Articles

Protection from harm- Issue 21, Spring 2004
by Monica Bray, Leeds Met University
I like reading. I even like reading research articles. And I particularly like reading research articles that make me say, 'Yes, yes, I can connect with that!'

So when I do read such an article, I want to share it.

Many of you who are reading signal will have had similar feelings to me, of cognitive dissonance when reading about the wonders of behavioural techniques in stuttering therapy, while knowing from your own practice, that quick changes in speaking patterns (even though they may lead to fluent speech) are not enough for you or your clients. There is that sense of anxiety when you stand up and say, 'Im not sure of this' about prolonged speech approaches, just in case you (and the 20 or so clients you have talked to) have got it wrong when you say, 'there is more to stammering therapy than fluency shaping'.

So when an article appears in a respected journal, written by the very people who have carried the flag for prolonged speech, and that article says all the things you (and your 20 or so clients) have been thinking and saying in private, there is cause for celebration! Eureka!

The first thing about this article is that it uses qualitative methodology. This methodology is designed to explore, in depth, peoples ideas, feelings, thoughts etc. It does not reduce everything to a set of numbers and statistical analyses. It is therefore a more valid way of getting an understanding of what it feels like to have gone through a particular therapy (whether you have come out of the therapy with 0% SS or not!) Through interviews, the authors explore the experience of people who have gone through therapy using prolonged speech.

The second thing about this article is that it acknowledges that there is a gap in the literature on outcomes and that this gap is in the area that we all discuss and think about (take any BSA conference!), ie, the area of personal experience as perceived by the people who stammer themselves. In qualitative methodology, the people who are important are interviewed and their thoughts and ideas are sought. The interviews are then carefully transcribed and analysed in terms of the ideas or themes that emerge through a very careful search of the spoken words. So the results arise out of the thoughts and ideas and feeling that are expressed directly by the clients the way these clients think and feel is not inferred from the results of attitude scales or counts of their fluency and so on.

So what did arise from this study? All the things that most of us would expect to arise! Sadly most of us have not had the courage to print these thoughts and ideas because they are too intuitive and not sufficiently scientifically rigorous! But another good thing about qualitative methodology is that, with care and a systematic approach (and time!) the rigour that is expected by the scientific community can be met and the results that arise can therefore be respectably written about.

The overarching theme that emerged from the study is that people who stammer feel different from those who do not stammer even when they have become fluent through prolonged speech. They spend time and energy trying to protect themselves from the harmful consequences associated with stuttering (p385). Prior to therapy, the only ways that these people had of protecting themselves from the frustration and shame of stammering was avoidance and tricks. After therapy, they do have the option of using prolonged speech as well, but this does not always reduce their anxiety in fact sometimes it can exacerbate it! Some of the themes that emerged as particularly interesting are:

Fluency has a price prolonged speech does not sound or feel natural and comfortable it doesnt feel like me having to impose a speech pattern onto spontaneously emerging language dampens down the expression of the self such speech does not suit the personality of individuals who happen to stammer operating on two levels concentrating on both what you want to say and how you want to say it, is exhausting to many and makes talking an effort.

Overall, the results of the interviews of these ten adults who stammer lead the authors to comment on the central importance of the self and the desire to protect the self from harm (from unhappy experiences in life). People who stutter feel different and this does not change with the imposition of prolonged speech in fact prolonged speech can make some people feel even more different! However, whatever therapy is learned will be incorporated into a repertoire of ways (many of which are self learned) of protecting the self from harm.

Finally, the authors acknowledge that practice doesnt always make perfect! Addressing issues that arise because of being a person who stammers and accepting that learned techniques can be merged with the tricks of the trade of stammering (even, I dare suggest, avoidances!) is an important aspect of the problem solving nature of therapy with people who stammer.

So, what ideas/feelings emerge from this study for me? It is always nice to have beliefs that one holds dear confirmed! Working, as I do, with parents of children who stammer, many of whom are dysfluent themselves, I have come to realise that avoidance (as long as it doesnt wreck your life) is not such a bad thing. In fact we all avoid situations that we find uncomfortable so it is natural for someone who stammers to do the same. It also adds support to the approach that any options that suit the individual (any control mechanisms; or ways of opening up and talking about stammering; or developing confidence and improving communication skills etc etc.) and which can become part of that persons tool kit should be on offer.

The last thing that I have taken from reading this article is the importance for the therapist of helping people who stammer (whether children or adults) accept that personal experiences of stammering can feel 'harmful'. Such feelings are experienced by many who stammer and the therapist is there to collaborate in activites that can protect the client from harm.

Reference Cream, A., Onslow, M., Packman, A. and Llewellyn, G. (2003) Protection from harm: the experience of adults after therapy with prolonged speech. International Journal of Language and Comm. Disorders. 38: 379-396.