 About the Author:
Courtney Luckman Margulis is a person who stutters, speech-language pathologist, and doctoral student at New York University studying social cognitive influences on stuttering. Courtney also serves as an adjunct instructor at Pace University. She has been an active member in the stuttering community for over eleven years, currently serving as Professional Relations Chair of the National Stuttering Association Board of Directors. She is co-author of the 3Es model for stuttering therapy and her research has recently been published in ASHA Perspectives and the Journal of Fluency Disorders. She is the founder and director of RISE Speech and Communication Center and is particularly interested in bridging the divide between research and practice. In 2020, she received the Distinguished Early Career Professional Certificate of the American Speech-Language-Hearing Association (ASHA). She is a writer for Medbridge Education and has presented on stuttering at several national and international conferences. |
We all stutter differently. Yet, over and over we seek to define what the root, or core, of stuttering is. This is problematic. One size does NOT fit all.
I did not know that I stuttered until I was 15, when I googled “not being able to get your words out” and learned that blocking is a form of stuttering. No one ever thought that the way I spoke was stuttering because we thought that stuttering is when someone just repeats a sound or a word over and over. My mom would just tell me that my brain moved faster than my mouth.
I have had silent blocks since onset and have never once repeated or prolonged except when voluntarily choosing to in an attempt to “get on the sound.” When I began talking, I would point to things and make a grunting noise to request. When I did put words onto my grunts, my stuttering was always in the form of silence, or not being able to get the initial sound started.
There are three types of stuttering: repetitions, prolongations, and blocks. However, some approaches (1) to stuttering propose that blocking is not a core stuttering behavior, but rather, a response aimed at avoiding the core behaviors of repetitions and prolongations. Essentially, this perspective considers blocking as a decision – albeit often unconscious – to wait for the moment of disfluency to pass.
This leads me to two fundamental questions:
- What constitutes the “core” stuttering behaviors, and historically, how were they defined?
- Are there potential negative consequences of categorizing stuttering behaviors into core and secondary?
The theory
The distinction between primary or “core” stuttering behaviors and secondary or accessory behaviors was pioneered by Marcel Wingate2 in 1964. Wingate proposed a “standard definition of stuttering” based on “a careful analysis of elements identifiable in the observable complex of stuttering.” He defined stuttering as sound and syllable repetitions and inaudible (previously referred to as silent blocks) and audible prolongations. He relegated other behaviors to “accessory features” which encompassed a range of speech-related movements, body motions, verbal traits, and associated features. Collectively, these attributes contributed to what he termed “speech-related struggle.”
According to this definition, blocks – referred to here as inaudible prolongations – are indeed a core feature of stuttering.
A few years later3, Wingate introduced the notion that stuttering isn’t caused by breakdowns during repeated or prolonged sounds. Instead, the crux of the matter lay in the transition from one sound to the next. This transition difficulty, according to Wingate’s “fault-line hypothesis”, results from a delay in encoding the rime component in relation to syllable onset. Stuttering, as he framed it, manifested between the first syllable and the subsequent part of the word. In essence, stuttering was defined as the inability to shift from the onset of a word to its rime, rendering everything else as “secondary” or “learned” behaviors.
Implications and challenges
Secondary behaviors, referred to as “tricks” in some stuttering therapy approaches, are behaviors learned in response to stuttering. These behaviors can then be unlearned to return to the core stuttering pattern, promoting open or “clean” stuttering. This perspective underscores the possibility of shedding extraneous behaviors to cultivate a confident communication style with a streamlined stuttering pattern. The message is clear: Stuttering is acceptable, but struggling is not.
However, some issues warrant consideration:
The spectrum of stuttering
Wingate’s theory raises questions about its applicability across diverse stuttering experiences. The initial study involved 20 adults who stutter who were recruited from a university speech clinic, potentially introducing a recruitment bias. It’s possible that people who block might not pursue therapy, unaware that such blocks are considered stuttering. This dynamic could skew the sample towards those who predominantly stutter with prolongations or repetitions. I’ve personally encountered several fellow people who stutter who share a parallel journey with mine, and they, too, were unaware that their silent blocks fell under the umbrella of stuttering.
Expanding the definition
Adams4 presents an alternative viewpoint that highlights the shift from silence to voicing as an integral aspect of stuttering. This expands the definition to include the involuntary loss of control inherent in stuttering. Such a perspective challenges the sole focus of stuttering as transitions between sounds and syllables, asserting that loss of control can manifest anywhere in speech. This is consistent with Perkins5 theory that the loss of control is what categorically distinguishes stuttering from typical disfluencies.
If we consider stuttering to be a loss of control in the forward flow of speech, it can happen anywhere in the utterance. Whether the block emerges at the onset or within subsequent sounds, it remains a block – a struggle to express sound. In a prolongation or repetition, a sound is prolonged until one is able to transition to the subsequent sound. Consequently, prolongations and repetitions effectively impede the progression to the following sound. In essence, these behaviors still represent a block, just on a later sound in a word. Could it be that a block – reflecting the inability to produce sound – is fundamentally at the heart of what defines stuttering?
