Desensitization

Speech therapy for stuttering is more than learning new speech motor skills. This is because the actual use of more fluent speech in every day life is complicated by time pressure, language, social, and emotional demands. So, while regular motor practice is essential (practicing 'speech tools'), therapy must consider how fluency changes as a function of what is going on both inside and outside the speaker. These fluency disrupters are somewhat consistent across students; however, speaking situations are very personal, with details that are unique to every case. This blog entry is about one way to manage the emotional demands which make stuttering worse. It is called desensitization.

The purpose of desensitization is to reduce the disruptive power of an internal emotional response. A detailed explanation of self-desensitization can be found at http://www.guidetopsychology.com/sysden.htm . First, the speaker learns how to diffuse physical tension and emotional feelings. Support for this approach comes from such titles as The Relaxation Response by Herbert Benson & Mirian Klipper (Harper Collins, 2000). An example exercise I've observed other SLPs teach is to simply ask a student to make a fist and pay attention to the feelings of tension in his hand and arm. Then, as the student unclenches the fist, he notes carefully how his muscles feel as they relax. Thus, the student becomes aware of what relaxed muscles feel like so as to seek that feeling as needed in the future. I used this technique alot in my younger days while learning to ride horses. I would almost constantly self-monitor muscle tension in order to ride more fluidly and in-tune with the animal.

One goal of the person who stutters is to localize exactly where in the mouth, neck, chest, and anywhere throughout the body, tension increases during stuttering. At first, this tension can feel like just a generalized sense of anxiety and possibly even panic. Some speakers experience quite intense physical and emotional responses in conjuction with stuttering. More about this can be found in an interesting paper by Louise Heite called La Petite Morte: Dissociation and the Subjective Experience of Stuttering at (broken link). Some speakers experience enough anxiety to avoid sounds, words, people, speaking tasks, and entire situations. Regardless of the degree to which tension/anxiety exists, desensitization may be helpful.

One way to use desensitization is to find a 'designated listener' who is knowledgeable about stuttering and comfortable with listening to stuttering. The person who stutters is allowed to stutter freely while talking to his 'designated listener.' The designated listener never responds negatively to stuttering, and therefore never fuels feelings of shame and embarrassment in the speaker. This allows the speaker to become more comfortable about stuttering openly. This is why, in my speech therapy, there are times when my students stutter MORE before they stutter less. As they learn to trust my response, they let the stuttering out. This is a major achievement, because then, we can examine what exactly is happening - discover where exactly the muscle tension is that needs to change. Or, alternatively, this can include staying in the moment of stuttering (as possible) in order to desensitize fear, stay in the present, and study the behavior. More about this method can be found at the end of an article by Starkweather & Givens, Stuttering as a Variant of Post Traumatic Stress Disorder: What We Can Learn at http://www.mnsu.edu/comdis/isad6/papers/starkweather6.html .

Another way desensitization is used in speech therapy is to practice relaxation responses in stressful speaking situations. Here, the focus is not so much on the stutter itself, but rather on the internal physical/emotional responses of the speaker and the characteristics of speaking situations. This is when we design hierarchies to represent gradually more difficult speaking tasks. I write hierarchies in the plural, because I've found that they change constantly. The SLP and student may revise a hierarchy at every meeting, tweaking it based upon the student's homework experience. The SLP teaches the student to become a scientist - experimenting, examining, evaluating and creating new hypotheses about how to move toward his own personal goals. This progress is easier when not confounded by negativity, which is why reducing phyiscal and emotional reactions with desensitization is important.