Beyond the Visible: Helping Students Look Beyond the Disfluency
Stephen B. Hood, Ph.D.
The University of South Alabama
ASHA -- SID- 4: Eighth Annual Leadership Conference
Academic and Clinical Training in Fluency Disorders: Future Directions
Toronto, Ontario, Canada: May 16-19, 2001
(This is the text that goes with the accompanying the PowerPoint Presentation.)
I. Welcoming Comments
It is wonderful to see so many longtime friends and colleagues here in Toronto, and it is nice to meet new people. I would like to express my appreciation to the SID-4 steering committee for asking me to participate in this conference. It is a humbling experience to stand before a sophisticated audience such as this, knowing full well that there are many of you here in this room that could just as easily have been selected to address this topic.
My assigned task is to talk about ways that we can help students to go beyond the hash-marks, to go beyond the overt characteristics of stuttering, and to help students to better understand the inner world of the person who stutters. I have interpreted my assignment to mean that I should discuss some of the things we might do to help students to get below the surface structures of stuttering, and get down to what Walt Manning has referred to as the "deep structures" of stuttering (Manning, 1999.) Due to time constraints, my remarks will deal primarily with helping students go beyond the hash-marks with persons for whom stuttering has become chronic, rather than with young children where treatment is focused more toward prevention and early intervention.
The topic of how we can best educate our students about stuttering, and how best we can educate our students about persons who stutter, remains timely and important. One reason for this is the de-emphasis on stuttering resulting from the 1993 ASHA decision to no longer require specific academic and clinical experiences in the area of fluency disorders. Yaruss (1997, 2001) has outlined some of the unfortunate fallout that has resulted from university programs reducing the amount of required course-work, and reduced practicum in the area of fluency disorders.
It is with both excitement and apprehension that I speak with you this morning. I am excited about sharing ideas with those of you who already try to take students below the surface levels of the disorder, and in this sense I will probably be "preaching to the choir." My trepidation comes from my concern that some of you may think this is an unimportant issue that is a waste of time.
II. Let me begin by briefly explaining some of the significant learnings I have experienced during the last 35 years. By telling you a little bit of my personal history, I hope to share with you some insights into how some of my beliefs and attitudes developed.
As a child, I remember having an older cousin who stuttered. As a pre-teen I had some friends and casual acquaintances who stuttered, but I really didn't think much about it. As an older teen and college student I worked during the summers as a camp counselor, and there were several campers and two fellow counselors who stuttered. One of the counselors was an undergraduate student at the University of Wisconsin, and I remember him telling me about their clinical program, and a faculty member by the name of Lois Nelson. In college, one of my fraternity brothers stuttered. Until well into my junior year in college, the thought of becoming an SLP was certainly the furthest thing from my mind. My early academic performance was really abominable, and unlike those of you who may have graduated as "Magna Cum Laude," – I was on course to graduate "Lordy, How Come."
During the middle-to-late 1960's I was a graduate student at the University of Wisconsin, and I remember being mesmerized by Lois Nelson. Later, she was joined by Ted Peters, and I received yet another dose of enthusiastic encouragement. Possibly my childhood, teen and college experiences with persons who stuttered somehow served to push me in the direction of selecting stuttering as my major area of interest. This curiosity about stuttering may have been much more than a random circumstance.
I often use the plight of the person whose stuttering is highly internalized, covert, hidden or masked to exemplify areas where we must look beyond the obvious and overt dimensions of the disorders. My doctoral dissertation was based in part upon some of the work of Ernest Douglass and Bruce Quarrington, and in about1971, I drove to Toronto to meet with Dr. Quarrington and make a presentation to his students at York University. I was nearly arrested crossing the border by overzealous border guards who thought I was trying to escape from the United States in order to avoid the Viet Nam draft. They must have thought I was smuggling a briefcase, carousel projector and tray full of research slides across the border.
