Changing Thinking, Changing Action, Changing Behaviour – strategies for dealing with stuttered feelings, stuttered speech and stuttered communication.

Note: This paper was first presented in 2002. The title is now alternatively explained by the phrase “strategies for dealing with stuttering and associated social anxiety disorder (stuttered speech syndrome)”

Realisation

I had stuttered since age 4 and had made my way by hiding it, substituting, avoiding and pretending ignorance when asked questions. At age 30 I was a dentist and used to seeing between 10 and 16 patients per day. I would say as little as possible leaving it to staff to deal with all phone calls and patient interaction. When I had began private practice 6 years earlier my speech was terrible (it is difficult substitute scientific and anatomical terms, and displaying ignorance in response to a patient question just as bad as stuttering.) But over the years my speech had improved slightly and I was able notice something quite significant. On any day my fluency would vary with every different patient. For the very young, very elderly and very nervous I was relatively smooth, but for the highly impatient, fast talking and demanding businessmen I still had serious difficulty. And between these two extremes there was a range of correlated speech success. The obvious realization to me was: my speech was a function of how I perceived the interaction between myself and the other person. Clearly my stuttering was more about my perceptions than my physiological ability to produce speech. ( I could speak quite well when talking to myself.) I felt if I could change those perceptions then I could change my speech. From then on it would be a matter of changing habits of both thinking and speaking.