Recognizing the complexity
Recent research6 surveying 430 adults who stutter offers an insight into the lived experience of stuttering and found that stuttering was defined by speakers as a sensation of anticipation, feeling stuck, and losing control, leading to emotional, behavioral, and cognitive reactions that become deeply ingrained. At its core, stuttering is a loss of control of speech. Everything else is a reaction to this loss of control. This perspective suggests that Wingate’s original definition may not encapsulate its full scope.
Harmful dichotomy
The distinction between core and secondary behaviors might inadvertently foster a sense of shame among people who stutter, promoting the idea that certain behaviors are more acceptable than others. Encouraging people to change blocks to repetitions or prolongations could lead to increased struggle and self-judgment, ultimately hindering their progress.
Personally, trying to change my blocks to repetitions and prolongations just causes me to block and struggle more. It’s that voice in my head that just keeps saying, “Don’t block, don’t block, it’s not okay to block.” I shouldn’t feel shame about the way I stutter just like I shouldn’t feel shame about the way I talk.
For another perspective, Ezra Horak7, a person who stutters, adds:
“One of the main issues with the perspective that blocking isn’t a core stuttering feature, but a secondary, is that it brings back some of the psychological narrative that the stuttering community has finally moved away from. Let’s say you’re being told, ‘Blocking is a secondary behavior and is therefore rooted in avoidance of stuttering, so you block because you’re ashamed of your stutter.’ With this perspective, blocking is due to shame or anxiety. Isn’t that the exact message the stuttering community worked to get away from?
I don’t think it’s a worthwhile pursuit to take blocking out of the ‘core’ stuttering category. Yes – some people may pause before speaking if they know they will stutter. Perhaps some people even have a tension that resembles a block. But does that mean it’s true for everyone? Not necessarily. We need to believe people who stutter and have blocks who say their blocks feel the same loss of control as the repetitions or prolongations.
I myself do both. And I have had many ‘secondary’ behaviors, both conscious and subconscious. No matter how subconscious, it’s not challenging for me to identify secondary behavior, once I become aware of it, as a secondary. Blocking? No. Not to me. Blocking feels as core to my stuttering as my repetitions and prolongations.”
Embracing complexity and individuality
It’s impossible to simplify something that is so complex. Just like we don’t have a single cause of stuttering, an overarching definition might be too simplistic for such a nuanced phenomenon. Our primary concern should be the individuals we are working with, not the disorder behind them. There is no one right way to stutter just like there is no one right way to talk. What is core? What is secondary? Our body adapts, reacts, and heals. Is it necessary to draw the line between the disorder itself and the compensation, or reaction, to it? Whether a block is a core stuttering behavior or an avoidance response, it is still stuttering.
References
- Sisskin, V. (2018). Avoidance reduction therapy for stuttering (ARTs). More than fluency: The social, emotional, and cognitive dimensions of stuttering, 157-186.
- Wingate, M. E. (1964). A standard definition of stuttering. Journal of Speech & Hearing Disorders, 29(4), 484–489.
- Wingate, M. E. (1969). Stuttering as a phonetic transition defect. Journal of Speech and Hearing Disorders, 34, 107-108.
- Adams (1999). A perspective on stuttering. Contemporary Issues in Communication Science and Disorders, 26, 5-13.
- Perkins, W. H. (1990). What is stuttering? Journal of Speech and Hearing Disorders, 55, 370–382.
- Tichenor, S. E., & Yaruss, J. S. (2019). Stuttering as defined by adults who stutter. Journal of Speech, Language, and Hearing Research, 62(12), 4356–4369.
- Quote from Ezra Horak, person who stutters and advocate behind Stutterology.
Hi Courtney, thanks for writing about this – it’s an important topic! I wondered, could you describe your silent blocks in a bit more detail? For example, do you know what you want to say but are unable to say it? Or, is it that you cannot find the words to summarise your thoughts at the moment you wish to speak? Or, something else? I wasn’t sure from what you wrote.
Hi Max,
Thank you for your question. I know exactly what I want to say but the word won’t come out. It’s the feeling of being completely out of control of your speech mechanism and unable to get any sound out.
Courtney
Thanks Courtney! I thought for a while you might have been describing something other than stuttering 😊
I think the term “block” might be used in different ways by different people. In your article and the discussion it seems to be used with at least three definitions:
(1) Silent blocks in which the speaker is actively trying to speak, but cannot create airflow enabling phonation. This is the way in which I’ve used the term.
(2) Silent blocks in which the speaker for that moment abandons the attempt to use spoken language, and instead uses another form of communication – e.g. pointing, or grunts in an attempt “get on the sound”. This is what I think you are describing although I may have misunderstood – if so, please clarify.
(3) Loss of control during the moment of stuttering. In this sense, “block” would mean that stuttering itself is presenting an obstacle to completion of a speech act. This seems to be the way in which some commenters (Hanan, Ezra) have used “block”.
With definition (1), blocks are part of primary stuttering. With definitions (2) and (3), blocks are a mixture between primary and secondary stuttering.
Does this make sense to you?
Hi Max- Ezra here. Could you please cite anything showing the difference between 1 and 3? I’m not even sure I understand 1- that sounds like possibly something else. Not stuttering.
Also it sounds, to me, like Courtney is using the same definition as Hanan and I are in the comments.