During the summer of 1971 I participated in the Stuttering Foundation of America's Intensive Therapy Demonstration Program. It was at this time that I was first introduced to Malcolm Fraser and Charles Van Riper. What an awesome experience it was to have expert consultants visit each week! And what apprehension there was knowing that our clinical work was to be evaluated and critiqued by people like Joe Sheehan, Hal Luper, Dean Williams, George Shames, Stan Ainsworth, Al Murphy and Charles Van Riper. It was also during this summer that Woody Starkweather, Dale Gronhovd, Dick Boehmler, Tony Zenner, myself and some others fantasized about one developing a Journal of Fluency Disorders. I organized a meeting for the ASHA Convention during the next fall and we continued to dream and plan for this new Journal. Dr. Van Riper donated some "seed money" to get the program started, and Tony Zenner was later appointed as the first Editor (Zenner, 1989.)
My experience with the 1971 SFA summer program was followed by spending the summer of 1972 working with Dean Williams at the University of Iowa, and editing the Stuttering Foundation of America's Book, TO THE STUTTERER. All during these times my interest continued to increase, and I was fortunate to have been able to rub elbows with some of the past, present and future giants in the area of fluency disorders.
Since 1978 I have enjoyed participating in activities of the National Stuttering Association.
So – What is the point of telling you some of my background?
FIRST, Because as academic teachers in the classroom, and as clinical teachers in practicum, we can have a very profound effect on our students. We are more effective when we have a large data base of personal experiences to draw upon.
SECOND, Because, not all of our students will have had friends and relatives who stuttered, and not all of our students can participate in events such as those sponsored by the SFA and the NSA. I was most fortunate to have had these experiences, and I think that students benefit from hearing about them.
THIRD, Because as academic and clinical teachers, we must try to provide opportunities and challenges that might ignite the flames that are prerequisites to obtaining the CC-- CCC: the Certificate of Clinical Caring, Concern and Competence.
III. My challenge this morning is to stimulate you to think of ways in which you can try to help your students get beyond the disfluencies of stuttering.
How can you help your students look beneath the surface structures of stuttering behaviors?
How can you help them to understand the deep structures – the affective and cognitive components -- that underlie the behavioral aspects of the disorder we call stuttering?
How can you help your students understand the Iceberg Analogy that Joe Sheehan talked about four decades ago?
As academic instructors in the classroom, and as clinical teachers in the treatment room, we must strive to expose our students not only to the behavioral issues of what the person does to interfere with talking, but also to the associated attitudes and feelings that develop. Although a number of universities have de-emphasized the amount of time devoted to stuttering, at the University of South Alabama we still offer one complete course at the undergraduate level and another complete course at the graduate level. Students who come to us from an undergraduate program with less depth are clearly at a disadvantage Let me illustrate some of the ways I try to structure my class in order to allow students to achieve some of these goals. To do this I will be showing you twenty slides. These are the same as the slides in the handout you should have received. Time will not permit us to go through the other eight slides, but they are all included in your handout, and I hope you find them helpful. If not, they make good targets for a dart board !!
(The abbreviations that follow, e.g., PP-2, P-3, etc, refer to the PowerPoint Slides in the accompanying file.)
A. The Nature of Stuttering
PP-2: Model: Stuttering – Behavioral and Emotional Dimensions
PP-3: Schematic Portrayal – Temporal Sequencing of Events
Examples of student assignments:
Project #1 Speech Rate, Articulation Rate and Normal Fluency.
PP-4: (1) Students are divided into groups of two or three students each. Their assignment is to tape record a 200-word monologue or lecture from a faculty or staff member, and to perform an analysis of speech rate, articulation rate, and "normal nonfluency." (2) Each group must submit the audio tape, along with a descriptive summary of the results.
Project #2 Perform a Rate and Disfluency Analysis:
PP-5: (1) Students individually tape record themselves in a 200-word monologue where they realistically demonstrate "moderately severe" pseudo-stuttering. (2) Each student performs an analysis of his or her speech and articulation rates, and completed an analysis of molar moments, and molecular types, of disfluency. (3) Each student submits the audio tape, along with the analysis, and narrative summary.
Project #3 Learning to Stutter – Pseudo Stuttering
PP-6: (1) Each student is to stop three people on the street and maintain good eye-contact while asking directions on how to get somewhere. For each different person they are to demonstrate moderate effort/tension/struggle with:
– sound and syllable repetitions
– sound prolongations
– tense pauses/hard contacts/silent blocks.
(2) Students submit a written report to summarize the experience: How did they do? How did they feel?
PP-7: Andrea & Jeanne – Pseudo Stuttering with the Easter Bunny . . .
