Stuttering 51while talking. Adults will usually eliminate head jerks, eye blinks, hand slaps, inappropriate artic-
ulatory gestures, lip biting, and head turning and will maintain eye contact with regular encour-
agement and direction from the clinician. Children often require a system of rewards in which
normal facial expressions are rewarded and abnormal vis i ble features discouraged. It is often desir-
able to reward normal facial expressions and body movements rather than to discourage abnormal
ones. When dealing with the vis i ble features of stuttering, it is not necessary to address the audible
symptoms; only the aberrant facial and body aspects of stuttering are targeted for elimination.
Stuttering: Anxiety and Associated Negative Emotions
Most therapies recognize the role anxiety and associated negative emotions play in precipitat-
ing and perpetuating the stuttering moment. Although not all persons who stutter experience
negative emotions during stuttering, most report that it is unpleasant and anxiety provoking.
Individuals who stutter also have the anxiety- free, normal nonf luencies experienced by all speak-
ers. However, a comprehensive stuttering program must address the client’s anx i eties and negative
emotions that are associated with dysf luent speech.
Brutten and Shoemaker (1967) first proposed that stuttering could be treated by eliminating
anxiety and the negative emotions associated with speaking. Although simply removing anxiety
and negative emotions may not be sufficient to cure or significantly reduce stuttering, the affective
aspects of the disorder must be addressed. Stuttering can be prompted by past associations with
certain sounds, words, situations, and persons, and desensitization can eliminate them as cues.
The pro cess of systematically desensitizing a person to stuttering begins with the client iden-
tifying stimuli or cues that prompt the disorder. Several sessions are usually necessary to identify
the specific sounds, words, situations, and persons that cause anxiety and associated negative
emotions during speech. They are listed in descending order of importance— the most impor tant
stimuli first, followed by the second, third, and so forth.
Once the client has listed the stuttering stimuli, relaxation training begins. This training has
two goals. First, it teaches the client how to relax the body and create a neutral or positive emo-
tional state that can be used in desensitizing. Second, it teaches the client to reduce hypertense
speech musculature. In many clients, stuttering and struggling with speech are synonymous, and
reducing hypertense speech musculature during speaking can produce an immediate improve-
ment in speech f luency. An audio recording involving progressive relaxation, meditation, and
autosuggestion can be used to increase the client’s ability to obtain the necessary relaxation and
the neutral or positive emotions for desensitization (Tanner, 1991).
Once the client is trained in progressive relaxation, stuttering stimuli are paired during states
of positive or neutral emotions. The client uses the sounds, words, or phrases repeatedly while
experiencing these emotions. He or she also practices using anxiety- provoking sounds, words, and
phrases in stressful situations and talking to persons from the stuttering hierarchy list. When it
is not practical to talk to persons or speak in stuttering-provoking situations, such as talking to a
police officer or a large audience, vicarious deconditioning is employed; role playing and imagery
can be used. Group stuttering therapy is also a way of deconditioning clients to stuttering stimuli.
Stuttering and Its Effects on Personality
The effect of stuttering on personality is a controversial topic. Some authorities believe that
a stuttering personality exists. They assume that stuttering affects all persons in similar ways
and invariably alters the way they view and interact with the world. However, Bloodstein (1981),
after an extensive review of the lit er a ture, suggests that there is no absolute stuttering personality
or even definable personality traits of persons who stutter. As a group, persons who stutter are
diverse, and they vary greatly with regard to the severity of the disorder and their reactions to it.
However, a person who developed stuttering as a young child and suffered years of ridicule and