I’m often asked, “How do you cure stuttering?” This question is charged with judgment. It renders stuttering a black-and-white issue, ignoring the condition’s many complexities. It is a view that polarizes the matter completely: stuttering = bad; fluency = good.
This dichotomy is missing a glaring piece―the individual. So let’s view stuttering in a more realistic, comprehensive, and empathetic way.
One of my adolescent patients recently asked me to write a letter of recommendation for her college application. I am her speech-language pathologist at the Rose F. Kennedy Children’s Evaluation and Rehabilitation Center (RFK CERC), so this came as quite a surprise. I thought that although we had worked together once a week for eight years, there had to be someone better suited to write this letter.
“I Stutter, Therefore I Can’t”
Rewind eight years to when Sarah, a timid 10-year-old girl, walked into my office. She could barely tell me her name and seemed overwhelmed by the mere thought of conversation. In school, Sarah never volunteered to read aloud and dreaded being called on. Although she had mild learning and language deficits, her stuttering was the biggest roadblock to academic success. Her lack of participation negatively affected her grades; she was even required to repeat a grade. This was a danger she faced on several occasions, not necessarily because the academic work was too difficult. Instead, she would rather have had teachers and peers think she could not read than reveal her stuttering.
Outside the classroom there were other struggles. Ordering in a restaurant was a stressful task. She was well liked by peers and had many friends, but it became clear that she did not reveal her true extroverted personality to most people, refraining from talking with friends on the telephone or actively participating in conversation. She took on the role of listener instead of telling the lengthy stories she often shared with me.
Stuttering undermined her sense of self—almost as if she viewed herself as simply a stutterer, and not as the friendly, capable, outgoing young woman she was. She had a fixed mind-set: “I stutter and therefore I can’t.”
After that first meeting, Sarah and I spent countless hours working on different strategies to reduce the frequency and severity of her stuttering through a combination of stuttering modification and some fluency-shaping approaches. We have focused equally on shifting her mind-set from one of “I can’t” to one of “I can.” Knowledge is power, and Sarah has learned about the etiology of stuttering, developed an understanding of the anatomy of the speech mechanism, identified her negative feelings related to stuttering, and engaged in avoidance-reduction therapy to help her face some of her fears about speaking.
“Meet My Boyfriend”
The frequency and severity of Sarah’s disfluencies, or interruptions in the flow of her speech, have measurably decreased; she has achieved a reduction in the use of secondary behaviors, shorter duration of disfluencies, and decreased tension. However, the emotional growth arising from these improvements has had an even greater impact on her life.
Sarah has learned to identify and analyze her own strengths and weaknesses, and to channel negative thoughts and feelings into more-constructive ideas. Her resilience has increased. Sarah has realized that her thoughts and opinions deserve a voice—even if that voice is disfluent. She has worked hard to understand her own speech patterns and to advocate for herself in school, no longer relying on her mother to fight her battles. She has even begun to involve relevant others in the therapy process instead of attempting to hide her disability.
A game-changing moment came a few months ago when she brought her boyfriend to CERC. This may seem insignificant (her boyfriend did not understand why I was so excited to meet him), but advertising her stutter in this way was a big deal. Until recently, she had told friends and relatives that she just attended “therapy” and left it open for interpretation.
The Therapeutic Alliance
Sarah being able to tell her boyfriend about her stuttering marks a degree of progress possible only because of the therapeutic alliance we have cultivated. My title did not automatically grant this level of trust. As in any relationship, it had to be earned. Now, when Sarah enters my office each week she knows that she has entered a safe space where she is fully accepted and that does not typify her everyday life. For a person who stutters, safe places and patient people can be all too hard to find.
About one percent of the population identify themselves as people who stutter. Feelings of shame and avoidance are far too common. Many people who stutter struggle to reveal their true selves while simultaneously trying to hide their communication difficulty. Breaking through this barrier and helping children and adults realize their own potential and self-worth are critical, but not easy. They require dedication, acceptance, trust, and respect.
“I Stutter, and I Can”
Is the goal of all of this a cure? That question does not allow for all the nuances of communication and relationships—and doesn’t begin to get to the heart of what success really is. It’s the kind of question that engenders the sense of defeat that Sarah entered into therapy with: “I stutter, therefore I can’t.” Together Sarah and I have changed that framework. That transformation began with formulating new and diverse questions.
Thinking about Sarah’s college-reference request, I guess I should not have been so surprised. I see her beyond the stutter. Through our work she has begun to see beyond the stutter herself and develop the confidence needed to dream. Those dreams began with small steps formed in the office: “I will tell my teachers I stutter”; “I will order food at a restaurant.” They’ve led to this moment: “I want to go college; will you write me a recommendation letter?”
So here I go: “It is my pleasure to recommend Sarah.…”