played itself out. And I remember ending up crying in that situation.

His father found it uncomfortable to have a son who stuttered. Peters remembers constantly being asked to say things over:

And it got to be I didn't like talking to Dad. And in fact if he'd come home from work, he'd say, "What did you do today, Ted?" and I'd say, "Nothing." Because that was easier than telling him and then going through all the correction.

And I think Dad must've figured he had a very dull kid, because he did nothing at all through his childhood. At least that's what I kept telling Dad. But I just didn't like that constant criticism. And it really soured our relationship, I think until the day Dad died.

Peters found his mother was more neutral or accepting. He added that from working with many people who stutter, he knew that many parents are very accepting of children who stutter, and sometimes it's the mother who might not be as accepting.

Peters grew up in a little country village in a very stable farming community. His school had three classrooms. He started Kindergarten with eight students and graduated with all of the same classmates in Grade 8. In the school, he doesn't remember ever being teased about his stuttering.

When he was about 8, his mother drove him to a house in Grand Rapids, Michigan and told him he was going to see a speech therapist. Peters recalled that:

I just still remember being scared, angry, upset, and I remember when we got into this woman's living room I started crying. I don't know whether it was the confrontation with my stuttering, but it took maybe a half hour for this woman to calm me down.

He never developed a close relationship with the therapist, who gave him lessons to practise, such as saying "Lee, Li, Lo, Lu" and "Me, My, Mo, Mu." He practised these 20 minutes a day on his own. He was also instructed to read short paragraphs. He spoke fine when practising on his own but there was no improvement in other speaking situations. After three or four months the lessons stopped.

A year or two later he was taken to a psychiatrist. Peters remembers lying to him a great deal, and trying to keep him away: "I didn't feel comfortable with this man. Or he didn't have the clinical skills to help me have confidence and to be open with him." In time these visits were also discontinued.

Then between his junior and senior year in high school, his parents hired Joe, a speech therapist who was completing his Master's degree with Charles Van Riper at Western Michigan University. The therapist attended school in the mornings and worked with Peters a couple of hours every afternoon, for one summer.

For a change, Peters felt comfortable with this therapist:

He seemed to accept me as I was. He seemed to accept my stuttering. I began to talk about my stuttering with him like I never could about it with anyone else.

And the other thing about Joe, he seemed to convey that he knew what to do about stuttering. Or how to help me. He had a very definite plan laid out that he shared with me.

The therapist applied Van Riper's stuttering-modification therapy. Much emphasis was put on starting to eliminate the avoiding of situations -- to "go ahead and talk in situations where you're afraid."

The therapy also emphasized eliminating the avoidance of feared words:

Give up those word substitutions. Give up those postponements. Give up the rephrasing of sentences, [where you try to] sneak your way around the feared words.

The therapy also focused on what Van Riper called desensitization. This involves toughening up to the stuttering, or being more open and accepting of it. Peters was instructed to begin to talk to people about stuttering -- "to get it out as a topic of discussion, which I had never done."

He also learned to do voluntary stuttering, or stuttering on purpose:

Put-put-put in some easy st-st-stuttering in your speech on purpose to find out that you could t-t-t-tolerate this thing that for years you were so a-f-f-f-fraid of.

That summer he worked with his therapist for an hour or two each day trying to sell can openers door to door: "I don't think that we sold more than one all summer, but this gave us a lot of talking experiences."

As well, Peters learned to modify the moment of stuttering -- to stutter in a more fluent fashion using techniques that Van Riper called pullouts and preparatory sets:

Instead of saying P-P-Peters [demonstrates while applying strong pressure on the P-P-Peters], I would learn to say P-P-P -- [at this point demonstrates a marked reduction of pressure] -- Peters, and sort of pull out of it easily.

Or if he sensed a feared word coming up in a sentence, he would approach that word easily, with a reduction in pressure in his speech musculature. The result was an easy, relaxed, slower, and more acceptable form of stuttering. Peters practised these techniques constantly during his door-to-door sales efforts.

By the end of that summer he was speaking well. He had a lot of fluency and he was handling his stutter well. But when he returned to school, in a different state, by Thanksgiving he was stuttering as badly as he had been in the spring.

Without the clinician, he stopped doing the things he had learned:

I could just feel the old fears coming back. The old avoidances began creeping in, the old battling-your-way-through-the-stutters: trying to jerk out of them.

He next enrolled at the University of Michigan, Ann Arbor, where a speech and hearing screening process lead to a suggestion that he again enroll in speech therapy.

