Real Change Can Be Constructed: Personal Contruct Therapy in Stuttering Therapy
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About the presenter: Margaret M. Leahy is Director of the School of Clinical Speech & Language Studies, Trinity College, Dublin, Ireland. She has been working as a researcher/practitioner in the field of stuttering/fluency for 25 years, and for most of that time has also been involved in student therapist education. Since the 1980's, she has presented papers and workshops on PCT and therapy, and has published a number of these. She has also done research on the 'stutterer' stereotype, particularly with regard to student stereotyping. She been involved with the IFA since its foundation, and is currently President of that organisation. |
Real Change Can Be Constructed: Personal Construct Therapy in Stuttering Therapy
by Margaret Leahy
from Ireland
George Kelly (1955) developed Personal Construct Psychology (PCP) to account for behavior in general and to provide an alternative to other psychological theories of behavior (see Appendix A). He considered the person as scientist, hypothesizing about the sense one has of the world by seeing how well that enables one to understand reality, and to test that understanding in terms of how it guides future events and behavior. The person as scientist anticipates events, and shapes behavior accordingly, thereby reducing uncertainty. Behavior resulting from the anticipation is the experiment in itself. Kellys (1970:1) idea of constructive alternativism is explained thus: all our present perceptions are open to questions and reconsideration even the most obvious occurrences of everyday of life might appear utterly transformed if we were inventive enough to construe them differently. Constructive alternativism states that there is always another way an infinite number of possible ways - of construing events.
Personal Construct Therapy (PCT) has a range of applications way beyond speech or language problems: it is a form of psychotherapy, usually practiced by psychologists. In the field of speech and language pathology, PCT is largely associated with stuttering, because of the pioneering work of Fransella (1970; 1972; 1977). Hayhow and Levys (1987) book Working with Stuttering is a valuable practical handbook for any clinician wishing to learn about applying PCT principles to stuttering. Few therapists have the qualifications necessary to practice PCT in depth, but some ideas can be usefully applied to personal change without formal training. In this paper, examples of how you can initiate change are provided, and an account of successful PCT with a client, Michael. PCT principles are stated following each example.
Experimenting with Change
To set PCT in context, try an experiment. This one has application if you feel threatened or inferior in situations where you would like to talk. Consider a meeting (Situation A) in which you are not entirely confident about your performance. The people there are in a different league (e.g., lawyers, or doctors, and youre a student lawyer, or doctor); they are more experienced, better informed than you are. Youre happy in the knowledge that you have a contribution to make, but uncertain that youll be able to do this convincingly. Now think about a situation where you are confident (Situation B) and at ease, aware of your ability to contribute to a conversation perhaps with colleagues who know you to be good at what you do and supportive of others. Look at some ways that these situations are similar: e.g., theres a group present; you are likely to be a focus of direct attention when you speak; you want to have your voice heard. Look at some ways that they are different: In A, you are familiar with the people only as teachers or supervisors, not in a personal way; in B, you are familiar with the people as friends. You feel you have to impress those in A, but not so in B they know you and respect you for who you are.
What do you do in Situation B? How do you talk? When do you choose to contribute? How do you let people know that youre ready to contribute? that youre not afraid to say what needs to be said? Now think about A as if you were at ease, confident and ready to contribute: Are there some ways that you can act in A as if you were in B? Yes! You can maintain good posture, and look relaxed, with head up, eyes on the group and the speaker as appropriate, and remembering not to cross your arms (it looks defensive). You can smile, indicating that youre at ease; you can raise a pencil when you have something to say, and you can say it early on, with a sense of contributing something useful and without apologizing, even if what you say is not entirely astute or brilliant. Its probably a good idea not to wait for the right moment, with the chance that you might be ignored, or that the right moment never arrives. If you begin to act as if confident and at ease, you can begin to manage Situation A as less threatening, and more like Situation B, in terms of how you act, feel and perform.
PCT Principles: the PCT cycle of experience leading to change begins with Anticipation. Your time needs to be invested to specify and compare your thoughts and feelings your constructs, and their implications. It is useful to look at your personal range of behavior, being confident, being at ease etc., some of which you cannot access for other situations. The encounter or Experiment happens after you have reconstrued the situation. If you can anticipate accurately, you can change, shaping your new behavior in the situation. You may come up against obstacles to change these are discussed later.