Project #4 Cancellations
PP-8: (1) Along with a partner, each student engages in a number of practice exercises in order to become proficient. Students must finish the stuttered word, immediately pause for two seconds, and then repeat the word a second time using some form of easy stuttering.
- Select 3 common words, and cancel them at least 5 times per day for three days.
-Perform a predetermined quota of cancellations during phone calls.
- Perform three proper cancellations in each of three different, realistic, speaking situations.
(2) Submit a report which summarizes the experience.
Project #5 Pull-Outs
PP-9: (1) There are various practice exercises where students work together to learn to stutter, then "freeze" and then release slowly, deliberately, easily and with voicing. (2) Students must enter realistic speaking situations where they collect 25 instances of moderately severe stuttering where they briefly freeze, and then release with a pull-out that is slow, gradual, deliberate and vocalized. (3) Each student submits a written report to summarize the experience.
Project #6 Proprioceptive Monitoring & High Stimulus Speech
PP-10: (1) Students are to enter four different speaking situations where they FEEL WHAT THEY ARE DOING as they engage in:
- 100 % high degree of continuous phonation
- 100% low degree of continuous phonation
- 10 % high degree of continuous phonation
- 10% Low degree of continuous phonation.
NOTE: It is important that students become proficient in these assignments because as part of the final examination, each student must come to my office, sit at the telephone and make real phone calls to real people. During these calls, students must demonstrate proficiency with such things as pseudo-stuttering, cancellations, pull-outs, continuous phonation, and proprioceptive monitoring.
Final Examination
PP-11: Final Examination question 9 (counts 20% of final exam grade.)
Students came to my office, individually, to make phone calls where their assignment was to:
1. stutter on approximately 20 % of words spoken with moderate amount of effort/tension/struggle.
2. stutter and cancel three times. (finish the word, stop and pause 2 seconds, then repeat the word with slow and deliberate co-articulated transition)
3. stutter, freeze, and then pull-out of three moments of stuttering. Pull-outs had to be gradual, voiced.
Project # 7 Turtle Talk: speak with a slightly slow rate by "stretching" the syllables, pausing between phrases and for turn-taking, and using slightly exaggerated prosody.
PP-12 (1) Students engage in a ten minute play situation with a normally developing child between the ages of three and seven. (2) Students tape record this session and analyzes their speech and articulation rates, disfluencies, pausing for turn-taking, and prosody. (3) Each individual student submits the audio tape, along with a report that summarizes the activity.
Project # 8 Internet Assignment: Visit Judy Kuster's Stuttering Home Page
P-P13 Stuttering Home Page (1) Each student is to select three papers, stories, or other items of interest: one must pertain to a child, one to a teen and one to an adult. Students must submit a copy of the article, along with a one page abstract of it.
PP-14: Additional (Optional) Opportunity: Visit the Home Pages of the Stuttering Foundation of America, the National Stuttering Association. Join STUT-L, .
These types of assignments have gradually evolved over the past 30 years, and should still be considered a work in progress. Data collected by SID-4, and reported by Nan Bernstein-Ratner at this Leadership Conference, indicate that a number of instructors use similar assignments and projects.
B. I try to expose students to things that go above and beyond the things that can be found in books and journals.
What do I hope the students will come to learn and appreciate? How do I attempt to communicate this?
PP-16 I tell them about self-help and support groups such as the National Stuttering Association and about Friends. If you are from Canada, you can tell them about CAPS. I want students to know about these important resources that are available to assist them in their clinical work, and are there to assist their clients, and the families of the clients.
When schedules permit, members of the local Mobile NSA Chapter visit class. Last month, three of our NSA Members visited class.
Students have the opportunity to watch video tapes from the National Stuttering Association, the Stuttering Foundation of America and other sources. Examples include "Speaking of Courage," "Voices to Remember," and Annie Glenn's Keynote Speech at the Cleveland NSA Convention.
Students learn about SID-4, and I tell them about Specialty Certification.
PP- 17. Students learn about National Stuttering Awareness Week, and International Stuttering Awareness Day. Until this year my graduate stuttering class was taught in the fall semester, and when it was, students were required to visit and participate in the International Stuttering Awareness Day Conference. The course is now taught in the spring, so the students can only visit, but not actively participate in the on-line activities.