Peters was one of four students in a therapy group conducted by a graduate student -- who appeared to feel uncomfortable about stuttering, and appeared not to know what to do about stuttering. The group quickly disbanded. Peters stayed at Michigan for four years, majoring in economics, but his stuttering was really getting in the way, socially and otherwise:

I couldn't participate in class. I really didn't know what the heck I'd be doing in a career. My grades were not particularly great. In fact eventually they asked me to leave, because my grade point got below a C average.

As an example of avoidance behaviours at this time in his life, Peters referred to meeting his future wife, Karen, at a New Year's Eve party. He was there with another young woman, and she was there with another date. He spoke with Karen for an hour and wanted to ask her for a date:

I learned subsequently that she was expecting me to call her for a date. Well next week there was no way I was going to get on to the telephone and risk stuttering when calling her for a date.

A year went by and again he met Karen at a New Year's party. Again, each turned up with their respective date:

Again I'd had something to drink, and again we met and talked for an hour or two. We got along beautifully. The next week I was not going to ask her for a date. I would not risk it and get on the phone. Six months later -- this was now a year and a half after our original meeting -- I had a mutual friend fix us up on a blind date. In other words he did all the phone calling and set it all up. I just had to show up. Well, that's a year-and-a-half avoidance behaviour. They subsequently began to date, and have now been married for 36 years.

Charles Van Riper

At the end of the four years at Michigan, Peters went to Western Michigan University and had therapy with Charles Van Riper himself. At that time Van Riper would have intensive group therapy, with seven or eight stutterers starting with therapy in the fall. They would meet three hours a day, five days a week for a semester.

There would be an hour of group therapy, then an hour of individual therapy, and then another hour of group therapy. A graduate clinician would be assigned to each client.

Again, the therapy focused on desensitization, voluntary stuttering, elimination of avoidance behaviour, and application of pullouts and preparatory sets. A typical assignment might involve spending an evening and the next morning talking to 50 people in Kalamazoo, Michigan, using at least two or three good pullouts or prep sets each time.

Peters was speaking well by the end of the semester. Karen and he got married and he began working for a company that manufactured school furniture. He worked a year and a half in an office in Grand Rapids, and a year in California as a furniture salesman.

Again he began to relapse. One time he was stuttering severely speaking with a school superintendent at the Edwards Air Force Base in California. When he left that meeting, he stopped his car in the Mohave Desert and said to himself the situation was becoming tiresome. He had been successful with treatment twice, and each time had experienced a relapse.

He decided to start doing therapy on his own. He began to give himself assignments, things that had worked in his two previous therapies.

His speech again improved, and he decided he did not wish to stay in a business career. He spoke with Van Riper, who suggested he return to university and major in speech therapy. Peter wrote to Michigan University, explained why he had flunked out, and within a week heard back that his last semester's work had been erased from his transcript.

Peters got a Bachelor's and a Master's degree at Western Michigan, and worked at a Veterans' Administration hospital and at a public school. Later he went to grad school at Michigan State.

By then Peters was speaking quite well, but there would be some situations where he would do some avoiding, and where he would not apply his pullouts and prep sets. He felt guilty because he could not use the controls well.

He also recalled some experiences during his early years as a speech therapist. One time the parents of a child with an articulation problem complained to a school principal that Peters himself had a speech problem. On another occasion, an aphasic patient at a Veteran's Hospital was startled at the thought that a speech therapist who stuttered was going to attempt to help the patient to re-learn how to speak.

At this time Peters met Joe Sheehan, who taught at the University of California, Los Angeles. Sheehan was associated with what was known as the approach-avoidance theory of stuttering. When he spoke with Peters at an ASHA cocktail party, Sheehan said Peters was right in eliminating the avoidance behaviour. But Sheehan added that: "You need to accept yourself as a stutterer." Peters quoted directly from Sheehan on this topic:

You are the same person, whether you stutter or not. There is nothing to be ashamed of when you stutter, and there is nothing to be proud of when you're fluent.

Peters admired another statement from Sheehan, which he believed was based on a quotation from Oscar Wilde:

He said there are two ways to be disappointed in this world. One way is to not get what you want. And the other way is to get what you want.

Peters added, "I think sometimes that's true with stuttering.... You've got to accept yourself as a person that has this propensity to stutter, but you're still you and you're still a good person, whether you have the stutter or not."

Sheehan's counsel diminished the guilt that Peters had sometimes felt when he couldn't control his stuttering. On this point Sheehan disagreed with Van Riper. He disagreed with Van Riper's strategy of using controls in such a way that the person sounds almost or completely fluent. Instead, you should let your listener know that you're modifying your stutters. Don't try to pass yourself off as a normal speaker.

