About the Author: Heather Najman, MS, MA, LMFT, SEP, has been a part of the stuttering community for more than 30 years serving in roles such as NSA/ISA workshop presenter, NSA Chapter Co-Leader, and as part of the co-hosting team on “Stutter Social.” As a psychotherapist, she consults and works with individuals, and families with a focus on resilience, stress, shame, anxiety, and trauma, including dealing with the emotional effects of stuttering. She is excited to finally cross over and share her thoughts and approach with her stuttering community.

This year’s ISAD theme of “Resilience” is one of my favorite topics, and one that I have been personally and professionally exploring for over a decade. I was originally introduced to it when I began my journey a decade ago in studying Somatic Experiencing© (SE), developed by Dr. Peter Levine, which is a modality of working with short-term or “Shock” Trauma, such as with car accidents, falls, natural disasters, PTSD, and so forth. Resilience is commonly thought of as how can we “bounce back” from when difficult things happen. 

Much of the study and literature on resilience has been influenced by the work of Dr. Stephen Porges, whose Polyvagal theory has had an important impact on those working with trauma. The sympathetic branch of the autonomic nervous system revs us up and prepares us to get ready for activity (action, threat, or exercise), while the parasympathetic helps to slow our systems back down. These two branches, sympathetic and parasympathetic, act as the gas and brake in our nervous system (Graham, 2018). Something happens: a twig snaps, a growl from the woods, a phone rings, and our hearts beat faster, we breathe quicker, and threat is upon us. Ideally, once the threat is gone, the parasympathetic comes on board, and our heart slows down, we can see/hear more clearly again, our hearts begin to slow, and we can “rest and digest”. 

These two systems help regulate our physiology, and support behavior.  Porges’ Polyvagal theory (Van Der Kolk, 2014) proposes that there are two sub-branches of the 10th cranial or Vagus nerve, Ventral and Dorsal, within the parasympathetic (slower) branch of the autonomic nervous system, that travels through our body, from our brain all the way to our gut (gut instinct, anyone?).  In a nutshell, when there is perceived threat, the Dorsal branch affects our energy conservation, it shuts things down when the engine/stress runs too high, and can be sometimes interpreted as a shutdown or freeze state. The Ventral branch, or vagal brake, will try to lower the sense of threat by social engagement, such as making a friendly connection, eye contact, soothing behaviors, laughter, pleasing/submitting, or negotiation. Think of a parent soothing a little one: eye contact, making facial expressions, higher pitched baby talk, and slowing down to connect. If this does not work, or social engagement is not possible, we then will likely engage our stress/threat responses, our fight or flight behaviors, or go to freeze. 

The psychiatrist, Dr. Daniel Siegel, has written extensively on his concept of staying within our nervous systems’ “Window of Tolerance” (Siegel, 2010).  When something gets our attention, our attention and our physiology go on alert to assess what we need to do. That sound in the bushes…is that a twig snapping from a hyena or a hippo? Will I become dinner or will I get dinner? Once I can ascertain the danger is passed, then my system returns to its’ normal state. However, when we live in chronic stress, our bodies may struggle to find its’ way to come back down to “rest and digest.” 

We need to feel some sense of safety in order to feel connected with others. When we feel stressed, our body responds in one of several ways: Fight, Flight, Freeze, Please. We usually have a default or preferred mode, though we are hardwired to fight/flight/freeze. When we feel our activation rise, if we don’t feel safe…one threat response is a sense of Fight. I wonder if the “Fight” response comes out as pushing through blocks/sounds? If we can’t stay and fight a threat, we look for the door, we look for a way out of the stressful encounter. Is Flight in stuttering an avoidance? Word substitutions? And then there’s Freeze. If we can’t Fight, and we can’t Flight/Flee, we can Freeze. Think of possums. Antelopes. They may appear dead, until the threat leaves, then they usually get up, shake and tremble, then escape.  We become silent, and perhaps even stop thinking of things to say…the stress is too constant. The tricky thing is that humans have these big three part brains: the Prefrontal cortex, that is our thinking, logic, reasoning part; our Limbic brain where our emotions, fear, memory, our “fire alarm” resides, and our Reptilian or lizard brain, which controls our heart rate, breath, digestion, just to name a few—all those biological processes that we don’t have to consciously think about to do. 