Hi Ezra,
You can deliberately create a silent block of the type described in (1). To do so, try to say the word “bang”, but keep your lips held firmly together throughout. The muscular spasms which result are a hallmark of stuttering. Silent blocks of this type can also be created at the larynx, and between the tongue and either the velum or the alveolar ridge. Blocks such as these occur involuntarily in stuttering, and can often be distressing.
The term “block” to refer to a general loss of control during stuttering, as per (3), would include silent blocks of the type described in (1). However, “block” in this sense of loss of control could be wider. For example, it could also include some prolongations and repetitions. It could also refer to the mixture of silent blocks, prolongations and repetitions which often co-occur during longer instances of stuttering – for example, if the stuttering is going on for 5 or 10 seconds, one might cycle between several of these types of stuttering. In addition, “block” when used to refer to loss of control could include word substitution, hand or foot movements and so on. If the desire is to eliminate a distinction between primary and secondary stuttering in favour of a generalised “loss of control”, then running these different types of stuttering together would seem to be a consequence. I’m not sure if this is helpful, or is what has been intended, but it’s the at the root of what seems to be a terminological confusion that I’m trying to resolve here.
I don’t know if Courtney considers the experience she has described as (1), (3), or something else entirely, which is why I keep checking.
Max
Hi Max,
It seems like 1 is what is happening physiologically and 3 is what appears behaviorally – the speaker reacts to this loss of control of speech. The reaction to that loss of control can manifest as prolongations, repetitions, or blocks. Blocking is not synonymous with loss of control. People who stutter do lose control all the time (that is essentially what stuttering is) and this can be in the form of any break in fluent speech.
I am not describing #2. I do not see myself as abandoning the attempt to create spoken language – the sound just won’t come out so it’s silence until my vocal folds create airflow (see #1)
Please let me know if I can provide further clarification.
Courtney
Thanks Courtney. I think this clears up any confusion for me!
I’ll try to summarise how I think primary and secondary stuttering relate to the feeling of loss of control:
– Primary stuttering is prolongations, repetitions or silent blocks (which I referred to as (1)).
– Secondary stuttering follows from primary stuttering. It can be overt (e.g. foot taps, loss of eye contact, arm movements) or covert (word substitutions, situation avoidances, feelings of shame or anxiety etc).
– The feeling of loss of control (which I referred to as (3)) describes a combination of primary and secondary stuttering. Some who stutter might refer to this loss of control as feeling blocked, which could lead confusion with the silent blocks which are a specific feature of primary stuttering.
In addition, there is some discussion of whether the primary/secondary distinction should be abandoned, and stuttering simply referred to as loss of control over speech. Such a definition may be advantageous for psychological therapies in which those who stutter will accept their stuttering as is, and will not try to change it.
I can see at least a couple of drawbacks to such a redefinition. This first is that it does not distinguish stuttering from several other types of dysfluency or impaired speech. The second is that it undoes the rationale and mechanism for any type of speech work specific to stuttering. This second objection may not be an issue for those who do not intend to do speech work.
Hi Courtney
Thanks so much for your paper. The topic you write about is really important, in my opinion, and really valuable for me personally.
You write that “The message is clear: Stuttering is acceptable, but struggling is not.”. I suggest that therapists who frame it like this are wrong. The word “acceptable” is not acceptable. Non-judgment must be key to therapy. The way that I learned (from Vivian Sisskin) to “Accept the stuttering, not the struggle” in no way caused me to feel shame about struggling. I learned that I can reduce my suffering by no accepting – for myself – the struggle. This is completely different, to me, from how the message you mentioned is framed.
No one should be ashamed, or made to feel shame, for any aspect of their stuttering. In that respect, differentiating between primary and secondary characteristics is indeed not important and not desirable.
The harmful dichotomy you wrote about is really interesting. For me, learning to differentiate between primary and secondary characteristics has been absolutely crucial to my recovery from the effects of the stigma of stuttering, and crucial to me being able to be at ease when I speak and when I stutter, since I am mostly not struggling. But I do not feel any shame about struggling. I understand why I struggle against stuttering, i.e. because of the stigma and as a result trying to hide the stuttering.
The possibility that “The distinction between core and secondary behaviors might inadvertently foster a sense of shame among people who stutter” is not a foregone conclusion. I suggest that this would only happen if the therapy was bad. There is absolutely no need for that sense of shame.
I have never understood the therapeutic approach of telling/teaching PWS to change their blocks to repetitions or prolongations. I am sorry that you had this experience and this unnecessary suffering.
Thanks for including Ezra’s perspective, which is very insightful. I believe they wrote this in response to Dr. Heather Grossman’s suggestion to consider whether blocks are primary or secondary characteristics. I value Heather’s courage and wisdom in bringing up the topic for discussion.
Anyway. Thanks so much, Courtney, for your courage and wisdom, too.
Hanan
Hi Hanan! Yes, I provided this information for Courtney to use. It’s not meant to take down anyone or invalidate the question. While an interesting discussion, I find that there’s no reason to remove blocks as a core stuttering behavior.
I think it’s more helpful to see it as blocks can stand on their own, while also acknowledging some people pause or block, even subconsciously, to avoid stuttering. And it’s worth digging into with someone, but by no means assuming it must be avoidance or subconscious behavior. It makes more sense to acknowledge normality around blocking, the way we do with stuttering. And if it comes up for the person, it can be dealt with then.
