From Freud To Dr. Phil: Applying One Hundred Years of Psychology To Dealing Effectively With Stuttering

About the presenter: John Wade, Ph.D. has been an active member of the National Stuttering Association for over 15 years, and has presented workshops on numerous topics at NSA National Conferences. He served on the NSA Board of Directors from 1996-98. He is currently serving on the ASHA Division 4 Task Force On Reimbursement and Diagnostic Codes. He is a Licensed Psychologist at the University of Kansas. He lives in Lawrence, Kansas with his wife and two daughters.

From Freud to Dr. Phil: Applying One Hundred Years of Psychology To Dealing Effectively with Stuttering

by John Wade
from Kansas, USA

Stuttering is not a psychological problem - it is a speech problem. But knowing a little about well-researched psychological principles can help us deal more effectively with our stuttering, which is the focus of this paper.

One of Aristotle's more famous quotes is that "an unexamined life is not worth living." There are many different approaches to psychotherapy, which is essentially to say that there are many different schools of thought regarding how to best facilitate change. However, the foundation of almost all psychotherapeutic approaches is the importance of self-awareness. Some therapies emphasize increasing awareness of a particular area, such as thoughts, feelings, or past experiences, but all major therapeutic approaches agree that it is that it is very difficult to change something without the willingness to look at it.

Be self-aware, not self-conscious.

I know that this is certainly easier said than done. One of the greatest ironies, and probably the greatest obstacle to be overcome when striving for change, is that we can't change what we don't first accept. Wait, before you look for something to throw at your computer screen, by acceptance I don't mean liking it. I regard acceptance of stuttering as the willingness to acknowledge our stuttering and the courage to look at what we do when we stutter and to tolerate the feelings we may have. Only by honestly acknowledging our stuttering can we effectively take steps to alter it or manage it. And usually increased awareness brings increased understanding, which helps us to look at ourselves in a more supportive manner.

Dealing with our stuttering with our eyes open is the first step. In the next several sections I'll briefly discuss some ways to facilitate changes you may want to make regarding your stuttering and the role it plays in your life.

Feelings are based on thinking and doing.

There are three general realms that comprise our experiences -- thoughts, actions, and feelings. As we have all probably discovered through experience, we can't simply change how we feel directly. We can't just scrunch up our face and change our mood. However, indirectly we can change how we feel by changing our thoughts and/or what we do. I'll focus first on the cognitive realm (our thoughts), and then on actions we can take to promote change.

Say to yourself as you would say unto others.

We tend to talk to ourselves in a much different way than we would talk to anyone else. We tend to be more critical, demanding, and focused on what we have done wrong instead of what we have done right. I personally think that we do this with the best of intentions. We don't set out to demoralize and discourage ourselves. We are by nature problem solving creatures and it seems reasonable to expect that if we focus attention on our problems, we'll be more likely to solve them.

However, I think that my driver's education experience confronted me with the error of this logic. (When learning to drive I also realized that I would have to find a way to stutter with my eyes open if I expected to live very long, but I digress.) For some inexplicable reason I was very concerned about running into the curb. So, of course, I could not take my eyes off the curb while I was driving. I did so with the best of intentions, because I didn't want to hit it. But as you might guess, the more I tried to avoid the curb, the more I kept steering within inches of it. Where we look is where we go. The more we focus our attention on what we want to avoid, the more likely we are to get exactly that which we don't want.

Basics of Effective Self-Talk

Many of us probably aren't doing ourselves any favors by how we talk to ourselves. But how should we talk to ourselves? First, think of how we would talk to a good friend or loved one who we want to support. Ideally, we would probably want to be honest and direct, but we would also be understanding and encouraging, and focus most on areas of strength and control.

Focus on Areas of Control

Anxiety is about control. We tend to feel anxious when we feel something is outside of our control. Stuttering can certainly feel beyond our control at times. And most of us probably know the frustration of trying not to worry. The more we try not to worry the more it just fuels the fire.

It is important to shift the focus of our attention away from those things we can't control to areas within our control. For example, if we are worried about giving a presentation, we do not have much control over the fact that we stutter. However, there are many things within our control, such as our rate of speech, eye contact with the audience, using humor to establish rapport with the audience, preparing well so we feel confident about our material, etc. Focusing on elements within our control can help us to use the energy of worrying for good, not just for becoming more anxious. Although it may not always feel like it at the time, there are always things within any situation over which we have control. Wendell Johnson, a well-known psychologist and speech therapy researcher who stuttered, hit the nail on the head when he said, "We may not be able to chose whether or not we stutter, but we can always choose how we stutter."

Practice Detachment

Stress and anxiety cause us to lose perspective and develop tunnel vision. When we have tunnel vision regarding our speech, it becomes difficult for us to see beyond our stuttering, and consequently our stuttering seems huge. Asking ourselves two simple questions can often help us regain perspective if we are temporarily blowing things out of proportion. One -- "What will this matter in five years?" Two -- "What can I realistically do about it?"

