About the Authors: Dr. Heather Grossman, the Director of the American Institute for Stuttering, has worked with people who stutter for over 30 years and was among the first select group of Speech-Language Pathologists to received certification as a Specialist in Fluency Disorders from ASHA (American Speech-Language Hearing Association. She has extensive experience in supervision and has taught graduate courses in fluency and other topics at several Universities including Hofstra, Queens College, and the University of Louisiana. Dr. Grossman’s research has focused on the phenomenon of voluntary stuttering. She is a frequent presenter at both national and international professional conferences. She is also an active member of the stuttering self-help community and regularly volunteers her time to support FRIENDS: The National Organization of Young People who Stutter. Mark O’Malia, M.S., CCC-SLP is a speech therapist and person who stutters. He is a full-time clinician at The American Institute for Stuttering in NYC, working with people who stutter of all ages. Mark is actively involved in the stuttering self-help community, frequently facilitating and presenting workshops at national conferences for both Friends and the National Stuttering Association (NSA).

Introduction

The term “Microaggression” has been defined as a ‘brief and common daily verbal, behavioral, or environmental communication, whether intentional or unintentional, that transmits hostile, derogatory, or negative messages to a target person because he or she belongs to a stigmatized group’ (Sue et al., 2007).  In the case of stuttering, these communications often take the form of “compliments” that nonetheless transmit a negative message. Unfortunately, listeners are often completely unaware of the negative messages underlying many of the well-intended suggestions that they give PWS. Think about the possible implied meanings behind the following examples:

• “Ok, just take a breath and slow down”
• “Can you say it again using your tools?”
• ”You sound so good!” or “Great job” (after a patch of fluency)
• “You sound so much better!”
• “Your uncle grew out of his stuttering, so will you”
• “You did great, you didn’t stutter at all”
• “You don’t even stutter that much, it’s no big deal”

Non-verbal examples of microaggression often take the form of listeners attempting to “spare” the PWS from being seen stuttering or talking in general. These include: 

• Looking away during stuttering moments
• Gestures that implies “move it along”
• Guessing/Filling in the stuttered words
• Speaking “for” PWS so they don’t have to

 PWS must call on their resilience in order for these microaggressions to not result in damaging negative self-talk related to stuttering. 

We assert that therapy protocols that focus on using traditional “speech tools” to achieve fluency, as well as the corresponding positive reinforcement that is provided for producing fluent speech can actually be very detrimental in the long run, eventually leading to excessive struggle to speak fluently and an ever-increasing set of avoidance behaviors to suppress stuttering.

There is one clear dynamic that most PWS will agree with; The consequences of demanding perfect fluency include anxiety, employment of avoidance behaviors, and an increase in physical struggle related to speaking. While it is human nature to ‘prefer’ fluency, it is empowering for PWS to give themselves permission to say what they want to say, stutter and all. As they systematically face communicative challenges head on without employing tricks to be fluent, many PWS come to rediscover their natural fluency, and find themselves stuttering without recoil or negative accompanying thoughts and emotions. Listeners can help those who stutter by supporting them in this pursuit for healthy acceptance. 

CLIENT PERSPECTIVE from a PWS, now an SLP

For many years of my life, fluency was the first thought that crossed my mind in the morning and the last thought that entered my mind at night. I was obsessed with sounding “normal”, and every moment of stuttering was seen as an affront to my ability to belong. I saw the content of my message as much less important than my ability to say something – anything – without a single stutter. 

In reflecting on these thought processes and following the threads back to their origin, I realized that much of my obsession came from the time I spent in and out of speech therapy as a child and young teen. Whenever there was a challenging presentation in class that resulted in struggle behaviors, a phone call that resulted in the dreaded “click” of a hang up, or an introduction that turned into a smirk, a laugh, or the dreaded “Did you forget your name?”, I would bring these situations up in the safety of my speech therapist’s room. While the faces of my well-meaning and kind SLPs changed throughout the years, the message of “That’s okay! Let’s try harder to practice your techniques!” did not change. I would quickly agree, and by the end of the session, I was using my tools with near perfect accuracy. This would be met with a variation of “See! You can do this! You sounded so great there – no stuttering at all!”. 

