Not focussing on how we are speaking
Hello, I am a person who stutters. As you are probably aware, people who stutter often have certain situations where they are (more or less) consistently naturally fluent e.g. when on their own or when talking to a small child. Based on what I have heard/read and based on my own experiences too, these are situations where we do not anticipate having difficulty speaking. We don’t think about stuttering and we are not thinking about how we are doing it, as we are talking. We just talk and it all happens effortlessly and automatically. So my question is, what ways have you discovered which help your clients to take their focus away from how they are talking, so that the brain can use its automatic neural pathway to produce natural, effortless speech? Thank you.
Hi Hazel,
This is a very good question. We know that the more people try not to stutter, anticipate how to talk, and think about talking, the more they stutter. This is because speaking is meant to be a subconscious, automatic activity. Conscious monitoring, using learned speech controls and thinking how to speak interferes with the normal speaking you sometimes experience. Given this knowledge, we need to address how a person who has spent a lifetime thinking about how to speak can become an automatic speaker.
The answer is that you need to trust that what you do when you are alone or speaking with children is all there is to speaking. What you do then is simply think aloud. That’s what fluent speakers do all the time.
For most people who stutter the reason for not doing this all the time is related to beliefs about speaking, anxiety, anticipating stuttering, wanting avoid error, and having established neural networks for speaking that are linked to your beliefs, thoughts and feelings.
Self or professionally guided therapy requires making changes in all these areas. It means giving up all the interferences in mind and body that negate your natural ability to speak fluently. Use your focus of attention and intention to become as oblivious of how you are talking in important situations as you are when you are talking to yourself.
Hi Barbara
Thanks for your thorough and insightful reply. I am just wondering if you have any specific tips which you can share, which might help a person who stutters to become oblivious to how they are talking?
Hi Hazel,
We humans can really only focus on one thing at a time, so the best way to become oblivious to the words is to intend to do something else aside from saying words. Since every speaker has to activate their voice in order to speak, the best intent is to activate your voice with natural intonation. The voice is separate from the activity of the mouth so forming the words is no longer part of your intention when talking. If it’s hard for you to intend to activate your voice, it is because your focus is still on the words. Play around with humming without a melody when you talk. The intent to hum, takes the attention away from mouth and how to form the words. You will no longer care about because you are just involved with humming. You’ll see that in a miraculous way, your speech will be very intelligible by not knowing what the speech sounds are. It does take trust speech will be clear on it’s own. Play with it. I promise it will be fun!
Hello Hazel
You bring up some excellent points.
Like you said, you are usually much more fluent when speaking alone or to a baby because, unlike as in other talking situations, you are NOT experiencing the negative emotions that are triggered by your thoughts telling you that it would be BAD if you stuttered. During these times of fluency, as Barbara said, there is no monitoring going on (and therefore no “tool” is being used) Your speech could be said to be free-flowing.
Rational Emotive Behavioral Therapy is a great way to increase natural speech-flow by referencing the above dynamic. You are guided to identify the irrational and/or highly unhelpful core beliefs that feed negative emotions, triggering tense and/or avoidant stuttering. Then, you work to change these beliefs by actively and repetitively disputing them using real-world experiential data. Over time, your emotional reactions improve, and more and more, you achieve a sense of freedom from the worry of stuttering. I have a paper on this topic co-authored by Gunars Neiders, who also has a great book on the topic.
People often ask of their stuttering, “How do I just not think about it?” Rather than trying to not think, better to learn to replace the self-defeating self-talk with something more helpful.
Hello Heather
Thanks for your comments. I find it interesting that you referred to monitoring as a “tool”. I had never thought of it that way before. For years, I was never even aware that I was monitoring my speech. It was only through reading Ruth Mead’s book “Speech is a River”, that I realised that I was, in fact, doing just that – and that it was interfering with my natural ability to speak. Before then, it was just something I did, outside of my conscious awareness; perhaps subconsciously thinking that it was “helping me to speak” or that it was normal to do that.
