Maintenance

When one learns something new, when one forms a new habit, definite physical-chemical changes occur in the brain that are the expressions of learning. These changes develop slowly ... clients must not frustrate themselves during this learning period since frustration serves merely to raise base-level tension and works directly against achieving goals. --- Dr Martin Schwartz, Stop Stuttering

In the previous two chapters, guidelines were presented for the gradual and systematic elimination of situational and other types of stress. Unfortunately life is not that systematic and logical. The programme as set out in the previous chapters did not address the problem many stutterers may have with their self-image. Moreover struggle behaviour and speech fears may be deep-seated and tenacious. The daily tension and stress to which most people are subject can easily reactivate these old behaviour patterns – and this is especially true if the new behaviour, ie the new speech technique, is not reinforced and maintained. This results in relapses and despondency ...

 Resisting the relapse

Schwartz has identified two significant causes of relapses:

1) the subconscious reaction of the self-image, and

2) failure to practise regularly and maintain the newly acquired fluency.

 1. Subconscious reactions

 Schwartz has provided an explanation for the higher tension and irrational anxiety a PWS may experience after a period of fluency. In his view the PWS has a subconscious image of himself as a stutterer. If the stuttering stops for long enough, it is as if the subconscious becomes ‘worried’; it receives a message that the status quo is changing.

 The subconscious then tries to restore the status quo by increasing base-level tension (see the chapter ‘A Possible Cause of Stuttering’ for an explanation of base-level tension). This higher base-level tension has a twofold effect: renewed stuttering, plus a disruption of the newly acquired fluent behaviour. (The neutralisation of newly acquired behaviour through stress is a well-known psychological principle.) As a result the PWS resumes his stuttering and the subconscious is ‘reassured’. This subconscious reaction is often responsible for the many relapses demoralising both client and speech pathologist.

Different techniques can be used to change the subconscious in a more gradual manner, so minimising psychologically-based relapses. Some techniques are discussed in the chapter ‘The Power of Visualisation’. It is also worthwhile doing something about your self-image – see the ‘Self-image’ chapter for this. Stress management (see the next chapter) may also be useful in minimising any subconscious reactions.

 In addition to these strategies it may be necessary to find other means of support, such as counselling. Schwartz, for instance, provides his clients with a CD containing inter alia hypnotic messages they can listen to as they relax in the bath or before going to sleep. Additional relaxation exercises and affirmations on the CD are aimed at gradually reassuring the subconscious that all is well.

 Remember: The subconscious reaction is an indication that you are on the right track – the subconscious stutterer within you has taken note of the progress and desperately attempts to restore the previous state of affairs.

You might say: ‘This is fine in theory, but what must I do in real life on those ‘bad days’ when my stress levels are very high?’ Schwartz recommends the following:

1. Do a relaxation exercise every morning and evening (see the next chapter).

 2. Use Low Energy Speech (see the chapter ‘The Passive Airflow Technique’).

 3. Get in touch with a fellow airflow speaker or therapist.

4. Don’t be discouraged! Stuttering is stress-related. Therefore an increase in stress can affect your speech. But such relapses don’t have to be devastating or permanent. A good night’s rest may be all you need to reduce your stress. Relapses do not mean that the effect of ALL your practising has been neutralised.

5. Accept that some days will be exceptionally stressful. Try to speak as little as possible when you feel very stressed. Some conversations and telephone calls can be left for another day – rather do something about your high base-level tension.

2. Failure to practise and maintain fluency

 As mentioned before, Schwartz attributes relapses to two causes. The first cause is the subconscious reaction. The second is failure to practise and to maintain and reinforce fluency.

A PWS enrolled in a good therapy programme usually finds that initially his speech shows a drastic improvement. His relaxation exercises and correct application of a fluency technique combine to lower his base-level tension and improve his fluency. Too often the PWS then believes himself ‘cured’ and stops doing all the things he should be doing: technique practices, relaxation exercises, keeping in touch with the therapist and a support group, etc.

For a while he manages quite well, ‘riding’ on his initial success and his lowered tension levels. Then, as his base-level tension increases and his technique deteriorates, his speech falters. Suddenly one day he finds himself stuttering badly. He tries to use his technique, but it ‘doesn’t work’ – the truth being that he hasn’t been using it correctly for some time. Now his base-level tension soars and his speech is at its worst ever. On top of this he has lost contact with his therapist and support group, and is too embarrassed to get in touch with them and admit defeat ...