From Automatic to Intentional to Automatic

If we tend to be self-critical, one of the stumbling blocks to changing this pattern of self-talk is that it involves changing an automatic response. (Much like speech therapy involves bringing an automatic process under conscious control.) For a period of time, it requires actively and consciously challenging the automatic, self-critical thoughts. And of course we can't challenge every self-defeating thought we'll have. However, as we begin to challenge some, it weakens the negative power of self-critical thoughts. Albert Bandura, a premier psychological researcher, stated it aptly when he said, "We can't stop the birds of worry from flying around our head, but we can stop them from building a nest in our hair." And like most habits we are trying to acquire, in time the new habit of more supportive self-talk will become more automatic and easier.

Four Components to Boosting Confidence

Regardless of our speech, most of us have probably experienced times when our confidence could have used a boost. The following is a compilation of the factors research evidence has shown to be positively correlated with self-confidence.

• Develop "Mastery Experiences" -- in which you have success in overcoming obstacles. Tackle easier challenges first to set the stage for success, then attempt more challenging situations.
• Role Models -- having positive role models increases belief in our own competency.
• Social Support -- foster relationships that are supportive, distance yourself from people who bring you down. (But be careful to give people the chance to support you.)
• Develop tolerance for your feelings. We can feel scared or anxious or down and still do what it is we want to do.

Cultivate Intimacy

The degree to which we hide our stuttering is the degree to which we prevent intimacy. Project to others that we accept our stuttering, even if we have to fake it at times. (We can't expect the listener to be more comfortable with our stuttering than we are.) No secrets, no shame.

Be Involved

It generally feels better to have tried and failed than not to have tried at all (once the initial sting has gone). Active participation in activities helps us to focus outwardly, not inwardly, encouraging us to keep things in perspective. (Contrary to the popular slogan, it is not all about me.) In fact, research on "flow" indicates that peak experiences result from being immersed in challenging activities, and forgetting about everything else except the activity.

Be Generous

One of the criticisms against popular psychology is that it is too self-focused. I think this is actually a pretty valid point. There is nothing more discouraging than to feel like you have nothing to offer. On the flipside, helping others almost always make us feel better about ourselves. This simple truth was even known among many ancient cultures, which would assign a troubled person a task to help the community, such as preparing the meal.

Relaxation/Stress Management

Relaxation and stress management techniques will not enable most people to be perfectly relaxed in all situations. However, learning control over our stress and anxiety level can be quite comforting, and having at least some control under times of pressure can typically change the entire experience. Stress management techniques are skills, and like any skill, they become easier to apply and more effective with practice. And with practice, stress management skills can help foster the feeling of control over anxiety and worry. The following is a very brief description of several common techniques:

Progressive Muscle Relaxation

• Sit or lie comfortably, with arms and legs uncrossed. Eyes may be open or closed.
• Starting with the feet and progressing all the way to the head, tense each muscle group and hold the tension for several second. Release the tension, relax for a few seconds, then repeat before moving on to the next muscle group.
• For most people, much deeper relaxation can be achieved with this contrast effect than trying to simply relax.

Mini-Tranquilizer

• Same principle as Progressive Muscle Relaxation, except you tense and relax all muscle groups at once.
• It takes only a few moments, and no one will know you are doing it (you can make it just look like you are stretching.)

Breathing

• Place your hand on your abdomen. (Relaxed breathing comes from the abdomen, not your chest.)
• Guide your breathing to become deeper and slower, but not to the point of being strained.
• To help further promote relaxation, say to yourself "relaxation in, tension out" as you inhale and exhale.

Goals

Goals are very powerful. A fifty-year longitudinal study at Yale surveyed students graduating in 1951 about their financial goals, and re-surveyed the remaining class members 50 years later. In the initial survey, only 3% of the class had financial goals with steps outlined to achieve those goals. However, 50 years later, those 3% had a combined net worth greater than the 97% of those without financial goals combined. (No, Bill Gates did not graduate from Yale in 1951 and skew the sample.)

Effective goals are reasonable, realistic, and observable. It would not be effective to set a goal of being the life of the party (how would you know if you were, and it's a good set-up for failure.) But an effective goal if you find mingling at parties uncomfortable would be to engage in short conversation with three people during the course of the evening. It is reasonable, realistic, and you know when you have achieved it. It is also important to expect setbacks. I tell my clients in psychotherapy that setbacks and relapses are likely, and that learning to work through relapse is the real test of improvement.

Involvement in Self-Help Groups Fosters Emotional Resilience

Research indicates that the largest predictor of dealing effectively with challenges or adversity of any kind is social support. Women breast cancer survivors who are in a support group live more than twice as long after the onset of the cancer as women not in a support group. There are countless other dramatic examples of the power of support. Although I have focused on providing a brief summary of a number of different strategies, a truism of counseling is that people can't change until they feel understood.

Did you notice how many of the items I discussed throughout this article occur naturally within a support group such as the National Stuttering Association?

• Social support
• Positive role modeling
• Understanding and intimacy
• Opportunity to create success experiences
• Focus on the person, not the stuttering.

I encourage you to experiment with those ideas in this paper that appealed to you, and most importantly, to find situations in which you feel understood and can offer others understanding and support.

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August 29, 2003