How to change perception and behaviour

1. Resist time pressure. I had to realise I had as much right to be there and could take as much time as suited me. It was silly but even though I was the dentist I had been giving away my power to the patient. Clearly I had been doing a similar thing in my interactions with other people outside my work. My strategy was to choose to watch (either directly or through television and film) and to spend time with assertive people, knowing their attitudes would rub off. Observational learning was extremely important for me.
2. Increase self esteem and self confidence. Know more-read more, take more courses. My issue was communication – I read all I could about body language, improved my English expression by studying grammar and developing my vocabulary, and furthered my general knowledge by studying psychology, anthropology and history. I figured that if I was going to speak well I also needed to have something to speak about. Also having more knowledge would improve my confidence.
3. Focus on positives. I realised I had to concentrate on what I could do right in the communication process (not on what I was doing wrong -i.e. being dysfluent). I learnt to smile more, to relax, to listen and breathe at the same time!
4. Monitor anxiety level in relation to that of the other person. I developed this technique which I called Controlled Emotional Response. I would simply focus on connecting with the emotional response of person to whom I was communicating (rather than worrying about how I was performing!) by giving THEM a score from zero to 10 as to how anxious I perceived them to be. I would then focus on relaxing sufficiently so as to achieve a score the equal if not less for myself. In doing this I was able to stand guard and stop the old uncontrolled feelings of anxiety from overwhelming me like they had always done. I was also taking the stress off myself by focusing on someone else. In addition, paying attention to what the other person was feeling also helped me in the communication process.
5. Restructure negative associations. Positive Replay. If for some reason I had had a negative experience rather than beat myself up about it (like I had always done in the past) I would replay the situation in my mind. But this time the replay was changed to have me perform positively. That is to perform in the way I would have preferred and certainly in the way I would like to when again in a similar situation. In this way I trained myself to give an automatic positive response when presented again with the same situation.
6. Lower resting level of anxiety. Use of Meditation and Self-Hypnosis. Have you ever noticed how some people seem to be more relaxed than others? I have and I resolved to become more relaxed myself. I felt that I had been anxious for so long that a hyper anxiety state had become part of me. I was so used to being anxious that being anxious was normal for me. So I studied meditation and self-hypnosis. Meditation. How to do it. Start in a chair in a quite room and practice relaxing ideally 3 times per day. Return to that chair each time and soon the chair becomes associated with relaxation. So it becomes easier to enter a deeper state of relaxation and to enter that state more and more quickly each time you sit in the same chair. Then while in that chair focus on the tip of a candle flame until you “see” a line of energy between your eyes and the candle flame. Breathe in the energy from that flame calling it in turn poise, strength and self confidence. Breathe out stress anxiety and confusion. A variation is to “see” stress, anxiety and confusion bundled in a canoe about to float over a waterfall and out to sea – way out of your life! Self-Hypnosis. How I did it. Again in that same favorite chair, while calling to mind several people who I regarded as outstanding communicators, I read myself the following passage. “As you become and as you remain more confident and relaxed each day so you will become more confident and relaxed in the presence of other people – no matter whether they be few or many, no matter whether they be friends or strangers. In everyday life you will enjoy opportunities to speak and do so with intonation and rhythm and breath support so as you speak you will become completely relaxed both mentally and physically, quite calm and composed. If at any moment you should begin to feel difficulty with a particular word you will stop speaking immediately for a moment or two, and during that brief period of silence, the muscles of your face your throat your tongue and your lips and the muscles of your chest will relax completely, so that when you speak again the difficult word slips out quite easily. You will cultivate the habit of speaking with POISE where in addition to a calm controlled manner P reminds you to Projection your voice, O reminds you to Open the mouth and articulate every sound, I reminds you to inhale, S reminds you to Smile and E reminds you to Exhale and speak with effortless effort.”In addition to this approach, which I believe was of significant benefit, I would also programme my mind before going to bed by reminding myself of all the things I had done well that day and look forward to doing even better the next day.
7. Practice Success. Practice in a winning environment. I think it is possible to build on success until you reach the limit of your physical and mental abilities. A strategy for achieving this was outlined in a book by Leonard Morehouse “Theory of Maximum Performance”. The central idea was the value of practicing in a winning environment. He quoted a study in which 2 groups, one successful sportsmen and the other a general group where introduced to golf. The various strategies of how individuals in each group went about developing their skills were analysed. It turned out that individuals in the general group were quick to pick up the most difficult club, one wood (or driver), and try to blast the ball as far as possible. The sportsmen group in contrast chose to start with something they expected success from. Their approach was to pick up one of the easiest clubs, a 9 iron, and chip relatively easy shots before building up their skills with gradual exposure to clubs of increasing difficulty. The last thing they attempted to do was to use a driver! The general group had limited success and often gave up in frustration while the sportsmen group used the success to build self confidence and enjoyed proceeding to the next level of challenge. I applied this strategy to learning to talk on the telephone. I was so terrified of the telephone I had to make my “success steps” very small in order to be situations where I had an expectation of doing well.My steps in order were:
   • Learning to relax in my favorite chair (in a quiet corner of my bedroom)
   • Learning to relax in my favorite chair while looking at my telephone
   • Learning to relax in my favorite chair while hearing the telephone ring
   • Learning to relax in my favorite chair while holding the telephone to my ear
   • Learning to relax while watching myself in a mirror hold the telephone
   • Learning to relax while speaking with the telephone and watching myself in the mirror
   • Learning to relax while ringing and speaking to a friend on the telephone
   • Learning to relax while making calls to strangers. (hotel and airline staff)
   • Learning to relax while talking on telephones other than the one in my bedroom! (It seems funny but for a while I could only be fluent on that one bedroom telephone.)
   • Learning to relax while using the telephone in front of other people.

   After success with each step I would move on to the next with a feeling of anticipation and excitement. But I realised from my studies in psychology I needed to reinforce the success. Simply doing it once was not enough. I found it necessary to practice each step 2 to 3 times per day and make at least 10 calls per day. I also realised from my psychology studies that I had to be constant it my practice. The longer I left it between practice sessions the more likely I was to return to the old fears.

   I have also used this strategy to develop my speaking ability and am pleased to report I have now reached Division standard in Toastmaster Public Speaking competitions. My steps here involved:

   • Learning to speak well when alone (rehearsing my speech)
   • Learning to speak well at my stuttering support group meetings
   • Learning to speak well at general meetings using Delayed Auditory Feedback
   • Learning to speak well at Toastmasters

   My next step is to speak well publicly at any time.

