58 Chapter 3
to say his own name. Even a toddler could do that! Just thinking about the surprised expressions
on people’s faces and their mean comments caused Juan to cringe. There always seemed to be a
budding comedian showing off to every one in earshot: “Cat got your tongue?”
At the top of the feared and anxiety- provoking “situation” list was the telephone. For Juan,
there was no question that answering the telephone prompted stuttering. It happened every
time the telephone rang, and shivers shot down his spine as he answered it. He knew that when
he picked it up, he had to speak immediately. If he did not, he would hear, “Hello, hello... is
someone there?” Of course, this caused him even more trou ble in speaking, and often the caller
would hang up in mid- stutter. A few seconds later, the phone would ring again, with a rerun of
the sad comedy.
Juan liked his boss, and he was sure that the feeling was mutual. However, she was at the top
of his distressing “ people” list. After graduating from college with a degree in robotic engineering,
Juan had landed a job at a local engineering com pany. Although the interview was a disaster (job
interviews ranked second on his situation list), he was hired on the spot. In today’s job market,
engineering gradu ates, especially those in robotics, can choose their jobs, even if they have a stut-
ter. His boss was in her 40s and reminded him of his mother. Although she had never talked about
his speech disorder, Juan knew she empathized with him. Lately, she had begun helping him talk
during stuttering moments, but that only seemed to make matters worse. Certainly, there were
times when it was helpful for a friendly cue to say a word, but most of the time, all he really wanted
was uninterrupted time to speak.
Juan also liked his new clinician. He seemed to know several theories about stuttering and was
very good about explaining them. Sometimes, however, Juan felt that he knew more about this
communication disorder than even the most knowledgeable specialist. After all, he had been in
therapy most of his life.
The new clinician was working on desensitizing Juan to the stimuli that prompt stuttering. He
explained that if the anxiety and negative emotions associated with sounds, words, situations, and
certain people are removed, the stuttering can also be reduced or eliminated. That was the theory
behind this treatment approach. Unfortunately, Juan knew that in stuttering therapy, what seemed
to be workable in theory often did not succeed in practice. But Juan was an optimist, and he was
doing his best.
It was true that certain sounds, words, situations, and persons triggered anxiety and muscle
tightness in Juan. For many years, he had felt out of control when trying to talk and had suffered
the ever- pres ent embarrassment of stuttering. He had come to expect the anxiety and associated
negative emotions when stuttering occurred. When speaking, he would scan ahead, searching for
approaching stuttering cues. Sometimes he could avoid them, but most of the time there was no
alternative but to forge ahead and suffer the anxiety and embarrassment.
The clinician explained that there were several ways of desensitizing Juan to stuttering stim-
uli. The idea was to pair neutral or positive emotions with the previously learned negative ones.
Because of these pairings, gradually the negative emotions would be minimized or eliminated. The
pro cess of desensitization would begin with the least anxious and negative stimuli on Juan’s lists
and gradually move to the top. According to the clinician, there were several ways of creating the
requisite neutral or positive emotions to be used for conditioning.
One way of creating these emotions was by medi cation. Juan had been prescribed Valium
(diazepam) for his stutter when he was younger, and he did not like that option. He knew that