Beware of this trap! The golden rule is: DON’T BE FOOLED BY FLUENCY. Fluency is NOT always an indication of progress – remember the effect of low base-level tension. Continue to reinforce and perfect your fluency technique. Evaluate your technique as you progress. Keep on doing the exercises described in the previous chapters. Focus on those that apply to your specific problem areas. Try to work on your speech every day – preferably in the morning. The following guidelines may be of help:

Analyse your mistakes and identify the underlying type of stress

Analyse any situation in which you experience problems. Imagine, for example, that your car breaks down on your way to an important meeting. You try to phone from your cell phone, but last night you forgot to recharge the flat battery. You walk to the nearest shop to make a call. It’s quite far, on top of a hill, and by the time you get there you are exhausted. You phone your new boss, who is actually German-speaking and whose English is not perfect, from the old-fashioned coin-operated telephone inside the shop to explain that you will be late for the meeting. It will have to be a snappy explanation; neither you nor the café owner has enough change for more than a single, brief call ...

This situation would probably cause speaking problems for you. However, let’s analyse the different types of stress impacting on your speech:

1. Situational stress (telephone calls may be difficult for you).

2. Authority figure stress (talking to your boss who wields power over you).

3. Exhaustion stress (from the long walk up the hill).

4. Uncertainty and communicative stress (your boss’s poor English and your lack of knowledge of German increases the possibility of misunderstandings).

5. External stress factors (you are upset about your car and about being late).

6. Speed stress (the lack of time may force you to speak too fast).

7. Word stress (if you have to say feared words).

Having analysed the situation, you can now do something about it so as to prevent similar problems in future:

1. Tackle telephone stress by following the telephone hierarchy (see the chapter ‘Applying the Technique in Real Life’).

2. Reduce authority figure stress and uncertainty stress by explaining the technique to your boss as soon as possible, and make him a Target Person (see the chapter mentioned in the previous paragraph for an explanation of ‘Target Person’). Practise conversations with him in advance.

3. Reduce exhaustion, external and speed stress, for example by using role-playing (within a self-help group or with your speech pathologist / monitor / fellow PWS) to prepare for such situations.

4. Reduce word stress, for example by using Nickel and Dime and Mass Exercises (see the chapter ‘Learning the Technique’) to eliminate your feared words.

Approach challenges in stages

It’s better to identify a series of realistic, attainable goals for the immediate future, rather than a vague ideal of complete recovery. For example: decide to use your technique consistently when speaking for the next thirty minutes.

Develop a fluency-enhancing lifestyle

A fluency technique is more than a speech aid – it should be part of a lifestyle. Self-help groups for PWS play an important role in this lifestyle. By attending meetings and keeping in touch with fellow PWS, you will constantly be reminded to use your technique.

An electronic wristwatch that signals every hour can also serve as a regular reminder to practise your fluency technique by doing Nickel and Dime Exercises (see the chapter ‘Learning the Technique’).

At the same time the technique should not become an obsessionit should be part of a holistic approach. Mere technique is insufficient – also work on stress management and psychological self-improvement to cope with stuttering. Guard against exaggerated speech control. Too much speech control serves no purpose. You will lose all spontaneity and merely increase your base-level tension.

In terms of lifestyle it would seem that people who stutter can participate in sport – but should avoid weightlifting. Weightlifters hold their breath while lifting weights, and when you hold your breath, your vocal cords close. So by lifting weights as a sport you develop your vocal cord muscles and their ability to lock the vocal cords – which would obviously contribute to the stress-induced vocal cord closures of a person who stutters.

Aim for a balanced lifestyle and a problem-solving approach.

Over-emotionality and self-created problems may be luxuries that the PWS cannot afford. The resultant stress will immediately be reflected in his speech. It is as if the disorder forces one to live decently – naturally it would have been preferable to have a choice in these matters!

Establish comfortable eye contact

Comfortable eye contact is important, but should not be exaggerated. Don’t stare - avert your glance occasionally. Comfortable eye contact contributes to interpersonal communication and helps overcome shyness.

Eye contact, however, should not overshadow technique. If eye contact distracts your attention from using your technique, look at the listener’s nose and not his eyes. (Test this - look at somebody’s eyes, then at his nose, and ask him if he notices the difference.) Schwartz suggests that you only maintain eye contact while speaking – during inhaling and airflow you should concentrate on your technique. In summary: look at the listener’s nose while inhaling and doing airflow, and shift your glance to his eyes as soon as you begin to speak.

