Stuttering 61Mrs. Lawson and the speech therapist met regularly to discuss ways to remove stress while
speaking and to minimize Steven’s self- consciousness about his dysf luencies. During this critical
period of prevention, Mrs. Lawson designed classroom activities that did not require Steven to
speak publicly or to answer questions, and she did this without drawing negative attention to him.
She also met with the pupil who was making fun of Steven’s speech and encouraged him to stop.
Steven’s mother was counseled to remove speaking stress at home and not to draw attention to his
speech dysf luencies.
In accordance with the Individualized Education Plan, the speech clinician did not remove
Steven from the classroom to work on his speech f luency. Pullout therapy, it was believed, would
draw attention to his prob lem and make him more self- conscious. The therapist regularly came to
the classroom and worked with Steven on classroom assignments and on his speech. Steven was
praised for speech f luency and encouraged to talk easily and without force. His speech- related self-
esteem was bolstered by frequent statements such as “Excellent talking,” “I like how you said that,”
“You certainly have good things to say,” and “ Great speaking.” With the help of Steven’s mother,
Mrs. Lawson, and the speech clinician, Steven lost his self- consciousness about his speech f luency
and stopped struggling to talk. Eventually, the memories of that disturbing show and tell faded.
He was monitored throughout elementary school for relapse and eventually began middle school
as a normal- speaking youngster.
Case Study 3-6: The Role of Stuttering Therapy
Secondary Gains in a Male College Student
Linda suspected that Chad, her first client with a stutter, was attracted to her, and she did not
know how to handle it. Linda is a second- year gradu ate student in speech- language pathology with
most of her courses completed. This semester, she is seeing clients at the university’s speech and
hearing clinic and looking forward to her off- campus externship next term. Most of her supervised
clinical activities are in the after noon, and three times a week at 3:00 p.m., she greets Chad in the
waiting room. Together they walk to the stuttering therapy suite and work on his mild stutter.
Chad has been a client of the clinic for several years, and Linda, like many clinicians before her,
is not making a significant, long- lasting improvement. Chad can achieve normal f luency in the
clinic, but there is no carryover to outside situations. What is even more frustrating is that Chad
appears to be more and more disturbed by his f luency disorder.
During a conference, Linda’s clinical supervisor states that Chad may be gaining secondarily
from stuttering therapy, which is contributing to the poor clinical results. The supervisor suggests
that perhaps Chad craves the interaction with female student clinicians and that stuttering therapy
is becoming a social activity. The supervisor thinks that, either consciously or subconsciously,
Chad resists speech improvement because he knows that the sessions will end and he will no longer
be able to enjoy the interaction with the clinicians. It is also pos si ble that the clinicians’ profes-
sional concern and empathy for Chad provide secondary gains. Apparently, Chad has few social
outlets and no family support.
Chad began going to the university’s speech and hearing clinic as a freshman and has been in
therapy ever since. He is soon to gradu ate, and even the thought of job interviews makes him ner-
vous. He looks forward to the sessions and wishes they could be held daily. The only criticism Chad
has about the ser vices at the clinic is the lack of consistency. Every clinician starts from scratch,
going over the same things addressed by previous clinicians and making no improvement until the
latter part of the semester. This semester his student clinician is Linda, and she is the best therapist
yet. He plans to ask the supervisor if she can be his clinician next semester.
Chad has always been awkward with people. As a teenager, he suffered from the usual adoles-
cent angst, particularly around girls. It was difficult to muster the courage to sit near them during