Applying PCT to stuttering
Early in therapy, its useful to explore the different kinds of ways you can talk: varying loudness, speed, pitch: you can shout, talk very fast or slow, whisper, use a high squeaky voice, and/or a low, gentle voice. You naturally speak differently in different situations anyway, and one changes how loud/fast/gently one speaks as appropriate. In PCT terms, checking out the variety of ways or alternatives open to you is part of the process of loosening constructs. If you stutter, you can move beyond the feeling that theres only one way to speak: with a stutter. Stewart (1999), and Stewart & Birdsall (2001) explain this process and it effectiveness in some detail.
PCT Principle: loosening construing leads to being able to make more choices, and ultimately to exercise better control in managing behavior.
Working with Michael
Before coming for therapy, Michael (24) had been asked to complete a case history and to describe himself in a character sketch (Appendix B). His story emerged as follows: Michael is a journalist with a national newspaper, on a full-time temporary basis. He has been stuttering since childhood, and believed that he would grow out of it as he got older and more confident. By now, he had expected to be able to talk without the stutter, which makes him self-conscious, and frustrated at not being able to get his message across. It was upsetting and discouraging for him that the stutter could strike in difficult, tense situations, and leave him feeling helpless, handicapped. Often, he could talk with a degree of fluency, especially with his younger brother Jim. In contrast however, he almost always stuttered with his older sister, and with his former teachers. At work, he handled stuttering by avoiding talking to certain people, and when he had to talk, he used a different accent, and could almost always disguise the stutter. As to the cause of his problem, he considered that he stuttered because he was conditioned to stutter, and had been doing it for so long now, that it was never going to get better by itself.
Michael liked what hed heard and read about PCP, but was skeptical about it all: he interpreted PCP to change personality characteristics; he wanted to find a new way of talking, and figured that he needed to learn techniques to do that. He didnt feel that he had a psychological problem at all, but that his talk problem was what he wanted fixed. He did agree to try out some ways of changing and thinking about change, and to specify the goal of therapy as being an effective communicator, with an ability to manage stuttering (rather than the goal of being fluent all the time). The journey begins with a structured conversation, exploring some experiences where stuttering was a feature, and comparing these with others where Michael was fluent.
Therapist (T): When you speak with your brother Jim, you dont stutter, whereas when you speak with Catherine, you do. Both are close family so are similar in that way, but what do you think is the difference between these speaking situations?
Michael (M): Jim lives at home, with Mum, so I talk to him regularly; he listens and is interested in what Im saying. Catherine is older and has been working away from home for two years. We talk on the phone sometimes, but mostly when shes home and I think shes inclined to be inpatient, putting pressure on me to hurry up and be articulate. I feel that shes tolerating me, but not really interested in what I have to say, as if she has something more important to do
T: Ok, so shes busy and not exactly interested? But Jim is attentive and does not put on any pressure?
M: Well shes interested in the sense that she wants to know whats happening and all, but I feel that she cant wait for me to get through the blocks she anticipates what Im going to say sometimes, and that really gets to me. Jim is easy to talk to, but what we talk about is mostly fun stuff not important really but we have some serious talks about football and that.
T: Ok, so its serious stuff with Catherine, and more trivial stuff with Jim, and you talk more with Jim, but you see him more often. Do you think that Catherine might be trying to help you out when she anticipates the words you block on?
M: She might be trying to help, but I feel inferior when she does it like Im not able to do something as simple as talk, and that I need the help and I dont
T: But with Jim, you feel ok, not inferior?
M: No, but not superior either: more equal if you like although he knows a lot more than me about some teams and matches and all.
T: Are there ways in which youre equal to Catherine? Can you talk about those?
M: yes, were both smart; we went to the same college, and I actually got a better degree than she did I think its better anyway. And we both have good jobs, although hers is permanent, and probably pays a bit better than mine but she has more experience.
T: So if youre equal to Catherine, how can you show this? Can you think of ways that you can let her know that you are equal to her?
M: Well I could look her in the eye, and let her know that its not good to finish off the words Im trying to say, that it puts me off
T: And what would happen if you did that?