I recently asked some PWS how they would describe their blocks. There was not one trace of avoidance in there. It was all about the feeling of a loss of control – sometimes identical answers to how prolongations or repetitions feel.
While an argument can be made that “it’s because it’s so subconscious” – I have to put a hard stop on that line of thinking. How many decades has the same thing been said about all stuttering? Haven’t we been fighting to stop that misinformation?
I think if multiple PWS confirm that yes, blocking feels innate to stuttering, in a way that many other behaviors don’t (looking away, foot tapping. These feel connected but not innate – then it is best to believe the stutterers.
Hi Ezra
Thank you for this additional information. The points that you raise, and Courtney’s, are very interesting for me. Stuttering, and perhaps specifically the blocking aspect of stuttering is complex, and it is wondrous that we are all working to gain better understanding.
No one who stutters should made to feel shame about how they handle their stuttering. I do not have an opinion on whether blocks are primary or secondary characteristics of stuttering. My own stuttering was and is mainly blocks.
I look forward to being able to discuss this and other topics face to face some time.
Thank you, too, Ezra, for your courage and your wisdom.
Hi Hanan,
Thank you for reading and for being vulnerable with this comment. I always appreciate your thoughts.
I understand and respect that this was your experience. I interpreted learning about the distinction between core and secondary (or tricks) and working on reducing struggle behaviors differently than you and that led me toward a downward spiral.
Changing how you stutter – going from struggle to more “forward-moving” stuttering is a common approach and although I think it’s valuable and useful to many clients, it created more shame and struggle for me.
I think the key here is exactly what you said – how the message is framed. This post is not meant to critique any particular therapy approaches (I was trained in ARTs and do value a lot of aspects of the approach). It’s just one person’s experience (mine) and maybe others can relate – or not! That’s healthy and good. Part of the reason I wrote this is to spark debate and I’m happy that we can discuss this topic here. I’d love to continue this conversation with you in person at a conference.
I also value Heather’s perspective and I’m glad she wrote that post. That is what sparked my article.
Thanks again Hanan.
Courtney
Hi Courtney,
Thank you for this dive into core and secondary behaviors.
Like you, I wonder if considering the notion that the dichotomy between core and secondary behaviors may no longer be a helpful contrast. Recent research (Tichenor and Yaruss, 2019; Jackson et al.,2022) related to loss of control has many of us wondering if observable (or unobservable) features of stuttering reflect the individual’s reactivity to loss of control. In this case, we might consider that individual stuttering patterns or profiles do not represent “stuttering” but an individual’s adaptive responses to loss of control throughout their journey, conscious or otherwise.
ARTS® does not seek to convert blocks into repetition and prolongation. Repetition and prolongation themselves can sometimes (depending on intent) represent efforts to hide or conceal stuttering – consider restarting to avoid overt struggle (initial sound/syllable repetition) or holding on to a sound to maintain control over how the disfluency is perceived by others (prolongation). ARTS® encourages stutterers to shed effort (including efforts to control) by reducing avoidance, concealment, escape, as well as efforts to control the thoughts of others and efforts to suppress one’s own feelings or identity.
For many who stutter, a block is effortful. They don’t like blocking, even if they embrace their identity of “stutterer” with acceptance or pride. For them, a block takes a hit on comfort, confidence, or spontaneity while stuttering. If blocks can be reduced by many by giving oneself permission to stutter openly and authentically, and by letting go of effort in response to loss of control, this can be a valued outcome for those who choose to do so.
My years of supporting stutterers to achieve comfortable and confident communication, while embracing and valuing their authentic identities, tells me that (for many) blocks represent early or current efforts to hold back from showing stuttering (or showing too much stuttering, or showing stuttering too openly or too loudly). They do reduce blocking and feel relief. This increases confidence and agency, as they accomplish a realistic goal (not fluency), that is stuttering-affirming.
In ARTS®, there is no shame assigned to any form of stuttering. Many stutterers feel shame related to self-stigma, failed efforts to fix stuttering, ideas that their form of stuttering is given a label of “severe”, etc. This is a reality. To do something to reduce shame (or any form of struggle) is a choice. I do believe that stutterers can make choices (if they desire) to shed the vestiges of old feelings, attitudes, or learned behaviors that may be current placeholders in their stuttering pattern. However, it’s ok to stutter, to struggle, to block, and to conceal/avoid. It all has to be ok. If not, then efforts to “fix” add to the physical, social, and emotional struggle.
Jackson, E. S., Dravida, S., Zhang, X., Noah, J. A., Gracco, V., & Hirsch, J. (2022). Activation in right dorsolateral prefrontal cortex underlies stuttering anticipation. Neurobiology of Language, 3(3), 469-494.
Tichenor, S. E., & Yaruss, J. S. (2019). Stuttering as defined by adults who stutter. Journal of Speech, Language, and Hearing Research, 62(12), 4356-4369.
Vivian Sisskin
Clinical Professor Emerita, University of Maryland
Sisskin Stuttering Center
Hi Vivian,
Thank you for reading and for this comment. I always value and appreciate your insight and expertise.
This was not meant to be a direct critique of ARTs®. Rather, it is a conversation around something I have experienced and have noticed in methods of stuttering therapy. I respect ARTs® and I know that for many, it has changed their lives.