8. Keep on track. Join a Support Group. It is well accepted that support groups have a therapeutic value of their own. I have found many benefits. They link us to people with a common interest which helps keep us on track with our plans for change. Also this link provides an opportunity to develop socially. (This is important for people who stutter who need to make up for lost time spent avoiding social situations.) But more than this it is important to have discussions because they help us consolidate our ideas, develop our self identity and check emotional reality. (PWS who have not engaged in discussions have missed an important opportunity for development.) The value of this to our psyche cannot be underestimated. An obvious if extreme example is the well known impact of solitary confinement which was used as a form of torture and often lead to insanity in the victim. Another value of a support group is that it provides an opportunity to help others. I believe this to be a prime human need and certainly have found it provides soul food. With it a centredness comes which in turn leads to a greater feeling of general relaxation and improved speaking and communicating.
9. Change Self Image as a Speaker. Record Success. Keep a Journal. Write down when you spoke well. (describe who, when and where.) I found reviewing the ever expanding list of successful speaking situations to be extremely powerful in changing my speaking self image. I think too often people who stutter have over emphasised their limitations as communicators. To my mind it is important that this false image be corrected by receiving validation as a speaker wherever possible. The journal helped me do this.
10. Keep a sense of humour and a realistic perspective. Whatever we may sometimes feel, stuttering is not the worst thing that anyone has ever done in the history of mankind. I find I communicate best when I allow myself a few dysfluencies and let go of the need to produce perfect speech. When and if, the dysfluencies come I take it as feedback to slow down and breathe more. I no longer feel as embarrassed, ashamed or as tense as I once did. With this approach I feel certain I am not only decreasing stuttered speech but I am also decreasing if not eliminating stuttered feelings which after all are the real cause of the pain of stuttering.

My perspective is a result of inspiration from the following statements:

• Life is a journey not a destination.
• The journey of a 1000 miles starts with a single step.
• (On that journey) Obstacles are only opportunities in disguise.
• The smallest action is better than the noblest intent.

The above points relate to specific action that can be taken to improve speech and communication. But I also think it is important to have a clear life philosophy in order to build a foundation from which this action can be taken. I have drawn a feeling of inner peace (which I believe provides me with general relaxation and better speech and communication) from the philosophy outlined in the following verses. Known as the Desiderata it reads:

“Go placidly amid the noise and haste, and remember what peace there may be in silence. As far as possible without surrender be on good terms with all persons. Speak your truth quietly and clearly: and listen to others, even the dull and the ignorant: they too have their story. Avoid loud and aggressive persons, they are the vexations of the spirit. If you compare yourself to others you will become vain and bitter, for always there will be greater and lesser persons than yourself. Enjoy your achievements as well as your plans. Keep interested in your own career, however humble, it is a real possession in the changing fortunes of time. Exercise caution in your business affairs, for the world is full of trickery. But let this not blind you to what virtue there is, many persons strive for high ideals, and everywhere life is full of heroism. Be yourself. Especially do not feign affection. Neither be cynical about love, for in the face of all aridity and disenchantment it is as perennial as the grass. Take kindly the counsel of the years, gracefully surrendering the things of youth. Nuture strength of spirit to shield you in times of sudden misfortune. But do not distress yourself with imaginings. Many fears are borne of fatigue and loneliness. Beyond a wholesome discipline be gentle with yourself. You are a child of the universe, no less than the trees or the stars, you have the right to be here. And whether it is clear to you or not no doubt the universe is unfolding as it should. Therefore be at peace with God, whatever you conceive Him to be, and whatever your labours and aspirations , in the noisy confusion of life keep peace with your soul. With all its sham, drudgery and broken dreams it is still a beautiful world. Be careful. Strive to be happy.”

Thanks and Best Wishes

I have received ideas, inspiration and encouragement from many sources and I say thank you to my friends and fellow travelers who have helped my efforts. Too often as people who stutter, we can be unnecessarily hard on ourselves and each other. I have really valued the support I have received and I hope this paper serves as a guide for others taking the same journey.

(first published 1/10/2002 in ISAD Online Conference, re-edited 25/01/09)