Applying the advice from Sheehan -- being open about how he was modifying his speech -- Peters found that he was becoming more and more spontaneously fluent. When he did have stutters, he handled them more easily:

And for the last 25 years or so now, I've been talking pretty much like I talk here this morning. I have a lot of spontaneous fluency. There'll be times when I still have stutters, and I'll need to modify them. Sometimes I modify them pretty well; sometimes they'll get away from me.

He doesn't do much if any avoiding -- "I keep my red flag out for that" -- and he still gives himself assignments. For example, in the last several summers, getting close to retirement, he hasn't worked, and by the time school begins he'd find himself having more stutters in his speech. His assignments might involve, say, putting in 25 little voluntary stutters during breakfast with Karen.

Speech therapy with adults

After his doctorate from Michigan State, Peters took a position where for 25 years he has taught courses in stuttering, and supervised grad students working with stuttering.

Early in his work with adults who stutter, he followed Van Riper's and Sheehan's ideas. Then 15 or 20 years ago he studied the work of people like Bruce Ryan, Ron Webster, and Bill Perkins who were exponents of fluency-shaping therapy. Here a client learns fluency-initiating gestures, or fluency skills where a person might modify the whole speech pattern by:

• beginning a phrase with a very gentle onset
• slowing down the speech rate by stretching out the syllables
• possibly being more relaxed in the articulatory movements

Usually these skills are taught in a structured speech situation, possibly with single words and phrases, followed by working the speech pattern into conversations, within -- and later outside of -- the therapy room.

Peters began doing more of the fluency-shaping therapy. In his experience it works but has downfalls because of insufficient focus on desensitization, and on elimination of avoidances.

So he began to combine features of the two approaches, a strategy that had also occurred to Barry Guitar at the University of Vermont.

From the stuttering modification approach he took the emphasis on avoidance-elimination and desensitization. From fluency shaping he took the learning of fluency skills.

Peters added that the two approaches are compatible. He noted that Van Riper's approach of going easily into a feared word is similar to using a gentle onset. "Working through it in a relaxed fashion" (Van Riper) is similar to "stretching out the syllables" (fluency modification).

A key difference is that in stuttering modification, the strategy is applied on just the feared word, whereas in fluency shaping it's applied to the whole phrase, or sentence.

In terms of proprioceptive feedback -- the muscle movement that is involved -- you're doing the same thing; the only difference is in the unit of speech that you're applying it to.

When clients are trained in both approaches, said Peters, some like to go the stuttering-modification route while some take the other route. He added:

And some combine them. And I think when I noticed this would be at conventions like this [one], talking to people who stutter. Sometimes you can't tell if the person came through a fluency-shaping program or a stuttering-modification program -- because they're both using these slow, relaxed movements in their speech, and both slowing down.

And I think some fluency-shaping people end up not doing it on the whole sentence. They just do it when they need it, which makes it even more difficult to tell the therapy they come out of.

Joseph Sheehan

Overall, Peters said that motivation is "just terribly important -- changing the way you talk takes a lot of hard work." He added:

If you're choosing a therapy, I think it's important that you feel accepted, understood by your clinician. And I think you also need to feel that your clinician is competent.

Also, I think you should feel very, very, very, very free to ask your clinician all sorts of questions -- about what they do, about what you can expect from therapy, what sort of results they get. I think often I have seen people who stutter may be reluctant to ask enough questions.

Peters also emphasized the importance of:

• acceptance of one's self as a person who stutters
  
• desensitization and elimination of avoidance behaviour
  
• voluntary stuttering: "I think you need some help with that, maybe from a clinician, but I think it has a lot of therapeutic value"
  
• learning stuttering-modification or fluency-shaping skills
  
• focusing on maintenance of skills after treatment

Three goals that Peters recommended are:

• occasional periods of spontaneous fluency
• periods of controlled fluency, and
• periods of acceptable stuttering

He noted that a person can have each of these kinds of speech in a given day.

Spontaneous fluency is the speech of the normal speaker:

I suspect that all of you have spontaneous fluency sometimes -- talking to good friends, your spouse. An idea pops into your head and you just talk -- words come out. No controls, nothing like that. I think most people who stutter will have periods during any given day when they will be spontaneously fluent.

Controlled fluency involves sounding very much like a normal speaker, said Peters, but it will take some effort in applying stuttering-modification or fluency-shaping skills:

So you're going to sound pretty good but you're paying a price in terms of the effort, the psychological effort that you have to put in to sound that good. But it's nice to have that ability when you want to use it.

The third goal, said Peters, is what he calls acceptable stuttering, where sometimes a person does some stuttering and feels comfortable with it.

Ted Peters finished his keynote address with the earlier quote from Joe Sheehan:

You're the same person whether you stutter or not. There is nothing to be ashamed of when you stutter, and there's nothing to be that proud of when you're fluent.