Enter into a contract

 This is a motivational strategy. You sign a contract with your monitor in terms of which you will pay him a small amount of money each time you fail to use the technique and stutter. The amount should be sufficient to motivate both parties. The contract should initially be valid for three-minute periods at a time. Beginners should engage in one such session per day.

This strategy doesn’t work for everybody. Some people find it counterproductive – the thought of losing money increases their stress and distracts their attention from their technique.

Don’t fight your way out of a block

A PWS having a block tends to ‘fight’ his way out of it – with unpleasant results. You need to learn to stop your struggle behaviour and apply your technique as best as you can as soon as you experience a block. Don’t go back to words that have already been said.

Once you start using the technique regularly, you will notice that your blocks are less severe than before. Every little bit helps. Even a poor technique is better than no technique at all.

After a block, immediately try to say the relevant word correctly by using your technique. This sends a message to your subconscious that you are able to say the word after all.

Exhale through your mouth

Always exhale through your mouth, even when not speaking. This will make you more aware of the airflow from your mouth.

One eventually becomes very conscious of the air pressure in the mouth. High air pressure in the mouth indicates that airflow is inadequate. You will also become aware of excessive tension in the jaw and face.

Stay in the ‘flow groove’

 The airflow speaker who has managed to apply the technique a number of times consecutively or even for a number of days will notice a remarkable improvement in his speech and a tendency to use the technique consistently. He is in what is called the ‘flow groove’. You should try to stay in the flow groove for as long as possible. This fluency may, however, induce over-optimism, faster speech and sloppy technique. Should this happen you will soon be out of the flow groove and back in the ‘stutter groove’. (Higher base-level tension may also force you out of the flow groove.)

Airflow treatment is characterised by a continuous shifting between the stutter groove and the flow groove. Don’t be discouraged if you continually find yourself back in the stutter groove. Just keep on practising – and try to stay in the flow groove for as long as possible.

Advanced airflow speakers should practise the technique for five minutes every morning to get into the flow groove. I find these quick early-morning workouts indispensable. If somebody phones me before my morning practice, my speech tends to be poor. Early-morning practising also serves as a 'warming-up' of the vocal cords. The vocal cords need to 'warm up' before functioning optimally. Singers know this, and also do warming-up exercises before singing.

Control your emotions

If you let your emotions get the better of you, you may forget to use the technique. Therefore the airflow speaker should make an attempt to control his emotions.

Distinguish between word stress and situational stress

It is possible to distinguish between the word-stress PWS, ie someone with severe word stress, who consequently stutters on most or all words regardless of the situation, and the situational PWS whose defect is dependent on the specific situation. Though this distinction is somewhat artificial, it helps to put stuttering in perspective.

A case comes to mind of a PWS in my self-help group who had a severe ‘internal’ stutter and extreme word-stress problems. He immediately benefited from the airflow technique – because without it he would not have been able to say a single word. The extent of the disorder necessitated applying the technique with almost every word.

Due to his somewhat exaggerated use of the technique his speech was extremely slow (which also sounded rather unnatural) during the first months. But he didn’t allow others to rush him – they had no choice but to remain patient. The very slow speech was, however, much more manageable than the stutter. Gradually his word stress decreased, and the tempo of his speech increased. His consistent use of the technique and resultant excessively slow speech had been a transitional stage in the gradual process of reducing his word stress.

 Situational PWS may find it more difficult to use the technique consistently than word-stress PWS. This is because the situational PWS already possesses some areas of fluency. This reduces the need to apply the technique consistently. Situational PWS who have mastered the basic airflow technique should pay special attention to the stress hierarchies discussed in the previous chapter.

Multiple reapplication

 In previous chapters it was mentioned that it may not be enough to just apply the airflow technique at the start of a sentence. It may also be necessary to apply it again WITHIN a sentence, or even between syllables within a long word. This is called ‘reapplication’.

In some extremely stressful situations, however, reapplication may also fail to prevent a block or to neutralise fear of a specific word or sound. The solution is to try ‘multiple reapplication’.

A multiple reapplication simply means using the technique as many times as necessary for fluent pronunciation of a word or sound. The airflow speaker persists with reapplications until stress in the vocal cords is sufficiently reduced.

