About the Authors: Jack Rodriguez is a senior in the Communication Disorders program at Texas State University. His personal experiences with stuttering inspired him to pursue a degree in Speech-Language Pathology. His research interest includes the psychosocial aspects of stuttering and is currently in the process of completing his Honors Thesis. He also serves as the president for the NSSLHA chapter at Texas State University.  Farzan Irani is a Professor in the Department of Communication Disorders at Texas State University. His research interest is in the psychosocial aspects of stuttering, bilingualism and stuttering, and treatment outcomes of stuttering therapy. His passion is working clinically with adolescents and adults who stutter using holistic, evidence-based therapy.

Growing up as a person who stutters, I have worked hard to change myself and my stuttering. Acceptance of stuttering is a key concept that served as a turning point in my personal stuttering journey. Since starting this journey of acceptance, I am fascinated by how my definition of acceptance continues to change. I will be sharing my personal journey with acceptance as a person who stutters and how my perception of acceptance has changed over time. Dr. Farzan Irani will provide insights as a clinician and discuss the importance of taking a client-centric and balanced approach as a clinician when it comes to stuttering therapy. 

My Journey of Acceptance – Jack Rodriguez

I have stuttered for as long as I can remember. My father stutters too. Around the age of four, I started to attend speech therapy for my stuttering. At the time, a major aspect of my therapy consisted of working on fluency, exclusively. I do not remember addressing the social, behavioral, and cognitive aspect of stuttering ever during my years of attending school-based therapy. At a young age our thoughts, beliefs, and values are shaped by our external environment and essentially drilled into us overtime. I feel the heavy emphasis my school-based speech therapy placed on fluency instilled anxiety, fear, and shame in me overtime because I was unable to prevent the inevitable stuttering disfluencies that arose. Every time I experienced more stuttering, I was told to work “harder” on my fluency techniques reinforcing the notion that I will not be successful or live a good life with a stutter. Growing up in an environment where everybody perceived stuttering as a taboo topic only amplified my shame towards my stutter and reinforced the feelings of worthlessness. As a young child, my primary coping mechanism was to do all I could to eliminate my stutter. I became a master covert stutterer all throughout my adolescence. My prime goal everyday was to hide my stutter under all circumstances. At that time, I viewed days that consisted of fluency and successful avoidance as “wins” and days where I stuttered frequently as a “loss.” Coping with the intensities of stuttering through constant avoidance of being my true authentic self-led to a lot of dark days that were defined by fear, doubt, shame, and worthlessness. I would experience extreme anticipation anxiety during every interaction. This persistent anxiety stemmed from my fear of being judged as a person who stutters. This fear prevented me from participating fully in everyday communication. I also feared the moments I had no control of my stutter. Ironically, the more I tried to control my stutter the more painful my physical concomitants were. Battling this beast was mentally and physically exhausting. It is safe to say that the word “acceptance” was foreign to me when it came to my stutter during my childhood and adolescence. 

Fast forward to 2018. I am in the spring semester of my freshman year at Texas State University. I was battling the growing pains of a major life transition moving away from my hometown. This led to the most severe period of stuttering I had ever experienced. Most days that semester, I could not produce a sound without experiencing 10- to 15-second-long intense blocks and repetitions. My secondary behaviors are what really amplified the painful experience of my stuttering. During this period in 2018, my body responded to my blocks and repetitions with severe tension in my face and my body to where I couldn’t breathe. I truly felt like I was being strangled. Experiencing this was pure hell. My dad, a fellow stutterer, knew that something had to be done and that I couldn’t live like this. So, he registered me for a two-week summer intensive stuttering program run by Dr. Farzan Irani at Texas State University. This therapy experience changed my life forever. It felt like the first breath you take above the surface after you have been drowning. In my case, I was drowning for 19 years. I shook hands with my stutter and gained an immense amount of acceptance and respect towards it. Before this therapy experience, I was unaware that accepting your stutter was even possible. So, the idea of stuttering acceptance was new to me, and I had the opportunity to define it in my own terms. My upcoming experiences played a critical role in my shifts in defining what stuttering acceptance means to me. 

The Dynamic Nature of Stuttering Acceptance

My experience at the intensive stuttering program led me to define stuttering acceptance as living your most authentic life by not letting stuttering hold you back from doing anything you want to achieve. As much as I still believe this definition holds true, my future experiences with stuttering demonstrated that my definition of acceptance needed to evolve and expand. Ever since my enlightening experience at the intensive program, I have exhibited a strong acceptance of my stutter. I have consistently stuttered overtly, tackled many difficult communication situations head on, and disclosed my stuttering to people I meet. This has all been life changing, but controlling my intense secondary behaviors was still a challenge for me. Although I would overtly stutter in nearly every communication situation, the stutter would often be accompanied with painful tension in the face, throat, and stomach. After the intensive stuttering program, my acceptance mindset was to let my stutter show and embrace everything about my stutter or at least tolerate it. I embraced my stutter openly, but only tolerated my painful secondary behaviors because this pain was a part of my stutter. As two years went on with this mindset, carrying this constant physical pain became a burden for me. I grew weary and tired of having to deal with my body taking a beating every time I stuttered. I was starting to relapse and fall back into my negative mindset and become a covert stutterer. The reason behind this was not because I did not accept my stutter, but it was merely to relieve myself of the constant physical pain my body was experiencing. I was tired of waking up in a constant pain cycle and being afraid to communicate. I knew I had to make a change. Why was I still experiencing physical struggle when I was at peace with my stuttering?