For me, manipulating my stuttering, or changing my core stuttering (which to me, is blocks because that’s what comes out naturally) to another type of stuttering that was more forward moving was counter-productive and felt inauthentic and awkward. It’s less about the objective concept itself (I frequently use forward moving speech with clients), and more about how it is presented.
The purpose of this article was to discuss how we classify stuttering behaviors and why, and if it even makes sense to distinguish core and secondary behaviors anymore. I also wanted to initiate a conversation about blocks, since I frequently see them classified as an avoidance behavior. This conversation is important, and I’m glad you shared your thoughts.
You’re absolutely right – it all has to be okay. It’s great that we have places like the ISAD conference to help convey that message.
Great paper, Courtney, as always. I admire your desire and ability to dissect something down to it’s core, to make it easier to understand. Your contributions are always very thought provoking.
I loved this line “Our primary concern should be the individuals we are working with, not the disorder behind them.” Right, we are people first, not the disorder we may be asking for help with.
Once you realized that your blocking was indeed stuttering, was it then that you sought therapy? Did your therapist know how to deal with “just blocking” that wasn’t accompanied by repetitions and prolongations?
Pam
Hi Pam,
Thank you for reading. Great question. When I found out that my blocking was a type of stuttering, I began Skype sessions with John Harrison who wrote a book about blocking (his page was one of the ones I came across when I googled not being able to get your words out). I thought he was the only one who knew about this weird form of stuttering that was blocking (ha ha). I met with him for several years and he referred me to the Successful Stuttering Management Program and from there I found the stuttering community – and here I am.
Relatedly, I did go to speech therapy for one session when I was 12 because I was so nervous about speaking at my Bat Mitzvah. The speech therapist did not know what was wrong with me – she did not know why I couldn’t get my words out. This was 2003, so I hope things have changed since then.
Courtney
I sure hope things have changed too! You are one of the influencers leading the charge for change.
Pam
Great article, Courtney. I am not an SLP; however, I am a person who stutters. For my entire life, I have always viewed blocks as one of the three types of stuttering.
Until reading this article, I never thought of blocks being a form of avoidance. After reading your article and the comments, I stand with your article. Most of my stuttering moments are blocks and I can assure you I’m not trying to avoid those stuttering moments.
Thank you for reading and for sharing your thoughts, James.
Hi Courtney,
Thank you for your article. I really enjoyed reading it as well as the comments below it.
This topic is perfect for the theme, “One size does not fit all”. For you and others, blocks are not a consequence of avoidance. Maybe for others, it could be. So, I consider it relevant to ask the students/clients about what they feel and think they are or perhaps discover with them if they are trying to conceal or if it just happens when they feel that loss of control.
Thanks again for putting this topic on the table. I keep thinking about your message, “Stuttering is acceptable, but struggling is not”. It reminds me when some people (parents, teenagers, adults) say that they want to accept and stutter and stutter as little as possible.“Stuttering is acceptable, but not when it is so frequent”. As a therapist, I should embrace all the complexity and nuances of stuttering.
– Cynthia
Thank you for reading and for this comment, Cynthia. Acceptance is so tricky – it’s easy to fall into the trap of being willing to accept some kinds of stuttering and not others. It’s our job as SLPs to not reward certain types of speaking.
Courtney,
Your insights and personal journey with stuttering offer a refreshing perspective that underscores the need for continuous reassessment of our collective understanding of stuttering. I was particularly moved by your own realization at 15 and how it highlighted the gaps in the prevalent definitions of stuttering.
Your discussion about Wingate’s theory and Ezra Horak’s viewpoint drives home the point that one-size definitions may unintentionally overlook or misinterpret diverse experiences. Instead of entangling ourselves in the “core” versus “secondary” debate, our focus should pivot to the nuanced experiences of each individual.
Thank you for initiating this conversation, emphasizing the significance of individual experiences and the need to continually reassess our approach to stuttering.
Warmly, Martha
Thank you so much for reading and for this comment, Martha. Yes – pivoting to understanding the nuanced experiences of each individual is crucial.
Hi Courtney,
I love the clarity of your questions:
What constitutes the “core” stuttering behaviors, and historically, how were they defined?
Are there potential negative consequences of categorizing stuttering behaviors into core and secondary?
You said:
“At its core, stuttering is a loss of control of speech. Everything else is a reaction to this loss of control.” I totally agree and disagree! How can I have it both ways? It’s in the use of the word “control”. People Who Stutter (PWS) do their best to control their speech, their speaking situations, and the perceptions of others, while people who do not stutter do not venture into those realms.
You may be thinking that you do not control your block, it just happens. Wham, there it is from out of the blue. I wonder though: is that always your experience? Are there ever times when you can feel a block coming on? If so, what does that feel like? What exactly happens in your body and mind before, during and after a block? What does your block want you to know about itself? I ask these questions because the answers are within you. You wrote: “It’s that voice in my head that just keeps saying, ‘Don’t block, don’t block, it’s not okay to block’ ” so it sounds like there might be awareness and anticipation, unless this voice speaks only when there’s no awareness or anticipation – it’s just a running generic admonition – which I doubt. Also, there’s a clearly stated Belief “It’s not okay to block.” How did this Part come to believe this about blocking? What does this Part believe would happen if it didn’t hold this belief? My point is, your blocking Part/s control when and how you block, and “You” are not your Parts. You are more than the sum of your Parts. Let me explain.