The role of emotions is interesting. I know that for some PWS, changing negative emotions to more positive ones, does have the knock-on effect of helping them to speak more fluently. As does changing perceptions/beliefs about themselves and stuttering. During recent years, I have done extensive work on my emotions, perceptions and beliefs (about myself, my listeners and stuttering in general); changing them to be more positive. But I am one of those people that, even when I am feeling calm, relaxed and at ease with someone, sensing no negative judgement from them, can still stutter quite severely, when not using a physical technique – which although a helpful “crutch”, is very tiring.
You are absolutely right though when you said that the best way to not think about stuttering is to think of something more helpful – which is definitely easier “said” than done 🙂
Hello, Hazel,
Essentially, there are two components to learning to speak with greater ease, which I understand to be the basis of the question you asked, based on my experience as someone who stutters now and then and who has worked as a clinician with others who do.
The first, to respond as if they were sequential, but, most probably are not, is: Learning to more fully attend to others. Listening well and whole-heartedly, as you may know, is one of the most difficult and under-rated skills in these times when people “talk-over” each other with hardly any regret. It’s become almost a way of relating and one which hampers communication and understanding. So, learning to attend and to concentrate on what another is saying and not saying is a very good skill to develop for someone keen on communicating. And it keeps us from being overly self-involved to the extent that we become increasingly stressed and anxious about ourselves, i.e. how we will fare. Will we stutter? What will we do about it? What will they think of me? etc.
The other is to examine and modify as needed how we view stuttering, our stuttering in particular. In fact, your question suggests that you are looking for a way to better prepare yourself so that you don’t stutter, or stutter so much, or stutter in a way you find unacceptable, and so on, something we’ve all considered or tried to do sometime.
What I and many have and are learning, and you may be one, is that it is OK to stutter. To do so with acceptance that we may, as may anyone, for whatever reason – and I say that because we still do not know why we stutter in the first place, and we never may – is to spare ourselves considerable emotional and physical cost trying to prevent or hide a stutter. So, to have any sort of ease about stuttering, we may as well live with the reality that we may stutter sometimes, embrace that possibility, and learn how to relax into it by refusing to resist it.
Further, I have found stutters occur in their own way and in their own time. There is no reason to expect that we will stutter in a certain situation or circumstance or that we may not. We will stutter when we stutter, and we won’t when we won’t. For instance, I rarely stutter. But when I do, I sometimes do when I’m talking myself through an activity, exclaiming about something when I’m alone, or talking to an animal companion. What I’ve learned to do, and so can others, is learn, in all ways possible, to accept the inevitability of stuttering as a likely surprise happenstance without dread and worry and to develop skills, such as listening to others. That leads us to put our attention in a more useful place and to learn how to relax into the stutters we may actually experience.
– Ellen-Marie Silverman
Hello Ellen-Marie
Thanks for your suggestions. I agree with you in that fully listening to the person we’re talking with, is very important and something which we, as PWS, have a tendency not to do – all the time. We can be so caught up in what we think is going to happen when we speak, or planning ahead what words we’re going to say before we say them, for example, that we aren’t fully in the present moment. So fully listening and being fully in the present is something that I will definitely work on more.
As far as viewing stuttering as being “OK” goes, I think I am pretty much on board with that. I am generally open with people about the fact that I stutter, use voluntary stuttering sometimes and give occasional talks in my local area about my journey towards overcoming stuttering – which I really enjoy doing and they are always very well received. I do think though, that it can sometimes be difficult to balance – “being OK with stuttering” with “wanting to express oneself easily, clearly and in a timely manner” – the two don’t always mix well together 🙂
Well, Hazel, being OK with stuttering in the main as you state you are doesn’t mean, as you said, that you are going to like the actual stutter. That’s a bit much to ask since stuttering can interfere with communication flow as we wish it to go and be a disappointment and, maybe, escalate into a cause of embarrassment and, even, self-deprecation for a period of time. And it physically doesn’t feel good and can be tiring.