Students find they can learn more about stuttering from reading essays and autobiographies from persons who stutter. Beginning next year, I am going to assign specific readings from sources such as the following:
Fred Murray: The Stutterer's Story
Marty Jeser Stuttering: A Life Bound Up in Words
Ken St. Louis. Living With Stuttering: Stories, Basics, Resources, and Hope.
National Stuttering Association: To Say What Is Ours
Stuttering Foundation of America: Advice To Those Who Stutter
PP-18 Students need to understand that persons who stutter will be more positively motivated if they view their clinical journey more as a challenge to approach, rather than as a threat to be feared;
Students need to understand that accepting a challenge requires giving up some of the false safety that results from avoidance, and accepting some reasonable, short-term risk
Students need to understand that persons who stutter will find it difficult to maintain improvement when they attempt to superimpose stuttering modification and/or fluency shaping, on top of fear, anticipation and avoidance.
PP-19 Students need to understand that fluency is more than the absence of stuttering.
Students need to understand that the conspiracy of silence serves to heighten the guilt, shame and denial. Shame about stuttering often leads to attempted interiorization.
Students need to understand that clients should be helped to get to the point where the possibility of stuttering does not enter into the decision making process. They can make personal decisions independent of the possibility of stuttering.
While the act of stuttering may temporarily impair the smooth and each flow of ongoing speech, stuttering need not become a disability or a handicap. As Yaruss pointed out in his 1998 JSLHR article "Describing the Consequences of Disorders: Stuttering and the International Classification of Impairments, Disabilities and Handicaps," it may be more important to give less attention to etiology, as per the International Classification of Diseases, and give more importance to how stuttering affects the person's ability to participate fully in "daily life activities."
PP- 20 Students need to understand that it is important to help our clients make stuttering less mysterious, less terrible and less awful, or as Bill Murphy would say, we need to de- mystify, de-awfulize, and de-terribleize the stuttering.
Students need to understand that clients have a greater sense of personal commitment and choice when they accept the fact that stuttering is something they do, and not something that happens to them. It will help if they use a language of self-responsibility. For example, when they say "when I stutter, I tense my jaw and tongue" — rather then "when I stutter, words get stuck in my throat."
And finally: Students need to realize that
The client is paying to speak
The clinician is being paid to listen.
Students need to learn to be empathic listeners.
PP-21. Realistic Outcomes
To be able to talk any time, any place and to anybody,
And to be able to communicate effectively and efficiently,
And to be able to do so with little more than a normal mount of negative emotion.
(THIS WAS THE LAST SLIDE.)
C. Over the years I have been saddened to know how some people have allowed stuttering to rule their lives, and let themselves be disabled and even handicapped by it. And I have marveled at how incredibly brave and courageous some of these people were in terms of accepting difficult challenges.
I tell students about the brave and courageous persons who take challenges and accept risks, to be successful in spite of stuttering, rather than become handicapped victims because of their stuttering. The pages of the NSA's Stutter Buddies and Letting Go are full of these stories, and so are the pages of Reaching Out, which is published by Friends: The Association of Young People Who Stutter. If I ever hear of a student who is bored and has nothing to do, I send them to Judy Kuster's Stuttering Home Page.
I tell my students about a man whose stuttering was highly interiorized, covert and hidden. He worked for International Paper in Mobile. The reason he decided to seek help was because he has been offered a significant promotion at work, but to accept this promotion would require that he do a major amount of speaking before groups of employees. As it turned out, he turned down a major promotion, and the accompanying multi-thousand-dollar salary increase that went with it, rather than take the chance of exposing his stuttering. His overt stuttering was to remain hidden at all costs, in spite of the shame, guilt, and denial.
I share Walt Manning's story of a student-athlete who was asked to report the score he had received on a test. Although the student had received a grade of 95, he avoided stuttering by reporting a grade of 75. As Manning noted, "No stuttering had reached the surface to be identified. But, it was in fact, a profound stuttering event. Important affective and cognitive events took place beneath the surface" (Manning, 1999.)
I hope the ideas presented this morning will help you to extend your own hash-marks, and I hope that this, in turn, helps you extend the hash-marks for your students the next time you see them.
