C.S.I.: Communication Scene Investigation
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About the presenter: Tim Mackesey, SLP, Atlanta, GA. In addition to owning a full-time private practice dedicated to fluency disorders, Tim Mackesey has taught the graduate-level Fluency Disorders course at Georgia State University. An SLP since 1992, he travels internationally presenting workshops on early intervention, stuttering treatment, and cognitive therapy. Tim is published and has been interviewed on a number of television and radio programs related to stuttering. He is a Board Recognized Specialist in Fluency Disorders and Specialist Mentor by ASHA. and certified master practitioner of Neuro Linguistic Programming. |
C.S.I. - Communication Scene Investigation
by Mackesey
from Georgia, USA
In 1991 I had the privilege of meeting the late Dean Williams, Ph.D. - a true stuttering guru. I asked him what the key to overcoming stuttering was. All he said was: "I'd want to know what I did when I stutter." I naively hoped for a golden technique to use like a wand and make stuttering vanish. His words burrowed around in my brain for several years until I understood his sage reply.
Dr. Williams must have meant for me to put the entire moment of stuttering under a microscope and dissect thoughts, feelings and stutters. I had specific phobias (i.e., saying my name and phone calls). In those situations I felt panic and could not use easy onsets and targets - I blocked severely. Memories of past stutters can linger for years and provoke the word fears and situational phobias. I started to study cognitive psychology to figure out how anxiety worked and a method to eliminate it.
C.S.I.
What happens before and after the stutter is as important as the stuttered word(s). Most adolescents, teens, and adults who stutter have developed a degree of anxiety related to stuttering. People Who Stutter (PWS) feel stuttering coming; generally in the region from the stomach to throat. Many PWS replay the stuttering events with shame and embarrassment. Learning to closely examine the thoughts and feelings associated with stuttering can help a PWS dramatically reduce his anxiety; and earn consistent speech. Many are familiar with Crime Scene Investigation (CSI) and forensics from television. Let's do a variation of "CSI" - Communication Scene Investigation.
Social Phobia
One part of the Communication Scene Investigation for PWS is to explore what has been called "social phobia." Social phobia is getting much deserved attention in stuttering research. The DSM IV (Copyright 1994, The American Psychiatric Association) offers this abridged definition of social phobia:
The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.
B. Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack.
C. The person recognizes that this fear is unreasonable or excessive.
D. The feared situations are avoided or else are endured with intense anxiety and distress.
E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
F. The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder.
During my 25 years with a severe stutter I had every irrational thought relating to my stuttering. I am intimately familiar with anticipating stutters and obsessing on past stutters. I discovered that reframing my thoughts about stuttering with Cognitive Behavioral Therapy (CBT) was essential for me to remove fear and avoidance. As a clinician for 20 years I have found that other PWS benefit from C.S.I. and changing their thought patterns. In fact, reframing stuttering thoughts is essential for stable speech control.
Two of the most toxic forms of thinking are projecting (also known as mindreading) and personalization. When a PWS imagines his listener is judging him he can manifest anxiety. This anxiety feeling can render a PWS unable to use targets or speech techniques designed to control the muscles of speech. Many PWS have reported that in-the-ear auditory feedback devices are useless when the fear of stuttering hits. Some PWS have tried anti-anxiety medications to treat the fear of stuttering. Let's examine how a PWS develops this anxiety, the scope and result of projecting and anxiety, and how to get rid of it!
Meaning
I find it interesting that the definition of the word meaning comes from German. Meaning is defined as what you "hold in mind." If a PWS is about to read out loud and projecting "If I stutter, I will look like a fool," that is what he is holding in mind. This belief will trigger anxiety.
Case Example- 8 year old
A third grader told me last week: "If I stutter the kids think I am stupid. . .they think I can't read." This is projecting and personalization of stuttering. Integrated therapy will help him reframe his thinking and learn behavioral targets.
Case Example- 35 year old male
Last week I helped a professional in information technology (IT) prepare for an interview. Here is an excerpt from our conversation. We will call him TR and I am TM: TM: You mention being anxious about stuttering during an interview. What do you believe about stuttering in an interview? TR: If they have a candidate that does not stutter, they will take the one who speaks better. (projecting) TM: If I understand correctly, you have been thinking that stuttering eliminates you from a potential job offer? TR: Yes TM: What specifically would the interviewer think of stuttering? TR: I am incompetent. (personalization) TM: Incompetent to do what part of the job description? TR: Talk to customers. TM: You mentioned that you have been in IT with two other companies and you stuttered then. When you realize that you were gainfully employed and effective communicating with customers in your previous jobs, what decision do you make about that notion: stutter = incompetent? Who taught you that? TR: It's false. I get it! I beat myself up when I stutter.
Bill Withers and Projecting
I saw Bill Withers- the singer of the timeless hit Lean on Me - interviewed on the Tavis Smiley show. Bill said: "I learned that I stuttered when I held my listeners in too high of a regard." I will take the liberty of translating that to: Bill made himself anxious when projecting his thoughts. Bill worried what his listener's opinion of him was when he stuttered. He said he stopped such projecting and his speech improved immensely.