Naturally there are disadvantages to multiple reapplications. The pauses needed for multiple reapplication may give unthinking fluent speakers an opportunity to interrupt you. However, as an airflow speaker you have a few tricks up your sleeve to prevent this from happening. Try to say the sound in a softer voice and use Low Energy Speech. If your speech slows down, pauses in your conversation will not be that obvious. And if you manage to say the word fluently after two or three reapplications it will give your self-confidence a tremendous boost.

External support

IT IS VERY DIFFICULT TO GET BETTER ALONE – so look to others for support. Support comes from three sources: monitors, speech therapists / pathologists, and self-help / support groups.

MONITORS were discussed in the previous chapter. THERAPISTS can provide follow-up sessions or, preferably, refresher workshops.

SELF-HELP / SUPPORT GROUPS provide the third source of support. Group meetings should be held regularly and should include exercises. The following is an example of minutes taken at a meeting of my self-help group:

Minutes of the meeting held at: (address and telephone number) on (date) at 19:30

Present: (list of names)
Apologies: (list of names)

 1. Opening the meeting. The chairman opens the meeting. He welcomes family members, friends and the two speech pathologists present as observers and points out that participation in the meeting’s exercises and activities is always optional. During the meeting, speakers may only speak with the aid of the technique.

Arrangements are made for the next meeting to be held at the same time in two weeks. The chairman will be (name).

2. Introductory speech. The chairman delivers an introductory speech (three minutes). (This should be an inspiring speech, starting the evening off on a positive note.)

Subject: Speed stress. The chairman compares people who pressurise the slow speaker into speaking faster, to a rushed motorist behind you who wants to pass you. You are already driving at the maximum speed on a single-lane road, however, and cannot move over. The car behind wants you to accelerate, but if you give in to his pressure you may be caught by the speed camera ahead. One has to learn to resist such pressure.

Similarly the airflow speaker must learn to control his conversational speed regardless of the pressure from others to speak faster. Resist the feeling that there is a time limit on your speaking turn. Let them wait! PWS tend to worry that they will bore or inconvenience the listener. You have a right to speak slowly! Many fluent speakers also speak slowly. If the other person is in a hurry, IT’S NOT YOUR PROBLEM. You will find that if you speak slowly, others will tend to relax as well. Do not allow someone else to determine the tempo of the conversation.

3. Reading exercise – two minutes each (unprepared). Participants read much better than at the previous meeting, although a tendency to read too fast persists. The exercise was recorded and the quality of the members’ airflow evaluated.

4. Individual reports – limited to four minutes each. Participants get an opportunity to report on their speech in the two weeks preceding the meeting. The reports are recorded for evaluation at home. Discussion: Some deterioration in your speech is to be expected if you are writing exams. The importance of doing more relaxation exercises to counter stress while writing exams is emphasised.

5. Toughening exercises (see previous chapter) - three rounds each.

6. Telling jokes. Two participants told prepared jokes. Even though their stress increased when saying the punchline, they managed well.

7. Telephone exercises. The chairman gave two volunteers pieces of paper with the name and telephone number of a restaurant and a squash club respectively. Both notes also contained a short sentence. The sentences, which had to be read aloud word-for- word to prevent avoidances, were: ‘How much are the pizzas?’ and ‘Do you allow non-members to play squash at your club?’

The two members attempted the exercise. Each had to read his sentence aloud to those present, then read it over a dead telephone and finally make the actual call. The calls were to be recorded.

Both excelled at the task. Member A had an initial problem with the word ‘much’, but his reapplication was successful and he pronounced the word correctly.

8. Tea and social get-together after the meeting.

Selecting club officials

To ensure that the group is run democratically, the position of the chairman alternates. The chairman is responsible for planning and controlling the meeting. He should guard against long ‘philosophical’ discussions (the ‘philosophy’ of stuttering and the technique can be discussed afterwards during tea). He should also vary the exercises to prevent monotony. Use a variety of role-playing exercises and think of new exercises.

The secretary is responsible for newsletters or minutes and acts as public relations officer, for example by answering public enquiries and issuing information pamphlets. Publicity is essential to attract new members, and can be had by writing letters and articles for newspapers, creating a blog or website, having the club’s telephone number entered in the telephone directory, contacting radio and TV stations, etc.

A senior member should be appointed as a training officer to educate and demonstrate the technique to new members.

A treasurer could be appointed to collect membership fees to cover any expenses.