Dr. Peter Levine has described trauma as things that feel “too much, too fast, and too soon” as in a sense that our nervous system has been overwhelmed. (Eves, 2020).  Trauma is seen not just as a “Big T” Trauma event—an earthquake, hurricane, attack, accident, a birth…”  but can be a series of “Small t” traumas that accumulate over time, and impede our ability to feel resilient. 

Some experience stuttering as a result of Trauma, whether head injury, or accident, as an example.  I wonder though, how many persons who stutter experience the effects of Trauma as a result of their stuttering, of the repeated assaults on their nervous systems, and frustrations day after day, minute after minute,  of feeling the repeated uncertainties of “Will I be able to say this word or sound today?”, the feeling of loss of control, the struggles of trying to use tools and techniques, and so forth. Over time, it takes a toll, there’s a “high cost of doing business” to our bodies. 

What do you do when the remedy, (the Ventral vagal part of the parasympathetic nervous system,) which uses social engagement and connection, which may be the source of more threat distress, for those who stutter? As infants, we look into the eyes and faces of our caregivers for reassurance (Levine, 2010).  Have you ever seen a baby look away when they become too tired, fussy or overstimulated? Breaking eye contact can be a way of regulating our emotions and activation levels.  How does this connect to the tendency that many Persons Who Stutter (PWS) have to break eye contact during a block? Is it an attempt to manage our own dysregulation? Can therapy, whether speech therapy, or self-therapy, find a softer, titrated way to help PWS’s regain eye contact? (I remember one grade school therapist that pulled the back of my hair to make me raise my head. I was too frozen, (and scared and mad) to tell her “Stop!”)  Do we *have to maintain eye contact at all costs? Fluent people don’t. Can Speech Language Pathologists (SLPs) and therapists allow our eyes to settle, to find something grounding or soothing to look at, then back at our faces?  What helps you feel a sense of safety or calm, even a little bit? 

When I went back to school and began studying Cognitive-Behavioral Therapy (CBT) as a part of my studies to become a psychotherapist, I chuckled…for the descriptions reminded me of what I had learned as a young adult in speech therapy. Hierarchies. Desensitization. Challenging automatic negative thoughts.   And it was helpful. It started to change my perspectives, as a person growing up with negative messages.    But CBT did not address my insides, my engine that felt like it was either continually revved up or stuck in a low gear.  It was not until I started exploring somatic (body oriented) approaches that I found change and felt my resilience begin to grow.  I could not think my way out of stress, but had to “tend and befriend” my body, and explore the signals, triggers, and what eased the stress. I began to learn to listen to the language of the lizard part of my brain, the language of sensations.  I began developing an awareness of my internal sensations, slowly, carefully, with support, and tuning into when I felt even the smallest bit of safety, which was a challenge at first, for speaking situations were likely to start revving my engine in microseconds. It is not all about deep breathing and meditating, for some people can actually feel more anxious and dysregulated, once the vagal brake is lifted and all the horsepower underneath comes rising up.  It can be helpful for SLP’s and PWS’s to work with somatic psychotherapists with training and experience in working with Trauma and dysregulation, to help our bodies develop new neuropathways and develop emotional and physiological regulation. 

