Guilty for Avoiding??

I am NOT a person who stutters… I am an SLP.   I am the chapter leader for a NSA Stuttering Support Group.  In our last meeting, we discussed use of avoidances in conversation. The BIG question that nobody seems to want to talk about is this:  should the goal be to NEVER EVER use avoidances? Is a PWS supposed to feel guilty for using avoidances? If a person can change the twang of their voice a bit… and still say what they want to say… and get their message across successfully… should this feel like a success or failure? Is this any different from using prolongations? If a PWS can change inflection (avoidance) vs. change rate/length of vowels (prolongations) and be more successful and natural… should that be considered an avoidance? And do people feel bad about avoiding because they have been told that it is a bad thing? Does it make a difference if you are changing your voice vs. changing actual words?  If I ordered a hamburger instead of a cheeseburger because it was easier to say fluently, then the message was altered and would definitely be considered unsuccessful.  But what if someone changed the twang of their voice and ordered exactly what they wanted?  Is this bad?

ALSO, is avoiding a slippery slope? Once you start avoiding, do you then avoid more and more so that you are never using your true voice? Can there be an acceptable amount of avoiding if you are truly comfortable having some dysfluencies in your speech? Many many older adults who stutter, and feel truly comfortable in stuttering openly and have reported that they have ‘found their voice’, still report that they use avoidance behaviors daily. As an SLP, I have mixed feelings on my response to these questions.  I am cautious about having an opinion on this matter… as a supporter of friends who stutter and as a professional.

Who has thoughts about this? I would love to hear responses.

 

Tricia

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Comments

Guilty for Avoiding?? — 10 Comments

  1. Dear Tricia,
    Thank you for your interesting question. Some time ago I had this young lady who stutters feeling very depressed because she avoids using the telephone when her manager is in the same office. She feels very uncomfortable and stutters a lot when speaking on the telephone and someone else is in the room. We tried some desensitization sessions but it was not as successful as I expected. So, I then offered an ‘instant’ solution. I told her to tell the manager that whenever she is in a room and there is someone she respects a lot, she would stutter severely on the phone. This is exactly what she did and he told her that it was OK if she stuttered while he was in the room. Some days later, she noticed that she did not stutter any more when he was in the room. The manager, with a smile, asked her if she had stopped ‘respecting’ him! She then told him that she is fluent when she is ‘around people who are friendly’.
    During my sessions trying to help this young lady, I realised that I myself (who is not a person who stutters) also try to avoid situations where I have to make a phone call and others are listening in the same room. I do not seek help for that and I do not try any desensitization exercises. I just problem solve or ‘avoid’ – and do not feel guilty about it.
    Bottom line is that as long as it is not affecting our quality of life and impacting our life so much that we need to seek help, some avoidances can be normal and should not make us ‘feel guilty’.
    Probably this is more of a personal opinion rather than a professional ‘expert’ opinion. And I am not feeling guilty for that 🙂
    Thanks again Tricia,
    Regards,
    joseph

    • Thanks for your reply, Joseph!

      I find that complete 100% open stuttering for a person who stutters severely can be an overwhelming task, yet I understand the high value of its role in embracing stuttering as part of yourself. When considering much of what a person does to avoid stuttering is what becomes their stuttering, then feeling comfortable in your own skin as a PWS is one of the highest priorities for treatment. I have met so many mature, happy, successful communicators who speak publicly about stuttering, advertise without hesitancy and feel they have truly “found their voice” who still report avoiding at times to facilitate efficient successful communication. I value their experience and wisdom. I would have an incredibly tough time feeling like my role as a professional (who does not stutter) is to advise them that their avoidances are wrong. If they are not seeking treatment and are generally content with themselves in communication situations, then addressing avoidances is not my job and is unnecessary. But what does that mean for my actual patients? those who are in search of improved communication? Should their therapy goals be 100% open stuttering? is complete exposure of stuttering severity part of the process? Can partial exposure in public be more effective if it is less intimidating? I must emphasize that I am a strong believer that voluntary and open stuttering are highly relevant and valuable tasks for a PWS to complete. (And I also practice fluency shaping. And I am certain to consider the patient’s personal goals into the plan for treatment.) But for those who are severe, is SOME open stuttering as beneficial as COMPLETE open stuttering? I think measuring the “success” of an interaction certainly involves more than just fluency. I like your comment that if it is not “affecting our quality of life” then some avoidances can be normal. I think we send messages of guilt and failure to our patients when we expect 100% of anything from them. I would love to hear more thoughts. Professional and personal!!
      Tricia

  2. Good questions Tricia. I don’t see anything wrong with a goal of no avoidance, even if it’s not totally realistic (i.e., in the same way that a goal of no junk food isn’t likely to be met, but it’s still an admirable objective). To me, it’s important that the client understands the costs of avoiding (increased stuttering, the formation of extraneous behaviors that in time no longer hide the stuttering, etc.). There may be times (hopefully not too many) when he or she decides the benefits of avoiding on a particular occasion outweigh the costs. But at least the client is making an informed decision. As an aside, on an occasion when I had the good fortune to speak to Fred Murray, one of the giants in the field, I wondered aloud how realistic it is to expect clients to stop using avoidance behaviors altogether. After all, I haven’t stopped completely myself. Dr. Murray admitted that he has not either (which made me feel better about my own failures). Some of the difficult situations we discussed included occasions when words needed to be uttered rapidly, talking to people who are quick to interrupt, and ruining the punch line of a joke. Silly reasons for avoidance perhaps, but reasons nonetheless. Sometimes the monster is tamed but not broken.