Watching Another Person Stutter - The King's Speech
The recent success of the blockbuster movie The King's Speech has attracted people who stutter (PWS) to the theater in droves. Many PWS are ecstatic over the portrayal of a hero who stutters- King George VI. Other PWS have confided that they don't feel they can go to the movie because seeing another person stuttering upsets them. Another group of PWS have gone and reported they felt very uncomfortable watching the actor Colin Firth stammer. What happens within us that could make us resist seeing another person stutter/stammer? It is important to solve this for our own peace of mind.
These recent conversations with PWS provoked a flashback for me. I saw A Fish Called Wanda in a crowded movie theater. When I heard the audience explode into laughter as Kevin Kline tormented a stuttering Michael Palin, I slid low in my seat to hide. I remember worrying that if the audience detected my stutter, they would turn in my direction and burst out in laughter. It was a low point in motion picture portrayal of stuttering. I hope we never see such a discriminating and cruel movie again.
The King's Speehc is the polar opposite from Wanda. King George VI works with speech therapist Lionel Logue (Geoffrey Rush), gains control over his stammer, and delivers a historic speech for the world to hear. King George is a hero. This can be a powerful and motivating movie if one lets it be so.
The phenomenon that makes a PWS either avoid The King's Speech movie or feel unease while watching it is called projecting. The Encyclopedia Britannica defines projection as: a form of defense in which unwanted feelings are displaced onto another person, where they then appear as a threat from the external world. A common form of projection occurs when an individual, threatened by his own angry feelings, accuses another of harboring hostile thoughts. Projecting, for example, could result in a PWS assuming that King George VI feels exactly the way you do about stuttering. Projecting is also called mind reading - when we presume to know exactly what another person is thinking or feeling without evidence. Projecting leads to a mind-body state called dissociation. Your physical body is in the theater but you drift off into thoughts and feelings about stuttering. The Merriam-Webster dictionary defines dissociation as: the separation of whole segments of the personality or of discrete mental processes from the mainstream of consciousness or of behavior. Your unconscious mind could be recalling a particularly tough moment of stuttering from your own past. You see another cast member's reaction and compare it to one of your stutter memories. In one scene the king's brother mimics his stutter and in another scene the king's father reprimands him for his speech problem. These two scenes are examples of moments that might provoke projection.
If you are a PWS, I encourage you to see the movie. The movie is a vehicle for you to explore any negative thoughts and realize they are irrational- Colin Firth is pretending. The winner of four Academy Awards, The King's Speech is a triumphant movie in which a PWS faces his fear, goes to speech therapy, and becomes a great leader with strong oratorical skills.
I have participated in adult group therapy sessions and National Stuttering Association support groups on and off for the last 20 years. Countless people have confided they could not come back to a second meeting because of their discomfort watching another person stutter (projection). It is in their best interest to return and try again. Their refusal to face projecting and conquering it is toxic for them. One person who attended our Atlanta, Georgia support meeting admitted to the group that he was projecting. We applauded his candidness and everyone reassured him that we accept him fluent or not. We cannot presume all adolescents or teens are ready for group meetings without preparation. Several children have confided that they felt great unease in a group of older PWS due to projecting.
De-mystifying and resolving the feelings of projecting and dissociation can allow a person who stutters to experience empathy and compassion but not displace unwanted feelings unto another person. Attending support meetings and establishing a tolerance for watching a movie character who stutters are steps in the recovery process. In the case of a movie character faking a stutter a PWS wants to be able to completely separate himself from that actor and see it is not real. Put frankly, if you have a strong visceral reaction to watching another person stutter you want to fix that.
Projection must be mighty powerful if a PWS cannot watch another person stutter. Because group therapy and support groups can be so beneficial the implications of projection deserve careful consideration. I encourage SLPs and group leaders to foresee the risk of projection driving away people and doing their best to make all PWS comfortable.
As David Seidler said when he accepted the Best Original Screenplay: "This is for all the stutterers around the world. We have a voice. We have been heard." Seidler, a PWS himself, must have resolved his own projection in order to create this masterpiece.
Doing your own C.S.I.
I use conversational reframing to dig up the specific thoughts the PWS has about stuttering. These cognitions can be put into a linguistic math formula: stutter = fool. That is some nasty math, isn't it? I will write these thought formulas on a dry erase board and ask the PWS if he wants to keep this belief or erase it. The PWS is challenged to nuke these irrational beliefs. A good resource for conversational reframing is the book Mindlines: Lines for Changing Minds.
Self therapy: if you a) anticipate a stutter or, b) if you are learning from a past stutter, ask yourself 1) what do/did I believe about stuttering?, 2) what does/did it mean to stutter? These questions will help you isolate the projecting and/or personalization of stuttering. Challenge these thoughts. You are more than stuttering! This paper is dedicated to Dean Williams.
Reference
Hall, L. Michael & Bodenhamer, Bob (2003). Mind Lines: Lines for Changing Minds 5th edition. Clifton, Co.. Neuro-Semantics publications.
Mackesey, Tim June, 2011. Are you Comfortable Seeing Another Person Stutter? Letting Go. The National Stuttering Association