It is when I met and began studying with authors Kathy Kain and Dr. Stephen Terrell, that my understanding of resilience grew and I felt the parallels with the stuttering community. In their book, “Nurturing Resilience” they remark on how the field of resilience is growing rapidly, and how it is not only about individual characteristics or traits, but many factors—such as family, community, “and larger cultural contexts—that influence how resilience is developed or restored.” They define resilience as “the ability to achieve positive outcomes—mentally, emotionally, socially, spiritually, –despite adversity” (Kain & Terrell, 2018).  I knew this to be true, for I believe that it is in these larger contexts, including self-help, support group, stuttering communities and speech therapy (for those who wish to), that our sense of resilience can be increased.  

It is in relationship that resilience is nurtured, grown, and birthed. Kain & Terrell (2018) cite protective factors that support resilience in children, (even those having undergone significant adversity):   Having supportive adult-child relationships; developing adaptive skills and building capacity for self-regulation; and having some sources of faith, hope and cultural traditions. “ They add that,  “Some people seem to be born with a fortunate predisposition toward resilience, but that is not the most potent influence on its’ development. Harvard’s Center on the Developing Child (2017) suggests that “the single most common factor for children who develop resilience is at least one stable and committed relationship with a supportive parent, caregiver, or other adult.” 

I was fortunate to have supportive parents when I was young. However, back in their day, they were told not to mention stuttering, so as not to draw attention to it. They meant well, but that silence only increased my sense of shame around my stuttering, rather than lessened it. There were others that became supportive in my struggles with speaking. I remember Mr. Lampert, a friend of my parents, who would walk along the beach with me at camp, engaging me in conversation, and listening to me. Mrs. Lazzo. Mrs. Doerr.  John Lowe–the first speech therapist to ever actually ask how I felt about my stuttering. These friends, teachers and professionals took an interest in me and listened to what I thought and what I had to say. Later, when I was in college, I finally met other PWS’s when I came across a conference of the National Council on Stuttering and my life changed. I remember meeting people like Mel Hoffman, Bill Murphy, and learning about the National Stuttering Project, (which is now the National Stuttering Association) but it was three women—Lisa Gibson, Kay Shipton, and Sandra Wagner, that I remember most that first year. Someone like me…women that stuttered. Women and men, with careers, relationships, productive and interesting lives, who happened to stutter. I knew I was not alone anymore.  Connections. My resilience began to grow.  Just as the most common factor for children developing resilience is a stable relationship with a parent, adult or caregiver, the same can be said for adults too. Meeting other PWS’s can feel like our “Safe Haven”. To meet others who will help us co-regulate and not look away, who will not interrupt us, who will not ask us if we have forgotten our name or fill in our words, but who wait patiently and know the effort it takes, can encourage the feeling of home. As the National Stuttering Association’s motto is, “You Are Not Alone.” Through the years, I have heard many PWS’s go to a chapter meeting, a conference, or a Stutter Social hangout, and, perhaps after initially feeling the fright of “What have I gotten myself into?” come back and say that it has changed their worldview, their perspectives, and themselves.  Resilience can be nurtured and grown, by developing awareness, developing emotional and physiological regulation skills, and connecting with others. As one of my teachers said, “If connecting with others is too scary, “try a tree.” (Nature can be a wonderful resource.) Find someone that can help you find your resources, and take one step at a time. It takes time to build new neuropathway roads of resilience, when we’ve spent a lifetime driving fast, bumpy speedways, full of fear and communication crashes. Take all the time that you need. 

References:

Graham, Linda (2018). Resilience. New World Books, p. 30. 

Van Der Kolk, Bessel (2014). The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Viking Books, p. 78. 

Ives E (2020) Peter Levine and Somatic Experiencing. J Psychiatry Ment Illn 3(1): 101 and Somatic Experiencing Training handouts, 2009. 

Levine, Peter. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness, pp. 98-99, 106. 

Siegel, Daniel J. (2010). Mindsight: The new science of personal transformation. Bantam Books.

Kain, Kathy L. & Terrell, Stephen J. (2018).  Nurturing Resilience: Helping Clients Move Forward from Developmental Trauma. North Atlantic. p. 3.