So, intellectually believing stuttering is OK and experiencing disappointment when we actually stutter is understandable and, possibly, inevitable for a time. So the way to handle that seeming disconnect I have found is to acknowledge the feelings of anger and, perhaps, sadness that arrive as the stutter manifests, accept them as being what is, and then decide whether you want to resist the stutter, i.e., try to beat it into submission, or “lean into it/relax into it.” We have that power to decide and ultimately welcome the stutter and feel we are living your belief.
Being kind to ourselves helps.
Ellen-Marie
Dear Hazel,
HI! Welcome to ISAD and thank you for being an advocate for yourself by asking such important questions. As a person who stutters, a professor, and speech pathologist, there are many ways to look and address your question. You have had two lovely women provide great answers to which I will just add some of my experiences and thoughts to, if you will permit me.
Like has already been said, when you are having great improved moments of fluency, I know for me, I’m not thinking about my speech or stuttering as much (or at all) but instead I’m just moving through the content. What is interesting is I’m not just “not thinking about my speech,” I’m not focusing mentally on the sounds and words I’m saying or about to say. When supervising graduate students who work with people who stutter I often ask them, “How often in daily conversations do you think of the sounds and words you say as you talk to people?” They usually say, “I might think about some words if I’m giving a speech in class or want to phrase something specifically, but not often at all.” This lends itself to the idea that cognitive behavioral science tells us that the more cognitive energy we are using on language demand, it can cause interference and thus can cause judgments (like Heather pointed out above with your thoughts telling you “it would be bad to stutter”). In other words, when you are finding significant fluency with speaking situations talking to children or pets, the language demand is lower along with possible cognitive energy spent on judgments (we can refer to The Demands and Capacity Theory here too by Starkweather).
One thing we have done with many clients is have them write down what they think about during a short speech (disclosure, the following technique comes from Acceptance and Commitment Therapy, ACT, but you can us anything that you are comfortable with and find confidence, there is not one approach to stuttering), We ask a client do a short speech, then ask them to list every thought they might have had during that small speech (1-2 minutes). They usually express many different thoughts from the words they said, fears of stuttering, feared sounds and words, self judgments, possible listener perceptions, the sounds or other environmental events happenings, sensations, or just thoughts about things happening in their life. We write them on stripes of paper while the client tells us what they are. When we are done we ask the client to hold their hands out and we put each in their thoughts in their hands one by one to show how many thoughts ran through their mind. We talk about what ones they think are helpful, what ones are in line with what kind of person and communicator they want to be. Thus helping the person who stutters possibly lighten their cognitive load as they speak.
Another tool we use with a lot of clients is we practice public speaking skills (which are essentially effective communication skills). Skills like organizing a speech, vocal power and intensity, body gestures that add to the message, vocal variety in tones and prosody, and appropriate eye contact to name a few. With these we are giving them parts of communication to focus on that are socially important to overall communication (and not just the physical action of fluent or stuttered verbal speech). This process allows people to improve the process of effective communication (we wall can improve with these skills, anybody, the student clinicians have to model these skills and do exactly what we teach the clients to do). We talk about what thoughts came up (any thoughts) with acceptance and welcoming them as part of us, so we can create our own filters to figure out what is right for us and what we want to be as a person (what matters, values) and who want to be as communicators.
These are just a few ways I myself, and some of our clients have worked on doing exactly what you are asking.
Bottom line is this, there are many ways to address this from ACT, REBT, CBT, and many others that all can be successful, as long the person using them wants to do it. Willingness is the first step to learning and doing anything. Willingness can come in the form of saying, “I will try this one time without judgment and see what happens” to ” I will try and live my life by these values and principles” and anything in between. It is all up to each person. Let me tell this story about how each person is different, and that there is not just one way to address stuttering. We saw a young man who stuttered who had no interest in doing any explicit talking about his emotions or feelings or thoughts or values (most of the time). But he loved to do the Van Riper stuttering modification technique of “cancelations.” He loved it! He would volunteer to go into stores and ask sales clerks questions, make difficult phone calls (for him) and use this technique. He would then talk about what he felt with a smile and confidence. At one point we ask (after he said he wanted to use Cancelations during a job interview), “What was your experience like using cancelation in your job interview?” He said, “Oh I thought about it right before the interview and planned on using it with specific words but when when I got in there I totally forgot about it and just talked.” We asked, “How was the interview?” He said, “It went well. I think I used cancelations, but I couldn’t say how many. I was just focusing on the message.”