M: Shed probably accept what Im trying to do particularly if I look directly at her when Im talking.
T: Would that be hard to do?
M: Well, a bit challenging, but not hard not really.
T: If you think about it, what else goes with looking someone in the eye when youre talking?
M: Do you mean like body language?
T: yes, exactly.
M: well, maybe expression, and gesture
T: Yes, posture, facial expression, and using some gestures to maybe indicate slow down a bit, or dont push me please so can you think out about the posture you use with Jim for example, and see if that would fit when youre talking to Catherine? Can you describe it?
M: Yes, ok. Casual, friendly, smiling and that. I think that would be ok.
T: Will you try it out? Experiment, and see what happens. You anticipate that by looking directly at her and saying what you need to say that shell listen and respond sympathetically. Check it out and report back next week.
PCT Principle: a structured conversation that involves comparing similarities and differences (constructs) will develop understanding about behavior, about tight construing, and about the possibilities for change.
PCT Principle: thinking about change is not enough. It has to start with easy ways of changing, which has to be accompanied by ACTION. Motivation and good thoughts and intentions are not enough.
One week later, Michael was exuberant about being able to talk openly with Catherine about his stuttering, and about her reaction to this, which was concerned and helpful. He had begun to use the more confident non-verbal behaviors in other situations too, and found it helpful, even if he did stutter. However, he had met a former teacher, one who had been encouraging, and found that although he had begun to use the more confident gestures (eye-contact, posture) he became choked with the stutter, and was almost unable to talk with him.
PCT Principle: change is gradual, and may be uncomfortable in the beginning. What will help? Support and understanding from someone who cares, and an ability to focus on positive outcomes as you proceed.
Although he had begun to feel more confident, Michael found himself back in the old stuttering mode with a teacher, and was annoyed with himself for not being able to be in more control of how he talked. This led to discussion about the hidden obstacles for change, using the ABC method (Tchudi, 1977).
Identifying Obstacles to change:
The ABC method is for exploring difficulties in changing encountered when one has begun the process, but when the old behavior simply turns up again, despite the motivation to change and the knowledge of how to change. We used this to try and identify what had happened.
A = the goal: how I would like to be A1 = how I am now
B= advantages to goal B1 = advantages to how I am now
C= disadvantages to goal C1= disadvantages to how I am
For M, the advantages to the goal of being in control of stuttering (B), had been overshadowed the advantages of stuttering with him (B1), as this returned him to a more familiar role with the teacher, where the teacher was the one in control. Being more confident and fluent with the teacher meant coming to terms with being equal to him; this was already present with Catherine, but had not been thought about for others. Disadvantages to being equal with the teacher held a threat to the kind of relationship they had, and M. was unable to predict what would happen if they were equal. Until this was resolved and the advantage of Michael being equal to others were clear, becoming more confident and more fluent were not going to be automatic. It took some months before M. was in a position to say that he was able to manage his communication ability better, and to become the kind of confident person he knew he could be.
Michael thought for awhile, and said So its all in my head this problem. The answer to that is a qualified yes. The possibility of change is in your head, and the process of change starts here, examining the meaningfulness of what youre doing, and considering realistic alternatives. But changing is also about exploring the meaningfulness or the implications of changes made, and managing these better. Doing things differently, is all important: tackling obstacles to change, removing these (or perhaps leaving it at that). Investing time and effort in experimenting with new behaviors is crucial: leaving some old ways behind, moving towards being more flexible, and becoming at ease with the constant business of change. It is of course also possible to experiment with speech techniques, but this is something that most people who stutter already know about. It took some months before Michael was ready for discharge, when he could manage communication better, and when he had become the kind of confident person he knew he could be in important situations.
References:
Fransella, F. 1970. Stuttering: not a symptom but a way of life. British Journal of Disorder of Communication. 5: 22-29.
Fransella, F. 1972. Personal Change and Reconstruction. London: Academic Press.
Kelly, G. A. 1955. The Psychology of Personal Constructs. New York: Norton. (A reprint of this work was published in 1991).
Kelly, G. A. 1970. A Theory of Personality: the psychology of personal constructs. Mew York: Norton.