For the record, I never saw stuttering behaviors (repetitions, prolongations and blocks) as the core of stuttering; it’s always seemed to me that stuttering is so much more than “the tip of the iceberg”. I’ve been using John Harrison’s Stuttering Hexagon since the early to mid ‘90s. John identified the following six elements that make up one’s Stuttering System: Behaviors, Emotions, Perceptions, Beliefs, Intentions, and Physiological Responses. This is a dynamic system with all of these elements playing interactive roles with one another.
I’ve added a piece to the center (Core) of the model. I used to call it Intuition (see my 2002 ISAD paper, the link is in references), and while that term still works, I ’ve found that some of my clients couldn’t always relate to that term, so I offer a variety of ways of understanding and relating to the Core of one’s Being. My clients have chosen to call the center of their Being their Core, True Self, Inner Wisdom, Authentic Self, Personal Truth, Real Self, Higher Self, Self Energy, True Essence, Intuitive Self and/or Heart. When my clients are speaking aloud alone, they are typically in this type of Core Energy (I teach my clients how to notice subtle changes in their Energy Systems) and speak with ease, naturally. Their Stuttering System, however it is designed, has no need to kick in, so all its Parts are at rest. If a judgment, thought or belief related to stuttering does slip into this private moment, the Stuttering System kicks into gear. The Stuttering System is based on experiences and memories, be they conscious or subconscious. This might explain the Jackson et al finding in the paper entitled Adults who stutter do not stutter during private speech.
My clients don’t convince themselves to accept stuttering because “it will never go away”. They learn to accept that there are Parts inside them that have been controlling their speech to protect them from shame, embarrassment, feeling lesser than, not good enough, broken, depressed, powerless, imperfect, you name it. When they discover and learn who these parts are, they can begin to generate and establish a trusting relationship with these young, frozen in time from when they first appeared, Parts (often two-five year olds, but sometimes stuttering emerges later, as it did with Courtney and me) who have only the best of Intentions.
These Parts truly believe that they are entrusted with protecting us from harm in some way. Listening to and understanding how and why the Part does what it does creates a compassionate, accepting and respectful relationship between one’s Core/Self Energy and the Stuttering Protector Part. This understanding relationship allows for healing misguided intentions from the Part/s and can lead to diminution or dissolution of the Stuttering System. This is what is called “Parts Language” or the Internal Family Systems (IFS) model, and we use this to get to know each client’s unique Stuttering System.
Even though I never bought into the notion that stuttering was just a behavior (as was the doctrine when I was an undergraduate), it took time to understand the nature of the System. While John’s mapping of the System was a guide, and my Intuition told me what to add to the center of that System, my work with clients has evolved over the years, just as the terminology has. It started with more concrete questions about what it felt like in my client’s body, what my client’s thoughts, emotions, beliefs, perceptions and intentions are, and how they reacted in different situations.
I had my clients use their imaginations, forms of self-hypnosis, guided imagery, meditations, reading and speaking aloud when alone, noticing the differences in the mind/body when speaking alone vs with a listener – just a mechanized listener such as a recording device, or the visual feedback of speaking to their Self in the mirror. They learned to embrace their Innate Ability to Speak Naturally (IASN) as their default system for speaking – and eventually accept and learn to speak from their Heart, not their mind since the mind controlled their speech. They learned to let go of all control and trust their IASN to operate automatically, without any interference or controls, gradually speaking as their True Self. These strategies certainly helped my clients learn to trust and use their IASN more. But it was like traveling without GPS. Sure, we arrived at essentially the same place eventually, but it wasn’t the most effective or efficient way to get to the desired destination. Using IFS changed all that.
Max shared a related thought regarding what he might think of as this kind of therapeutic approach: “…psychological therapies in which those who stutter will accept their stuttering as is, and will not try to change it.” My clients don’t come to me to learn to accept their stuttering. My clients seek me out because they want to stop or diminish stuttering. So that’s what we work towards. Not with any claim that they will never stutter, but with the goal of understanding how their Stuttering System and IASN work, and how these systems have (not) been working in harmony with my client and vice versa. It’s not my job to convince my clients of any tenet related to acceptance. It’s my job to help them understand and relate to their own Stuttering System the best I can. And I firmly believe that THEY are the experts on their Systems, not me. I listen to them and draw a roadmap of sorts – they typically make the connections on their own. I help them notice “Trailheads” (Parts language for a lead to a Part and its beliefs) and we proceed from there.
I agree with Cynthia, who asks her students/clients about how their block operates. Each person knows deep down what is going on inside. So I ask them to look inside to explore and find the answers. I don’t know their System, but they do, they just aren’t aware of it yet! And of course I agree with Martha who wrote “Instead of entangling ourselves in the “core” versus “secondary” debate, our focus should pivot to the nuanced experiences of each individual.” Martha and Cynthia seem to Intuitively gravitate to Parts work – they just may yet not know it!
