Intensive Therapy at the Warneford Hospital in Oxford
About the presenter: My name is Peter Hawkes and I am 28 years old. I am a severe stammerer and I have stammered since the age of five years old. My occupation is a forklift driver and machine operator at a printers. I am seriously considering returning to full time education next accademic year. I am currently setting up a self-help group for stammerers in my area as I feel this is much needed.
INTENSIVE THERAPY AT THE WARNEFORD HOSPITAL IN OXFORD
by Peter Hawkes
from the United Kingdom
Having been a severe stammerer since the age of 5, I had just about given up on speech therapy. I can clearly remember having speech therapy in early childhood and intermittently throughout my school life. Even though I was fluent with the therapist, when I went out into the real world my stammer was as severe as ever.
In my late teens I tried again, six one hour weekly sessions was all that was available and once again this did nothing to help improve my fluency. My faith in finding the "holy grail" of fluency was quickly disappearing.
In November 1998 I discovered the at last I was not alone, the information and self-help books were certainly a comfort but did little for my speech. Thanks to the British Stammering Association (B.S.A.), I found out about intensive courses at the Apple House. Armed with this information I referred myself to a speech therapist, who kindly helped me to secure a place on the forth-coming intensive in Oxford.
After nearly eight months of waiting, Monday 16th August finally arrived. At last two weeks of therapy which I desperately needed. The Apple House is currently undergoing structural work so the course was held in the Warneford Hospital. There I met Dr. David Ward senior speech-language therapist (SLT) and Vanna Karkasi, a student SLT who is specialising in dysfluency disorders. The group was small consisting of Shiva, Maryanne, Basharat, Ike, and myself. We all got on very well from the outset and it was so refreshing not to have to worry about my speech and what others would think. At least we all shared the same problem.
I am happy to be able to share my two-week experience with you through this online conference and look forward to learning from the experiences of others as well.
The first day consisted of baseline assessments. Video recordings were taken of us all reading and then in conversation. Watching myself severely stammering was not my idea of a fun day out but it was essential nonetheless. Two minutes of reading then one minute of monologue and two minutes of conversation was a really difficult task. My speech was very poor and it made it worse because I was in front of a room full of people that I only just met.
We spent the next day working on identification, learning about how we stammer and what we do when we stammer, a very important process to enable us to eliminate secondary symptoms. I had never confronted my stammering behaviour so openly before. It is not that I was not aware of it but rather that I did not like to see what I do when I stammer. Stammering is very embarrassing so it is only natural that you try to avoid looking at those stammering moments. This process also involved each of us looking at everyone else's stammering in the group. This in itself was interesting and clearly made me realise that secondary behaviours are actually unnecessary and can be eliminated. Throughout the course we learned how to monitor our own speech and be aware of why we were stammering and what skills would be needed to improve fluency. Two weeks is a very short time to change a lifetime of stammering. David and Vanna were basically training us to be our own therapists so we could leave the course with all the necessary tools to help ourselves.
Slow prolonged speech was the next stage. We started talking at 60 syllables per minute which sounds very slow but certainly gave us all control over our speech which we had not had previously. Over the next week we learned all the skills that make up this technique and the speaking rate was gradually increased to a more normal sounding 190 S.P.M. I had actually used this technique before but I only had a very brief understanding of it.
Airflow, in my opinion, is the most important, as most of my blocks are caused by breathing in while speaking. Proper airflow is essential to stop this poor breathe control. Starting each new onset with proper airflow unlocks the tension in the vocal chords therefore fluency is guaranteed, assuming the technique is properly used. Soft onsets and contacts between the speech articulators also give nice relaxed speech resulting from reduced tension in the mouth and throat.
The next feature, prolongation, means stretching the words by prolonging the vowels and running the words together softly and lightly. At slow rates of 60 S.P.M. we all managed to speak perfectly fluently. The fear of stammering at this speed and even 90 S.P.M was gone. It felt like a big weight had been lifted off my shoulders. All my life I have been in constant fear of stammering but now I could relax in the knowledge that these techniques work albeit at the slow rates. As we moved up the rates to 120 S.P.M and 150 S.P.M a few dysfluencies started creeping in. At this point I also had to put more effort into using the techniques. Thinking what to say and constantly thinking about how you are going to deliver each word can be mentally exhausting. I probably made this a lot harder for myself because I am naturally a very fast speaker and at times my rate was closer to 200 S.P.M than the intended 150. Constant nagging from David and Vanna worked wonders at bringing my rate down. One problem I had with my rate is that I am perfectly able to use all the features of the technique at a rate of around 300 S.P.M but only in a safe relaxed environment.
To everyone's relief we moved on to 190 S.P.M -- at last more normal speech. But a few of us started to slip back and forget to use the techniques. Personally in relaxed practice I was still in control and felt very comfortable with the rate. In between each rate we had a self assessment. Once again the video camera came out and several minutes of our speech were filmed. We then reviewed this and went through it with a fine tooth comb picking up on every mistake. An example of this would be a break in prolongation or perhaps hard contacts. We all commented on each others' assessments. Once again this was a useful exercise because it made us aware of our speech and the speech of the others in the group. Self monitoring was constantly used to make us aware of when and where we were going wrong. Even after a few days we all could see the mistakes we were making. Because of this it is then a lot easier to not only correct them but also to ensure they don't reoccur. Despite this at no time were we subjected to any negative comments. David and Vanna always encouraged us in entirely positive ways and helped us to see where improvements could be made. They were on our side 100% and that attitude, I feel, was responsible for our success.