Great question, Hazel! Keep asking questions! Keep being the person you want to be!
With compassion and kindness,
Scott
Thanks Scott for your great comments.
I agree with you that so many of our thoughts get in the way of allowing our brain to do what it is designed to do when speaking. Actually, I find it easiest to speak with natural fluency, when my mind is blank – free of language and what words I’m going to say, before I start speaking. When this happens, I am literally “thinking aloud” – like Barbara mentioned above – and all I am focussed on is the person I’m talking to and the content of what I am expressing. However, I don’t find doing this easy, which is why I asked my question 🙂
Practising public speaking skills are great! As a member of Toastmasters, I do this regularly and when I compare how I used to deliver speeches (rooted to one spot with very little vocal variety/body language) to how I deliver them now (much more animated) – there is a big difference. Definitely, I think that Toastmasters or similar public speaking organisations can really help PWS and I often encourage those I know, to give it a go!
Hi Hazel,
Anticipation sometimes sets one up for repetition of past behavior. Generally, people rely on what they have done in the past when problem solving. And, PWS often approach a moment of stuttering with an attempt to problem-solve.. in other words, trying to find a way to escape from it, or minimize it. Van Riper used the term “preparatory set” not only to refer to a modification strategy, but to refer to the mind and body “set” for which PWS approach a moment of stuttering. If one prepares to stutter with struggle (old behavior), one will. If one prepares to stutter in a different way (new behavior), eventually, the new behavior will take hold if it is more efficient and comfortable.
I find that changing the preparatory set is more effective over time than having a client try to find the brain pathway that does not repeat old behavior. Does the brain eventually do that? Perhaps. But from my perspective, if you help a PWS develop the agency to make that happen by approaching the moment of stuttering with a plan in mind, rather than approaching the moment of stuttering with a plan to distract and find another pathway, he/she has a better outcome. By putting the client in the “driver’s seat” (increasing internal locus of control) you can sometimes have better outcomes and less relapse.
Vivian
Hi Vivian
Thanks for your reply. Your comments remind me of something which I’ve often heard said – “What we focus on, grows”. If we anticipate struggling when speaking, that very thing is likely to happen because it’s what we’re focussing on. It is far better, in my opinion, to focus on the new behaviour we want and to repeatedly imagine ourselves doing it. Then, hopefully, our brain gets the message 🙂
Hi Hazel,
Excellent question and I absolute agree with and support all the responses before me. As a clinician and professor who works exclusively with clients to stutter, your question is something that has come up time and again with clients. Especially those who are able to maintain a certain level of fluency during the therapy session, but not outside. We do a lot of different activities to address approach behaviors, feared situations, unhelpful self-talk, and most importantly work on acceptance of stuttering as an initial step. For some, none of this seems to help become fluent. For me, a light bulb moment happened a couple years back when a brilliant young client who had some of the best social skills I have ever seen faced this same difficulty. The client came back one session and said, “Well I am pseudo-stuttering and doing everything you ask me to do to accept my stuttering, why am I still stuttering?” For me, that was it. The very fact that “all this work on acceptance” was to stop stuttering and be fluent! I don’t believe anyone has a “correct” or “perfect” answer, but the answer for each person its within themselves. We all need to explore what is “holding us back” and start to change that. Remain open to the experience, and accept stuttering so you can learn from it. Learning from the experience can be key to finding that answer within yourself as we can only change something we know.
Excellent question and all the best in your journey Hazel.