Example of a practice report (to be completed by the airflow speaker)

The airflow speaker can use the practice report for his own benefit, or include it with recordings of airflow practices which are handed to the therapist on a regular basis for evaluation:

Practice Report for the two-weekly period from _______to ______
Name: _______________________

 Address: _____________________

Telephone number: (home) _______ (office) _______

General remarks about speech during the previous two weeks:

__________________________

 __________________________

 __________________________

__________________________

 Any problem situations? What happened? Eg telephone conversation, public speaking, restaurant, shop, stranger, authority figure, etc. (Also mention type of conversation and name of listener.)

___________________________

 What caused your block(s)? (Tick as applicable.)

[ ] Pushed flow
[ ] No flow
[ ] Pre-forming
[ ] Not slowing first syllable
[ ] Thinking of the feared word instead of ‘rest’
[ ] No reapplication
[ ] Too loud

Evaluate your recorded exercises: (A = perfect; B = good (some mistakes); C = average (many mistakes); D = poor (mostly mistakes).

Did you do Target Person and Intensive Interval Exercises every day? YES / NO

 To whom did you explain and demonstrate the technique during the past two weeks? (Name 5 people.)

 __________________________________

I practised for an average of (   ) minutes per day.

I use the technique (   ) % of all speaking time in everyday situations and with a success rate of (   ) % when I use it.

Difficult words: Name the difficult words/sounds that caused specific problems:

________________________

Have you practised these words / sounds with the Mass Exercise since becoming aware of these problems? Yes / No

Did you attend a group meeting (if available) during the past two weeks? Yes / No

How many relaxation exercises did you do in this period?(     )

Did you do ‘Nickel and Dime’ exercises? Yes / No

Did you phone a fellow airflow speaker every day? Yes /  No

Additional comments or questions:  __________

Progress, management and ‘cure’

What constitutes progress? It varies from one person to the next. The number of feared words or sounds decreases, the duration and frequency of periods of fluency increase, or base-level tension decreases to the extent that general speech improves. Facing a feared situation for the first time also indicates progress. Or else your mental word scanner becomes less active and sensitive, there are fewer avoidances or distraction behaviour, or blocks decrease in severity. Progress also includes psychological benefits such as increased speaking confidence. Think of progress in a specific situation, not as immediate and total cure.

 But what does ‘cure’ really mean? Don’t judge a person on his externally fluent speech. Some people never stutter because they avoid difficult situations - but live in constant fear of being ‘exposed’ as a person who stutters ... According to Schwartz, the test for a true cure resides in the speaker, not the listener. A PWS is only cured if he considers himself to be a former stutterer. A cured stutterer has truly conquered all his speech fears and no longer regards his speech as a hindrance.

Killing the zombies

It is difficult to overcome fears acquired at an early age. And even when you think that they have been conquered, they may rise as if from the grave – like zombies in a horror movie. So make sure that they are really dead! This requires courage and persistent confrontation with these fears. Getting rid of all speech fears can take years.

It may happen that a fear isn’t really conquered, instead turning into an aversion. Eg. someone who was terrified of water as a child may in due course learn to swim when he needs to, but without ever genuinely enjoying it.

This implies that you shouldn’t rest on your laurels if you successfully used the step by step method (see the previous chapter) to acquire eg telephone skills. Continue to use the telephone as often as possible, phoning as many people as possible, for all kinds of reasons. If you don’t, it could be only too easy for your old fears to revive themselves.

The advanced airflow speaker

The advanced airflow speaker has eliminated a variety of speech-related stresses, and uses his technique to manage those situations and words which he still finds difficult. It is at his disposal as an alternative way of speaking, and has become an indispensable aid. On reaching this stage, many airflow speakers seem to feel that they have recovered sufficiently – they have learned to manage their most difficult problem situations. They may still stutter occasionally, particularly when in stress, but it is no longer the distressing defect it once was.

The limitations of a fluency technique

For many people, a fluency technique is not the answer, or not the only answer. The drawbacks of a fluency technique are:
  • It may FEEL artificial, even if it sounds completely natural to others
  • It robs you of spontaneity
  • It requires MUCH PRACTISING to apply correctly, apply in real life and maintain it
  • It’s difficult to apply in high stress situations
  • It only addresses the physical stuttering and not the psychological side of stuttering.
 Because of this we will also consider other issues, such as self-image, as it may not be sufficient to merely speak fluently. For many PWS it may also be necessary to change the stutterer within you. When travelling on the road to fluency, you must take your subconscious with you. But first we have to consider stress management – an essential component of stuttering control.

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