The second part of the therapy was block modification. We learned how to use cancellations and pull outs. Cancellations are where you block, then instead of pushing through you stop and releasing the tension, you take a breath and start the word again slowly, lightly and with proper airflow. This should result in not only fluent speech but also a feeling of control which is so very important. Pull outs are similar but you stop pushing and begin the word on the same breath. This is useful for smaller blocks. Cancellations were our main focus. I must admit I have trouble using these in the "real world" but when I get to grips with them I know they will help no end. There is nothing worse for me than starting to block and then continuing to block on every word thereafter. This technique gives me a chance to regain control and continue fluently, something which I need to master.
As the course progressed it was obvious that David had designed an excellent program for the two week. He wasn't just going through a set schedule. Everyone was given extra help with his/her own particular problems and even though it was group therapy, David also looked at as individuals and ensured we all progressed to the best of our ability
The second week concentrated on conversational speech and role plays, we certainly had a lot of laughs doing that, I think David found our acting skills quite entertaining!!! The role plays we used as a transition to the real world and to my surprise they felt more uncomfortable, anxiety and tension started to creep back in. However this was a good thing because it increased my confidence to know that I could take on more demanding situations and still be fluent.
The transfer phase was nearly upon me and I wondered just how my new found speech skills would hold up in the real world. As someone who has always avoided all difficult speaking situations I was not looking forward to this next step. Phone calls were the first hurdle I had to jump. First we used internal phones to practice on each other. Then we used the Yellow Pages phone directory to make some phone enquires to complete strangers. Personally I found this very hard but I did have some success. One call went particularly bad speech wise, but at least I was actually using the phone, something I always avoided. I was pleased with the fact that I was reducing my avoidance which goes hand in hand with increased confidence and desensitisation. For me this was a new achievement, something I had thought of as impossible before this course. To speak in situations that are difficult and stammer was not exactly my idea of progress but the fact that I was giving it my best was to me, more important than being fluent. To overcome my deeply rooted fear of the telephone was not easy and I feel that the support of the group was to thank for this. As the second week continued we moved out of the hospital into the real world. For us this was a trip into Oxford, plenty of shop enquires and ordering lunch as well as a rather embarrassing survey. Asking people to answer some questions on stammering and their views on stammerers was no picnic but once again it was not quite the nightmare I had thought it would be. The results of the survey actually surpirsed me. Nearly everyone who was interviewed said that they did not feel uncomfortable speaking to a stammerer, but most of them did say that they felt like finishing the word for them. Overall their comments were very positive.
To be honest I was not that fluent in the "real world" -- but I did have far more control over my speech than ever before. Taking into account that I was taking on situations that previously I would not have done, I felt this was a step in the right direction. Not only that but I now realise that it is not a crime to stammer. I started the two weeks as a very unhappy stammerer who could not accept the problem. Now I am a more confident stammerer with a much greater level of fluency. I feel the course has given me not only new fluency skills but also non-avoidance skills. I knew from day one that there is no magic cure, but these two weeks have given me a real boost in all aspects of my life. No I am not "cured" -- but I am now in a far better position to tackle my stammer. My high levels of anxiety before speaking have now dropped considerably. This in itself is very important. Reduced stress levels give a sense of greater control which escalates into more confidence which, I feel, is needed by all stammerers.
In the past I have let my speech pull me down so much. My school days were filled with fear and horror. I can still vividly remember my embarrassment and those feelings will take a long time to subside. Therapy is in my opinion a very important step to acceptance, but more important than that is group therapy. Stammering makes you feel very isolated. Unless you know other stammerers, life can seem very lonely. Sharing experiences and realising that you are not alone takes away that feeling of isolation and helplessness. I still stammer and yes I am a stammerer. Personally I am not ashamed of that anymore. This new change in attitude is due to the group support as well as the fact that I know I am trying my best to improve my level of fluency. The two weeks at the Warneford Hospital have really turned me around. As David told me on numerous occasions, "It is not a crime to stammer." I was very lucky to have been with such a fantastic group of people. I cannot begin to express my appreciation to all my fellow stammerers in the course. The support and encouragement was much needed and gratefully received. David, Vanna and Polly (who joined us later in the second week) really did put in so much effort. They really cared that we were getting on well and nothing was too much trouble. Vanna who is a student from Greece was absolutely brilliant. Let's hope she stays in England when she is fully qualified, I know she will help many stammerers. More speech therapists specialising in stammering are much needed.
The course is not completely finished. There are several follow-up days, one which I attended two weeks after the completion of the course and another scheduled five weeks later with a final follow up day three months later. Even after this period we are not let "out in the cold." David and vanna wish to keep in touch and everyone has swapped phone numbers and email addresses. So constant help and support is available on a continuing basis.
Stammer therapy is not easy and while the course was a brilliant experience, I am fully aware that this is just the beginning of what I see as a life-long therapy course. There is no time to sit back and be complacent. Constant practice and self-monitoring are essential. I feel that I now have the skills to work on my stammer, but for me this is the beginning of my search for greater "fluency." I intend going to another intensive program at the City Lit in London, and am aware that they offer a slighly different approach. It will be very intersting to see if I can interate several programmes and give myself more skills.
I am also in the early stages of setting up a self-help group in my area. This I feel is essential for maintenance of fluency. A safe enviornment that is non-judgemental will be very useful to practice new techniques as well as old ones. Group therapy is also very similar to the benefits that are derived from counselling. This will be a very positive experience not only for myself, but for the other members as well.
I intend to continue tackling my stammer head on. In the process I look forward to meeting other fellow stammerers which I have started to do via the internet and British Stammering Association.
September 15, 1999