Courtney, you wrote “The purpose of this article was to discuss how we classify stuttering behaviors and why, and if it even makes sense to distinguish core and secondary behaviors anymore.” John Harrison offered five ways to classify stuttering:
“The dysfluencies related to primary pathology such as cerebral insult…’call pathological dysfluency”
“The disfluencies that surface as the young child struggles to master the intricacies of speech we’ll call developmental disfluency.” (note his use of dys for pathology and dis for developmental.)
“For the easy and unselfconscious disfluency characteristic of those who are temporarily upset or discombobulated we’ll need to make up a word, since one does not exist. We’ll call this kind of disfluency bobulating.”
“The struggled, choked speech block that comes about when someone obstructs air flow and constricts muscles we’ll call blocking because the person is blocking something from his awareness (such uncomfortable emotions or self-perceptions) or blocking something from happening that may have negative repercussions. This is the chronic disfluency that most people think of when they speak of ‘stuttering’ behavior that extends into adulthood. Unlike developmental disfluency and bobulating, blocking is a strategy designed to protect the speaker from unpleasant consequences.” (Wow! John didn’t even know about IFS and yet he intuited that that blocking is a Protector!)
“Finally, there is a fifth kind of dysfluency related to blocking that occurs when the person continues to repeat a word or syllable because he has a fear he will block on the following word or syllable. Since he is just buying time until he feels ready to say the feared word, we’ll call this kind of dysfluency stalling. Because stalling is an alternative strategy to the overt struggle behavior associated with speech blocks, the two must be considered in the same vein.”
I see John’s suggested terminological changes as ways to communicate about the nuances, and to educate my clients and their Parts about the differences, but I don’t have a need for using the terms for deeper analysis or therapeutic intervention regarding the Stuttering System since I see blocks and stalling as Parts of the Stuttering System that each client needs to figure out for themselves. Now that’s one size that does not fit all!
As for your second question: “Are there potential negative consequences of categorizing stuttering behaviors into core and secondary?” I’ll say absolutely! It keeps us from seeing the BIG PICTURE. Stuttering or blocking and stalling are just behaviors. There is so much more that goes into what creates and maintains a person’s Stuttering System.
A Guide to Recovery Redefining Stuttering What the Struggle to Speak is Really All About, 2011 Edition, by John Harrison available as a free ebook
https://freestutteringbooks.com/wp-content/uploads/2023/02/redefining-stuttering-2011.pdf pages 14, 15.
Foer, Marjorie, Working From the Inside Out: A “Soul-Directed” Approach to Stuttering Therapy
https://ahn.mnsu.edu/services-and-centers/center-for-communication-sciences-and-disorders/services/stuttering/professional-education/convention-materials/archive-of-online-conferences/isad2002/working-from-the-inside-out-a-soul-directed-approach-to-stuttering-therapy/
Jackson, E.S., et al, Journal of Fluency Disorders, Volume 70, December, 2021, 105878
https://www.sciencedirect.com/science/article/abs/pii/S0094730X21000577
Dick (Richard) Schwartz, Internal Family Systems https://ifs-institute.com/
Thanks again for such a provocative article,
Jorie Foer
Hi Jorie,
Thank you for reading and for putting the time and effort into this response. I appreciated reading about your perspective.
Yes – of course I anticipate a block coming on. Anticipation is such a core part of stuttering and I often wonder what would happen if we DIDN’T anticipate a moment of stuttering. My argument here is not about anticipation – it is about distinguishing between a block and other types of stuttering. In my experience and my professional opinion, the anticipation is the same whether the type of stuttering is a block, repetition, or prolongation.
I will also clarify that I am not defining stuttering as prolongations, repetitions, and blocks. Of course we know it is more than that and there is a slew of research to support that. I am discussing the classification of how we distinguish OVERT stuttering behaviors.
Thanks again for your contribution.
Courtney
Hi Courtney,
I do understand that you’re concerned about distinguishing between a block and other types of stuttering. And we’re in agreement when you express “Anticipation is such a core part of stuttering and I often wonder what would happen if we DIDN’T anticipate a moment of stuttering.” EXACTLY! My hope is that your research follows your curiosity around that very question.
When our profession focuses on “…the classification of how we distinguish OVERT stuttering behaviors”, in my professional opinion, it promotes the pursuit of a red herring. The dynamics of what goes on beneath the surface of the iceberg is what fuels the stuttering behaviors (blocks, repetitions and prolongations).
These components BENEATH the surface of the iceberg – the avoidance, shame, fear, doubt, perfectionism, inner critic, etc. create and maintain the stuttering behavior – no matter the type. Therefore, research, training and therapeutic intervention need to focus on what’s BENEATH the surface of the iceberg because that’s where the core of the Stuttering System lies.
Thanks for considering these thoughts,
Jorie
Courtney, I appreciate learning from your experience, thank you for sharing. Important discussion and food for thought!
Thank you for reading, Ana Paula!
Hi Courtney
This is a long and complex thread, which I fear I am losing! It is fascinating and I suspect important.I am a little overwhelmed by the august company I find myself in on this thread – yourself, Vivian, Max and others!I am not a speech and language therapist but a person who stammers who has an personal interest in the theories of stammering leading to better treatment. It would be an ideal world indeed if all therapists agreed on the theory therefore making it easier for people who stammer to choose one practise!
I agree with Max that the definitions of ‘block’ are important and that we are all using the same definition when talking to each other.