Regards,
Farzan
Hi Farzan
Thanks for your comments and encouragement. You are right, I think, in that there is no “one size fits all”. We are all different and although we have common issues and challenges to deal with, what helps one person might not help another in quite the same way. As you say, each one of us needs to explore what is holding us back, and to change that.
Dear Hazel,
You’ve received some great comments and replies, so I’ll try and reframe some issues such that we can push our thinking outside the box a little.
While it’s very well documented that overt stuttering frequency is highly malleable, why this is the case isn’t always as straightforward as we wish. For example, you correctly cite that when a PWS speaks to a small child, they’ll do so with less overt stuttering frequency (true!); however, to simply suggest that this is true because the speaker isn’t anticipating stuttering may be missing the mark. (For example, speaking to a child usually entails a significant reduction in linguistic complexity or a novel speaking pattern (accent), which can also account for enhanced fluency. Please note that I’m not discounting your explanation; I’m simply suggesting that when we limit our thinking to simple “if/then” statements about stuttering, we can often miss a larger reality.
Tangentially, there was an interesting study done by Salmelin et al (1998, I believe) where she reports an unintended finding suggesting that when the stuttered brain was activating in an abnormal fashion, it was associated with enhanced fluency; interestingly, when the stuttered brain was activating more like a fluent brain would, it was associated with increased stuttering frequency. (Don’t quote me on the exact specifics; we’d have to pull the article.) Point being, when the brain gets to act (or compensate) as it wants, it seems to help; and when we try to force the brain into a different compensatory strategy, it may not help.
Anecdotally, I’ve found this to be true in my own life, and in many of our clients. When I began to work with stuttering, I gained greater control; when I was trying to fight stuttering, it had a tendency to control my speech.
Another consideration would be to investigate a variety of prosthetic or pharmaceutical options that can provide help in these areas as well. These are topics that can be controversial for some, but I’ve seen both used in both short and long term applications with good results; in the short-term, it may help reduce uncontrolled secondaries and give a boost of real-world controls. Long-term use also seems to be helpful in some clients, provided they understand how to best use the prosthetic devices.
Hope this helps,
Greg Snyder, PhD CCC-SLP
Associate Professor
The Wheat Laboratory for the Voice, Speech, and Hearing Sciences
Department of Communication Sciences & Disorders
George Hall, Office 310
P.O. Box 1848
University, Mississippi
38677-1848
GoogleVoice 662.259.0123 / Office: 662.915.1202 / Fax: 662.915.5717
GSnyder@OleMiss.edu / Greg.Snyder@SpeechandHearingCenter.org
Hello Greg
Thanks for taking the time to comment on my question. You raise some interesting points. With regards to talking to a small child, you are right in that our way of speaking often changes. We can use a lot more intonation, put on different voices for fictional characters when reading to them and almost “sing” as we’re talking to them. My personal view as to how all these things can help, is that a) we are expressing more emotion (which when blocked, can, I believe, be a significant factor for some people in contributing to their stuttering/holding back behaviour) and b) there is more emphasis being placed on the voice rather than anticipating difficulty speaking. Of course, other factors may well come into play too.
I know there are various viewpoints on the issue of control. Having been a member of the McGuire Programme for a number of years and really benefitted from the various techniques and strategies taught, I appreciate how physical intervention can help to manage stuttering (which I see, as being a symptom of us overloading our brain with too much thinking and giving it too much to do, in an attempt to “try to speak”). However, when I give up thinking of the words before speaking and any form of monitoring how I am talking and am simply aware of the general idea which I want to express and the person I’m talking to, my speech flows naturally and effortlessly (as it does with “fluent speakers”). It is when I am approaching and doing speech this way, that I believe, I am using my brain in the way it is designed to be used, when speaking. Maybe this is an oversimplification but I can only speak from my own experience 🙂
As far as prosthetic devices are concerned, I can see their value if they help a person to reduce thinking about and monitoring their speech.
Thanks again for your thought provoking comments 🙂
Hazel