Stuttering 59antianxiety medi cations are habit forming, and he disliked the negative effects such as drowsiness
and lethargy. He also did not like to use a biofeedback device to achieve neutral or positive emo-
tions for counterconditioning. Learning to relax muscles to the beeping of a tone seemed artificial.
Of all the options, Juan most preferred progressive relaxation, autohypnosis, and meditation on
an audio-recorded program. The clinician had provided him with individual instruction on the
pro cess and a disc that he could use at home.
In desensitization therapy, Juan came to the clinic 1 hour early. In the “relaxation room,” he sat
in an overstuffed chair and listened to the announcer’s voice on the relaxation tape. The announcer
instructed him to alternately tense and relax vari ous body parts. Starting with his feet and sys-
tematically working up to his speech muscles, the announcer had Juan concentrate on groups of
muscles and how to relax them. He also had Juan focus on his relaxation word to the exclusion of
other verbal thoughts and told him to imagine serene, tranquil scenes. During the exercise, Juan
took deep breaths and gradually exhaled while sensing the tension leave his body. At the conclu-
sion of the 50- minute tape, the announcer counted backward from 10 and, with each number,
suggested that Juan felt even higher levels of relaxation and a sensation of well- being. Juan also
used the audio recording each eve ning and sometimes during his lunch hour. In therapy, he was
being taught how to group muscles and to achieve the same levels of relaxation in an abbreviated
way. The clinician wanted him to be able to relax his body, and particularly his speech muscles, in
2 to 3 minutes. Most importantly, the clinician wanted Juan to not allow his anxiety and tension
to increase to high levels while stuttering.
In previous sessions, Juan had been deconditioned to the ringing of the telephone. Initially,
he sat and simply listened to it ring. Later, he practiced relaxing his body, particularly his speech
muscles, while walking to answer it. Today, Juan is being desensitized while talking on the tele-
phone. The clinician has removed a telephone from its jack, and Juan is talking while holding the
dead receiver to his ear. In the past, Juan ref lexively tightened his muscles and felt a deep sense
of dread and anxiety about talking on the telephone, but today he is doing it with positive emo-
tions and relaxed speech muscles. As an added deconditioning goal, Juan is using the top five
anxious and feared words on his list in sentences. In future sessions, Juan will make telephone
calls to friends, relatives, and business acquaintances while maintaining positive psychological
and physical states.
During the 6- month course of stuttering therapy, Juan became desensitized to the sounds,
words, situations, and persons on his lists. Each of these stimuli gradually lost its ability to create
anxiety and associated negative emotions. Loss of their power to cause stuttering, combined with
talking with relaxed speech muscles and using other f luency- enhancing methods, allowed Juan to
control his communication disorder. Juan did not like using the word cure to describe the results of
therapy because when he was tired or distracted, he sometimes slipped back into the old patterns of
stimulus– response stuttering. However, most of the time, he could control his stutter. His victory
over anxiety and verbal impotence was apparent when Juan called his boss, requested an appoint-
ment, and successfully negotiated a hefty raise— all without significant stuttering.
Case Study 3-5: Preventing Stuttering in a 5-Year-Old Boy
Steven started stuttering when he was just 5 years old. It was the kindergarten “show and tell”
fiasco that had devastated him. Afterward, his mother came to school and took him home. He
spent the rest of that memorable day in his room playing with toys and watching tele vi sion. As
usual, the next morning, he rode the bus to school, but things had changed. A schoolmate was now
calling him “Stuttering Steven.” He dreaded returning to the classroom.
Fall was in the air, and Steven enjoyed capturing the bug for show and tell. He found a yellow
caterpillar hiding in the red and orange leaves under the big oak tree in his backyard. It had more
legs than he could count, and he carefully placed it in a jar with breathing holes punched in the