Tchudi, F. 1977. Loaded and honest questions. In D. Bannister (Ed) New Perspectives in Personal Construct Theory. 281-299. London Academic Press.
Stewart, T. 1996. Good maintainers and poor maintainers: a personal construct approach to an old prolem. Journal of Fluency Disorders, 21: 22-48.
Stewart, T & Birdsall, M. 2001. A review of the contribution of personal construct psychology to stammering therapy. Journal of Constructivist Psychology. 14 (3) : 215-225.
Useful Websites for PCP work:
http://repgrid.com/pcp/ Provides a list of other websites in PCP
www.Enquirewithin.co.nz Broad application of Repertory Grids
http://www.rdg.ac.uk/slals/pcp.htm Current research in areas of PCP
Appendix A:
Background : George A. Kelly; PCP theory; PCT Terminology.
George A. Kelly was born in Kansas USA, in 1905. Part of his college education entailed the study of mathematics and physics; he received an M.A. in educational sociology in Kansas, a B. Ed. from the University of Edinburgh, and a Ph.D. in psychology from the University of Iowa. Before his teaching career began in 1931, he had been an aeronautical engineer for a time. During the 2nd World War, he served as an aviation psychologist in the US Naval Reserve. He was appointed as professor of psychology at Ohio State University in 1946. Before he died in the mid-1970s, his work in PCP had inspired a large following worldwide, and this trend continues to this day.
PCP the theory: Kellys observation - that people behave in a meaningful way with flexibility and goal-orientated action according to how they constsrue events - is an alternative explanation to the Freudian idea of drives determining behavior, and to the behaviorist ideas of conditioning, and leads to the fundamental postulate (or proposal) on which PCP rests: a persons processes are psychologically channelized by the ways in which they anticipate events. By focusing on the persons anticipation of events, the formal statement introduces the subjective nature of the individual, and the language of hypothesis the as if element of make-believe, which allows for a range of alternatives to be explored, elaborated and considered for the purposes of changing behavior. It also provides the meaning of the term scientist as Kelly used it: each person is a scientist; each individual is in the business of understanding reality and the nature of the world, and to test that understanding in terms of how it guides future events and behavior, i.e. to anticipate, modify and attach meaning to events and thus, reduce uncertainty.
PCP theory is a complete one, stated in detail, with 11 statements or corollaries supporting the fundamental proposal which provide for a means of changing personal behavior: in short, everything can be re-construed, there is nothing sacred or above the possibility of change in the way you attribute meaning to your experience. For Kelly, the term constructs denote transparent patterns through which life is experienced (in a sight sense the glasses through which you see; but patterns are experienced through all the senses, and interpreted in feeling and cognitive terms, encompassing all means of experience). Constructs are not objects or things construing is active, personal, and moving and changing, as we make sense of reality. A persons construct system is deeply personal in the sense that no one else can experience exactly what a person experiences (although people may have experiences in common, and share interpretations of experiences the commonality corollary) and highly organized, with a wide range of dimensions that form various relationships with each other and carry implications about how the person thinks, feels and acts (the organization corollary). The active process of construing puts the person in the position of formulating and reformulating hypotheses and testing them in experience, evaluating the results and confirming or adding to the construct system. We do this all the time, repeating behaviors that have predictable outcomes, and feeling secure in what we do, and developing some new behaviors on the basis of experience. In order to change, one needs to examine behavior in terms of meaningful alternatives, and examine or check out how some alternatives fit ones way of being in the world. This involves taking risks, experiencing threat, and being uncomfortable for a time as we begin to change. Experimenting with changing behavior however, and investing time and effort in the encounter with change, will lead to new ways of understanding oneself and ones behavior: in short, will lead to reconstruing events. Important Principle: there is always another way to construe events, and to experiment with behavior accordingly.
Appendix B: Assessment procedures to elicit constructs include the Repertory Grid (see Enquirewithin website for examples), structured conversations, and the Character Sketch.
The Character Sketch instructions are precise and clear:
I want you to write a character sketch of (yourself, Margaret) just as if she were the principal character in a play. Write it as it might be written by a friend who knows her very intimately and very sympathetically, perhaps better than anyone could ever really could know her. Be sure to write it in the third person. For example, start out by saying: Margaret L is.
July 29, 2002