    • Awesome response, Dale. As you said, you felt like your continued use of avoidances was a failure until someone (a highly respected professional) told you differently… told you that it was okay to still use some avoidances because 100% was unrealistic for all circumstances. By telling our patients that the goal is “no avoidances, ” are we then setting them up for failure? Setting them up to feel bad about their progress? Like junk food, if we have a goal of no junk food, then do we feel bad for eating a cookie and feel like progress is lost? Or do we act more like Weight Watchers and say…”Go ahead, have a cookie… just not too many.” I ask not to doubt you, but because I am torn and struggle with the question myself. Glad to hear your thoughts.

      Tricia

      • We basically agree here. To try another analogy, if I take a test, my goal is to answer every question correctly. But if I get only 95% of them right, I’m still high-fiving everyone in sight. However, if a teacher told me I HAD to get 100% or I’m a failure, then I don’t feel any sense of accomplishment. And if there’s a perfectionist taking the test who is disappointed with anything less than 100%, the goal for that person has to be adjusted accordingly. I guess what I’m saying is it depends on the client and how the SLP presents the goal.

  3. Hi Tricia,

    Great discussion, one that is near and dear to my heart as an SLP and a PWS. I’ve had to contend with those issues with my clients, as well as with myself. As far as the “advertising” or “self-disclosure” or stuttering, this is something I use myself and recommend to other PWS. I definitely would NOT consider this to be an avoidance behavior. Many PWS have found this simple strategy to be helpful, although each one of us needs to decide when and how to use it.

    My research team has been examining the effects of self-disclosure on listeners’ perceptions of a PWS, and we’re getting some interesting results. The question at this point, in my mind, is WHY disclosure seems to work. For example, does it just serve as a signal to the listeners that stuttering is coming? Or, does it create a feeling of respect or admiration for the PWS? Or, does it just make the PWS feel better because he or she doesn’t feel the need to hide or avoid the stuttering any more?

    The is much clinical information on this, but very few research studies examining disclosure more closely; hopefully, that will change 🙂 When I presented findings from one of our studies at the Oxford Dysfluency Conference in 2014, folks from the Michael Palin Center were excited and interested in sharing the findings with their clients. They seemed to feel that PWS who are reluctant to “advertise” their stuttering might be more willing to do so if they are shown empirical evidence that it changes listeners’ perceptions of them. This was very encouraging to me, as that is what it’s all about 🙂

    Cheers,
    Paul

    • I love self-disclosure and advertising! It’s quite the opposite of avoiding. I also love voluntary stuttering. I think many of my patients feel almost immediate relief in doing any type of advertising. As with anything, if you spend a lot of energy hiding something, it is liberating to finally put it out there. The anxiety levels go down. What we have built up in our heads is usually far scarier than what actually happens when we reveal our true selves. Thanks for your response, Paul.
      Tricia

  4. Hi Tricia,

    That is an excellent question. Like you I am an SLP and am active with my local NSA group; however, I am not a person who stutters. As a graduate student when I first learned about the importance of not avoiding, I used to be fairly “militant” about it 🙁 As I have worked with more PWS and also interacted more and more with friends who stutter and other NSA members, my perspective has changed considerable on the topic. ***Please note that I am providing an opinion based on my experiences with friends, colleagues, and clients who stutter which is not necessarily supported by any solid “research”****. Similar to Joseph, I do not feel all avoidances are “bad” – instead I ask my clients to list their avoidances (that they are aware of) and we then discuss which ones are helpful short-term vs long-term. The final piece within this activity of identifying helpful vs not helpful avoidances is whether the avoidance impedes you from achieving your personal and career goals? For e.g. not talking at a work party (adapted from a discussion with a client) provided immediate short-term relief for the person. However, when probed further, does this affect your job performance and professional future in any way, resulted in an emphatic “YES! I did not have the chance to network with people who could help me get a better job in the future”. Now compare this situational avoidance with, “I ordered a chicken sandwich instead of a hamburger” (made this one up!) did it give immediate relief, “Yes” did it harm you in the long-term? “Not really, chicken is probably better for my long-term health!” So in short, I think it is very important to work on avoidances but it is more important to be discerning – it is not feasible to stop all avoidances, but it is feasible to raise awareness and set goals to reduce avoidances that are not helpful to the persons’ life (quality and choices). A very helpful approach in this matter is Acceptance and Commitment Therapy (ACT) which has been discussed widely with regards to its application to stuttering therapy. There are 2 papers published in this years ISAD online conference about ACT as well. Definitely a great read, it has changed a lot of my perspective and approach to therapy and these situations. Best luck and thank you again for this great question!

    Farzan

  5. Such great posts and advice here! Avoidance is such a difficult thing to work on for many clients. As many of those who posted, as well as our colleague, Lisa Scott points out, avoidance is a natural coping mechanism for the chronic condition of stuttering, so a client who is avoiding is also coping with the disorder. If we try to encourage taking avoidance away without giving the client another coping strategy, we will likely fail. Many of the commenters here make excellent suggestions to give the client that coping strategy: weighing out how important it is to say what the client wants to say, or how much personal cost there is to avoiding. Some clients are just not ready to delve into avoidance, obviously, and for these I take heart from Alan Badmington, who has a paper here on the ISAD conference about avoidance, and that’s to help the client not be negatively self-judging; not all are in the place where he is ready to banish avoidance.

    • Forgot to sign my post. Thanks Tricia, for your question, and I enjoyed reading the thoughtful comments.
      Kind regards,
      Jean