 I reached out to my mentor and professor Dr. Irani for guidance. We talked through what I was experiencing and both of us agreed that: (a) I do not need to accept physical pain to accept my stuttering; and (b) attending the intensive stuttering therapy program for the second time might be helpful. My second time attending the program was different due to my new mindset of acceptance of my stutter. To this point, I had felt very strongly and positive about being a person who stutters which equated to a strong level of acceptance. My own experiences with stuttering and learning from Dr. Irani and other pioneers in the stuttering field led me to develop my own personal values for stuttering therapy which include focusing on the mental and behavioral aspects of stuttering. One aspect of stuttering therapy that I do not agree with is working on fluency shaping exclusively. I feel deeply passionate about this due to my personal experiences with stuttering therapy as a school-age child. Also, my experiences volunteering at Camp Dream. Speak. Live at the Blank Center for Stuttering Education and Research at UT Austin with Dr. Courtney Byrd, the camp supervisors, and participants strengthened my stance on focusing on effective communication over fluency for stuttering therapy. My time volunteering for Camp Dream. Speak. Live was shortly before my intensive stuttering therapy program so my “anti-fluency” mindset was at an all-time high. This mindset led to some very interesting discussions with Dr. Irani and my graduate student clinician. I was nearly all in for Dr. Irani’s therapy plan for me, but I did have some reservations about using techniques for my stutter. In our discussions, I expressed that I did not like the idea of using techniques to prevent my stutter. In my mind, I saw this as a way of eliminating an important part of myself. I was worried about compromising my strong acceptance towards my stutter by using stuttering modification techniques. Dr. Irani explained thoroughly that the use of these techniques was not to eliminate the stutter, but to stutter easier and reduce the physical pain. In other words, he explained that these stuttering modification techniques can be used to combat the physical pain I was experiencing in response to my stutter. He also assured me that my stuttering acceptance did not have to be compromised to use these techniques. In this insightful discussion, the most notable thing Dr. Irani told me was “stuttering acceptance does not mean resigning to the physical pain that comes with it.” This simple statement had a major impact on my understanding of stuttering acceptance and further distinguishing acceptance from resignation. After hearing this, I realized that my recent struggles with stuttering was not the stutter itself, but the tension and physical pain I experienced when I stuttered. I have since experienced easier stuttering, and I could not be more thankful for the pain relief. Acceptance of stuttering does not have to hold me back from making meaningful changes to make stuttering less painful. I am excited to see what the next stop is in this journey of acceptance. 

A Clinician’s Perspective on Acceptance – Farzan Irani

As a student clinician who did not stutter, I learned about fluency shaping techniques, stuttering modification techniques and Cognitive Behavior Therapy (CBT; see Menzies et al., 2009; Prins & Ingham, 2009 for details). I also read about the concept of “acceptance” and its importance in stuttering management. Conversations with my colleagues and friends who stutter coupled with the latest research at the time (Menzies et al., 2008; L. Plexico et al., 2005; L. W. Plexico et al., 2010) shaped my clinical view on the limitations of fluency shaping. What really stood out was the unintended negative consequences for many, as Jack has elaborated above. This was the beginning of my journey (circa 2007-2008) in the application of “acceptance” to my repertoire of goals for stuttering therapy. In the beginning, my understanding and implementation of acceptance was limited – I considered it a goal, “I will help clients accept their stuttering through clinical activities and discussions.” While this view of acceptance is not inaccurate, I soon realized it was inadequate. There is more to acceptance than just teaching clients how to accept their stuttering. As Jack has discussed above, acceptance is a dynamic process. I no longer view it as a goal to accomplish, a “destination.” I now view acceptance as a “journey” that our clients undertake, and we are a part of it. It waxes and wanes, just like the stuttering behaviors do. We need to engage in difficult discussions about what acceptance means to each person at a certain time in their life – make room for this definition to evolve and adapt with the times. As with Jack, when acceptance was a new concept and he learned to accept his stuttering and himself as a person who stutters for the first time, that definition of acceptance helped him effectively manage his stuttering. Moving forward, while Jack continued to accept his stuttering, he also started to experience more secondary behaviors that were causing physical pain. During our discussions we realized the need to recalibrate and modify our definition of acceptance to ensure it was not impeding his ability to modify/reduce physical pain. We decided that acceptance of stuttering does not need to include acceptance of physical pain. Furthermore, acceptance does not preclude one from working on meaningful and desirable change, that is resignation. 

In conclusion, it is important for us to remember that healthy acceptance is a dynamic process that involves adapting to the current circumstances, building tolerance, and not allowing stuttering to dictate one’s life. 

 

References:

Menzies, R. G., O’Brian, S., Onslow, M., Packman, A., St. Clare, T., Block, S., O’Brian, S., Onslow, M., Packman, A., St Clare, T., & Block, S. (2008). An Experimental Clinical Trial of a Cognitive-Behavior Therapy Package for Chronic Stuttering. Journal of Speech, Language, and Hearing Research, 51(6), 1451–1464. https://doi.org/10.1044/1092-4388(2008/07-0070)

Menzies, R. G., Onslow, M., Packman, A., & O’Brian, S. (2009). Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. Journal of Fluency Disorders, 34(3), 187–200. https://doi.org/10.1016/j.jfludis.2009.09.002

Plexico, L., Manning, W. H., & DiLollo, A. (2005). A phenomenological understanding of successful stuttering management. Journal of Fluency Disorders, 30(1), 1–22. https://doi.org/10.1016/j.jfludis.2004.12.001

Plexico, L. W., Manning, W. H., & DiLollo, A. (2010). Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. Journal of Fluency Disorders, 35(4), 333–354. https://doi.org/10.1016/j.jfludis.2010.07.001

Prins, D., & Ingham, R. J. (2009). Evidence-Based Treatment and Stuttering—Historical Perspective. Journal of Speech, Language, and Hearing Research, 52(1), 254–263. https://doi.org/10.1044/1092-4388(2008/07-0111)