It was only a matter of time before I was back in class, paralyzed with fear at the thought of raising my hand or reading aloud. My “fight or flight” response was activated, and I was physically, mentally, and emotionally unable to access rational thought to use my “toolbox” in the ways I showed my therapist I could just hours before in the low-stakes therapy room. This would crush me, and my feelings of disappointment and self-blame would be increased when I was met with a variation  of “What’s going on, Mark? You and I both know you can use those tools so well! Speaking fluently is in your grasp – are you still practicing?” from my SLP in our next session. On the outside, I agreed and committed to practicing even harder. On the inside, I was given confirmation that the only way I would ever be worthy of sharing my true self would be if that true self never stuttered. 

This cycle continued for the first 21 years of my life, and it caused me to convince myself that every moment of stuttering was nothing more than an “X” on a data collection sheet, which inevitably led to shame, fear, and eventually, avoidance of speaking situations that would have brought me joy.  

I was stuck in this loop until I found speech therapy as a young adult that fundamentally addressed my relationship with stuttering and the toxic attitudes that came along with it. For the first time, I heard messages that placed explicit value on my contributions to a conversation, on staying with a moment of stuttering instead of choosing avoidance and compromising myself, and validated the fact that facing a fear is a success in and of itself, no matter the percentage of syllables stuttered while approaching it. Fluency was acknowledged, but was not actively celebrated as adding any more or less value to my communication. This allowed me to develop a solid foundation of valuing saying what I wanted to say, sharing my experience of stuttering with others to create a support system, and eventually, making adjustments to my communication behaviors (e.g., establishing eye contact, reducing unhelpful escape behaviors, “leaning in” to moments of stuttering, and reducing tension) because of my personal choice to become the best communicator I could be, rather than an obsessive need to eliminate stuttering in order to feel that my messages had value. 

I have come to learn that it is not necessarily what we say that matters most, but what we are not saying under the surface that leaves a lasting impression. While comments that come from a genuine place of encouragement about fluency can seem harmless or even motivating, they also make it clear what is being valued most in any given situation. By definition, if we are constantly praising moments of fluency and never mentioning the valuable content of a client’s words, we are also sending the underlying message that stuttering is something “less than”. This becomes problematic (or even traumatic) when we have not helped a person develop the skills to “bounce back” from challenging situations where they first may need to work through their fear of speaking. 

The Role of the SLP in Cultivating Resilience 

While we do not claim that there is a “one size fits all” approach to working with people who stutter, we recognize that the words we use as both clients and as speech therapists to describe stuttering directly inform values and goals for communication. No matter the individual philosophy of stuttering therapy used, therapists must be mindful of the messages that they are sending to their clients, and work to minimize any implicit shame that is in the form of “reminders” or “helpful tips”. It is vital that we emphasize communication over fluency as well as spontaneity over diligence. 

For children, we help parents support their child’s freedom to communicate and grow in their resilient coping responses. Rather than praising fluency, we encourage parents to use comments such as: 

• “I love the way you talk!”
• “Wow, you made such a great point, that was so smart!”
• “I know that took courage to talk there and I am very proud of you”
• ”What you have to say is very important, and I am here to listen no matter how it comes out or how long it takes”
• “You can talk to me anytime about stuttering, and I will always try my best to understand”
• “I have struggles too, maybe we can talk about them together..”

For older children and adults, we most likely will need to address “bouncing back” from the negative messages conveyed by past microaggressions. In addition to helping the client identify and dispute the validity of the underlying messages of these experiences, we promote self-advocacy skills to help deflect those that might occur in the future. Helpful therapy protocols may include stuttering intentionally, working on self disclosing stuttering confidently and without apology, and reinforcing open, forward-moving, non-avoidant stuttering. 

We assert that given the many microaggressions that PWS typically experience in their journeys, it requires significant resilience for those who stutter to speak freely without fear of reaction. It is vital that therapists be aware of the often paradoxical impact of rewarding fluency, and instead work toward helping both children and adults who stutter to speak their mind without fear.  

References

Sue DW, Capodilupo CM, Torino GC, Bucceri JM, Holder AM, Nadal KL, Esquilin M (2007). “Racial microaggressions in everyday life: implications for clinical practice”. The American Psychologist. 62 (4): 271–86.