I first became aware of the word in the ‘Block’ Modification of Van Riper. This was over 25 years ago now and my memory may be suspect. I took block to mean silent blocks and repetitions and prolongations. I didn’t think you could modify a silent block – so just took block to mean repetitions and prolongations, which you could modify. I can’t remember if Van Riper told you to do anything with silent blocks.
I then moved on to Sheehan and I took it that silent blocks were a form of avoidance.
Perkins was next and I literally nearly fell out of my chair when he said that the block was the core feature of stammering and the repetitions and prolongations were secondary to that and a means of escape. For some reason it resonated strongly with me.
I think he thought that the block was THE core of stuttering, rather than A core, including repetitions and prolongations. He seems to agree with you that the inability to produce sound (block) is at the heart of stuttering.
I hope this is a useful contribution.
Best Wishes
Tim
Hi Tim,
Thank you so much for reading and sharing your insights. You summarized the work on this topic eloquently and concisely, thank you. The original title for this article was actually “Is the silent block at the heart of stuttering?” but I shifted the topic a bit in order to discuss the possible consequences of classifying a block as an avoidance behavior. I do think Perkins was onto something. I am no expert on Van Riperian theory but I think the only way to modify a silent block is through cancellation (saying the word again in a new way).
Thanks again,
Courtney
Hi both,
Van Riper recommended use of vocal fry to modify silent laryngeal blocks. There is even an audio demonstration of him demonstrating how to perform these. If you hunt around on Judy Kuster’s website, which is such a great resource, it’s the clip where Van Riper is being interviewed by a student from one of the Scandinavian countries, IIRC. They use the word “editor” as the example. The clip is probably on this page, but I didn’t immediately see it when I checked just now: http://judykuster.net/stut/voices/voicesindex.html
I’ve found the vocal fry by far the most difficult to use of any of the stuttering modifications. The other types of silent block (at the lips, or between the tongue and either the velum or the alveolar ridge) can be resolved by using what Sheehan referred to as “slides” or what Van Riper referred to as “preparatory sets” and “pull-outs”. I should emphasise that if you do any of these things, you are still stuttering! However, you are choosing what type of stuttering you do, and this can have important psychological benefits in terms of feeling in control and so on. It is also possible to reduce some of the more unpleasant secondaries such as jaw jerks and word avoidances.
I incidentally think that the original title of this article was better! There is a thread of empirical research, which begins with Sheehan in the 1960s and continues through to work by Sheila Stager a few yeas ago, supporting the idea that the block is the most identifiable feature of stuttering. The silent block is particularly interesting, since it temporarily removes the ability for spoken communication entirely.
Max
Hi Courtney! I am currently in graduate school to become a speech-language pathologist. I think your perspective on the potential harm of the distinction between primary and secondary behaviors is one I had not considered until now, so thank you. However, I would love to hear more of your perspective on what we can do as professionals to make potential improvements. How do you see a more inclusive and acceptive definition or perspective on stuttering that considers the diversity of experiences for terms of diagnosis?
Thank you for reading! That’s a great question. I think it speaks to how important it is to be client centered. There is no one right way to stutter just like there is no one right way to talk. I love how Seth Tichenor and Scott Yaruss define stuttering – as a loss of control. I think their papers can be extremely beneficial to new clinicians to help them understand the experience of stuttering.
Hi Courtney
To me, whether what I do is primary or secondary, can vary. Sometimes I know I will stutter. A person’s vibe, background noise, impatience. But sometimes it comes as a surprise. All the externals are perfect, people are nice, waiting, they know I stutter, I’m at ease, that just like that, it just stops and I cannot get the letter out. Earlier this year I was out for dinner with my siblings. They ordered desert and I just wanted a spoon to taste theirs, as a whole desert would be too much. I hardly every had problems with saying spoon, (or in Dutch: lepel), but there was nothing. Absolutely nothing. The waiter patiently waited, my siblings were laughing and so was I, as the situation became hilarious, as I wanted to make the order myself and the others had no clue what I wanted. I never had a block that long. There was no shame, I could say whole sentences, but this very word just didn’t come out. For minutes. And then finally, there it was. Lepel. I also told the waiter I was not kidding him, as I really stutter, and even showed him my button with “Sure I stutter, what are you good at”.
So whether it was primary or secondary, I don’t know. Did the situation make me block, or did I block and couldn’t get out because of the situation. And to be honest, I don’t really care. I even doubt if any SLP could give me the tools to get out of that block. What I’m simply trying to say is that, even if books and research says which is which, it can stil vary for different individuals. Says I who’s not an SLP nor a researcher ;-), just simply trying to analyze my own speech, my emotions around it. But I wonder, even more when reading this thread, is there is a one size even here. Which is why I don’t envy SLPs, but appreciate every single one of you who’s trying to make sense from this thing called stuttering. 😉
Happy ISAD
Anita
Thank you, Anita, for this lovely comment, and for sharing your experience. That variability drives me insane sometimes! I love what you said – “What I’m simply trying to say is that, even if books and research says which is which, it can still vary for different individuals.” That’s a great point. Whether we categorize something as core or secondary depends on the individual. I sometimes wonder if there aren’t subtypes of people who stutter. I always wince when I read research that makes generalizations about all people who stutter – as everyone’s experience is slightly different. Thanks again for this – always appreciate your insights.